Thursday, April 13, 2017

I have a philosophical objection to falling sick or dying due to a stupid, avoidable error

Back in hospital for a routine shunt angiography, a nurse comes in to draw blood. She takes out the needle from its sheath, and accidentally drops it onto the bed. The exposed needle has now made contact with the surface of the bed, where I have been sitting for 15-20 minutes. What is the correct procedure here? It doesn't take 10 years of medical school to work it out: you replace the needle with a new one. But no.

The nurse proceeds to pick up the needle to put it into my vein. I stop her and ask her if she can use a new needle, and she immediately says, "sure", and replaces it.

What could possibly happen if she had put the needle into my vein? It's possible nothing would happen. As a nurse once casually informed me when I complained about lack of hygiene in a Berlin dialysis center I used to be at, whether one would get an infection in such situations really depends on how many bacteria are entering your body. This may well be true. But, if there is an avoidable source of infection, is it not reasonable to avoid it?

If, instead of nothing happening, I now get an infection that knocks me out for some weeks, or I get an infection that kills me, if all that it takes to avoid that rare event is that the needle be replaced, is it not worth doing it? Clearly, the answer for the nurse was, fuck that, I'm too damn lazy to now go get a new needle that's one meter away from me. For the nurse, it's just another day in the workplace, *she* will go home to her family, *she* will not have to pay any price for her mistake. The risk is all mine to take.

My impression is that German nurses and doctors are especially casual about hygiene in a medical setting. In Japan, the UK, France, Sweden, the US, the standards are much, much higher. There are stringent rules about disinfecting the hands even before one puts on gloves; this is unheard of in Germany. A doctor at a dialysis clinic in Berlin once yelled at me when I mentioned that there was an infection risk if nurses didn't disinfect their hands. Her argument: the clinic has a zero infection rate so the current procedures are adequate, and besides it's not reasonable to require that medical personnel disinfect their hands every time they move from one patient to the next, it's just too much work. The patient must pay the price for this casual attitude.

I have a strong objection to all this: I don't mind dying as a result of an unavoidable situation. The heart can and will eventually fail. A deadly infection that you get by chance that ends your life. An accident on the street ends your life. I can live with all these ways of dying, so to speak. But, on principle, I have a strong objection to having to incur risks just because of situations like a nurse being too sloppy to replace a needle she has dropped on the bed. I understand fully that nobody gives a rat's ass what my position on this important issue is, but here it is, for the record.

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