Alleged Patient Exposure to HIV/Hepatitis After Drug Diversion

I want to start this post by saying “Oops, it happened again.” The problem is, I shouldn’t have to blog about this topic considering how serious it is and the potential risk to patients.

I live in Colorado. In February, 2016, it hit the news that one of the Denver areas largest hospital, Swedish Medical Center, was testing close to three thousand patients for possible exposure to HIV and Hepatitis after a surgical tech was suspected of diverting drugs.

What is drug diversion? Drug diversion is using a narcotic for anything other than its intended use. The most mildest form is not wasting drugs properly. It requires two licensed personnel to waste a drug and sometimes you just can’t find another person at that moment and then you forget. Not excusable but understandable. The most serious form is healthcare workers using the drug themselves and not giving them to the patient or using the “waste” or overage for themselves.

The problem is, a relatively similar scenario happened at another Colorado hospital in 2008 and 2009. This was the case of Kristen Parker, a surgical tech who is currently serving a thirty year prison term for infecting three dozen patients with Hepatitis C. She was stealing unlocked Fentanyl set aside for surgery, injecting it into herself, and then drawing up saline into the same syringe where then an unsuspecting provider injected it into the patient causing transmission of the virus.

In fact, one of the anesthesiologists involved in this case went public and even wrote a novel based upon her experience. This wasn’t a quiet news story.

In this blog piece from The Daily Beast in February, 2013, Gorman states:

“At that time, we didn’t think about locking drawers,” she says. “No one ever told me I was doing anything wrong. If there were rules to enforce locking the drugs up, they were not enforced.” Rose has said it sent memos to its anesthesiologists in 2001 and again after Parker’s crime, warning them “never leave controlled substances unlocked or unattended.”

In light of this incidence, it is unbelievable to me that a case of suspected drug diversion involving a surgical tech could happen again in this state and it makes me wonder if potentially the same process of drug diversion was used as Kristen Parker employed– unsecured narcotics awaiting injection for surgical procedures.

The tech, Rocky Allen, has been arrested and has pleaded not guilty. Thus far, it appears two patients have tested positive for Hepatitis B.— although the hospital currently denies they transmitted the virus as part of this case.

So please, hospital OR’s everywhere, can we please develop a system where narcotics can be dispensed safely to surgical patients?

Author Question: Surgical Spleen Removal

Amanda Asks:

I have a character who was shot in the side, not life threatening, but he had to have surgery to remove his spleen as well as the bullet because some rib fragments damaged his spleen.

My question is how long would he be in the hospital after surgery? I’m sure when he first comes home he’ll be getting around in a wheelchair or something while he heals and gets his strength back. When could I plausibly have him on his feet slowly walking around? I don’t want any dramatic complications with his injury or anything. He’s going to heal up great and be perfectly fine afterward.

Jordyn Says:

I ran this question by some of my nursing cohorts who focus in adult surgery.

Having your spleen removed would require a couple days stay in an intensive care unit. This would be due to risk of post-surgical bleeding and concern for infection.

The surgical nurse I spoke to said these patients are up and walking by the time they come to the floor so there would be no need for the character to use a wheelchair.

Once research point that is helpful with this question is that you can Google search for discharge instructions regarding many kinds of operations. For this one, I searched for Home Care Instructions after Spleen Removal. This document gives excellent information that can be translated into your novel.

For instance– how long the patient should expect to have pain. Driving and lifting restrictions which can help determine what they would physically be capable of in your novel.

FYI– patients who have had their spleens removed are at more risk of serious infection. Your spleen is part of your immune system. So some infections that would normally not be a big deal for the general population can be life threatening to those who have had their spleen removed.

What REALLY Happens While I’m Under Anesthesia: 3/3

Today concludes a three-part series by guest blogger and CRNA Kim Zweygardt about what really happens in the OR. Kim took on several FB questions regarding anesthesia and the OR that I thought would be great info for writers.

Thank you, Kim for sharing your expertise with us.

Follow the links for Part I and Part II.

7. How aware are you under anesthesia? And I’ve heard sometimes people wake up during surgery but you give a medicine so they don’t remember. Is that true?

Let me answer the second part first. As I mentioned earlier, we give a combination of medicines in anesthesia and some drugs have an amnestic effect. So yes, there are drugs that we give you that provide amnesia so you don’t remember what happened. They can be given as part of a general anesthetic or as a sedative. But there are times someone says they “woke up during surgery” when they were sedated not anesthetized.” So what constitutes being asleep for surgery? For us, being asleep is a general anesthetic where you are so deeply unconscious that we are assisting your breathing. But, sometimes the actual anesthetic is a spinal, another nerve block or a local anesthetic. Because most people don’t want to know what is going on, we will give you sedation and you take a nap during the surgery. From our perspective, you are not “asleep,” you are napping, but from your perspective, you went into surgery and “went to sleep!” That causes confusion. I have patients tell me they woke up during their surgery. When we give you medicines to nap, you may wake up and be aware of what is going on. I tell patients that the difference is if I want to talk to you, I can call your name and ask you how you’re doing. You’ll wake up and talk to me and then when I leave you alone, you’ll drift back into your nap. But if you have a general anesthetic, I can talk to you all day and you won’t answer because you are totally unconscious.  As far as awareness, it depends on whether you are sedated (you may remember some things) or have a general anesthetic (you should not be aware during the operation). We’ve all heard the horror stories about people being awake during an operation. It does happen but is very, very rare.

8. How do you let the doctor know you are awake during the anesthetic?

As I said, true awareness is very rare. When it happens (or when they make awful movies about it) it makes the headlines but don’t forget that hundreds of thousands of anesthetics are done every day without awareness. I mentioned before that the amount of anesthetic you need is based on how much surgical stimulation there is (fancy way of saying how much it hurts). Even when you are anesthetized, your body still responds to pain if the anesthesia isn’t enough. The heart rate goes up. The blood pressure goes up. You will even have tears when it hurts. That is one of the reasons we are watching you every moment. If we see those changes, we can give you more medicines so that your body doesn’t have that stress response. The patient “tells” us the anesthetic needs to be deepened by all those changes in vital signs.

9) What do people say while they are asleep?

When I became a CRNA, we used Sodium Pentothal which was famous in movies as “truth serum.” It was a common question then about what they might say during an anesthetic. For “truth serum” very small sedative doses were given so the person was groggy. The thought was they were too drowsy to lie! But for anesthesia, a large dose is given so the patient is asleep in minutes with no time for conversation! I once interviewed a man who questioned me extensively seeking assurance he wasn’t going to say anything because of “that truth serum!” He even sent his wife out of the room while he questioned me further! I always wondered what he wanted to hide! Now we use a drug called Propofol. It works even quicker than Pentothal so rest assured, if you are going to sleep (general anesthetic), you’re not giving away any secrets!

10. What is the strangest thing you’ve heard someone say under anesthesia?

I once put a known psychic to sleep. The case was added on to the end of a long surgery day because the patient had forgotten to come for surgery the day before. (Which I found funny since she was a physic. Those of you who know me personally, get my sense of humor!)  She was a very pleasant woman and when questioned didn’t mention anything about having problems with anesthesia in the past. She was completely anesthetized when the surgeon stuck his head in the door to ask, “Did she tell you she has a history of recall during anesthesia?” Well, no, she hadn’t mentioned that small detail to me! I immediately turned up the anesthetic gas and gave some other medicines and but as I did, in a spooky séance’ type voice said, “If you can hear me, let me know!” As soon as the words were out of my mouth, her pulse went up significantly and I am sure she was doing exactly that although I never had the heart to ask after I woke her up! Years later I read a fascinating article about the subconscious mind and anesthesia awareness that made me think of her but that is another post!

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Kim Zweygardt always knew she wanted to be someone special.  Her heart’s desire when she was 7 was to be a famous ballerina but when she read their toes bled from dancing on them, it became a less desirable career choice. Then Kim decided to be a famous lawyer solving mysteries and capturing the bad guys just like Perry Mason, but as she got older she discovered sometimes it was hard to tell just who the bad guys were.

Instead Kim chose a career in medicine practicing the art and science of anesthesia as a Certified Registered Nurse Anesthetist in rural Kansas, Colorado and Nebraska.

Kim is married to Kary, the man of her dreams, who has done a fabulous job of making all her dreams come true. They have three children but an empty nest and enjoy conversation with friends over good coffee and great food. They enjoy travel, the arts and taking a nap.
Member American Christian Fiction Writers, International Speakers Network, www.bookaspeaker.netwww.womenspeakers.net

What REALLY Happens While I’m Under Anesthesia: 2/3

I’m continuing with a three part series written by guest blogger Kim Zweygardt on what really happens while you’re under anesthesia. Great information for authors. 
You can find Part I here.
Welcome back, Kim!

4. Why is my throat so sore after anesthesia? (The actual question involved us ripping your throat out under anesthesia but I niced it up!)

With almost all surgeries, you are breathing extra oxygen that isn’t normally humidified and can really dry your throat out and cause it to be sore. Sorry about that! With bigger surgeries, we insert devices to maintain your airway. Anesthetics depress your breathing and these devices allow us to breathe for you to make sure your body gets all the oxygen that it needs. They are made of soft plastic, but they can irritate and cause a sore throat after surgery. And some people have anatomy that makes the insertion more difficult and that can also cause a sore throat. As a general rule, the sore throat is gone in about 24 hours. Treat it like a normal sore throat–pain meds and warm fluids help lots.

5. I love going to la-la land, but why is it so hard to wake up? (I’ve also heard this–“I just wanted to sleep and the nurses kept making me wake up in the recovery room! How come?”)

I could give you lots of technical mumbo jumbo about how drugs are metabolized but I think the more important thing to remember is this: We give you medicines based on your weight and that health history we took but also based on what type of surgery you are having and how uncomfortable that surgery is! It’s not the same amount of pain to have eye surgery or your gall bladder out. We give you these drugs so you will be comfortable and/or asleep, depending on what the surgeon is doing–that even varies at different times during the surgery because some parts of the operation may be more pain producing than others. A few minutes later, the surgery is over and what was the perfect amount of anesthesia now has you really sleepy because that stimulation is gone. We can reverse some of the medications but we also let your body gradually metabolize them so you are groggy and comfortable after surgery. And just like when you are fast asleep at home and someone wants to bug you? You’d rather be left alone!

6. I was told to think of something pleasant as I went to sleep and I woke up great! The doctor said how you go to sleep is how you wake up. Is that true?

There is a lot of truth to this. When you are anxious you release all kinds of stress hormones into your bloodstream and that can translate into a very rocky anesthetic including wake up. Thinking of something pleasant causes you to release endorphins which is like the body’s own morphine. That sense of wellbeing carries over as well not to mention the power of positive thinking! One technique I use with teenagers who tend to wake up wild is to explain to them pre-op how it will feel waking up and what I want them to do. Because they have had a chance to think about it ahead of time, when I tell them surgery is over and they should lie still, they do it because even through the “waking up fog” their subconscious remembers my words. Anything we can do pre-op to allay anxiety makes for a smoother waking up.

Tune in next post for Part III. 

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Kim Zweygardt always knew she wanted to be someone special.  Her heart’s desire when she was 7 was to be a famous ballerina but when she read their toes bled from dancing on them, it became a less desirable career choice. Then Kim decided to be a famous lawyer solving mysteries and capturing the bad guys just like Perry Mason, but as she got older she discovered sometimes it was hard to tell just who the bad guys were.

Instead Kim chose a career in medicine practicing the art and science of anesthesia as a Certified Registered Nurse Anesthetist in rural Kansas, Colorado and Nebraska.

Kim is married to Kary, the man of her dreams, who has done a fabulous job of making all her dreams come true. They have three children but an empty nest and enjoy conversation with friends over good coffee and great food. They enjoy travel, the arts and taking a nap.
Member American Christian Fiction Writers, International Speakers Network, www.bookaspeaker.netwww.womenspeakers.net


What REALLY Happens While I’m Under Anesthesia: 1/3

A fellow writer and good friend of mine is a CRNA– certified registered nurse anesthetist. That means she was first an RN and then specialized in anesthesia. Kim works in a rural setting delivering primary anesthesia care covering thousands of patients. If it weren’t for CRNA’s like Kim, people living in rural communities would likely have to travel hours (or be transferred by EMS services very expensively) for even minor procedures.

Kim put out a call on her FB page for questions about anesthesia that I thought would be good info for Redwood’s readers.

Welcome back, Kim!

Let’s start with the boring stuff:

1. Why do I have to answer so many questions before surgery?

One common misconception about anesthesia is that we just give you some magic drug that makes you sleep for as long as surgery takes. It actually is a lot of different drugs that work in different ways and that your body metabolizes in different ways. Some drugs last different amounts of time. Some drugs depress the heart or aren’t good for people with lung problems. We ask all those questions so that we can give you the best anesthetic for you! And that’s another thing–we don’t really care or judge you about things you do or don’t do. We just want to take the best care of you so don’t lie to your CRNA! If you have had something to eat or drink, taken a medication, or if you drink, smoke or use drugs, tell us! It could be life or death!
2. I thought only doctors gave anesthetics. What is the difference between a CRNA and an anesthesiologist?
Nurses were the first anesthesia providers and have been safely providing anesthesia since the late 1800’s. We were the first Advanced Practice Nurses and have the most autonomy of any nursing specialty.  CRNAs provide anesthesia in all 50 states and our military men and women are cared for by CRNAs around the world. Over 60% of all anesthetics are given by CRNAs. The main difference is where our training begins. A CRNA goes to nursing school, works as an RN in Critical Care and then completes both clinical and didactic training in anesthesia to become a CRNA after passing boards. An anesthesiologist goes to medical school and then completes a residency with clinical training in anesthesia. Often the cases and textbooks used are the same and many large teaching hospitals train both CRNAs and their doctor counterparts side by side. Over and over studies have shown no difference in safety and outcomes between CRNAs and MDs, so no, you don’t have to be a doctor to do anesthesia.

Now for the more interesting stuff!

3. Where do you go while I’m asleep?

Nowhere! We monitor you heart beat by heart beat and breath by breath to make sure you are getting exactly the amount of anesthesia that you need. Our only job is to take care of you during surgery! We don’t leave you from the time you come into surgery until we take you to recovery. And, we don’t leave you in the good hands of the recovery nurse unless you are stable. We are your advocate, asleep or awake!

We’ll continue with Part II next post. 

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Kim Zweygardt always knew she wanted to be someone special.  Her heart’s desire when she was 7 was to be a famous ballerina but when she read their toes bled from dancing on them, it became a less desirable career choice. Then Kim decided to be a famous lawyer solving mysteries and capturing the bad guys just like Perry Mason, but as she got older she discovered sometimes it was hard to tell just who the bad guys were.

Instead Kim chose a career in medicine practicing the art and science of anesthesia as a Certified Registered Nurse Anesthetist in rural Kansas, Colorado and Nebraska.

Kim is married to Kary, the man of her dreams, who has done a fabulous job of making all her dreams come true. They have three children but an empty nest and enjoy conversation with friends over good coffee and great food. They enjoy travel, the arts and taking a nap.
Member American Christian Fiction Writers, International Speakers Network, www.bookaspeaker.netwww.womenspeakers.net

Author Question: TB and Lung Surgery

What happens when a surgeon takes out the wrong lung?

This writer’s question came from Lana and actually brings up several interesting points of discussion for her novel. First of all, the question stems from a family incident in 1954 which would really be considered historical as far as medicine is concerned.

Let’s dive into Lana’s question.

Lana asks:

I am a new writer and have some questions regarding a medical incident that occurred in my family in approximately 1954, but today the details are sketchy. Dr. Mabry (thanks Richard!) gave me your name.

The story: My uncle was told he had TB and must have his diseased lung removed. He had surgery, but the wrong lung was taken out.

Question #1: Would they have planned to remove the lung because of TB and would a doctor have actually taken out a whole lung or would it have been one lobe?

Question #2: Would the doctor have been able to see his mistake immediately after surgery? I’m not sure how the mistake was made or discovered.

Question #3: After removing the wrong lung (or lobe), how long would it have taken to reschedule another surgery?

Jordyn says:

One– I have to thank a physician coworker for her help on these– thanks, Liz!

Question #1: It depends on how diseased the lung was. Back then– there weren’t antibiotics to treat TB like there is now so this was considered treatment. However, since it didn’t cure the infection like antibiotics would– I’m not sure how beneficial it was for the patient. If on x-ray it looked like the whole lung was involved then they would have taken the whole thing out. If it looked like just part was involved– then perhaps just a lobe.

Question #2: The doctor would not have known about his mistake until the pathology report came back. The doctor I spoke to said on the outside– the lung might be very normal appearing (which perhaps played into the wrong lung being removed) but all removed biological things go to pathology to confirm a diagnosis. The wrong something being taken out or off is rare but does happen and lots of things play into these surgical errors. I’m going to provide some links below that talk about how these happen in some other situations.

Question #3: Reschedule surgery? Obviously– if they took out the whole lung he could not go back for another surgery to remove a whole other lung– because then he’d have nothing to do oxygen exchange and would therefore die. I guess they could remove part of the remaining lung but I’m not sure how much lung tissue you need to survive. This could be an area for you do some reading on. I couldn’t find a quick answer for you. It looks like the first successful lung transplant was in 1963 and it would have taken time for these procedures to become commonplace. If they did take him back– perhaps they’d wait for him to recover from the first surgery which might be a good 2-4 weeks I’m guessing.

Here are some links to this particular kind of surgery error:

http://www.nytimes.com/1995/09/17/us/doctor-who-cut-off-wrong-leg-is-defended-by-colleagues.html

http://www.cnn.com/2010/HEALTH/10/18/health.surgery.mixups.common/

http://www.lasvegassun.com/news/2011/jan/29/double-ouch-doctor-operates-wrong-knee/

Has anyone had this experience or known someone this has happened to? Did the hospital disclose why the error happened?

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I’m Lana Kruse—last name pronounced Kruzey, rhymes with doozie! I’m one of the original baby boomers—you know, before we became a whole generation. It’s been fun to have been well-known, watched and written about since birth! I’m a wife, mother of two, grandmother of five (aka Mimi), and friend. I hope you will join me in that last category via my blog. I love people, words, laughter and eating out. Put all of these things together, and I’m in heaven!

Tonsillectomy: Useful But Not Without Risk

I’ve been fascinated by the case of Jahi McMath, who is the girl who suffered surgical complications after a tonsillectomy and has been left brain dead. I’ll be discussing other aspects of this case next week but I thought I’d invite fellow medical musketeer and ENT physician, Dr. Richard Mabry, by to discuss the risks/benefits of this procedure.

I happily endorsed Richard’s forthcoming novel Critical Condition. It’s a great story and gives insight into that elusive area of the hospital– the OR. I hope you’ll check it out when it’s released in April.

Welcome back, Richard!


Any resident physician in otolaryngology (ear, nose and throat) can tell you that tonsillectomy is not a benign procedure. It’s very useful when indicated, but strict criteria for its consideration have been developed.  These include recurrent documented infections as well as sleep-disordered breathing. Attention to these criteria is important before tonsillectomy is considered.
Prior to the procedure, parents should feel free to ask questions or seek clarification of any points they don’t understand. Most physicians have instruction sheets that are given to help prepare families for the procedure.
The procedure itself is typically short—30 to 60 minutes—after which the child is observed in the recovery room until they are fully awake and stable. The child may be discharged later that day if they’re doing well, but sometimes complications necessitate an overnight stay.
The risk associated with a general anesthetic administered by competent personnel is tiny. Probably equally or more important is the possibility of complications occurring after the procedure. 
Undoubtedly, the number one risk is post-operative bleeding. If the child expectorates clots or large amounts of bright blood, parents should seek medical attention immediately. They are also warned to watch for and report fever, persistent vomiting, or difficulty breathing.
The tonsils receive their blood supply from branches of five different arteries, so bleeding—at surgery and afterward—can be a problem. To deal with this possibility, various methods—primarily application of caustic chemicals, use of ligatures, or various types of cauterization—have been traditionally been used. In recent years, surgical methods other than sharp dissection have become more popular. These include partial tonsillectomy and use of lasers to remove tonsil tissue. Thus far, the perfect solution hasn’t been found.
What are the risks associated with tonsillectomy? According to a recent journal article, the risk of dying from the operation ranges from 1 in 10,000 to 1 in 35,000 cases. Although mortality (i.e., dying) is rare, morbidity (i.e., complications) still occur. The most important, of course, is bleeding after the surgery. In one study, the incidence of bleeding was reported at from 2% to 3% of cases. The two most common times for post-tonsillectomy bleeding to occur are immediately after the surgery and after about a week, when scabs separate.
Does that mean that all parents should shy away from a tonsillectomy for their child? Not at all. It’s a very beneficial procedure when indicated and performed by a competent physician. But it behooves every parent to ask questions, learn what to watch for, and participate in the care of their child while they recover from the surgery.
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Richard Mabry is a retired physician, past Vice President of the American Christian Fiction Writers, and author of “medical suspense with heart.” His novels have been a semifinalist for International Thriller Writers’ debut novel, finalists for the Carol Award and Romantic Times’ Reader’s Choice Award, and winner of the Selah Award. You can follow Richard on his blog, on Twitter, and his Facebook fan page.