Out came the Valium to stop the seizure. The seizure ceased, but I am sure that you can figure out what happened next. The woman stopped breathing, total silence following a horrific gasp. Faced with another misery of our making, we had to intubate the woman and perform a complete resuscitation. Fortunately, we pulled the woman through—I was the chest thumper, and there were no cracked ribs—but the intern was now seething over the therapeutic misadventure instigated by our squad of Keystone docs, and he was too angry to talk to the family.
“You tell them,” he said sharply to me, his words bullets, as if I were responsible for the whole mess. Dutifully, I went off to the alcove where the family had assembled anxiously, fearing the worst. On my arrival, they rose as if one, and I mumbled something about how we had handled a succession of problems, not mentioning, of course, our own complicity in the troubles. Nevertheless, the family was overjoyed that old lady had survived. They then praised me as a wonderful doctor, indeed, a miracle worker who had snapped the family matriarch from the jaws of death—even if those jaws were iatrogenic.
Within a few minutes of the digoxin administration, the heart monitor began to beep wildly and the screen exploded with a profusion of mean-looking extra beats, which were obviously premature ventricular contractions.
Search for Balance on Uncertain Ground
Digoxin, ventricular arrhythmia; lidocaine, seizures; and Valium, respiratory depression. These are all well-known side effects of the drugs and, as they say, stuff happens even if this trifecta of badness was a rare occurrence.
Stuff happens. Red cell aplasia with gold; leukopenia with propylthiouracil; cirrhosis with methotrexate. These are all calamities that can be caused by drugs that I prescribed in my practice. It goes without saying that I have seen gastrointestinal bleeds from nonsteroidal antiinflammatory drugs and osteoporosis from prednisone.
As I wrote in my previous column, drug safety is a personal matter. Because I have witnessed in my practice some very serious side effects, my personal reaction to certain drugs is likely to be different than that of my colleagues, and I worry more about writing some prescriptions than others. I am not reassured that certain side effects are rare. My own personal experience has taught me that “rare” means it can happen—a tablet of aspirin can provoke near fatal asthma and allopurinol can make the skin blister and boil.
