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The Swiss cheese holes

It was our sixth code in a week. This is unusually high at our small community hospital. Sometimes the ‘holes ’ lineup and things go very wrong.

Walking to our godmother’s house on Boxing Day, our neighbours’ dogs came bounding into the road. I knew my neighbours were away and therefore unaware their dogs had gotten loose. My husband tried to shoo them away, but S, the puppy, really wanted to dart back and forth and follow us. Then another neighbour hit her with his van, shattering her leg.

Most times, we’re lucky. You hit one hole in the Swiss cheese, but the others are staggered. You didn’t wear a helmet to toboggan, but you fell against your mom instead of hitting your head, for example.

In a tragedy, all the Swiss cheese holes line up: the dogs escaped. We were in the road. S the puppy wouldn’t listen. The van came down the hill right that second. I wanted to yell and wave but also wanted to hold on to my children. The driver assumed S was on a leash. Bang.

Read: Dr. Melissa Yuan-Innes: Terrible clinic. Send wine.

In medicine, we’re often doing our best with the holes. Here’s one that made the news recently: the pregnant woman was unvaccinated against COVID. Pregnancy increases your risk six-fold. They had to do an emergency C-section on her at 30 weeks and transfer her for ECMO. The NICU is doing their best with the premature infant. All preventable.

I wrote a note to our administration after our sixth code in a week. This is unusually high at our small community hospital. Two codes came in by car, driven by a family member. Zero of those two survived.

I can tell you the family member at my code wanted us to do “more.” But with a GCS of at best 11 and a lactate of 8.8, the coroner agreed with me that Swiss cheese holes had lined up at least hours before.

My note to admin asked if we could send out a polite note to the community asking them to call the ambulance instead of driving a considerable distance in icy weather.

That won’t replace the judgment of calling hours to days before your loved one is near death. But it would help shift the last Swiss cheese hole and give us time to assemble our team before a perimorbid person shows up at our door.

Of course, this is why we need family doctors. To prevent and mitigate diabetes, asthma and COPD. To catch cancer early. To convince people to get vaccinated. To let them know they’re not alone and depression is treatable. To plug all the Swiss cheese holes before they get too big or unstoppable.

But our system doesn’t want to fund family doctors, public health or any sort of preventative medicine.

And S didn’t have a GPS collar to keep her on her own property.

The good news is, S got emergency surgery from a vet within hours. This week, I saw her walking on a lead.

I felt terrible about S getting hit. I thought my neighbours would blame us, or the people who hit S. Instead, they took full responsibility and said, “She should never have been on the road. We’ll invite the other neighbours over when S isn’t limping anymore.”

Swiss cheese holes will line up. All we can do is work together and try to do better in the future.

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