Laura does Medical Research

An hour later they were at home. By then Laura was now not having any significant pain. The Novocain and the pills had both kicked in and were working. Laura went to her bedroom as soon as they got home. She logged on her computer and brought up the hospital web page. She found a link to a state medical quality and statistics page. She went to the page and found a section that had statistics on sarcoma.

The information was appalling. There were three hospitals in town, one had a seventy eight percent survival rate, the second a seventy four percent survival rate. Laura looked at the numbers. The survival of one more person would have made the seventy four percent jump to more than seventy seven percent. Her math teacher had told them any time a change of a small number in the sample would so much impact the statistics; you could not make conclusions from the answers. There was probably no difference in the care of the two hospitals.

When she got to the third hospital she was stunned. The survival rate was forty seven percent, just over half of the rate of the other hospitals. There was no way that a change of a small number of cases would change the result. Clearly the other two hospitals were superior in treating this disease. How could this possibly be so? How could a hospital be so bad and the state not step in. She looked at the number of cases. There were thirty nine. Only eighteen survived. It was a bleak view, twenty one deaths. With the other two hospitals together, there were one hundred forty-three cases, of them one hundred nine survived. That meant thirty four died. She looked at the number of hospital admissions. The number of deaths was about the same compared to the admissions for all three hospitals, the number of survivors much higher in two of the hospitals. “Why the big difference?” she wondered.

She closed out the internet and stretched out on the bed. “What had Mr. Sprenkle said about selecting samples?” In their Math class he had given more than a few examples where statistics were way off. One of the reasons was because of a bad sample. Her head was fuzzy. She couldn’t remember them. If she could just think. The codeine was really making it hard for her to concentrate. She turned on the TV. She rarely watched it but right now she needed some diversion. She told her friends she didn’t watch it because TV stood for totally vacant. She flipped to the Discovery Channel. At least it and the History Channel had some value. They were talking about a plant study. The researcher noted that there was some concern about the accuracy of the testing of the sample. She was about half asleep when the comment was made. She was fully awake in seconds. What if the sample selection was flawed? But how could this sampling be flawed?

Laura got out of bed and went back to the computer. She connected to the internet and went back to the page on the diseases. She pulled up the page on the hospital admission statistics. The overall admission statistics of the three hospitals varied by less than ten percent, Mercy was the largest, the other two were nearly the same. She checked the breast cancer numbers. The number of surgeries and the number of survivors were about the same for all three hospitals, with Mercy again being a little higher than each of the other two. She went to prostate cancer, the same thing. Every disease she checked other than leg Sarcoma was nearly the same. Why did Mercy Hospital have such a deplorable rate of survival for sarcoma? She looked at the numbers for a while. Then it hit her. There was another answer, what if Memorial and General had a diagnosis problem. What if they diagnosed people with the disease that did not have it? These would be miraculously “cured” and make the statistics look good compared to someone who only diagnosed real cases. She looked for bone biopsies. The numbers of procedures performed by the hospitals were nearly equal. But the number of surgeries in two of the hospitals were nearly the double the third. There was only one explanation. The results of the biopsies in the two hospitals were wrong. But why would two be wrong by the same amount? Everywhere she looked she found another question. Mr. Sprenkle told them there was always a reason. You failed only if you didn’t find the real reason. To know if it was right she had to find the reason.

She printed the various numbers and started browsing around the web. She started looking at more hospitals. Other than the local ones, three others about twenty miles away had a survival rate of about seventy five percent. Most were much lower, usually between forty two and fifty five percent. She found twenty five hospitals in the state that seemed to be having a problem. But she already knew better. There was not a problem with the hospitals with the lower survival rates. It was obvious to her, the ones that had the higher survival rate that had a problem. She could not prove it but in her gut she knew.

She went back to bed and turned on the TV. She was tired and getting more groggy and the pain in her leg was coming back. Her mom came in with a sandwich and a glass of soda. “Do you need anything else?”

“Something for the pain, it is coming back.”

“You should be starting the antibiotics too.”

“Bring them in, I’ll take them.”

Leah left and came back with the pills. Laura took them and ate her lunch. When she finished she pulled out the pages she printed and a notepad. She started doing some figuring with a pencil. If she was right there were about eighty four people out there that had unnecessary surgery in the five years. And this wasn’t minor surgery. They were missing a limb, usually a leg. She looked at the cast on her right leg. As she did her mom came in. “You done yet?”

“Yes.” Her mom took the tray.

“Anything else you need?”

“No mom. I need to get some things thought through.”

Jim was in the living room reading when Leah returned from Laura’s room. She sat down on the chair across from him. “Hon, we have to talk.”

“Talk.”

“Laura really hit me between the eyes today. On the way to the hospital she said they weren’t going to cut her leg off without her knowing it had to be done.”

“When we get the biopsy we will know.”

“Like we did when the surgeon said my breasts had to go?”

“No, it’s not the same. With you they thought you might get cancer, with her, she has it.”

“Are you sure?”

“If the biopsy comes back positive she goes for the surgery.”

“And how are you going to handle it if a week or a month or a year later we find out it was a mistake.”

“So we get a second opinion.”

“And what if the first says cancer and the second says not?”

“That can’t happen.”

“But it did for me. The frozen sections said pre-cancer and the permanent sections said no. And I found out today how important my breasts were to me.”

“You look good with the forms.”

“And they are just that, false. And there is one person who knows they are that makes a difference, me.”

“How’s that?”

“I’ve pushed you away to the point that I have hurt our kids. Today Laura told me she felt safe when she saw us together. Do you remember how you always stood behind me and held me?”

“Yes, but you told me it hurt you after your surgery.”

“It hurt, at first it was physical, later it became emotional. Sure in the early days where they cut and stitched was sore, but later I didn’t want you to touch me. I just realized that I have never let you really look at me naked above the waist. We haven’t taken a shower together since then. We once had fun doing that about once a week. And Laura told me that when we stood with you standing behind me holding me she knew I was safe and she was safe. My breast surgery took that away from you, me and her. Who knows, the boys may feel the same way.”

“Is it that big a thing?”

“If she needs this surgery she will need every edge she can get. We need to give it to her.”

“How?”

“We need to do something, now.”

“What?”

She reached out to him and led him to the bedroom.

After some time he looked at her. “Sorry to break this off but the boys need to be picked up at school soon.”

“Let’s go in to see Laura first.”

They walked to her room and knocked. She responded, “Come in.”

They walked in and Jim stood behind Leah and held her. “Someone needs to go for the boys. Can you be here alone for a while if we go together so we can pick up your car?”

A big smile broke across her face, “Dad, you should be ashamed of yourself.” He blushed and she started to laugh. “I’ll be fine. Take the cell phone in case I need anything.”

He released his wife and started out of the room. She motioned to her mom and she shut the door behind her. “Yes.”

“I feel safe. Thanks. Did you show him?”

She nodded.

“I bet it was really hard.”

“Not as hard as I thought and boy it was worth it.”

“A little afternoon delight?” About three years before Laura had innocently asked what that song title meant. After about four abortive attempts to avoid the question Leah answered it plainly.

“No, maybe we should have but there was too much else to do. We were just together. Maybe some day you will understand.”

“I think I do now. Get out of here. See you later.”

When her mom left she quickly went to her computer and logged on the internet. She downloaded mail and looked at the titles, there was nothing there that could not wait.

She looked up Mr. Sprenkle’s mail address and started a message.

“I need some help. Would you look at some statistics and tell me what they mean?” She included the information and sent the message.

With that done she went to the hospital pages and started looking at them. She had no idea what she was looking for only that she was looking for something others apparently had missed. The thing that bothered her was, those people were smart, they were trained and they missed it. The thought was scary.

She spent time on the Mercy page then went to the General and Memorial pages. Finally she turned to her e-mail and answered the forty five outstanding messages. Most were from friends at school asking about her. She collected most of the addresses and wrote one message. She simply told them she had gone for tests. She would not be at school on Tuesday because she was going to see the doctor again. She mentioned that there might be an infection in her leg.

She finished her messages and sent them. Another message appeared from Jackie. It simply said, “Call me.”

Laura logged off the internet and called Jackie. “Hi.”

“What happened to you today?”

“The doctor wanted to see me. They wanted to check the bone in my leg.”

“Is there a problem?”

“They were concerned that I might have an infection. They cut a hole in the cast to check my knee, then patched it shut.”

“How did they do that?”

“They cut an area out of the front of the knee with a saw and pulled out the plug, looked at the knee, took a sample and put the piece of the cast back in. Then they plastered it over with a layer of plaster. If a big cast turns on guys, this one will really do it. My knee is so big.”

“The teacher really unloaded on the guys for staring at you.”

“Oh?”

“He told them they were dead wrong. They were staring. It was like you were on display.”

“I felt so conspicuous going out of the room.”

“The teacher saw that, he blocked their view and then he unloaded. I doubt this will happen again.”

They discussed some other items and Laura hung up as she heard her mother and brothers come in. All three of them bounded into her room. She was on the bed with her cast fully exposed. “Mom said they made it bigger, but wow, they really did. Can you walk with it?”

“On crutches, yes, but it is really heavy. I haven’t gone far today. Mom, can you get me one of the pills, this is hurting again.”

“Be right back.” She checked the time. The antibiotics were due again too. She returned with the pills and some water. “Dad is picking up Chinese for tonight. Want to go to the dining room?”

“Yes, can someone get me a footstool for under the table?”

Lem bounded off and by the time she got to the dining room it was under the table. He bent down and positioned it for her. It helped keeping her foot a little higher.

“Thanks Lem. That is a big help.”

“No problem Laura. Just let me know if you need something.”

“Did mom order you to be nice to me?”

“No, but I keep remembering how many times my big sister did things for me. Now I get a chance to help you. But I hope you get better soon, not because I have to help you. I don’t mind that, but I don’t want to see you hurting. It makes me feel bad.”

Some tears filled her eyes. She had no idea this little brother who had done more than a few unspeakable things to irritate her really cared about her.

“Thanks, I’m sure with your help and the others, I’ll manage.”

“You have to, I need you.”

With that her dad came in with the Chinese and they ate.

After eating she checked her e-mail. Several of her teachers had dropped notes to her including information on assignments. She worked on them for a while and then pulled down new mail. One was from Mr. Sprenkle.

“Laura, I first thought you were making too much out of this but my wife looked at it. She is a nurse. We started looking at the web and found that the survival rate in most hospitals is usually in the mid forty percent with a few near eighty percent. Only a very few are between those numbers, they are hospitals with only a handful of cases, where one or two cases would make a difference. Statistically this would seem to be an unusual pattern. She is amazed and concerned that nobody else has noticed this. Unfortunately we have no explanation that fits other than yours, unless the doctors are actually treating the patients very differently. This is contradicted by the fact that some of the same doctors work at all three hospitals and there would be no reason for there to be a significant difference in care. There is another explanation. If the percentage of Mercy was over seventy three percent it could be explained as a fluke. This is an extremely bad mix of patients, one in nearly 100,000, or the diagnostic test is bad. We agree with your assessment that if the testing is bad there are some people out there who have had unnecessary surgery.”

“My wife suggests that if you are faced with any surgery have a second pathologist look at the biopsy. She is very specific that it must be a different person doing the biopsy and the lab work, not a second test by the same person. Sometimes a different hospital will send a test out to a different lab but the same person is contracting to read them. She also is concerned about what you do if one test comes back positive, one negative. Remember that either can be wrong and there is a risk either way.”

She wrote a short reply thanking him. He had just confirmed her fears.

Laura Chapter 1

Laura Chapter 4

Laura Chapter 06