Who Was Caring for Mary?

An academic physician gives a personal account of his wife's progressive deterioration during her hospitalization at a university medical center. He encounters physicians who are too distracted by other academic pursuits to care adequately for his wife. Her hospital course is complicated by bilateral pulmonary emboli, which occur during inadequate heparin therapy and are followed by myocardial infarction, shock, and the adult respiratory distress syndrome. His experience exemplifies the importance of closely supervised care. He calls on the leaders of academic medical centers to make excellence in patient care a top priority and recommends that clinical as well as research skills be rewarded.

It is hard to believe that not long ago my wife Mary was lying in the intensive care unit with less than a 10% chance of survival. How could this be? How could a young, healthy dance instructor and a mother of two children become so desperately ill? The answers to these questions tell us something about how a very healthy, seemingly invulnerable young person can suddenly become extremely ill and can help all of us to understand what can go wrong in our academic medical centers. Criticism of the very institutions that have nurtured me for more than 20 years is difficult. I now see that the lessons learned from Mary's case should be taken to heart by all who wish to return our academic medical centers to their former clinical greatness. I have waited 3 years to describe Mary's encounter with academic medicine. Time and a move to a new university have allowed me to recount my family's experience more objectively. Despite this distance, my story remains a very emotional one. How could it be otherwise? Sometimes a profound personal experience speaks louder than averages, standard deviation, or statistical significance.

The beginning of Mary's symptoms …