Doctor's Orders

Physician Karl Shipman devoted his life to medicine. But when he needed it most, the health-care system let him down.

On a golden September afternoon, Karl Shipman climbed two rungs up a ladder to trim a tree near the 150-year-old Vermont farmhouse he owned with his wife, Claire. Shipman had grown up near this maple-lined patch of countryside; from the ladder, he could see the cemetery where years ago he'd played hide-and-seek with his kids.

Suddenly the ladder buckled, and Shipman clattered to the ground, instinctively jutting out his hands for protection. He sat up, stunned, but he'd only broken his left wrist--a dime-a-dozen injury, as any doc would know. Any doctor like Karl Shipman, M.D., for example.

When not puttering around his precious acre of Vermont on vacation or skiing at Loveland every chance that he could, Shipman was a well-respected internal-medicine specialist who practiced at Presbyterian/St. Luke's Medical Center in Denver. A fellow with the prestigious American College of Physicians, he'd even served as chief of medicine at Presbyterian Hospital from 1975 to 1977, fifteen years before it merged with St. Luke's. Throughout the 35 years of Shipman's medical career, the hospital had been his second home.

It would also be the place he'd die a gruesome and premature death.
Shipman's fall started a slow-motion plummet toward disaster: Over the next two months, the medical profession to which he'd dedicated his career would collapse just like that ladder beneath the maples, dropping him rung by rung, with no safety net in sight.

After Shipman's accident in early September 1997, surgeons in Vermont fit his wrist with an external fixator, a contraption that holds the bones in place with temporary metal pins about as big around as a household screw. Although it's a common procedure, fixators are associated with a high risk of infection; after the pins are taken out, normal bacteria on the skin can make their way into the holes before the skin has healed.

Wrist immobilized, Shipman wrapped up his month-long vacation and returned to his patients in Denver.

Most mornings, Shipman, a vigorous 64-year-old, would leave his Cherry Hills Village home early--in his typical white shirt and tie, carrying a lunch packed by his wife--to make rounds at Presbyterian/St. Luke's, checking in on any of his patients who might be hospitalized. From there he'd head to his office in Cherry Creek, where he worked with six other physicians in the Denver Internal Medicine Group. As an internist in private practice, Shipman filled the role of long-term "family doc" for adults, performing regular checkups or working on more specific problems: helping patients manage their diabetes, treating their infections, figuring out the source of their aches and pains. If he suspected something life-threatening, such as cancer or a severe heart problem, he would match up the patient with a specialist. Before heading home at night, Shipman would swing by the hospital again for evening rounds.

Twenty days after Shipman's operation, a local orthopedist removed the pins from his wrist. Thinking he was on the mend, Shipman and his wife headed back to Vermont for a couple of weeks to enjoy the fall colors and close up the farmhouse for the winter. But a few days later, Shipman began experiencing severe pain in his neck and shoulder. A physician's assistant attributed the pain to "muscle spasms" resulting from the few minutes Shipman had spent painting a patch of ceiling.

In early October Shipman flew back to Denver and returned to work. Still plagued by pain, he visited two different orthopedists at the same practice where he'd gone for treatment of his broken wrist; each diagnosed muscle spasms and prescribed painkillers and physical therapy. According to medical records, neither doctor did an old-fashioned checkup to measure vital signs: heart and respiratory rate, blood pressure and temperature--which, if high, can point to an infection.

When the orthopedists had removed the fixator from his wrist, they'd told Shipman to expect some swelling. And after the wrist continued to hurt, Shipman chalked it up to overuse and all the suitcase-lugging he'd done on his Vermont trip. Besides, the pain in his back was now so severe that a sore wrist seemed incidental. He told his children he was feeling "lousy"; despite treatments ordered by his specialists, he seemed to be getting worse. But he continued to follow doctor's orders.

He trusted his doctors. "He was a physician himself," says Debra Malone, his daughter, "but when you're a patient, you're a patient."

Shipman's pain became excruciating, disabling; to check on his hospitalized patients, he had to support himself on an office chair on casters that he pushed down the hallways of P/SL. More physical therapy was prescribed.

The doctor's doctors didn't recognize the real problem: A raging staph infection had climbed from Shipman's wrist into his blood and lodged in his spine. If nothing was done, toxins would steal into his organs and kill them off, one by one.

Shipman's skin took on a yellow cast. He couldn't eat. He started acting absentminded, confused. He thought he had the flu, but he'd never been weakened like this before. "He was a very strong man," says Malone. "He hated to be sick."

While Shipman struggled through another round of physical therapy on the morning of October 21, 1997, Claire decided enough was enough: Her husband was going to the hospital. A strong, quiet woman, Claire had been trained as a nurse, although she hadn't worked much since her children were born. Now she called one of her husband's partners, an older man with whom Shipman had practiced medicine for more than three decades. The colleague admitted Shipman to P/SL.

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