Worms Part II: Snakes in the grass
To keep this part of the story short let me quickly bring the reader up to the crucial juncture. It turns out that the pathologist that did the autopsy called the mother and told her that the doctors who said they were ventilating her son (me) were lying because her son actually had ‘epiglottitis’ (Google it) and thus the doctor (me) would not have been able to ventilate him as the doctor (me) claimed so the doctor (me) should have done an immediate tracheostomy (this is a hole in the throat to the windpipe to enable air to get to the lungs.) The family were somehow close to their local alderman, who phoned the coroner, and insisted on an inquest. The family’s lawyer concurred and pushed the coroner as well. (This inquest would give the family a free “discovery” which would markedly speed up and reduce the cost of their intended law suit.) Finally, the pathologist called the coroner of his own accord and discussed his findings, strongly suggesting an inquest. The coroner ordered an inquest.
The hospital approached me and offered to have their lawyers defend me. Good on them for trying but I already knew about this trick: The hospital lawyers defend the hospital and don’t give a damn about the residents and interns. They come and go. Their best fallback position (or even an opening position!) is for the hospital is to admit the resident screwed up. The CMPA pays and they are off the hook. So I contacted the CMPA. They are focused on defending me and leave the defense of the hospital to the hospital lawyers.
The CMPA sent me Mr. Bjornson, a quite tall man in his 30’s with blond hair and a rather big thin nose. He was sort of soft spoken and didn’t make eye contact. Didn’t inspire confidence. After I discussed the case with him he asked, “so why didn’t you do a tracheostomy?” I answered, “First, there was no indication for a tracheostomy as I was able to ventilate his lungs. Second, by the time the patient arrived at our hospital he was stone dead and stayed that way until we called off the attempts at CPR. So what good would a tracheostomy do?”
“OK, good. I get it.” He said. And to make sure, I I wrote this stuff all out for him, including a minute by minute narrative and a glossary of terms.
The next meeting with me he presented some more news about the inquest and trial: The hospital, through their lawyers have taken the position that a tracheostomy should have been done, and that it was not done, makes it my fault, not theirs. My staff, Dr. Dicks, who was a gastro-enterologist and sleeping at home at the time when the patient arrived, made a deposition that said that Dr. Fisher did not call him to discuss what to do, and had Dr. Fisher called him he would have insisted on a tracheostomy. Indeed, he would have come in to do one. “So,” Mr. Bjornson said, “tell me again why you didn’t do a tracheostomy.” I repeated the above mantra. “So why would Dr. Dicks, who is a full specialist, while you are a junior resident, say that he would have done a tracheostomy or told you to do one had you called him?”
“Well, Dr. Dicks is a gastroenterologist with an office practice and has not attended a CPR for at least 2 decades and was never trained to do a tracheostomy, and probably would have not the slightest notion on how to do it. Certainly he has no idea as to when it is indicated—which it is not in this case. Surely you can cross examine him when he presents that at the inquest.”
“OK.” Said Mr. Bjornson, “can you write out the reasons again why you didn’t do a tracheostomy?”
Write them out again?? This rattled me. I called my friend and former classmate Simon Zucker, who had graduated from law school a couple of years earlier, and asked him to represent me at the inquest as this CMPA guy is going to send me down the river.
At the inquest, the pathologist got up and testified that the patient had epiglottitis. He projected on a large screen a slide of a cross section of the epiglottis. He used a pointer to direct the attention of the coroner to a tiny circle at the tongue base of this epiglottis. He pointed out the small dots in the circle. He told the coroner that these dots were white blood cells and this was a epiglottic abscess which he considers the cause of death and a tracheostomy the only effective intervention.
I was livid. I leaned over to Mr. Bjornson and told him to ask the pathologist why the airway would have been obstructed if there was no swelling in the epiglottis. Mr. Bjornson held up his hand and shushed me. When offered by the coroner to examine the witness he said “no questions”. As the pathologist was getting off the stand, he leaned over to me and said, “So why didn’t you do a tracheostomy?”
Fast forward. The inquest took a turn of focus to the ambulance drivers. The patient’s mother insisted that they take her son to Sunnybrook and was against taking him to Toronto East General Hospital. This became big front page headline news in the Globe and Mail and on the radio. Clearly, they saw that this tac may lead to a more lucrative payoff than going after some junior resident. Over the next few days they forgot about me, the tracheostomy, and the rest. The inquest verdict dealt with the ambulance drivers.
This nightmare is over, but it remains as a paradigm of what I experience over and over throughout my life—personal, professional and scientific. Of the former, there are plenty of worms to go around in this story as in many more episodes of living day to day. Of the latter, it is hard to believe such persistent blindness spills over into scientific work, but it does. Our treatment of carbon monoxide poisoning continues to be classed as “too problematic and complex”. This, by elite scientists from Harvard and University of Pittsburgh who advocate sticking fiberoptic cables in people’s lungs and chests and advocating infusing intravenously massive amounts of an artificial protein they concocted, respectively.
Our brain vascular reactivity stimulus which is non-invasive, automated and precisely repeatable, is widely said to be complex and unnecessary by top neuroscientists and MRI physicists who advocate injecting their subjects with drugs or getting them to hold their breath, both of which have no precision or repeatability. “So, why don’t you just do breath hold or give acetazolamide?” Fortunately the braying of the latter is now starting to wear thin as elite labs from all over the world are adopting our methods. Still, it took 20 years to just start this recognition process.
Had they kept focusing on the tracheostomy, there is no doubt I would have been blamed by the inquest and lost the law suit.
And so it goes.
