It Was All My Fault That a Patient Died.

Back in the late 1980’s, I was working as a junior general surgical registrar. In such a role, I was allowed to perform minor surgery, often unsupervised. Back then, general surgeons were commonly performing carpal tunnel release surgery although nowadays, they are performed predominantly by specialist hand surgeons. I operated on a man who had bilateral Carpal Tunnel Syndrome.  The surgery was performed under a local anaesthetic block which means that his arm was made numb and he was able to be awake for the duration of this short case. I operated on one side.  All went well.  About three months earlier, he had been operated on the other side by one of colleagues (who was at the same level of training as myself).

Totally unbeknown to me was the fact that an intern had ordered pre-operative blood tests, an electrocardiogram and chest X-Ray in the week prior to the surgery.  These tests in an otherwise well man with no co-morbidity and having a procedure under a local anaesthetic block is unnecessary. I was to learn that this was the case about 8 or so months after performing the surgery and by this time, I was working rotation at a secondment hospital.
I was one of two carbon copied doctors on a letter that had been written by a cancer surgeon.  The other cc doctor was a respiratory physician.  

The surgeon described the history that had led to the presentation by this patient with symptoms. He wrote “somebody had operated on this patient and not checked his CXR which at that time showed an obvious coin lesion in the lung”.  It was intimated that the patient could have been cured of cancer if diagnosed at that time had the CXR result had been checked at the time.  It was very obvious that he was apportioning blame on me for not checking the result of a test that I had not even known or should have expected to have been performed. It was interesting that the same unnecessary work up had been performed for the patients first carpal tunnel operation a few months earlier.  I could see exactly how this would have happened on the second occasion where an bewildered intern just followed what was done on the  previous occasion.

http://grammar.about.com/od/ab/g/Bad-News-Message.htm

I was devastated to receive this letter.  I did not dare communicate with the surgeon to explain my case as I truly believed at that time, any disagreement with the surgeon would be the end of surgical career. Over the next 18 months, I continued to be copied in on correspondence outlining the patient’s demise in spite of curative attempts and ultimate death.  Every time I received these letters, I would fall into depths of depression for several days but I would always develop a mechanism to cope. When the letters arrived, dread would fill my face before opening the envelope as I always knew what lay within.  I would go to a room by myself and read it again and again and again.  I looked at it as being my problem and could not feel I could raise it with anybody, including my partner at the time or my surgeon mentors.  He had amassed incredible power in surgical politics and was not one to be reckoned with.  I was totally and absolutely petrified of him.

Periodically I would think of this case and it was not until some 15 years after the event that I would seek closure. This matter had ruminated in my head like a festering sore.  This process began went I was invited to a 50th birthday party and at dinner happened to be seated next to the respiratory physician who was involved in the case.  I found myself opening up to him about this story that I had kept locked away for so many years.  It was quite liberating to be able to speak about it for the first time.  It was amazing that he seemed to remember the case.  The physician was less than complimentary about this surgeon's general behaviour over many years that had been characterised by bullying, narcism and arrogance.

I had copies of the letters and selected additional clinical information and certainly more than enough evidence for commencement a bullying claim.  I had already briefed a high profile lawyer who was eager to take the case,  Given the particular high profile of the individual and what she considered to be unjust treatment, she was prepared to commence this case without any cost to me. I reflected and asked her to allow me do one last thing before commencing litigation.

I took the step of writing to the surgeon who at this stage was a national figure. He was  big fish to fry if I were to take the matter further. He wrote a meticulously neat hand written letter to me explaining that he regrettably had no recollection of the matter and wished that I had been able to raise the matter with him at the time. The final paragraph was repeated unreserved apology.

Whether the apology was disingenuous or not, I felt that I had got this matter off my chest and he was now aware of what I had experienced as a result of his actions. The act of opening up about this case and to then communicate my story to the perpetrator was extraordinarily liberating to me and to the extent that I had lost energy to commence litigation that was destined to make the press.  

I destroyed the documents.  The matter was over from my perspective.  The chapter was closed.  I did not think about this story again until the recent media coverage of harassment in the medical workplace.  I have my blog and here is my story. Do you have a story to tell?

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Background to my relationship with the surgeon discussed is covered in the short piece that precedes this post.