He was upset. He was angry. He learned some terrible news.
He took his frustration out on the glass window. That was just the beginning of his problems.
In the blink of an eye, the glass shattered and severed an artery in his arm. Blood was spurting everywhere. The walls. The ceiling. The floor. He put pressure on the wound but he knew that wouldn't stop it. His friend rushed him into his car and sped over to the closest emergency room only five minutes away.
He ran into the emergency room with blood spurting from his arterial wound. Nurses placed pressure on the wound and yelled for a doctor immediately.
This was life-threatening.
One of the doctor's-in-training, known as a resident ran to the patient. He immediately began putting sutures in the wound in an attempt to stem the flow of blood. After a while, the bleeding was under control. The doctor closed the wound with more stitches and gave the patient follow-up instructions.
The doctor-in-training told the patient that he'd be numb in his arm for a while because of the anesthetic and to follow up in the hand clinic in a few weeks.
First, he never did a neurological examination while stitching the wound up. Nor did he ever do a neurological exam on the patient's fingers, hand & arm after he was done closing the wound.
The patient returned home after this episode, thankful that he was still alive.
Over the next few weeks, he began to recognize that he had difficulty moving two of his fingers. He also, didn't have any feeling in part of his arm. Weird. He didn't know what to make of it and planned on telling the doctor in the hand clinic when he saw him shortly.
The numbness and tingling didn't go away. He figured that his inability to move two of his fingers was just the trauma of the injury and would get better. Unfortunately, he was wrong on both counts.
One month after this glass break incident, he goes to the hand clinic and they look at his arm and hand. He tells them of the tingling and numbness and inability to move two fingers. He also tells the doctor that he can't feel part of his arm.
His concerns are brushed aside by the doctor-in-training in the hand clinic and he's again told to follow up in a few more weeks to check the progress of his wound healing. The patient again returns a few weeks later with the same exact complaints.
This time, he's seen by a senior doctor who actually knows what he's doing. The senior physician does a neurological exam and immediately recognizes he has a problem. He schedules him to see a hand surgeon the next day.
The next day, he sees a hand surgeon who does a complete neurological evaluation of his fingers, hand and arm.
"You have a problem," the surgeon says. "It would appear that you have a nerve injury. I don't know if it's from the original trauma or something else. The only way to know for sure is to surgically open you up and try to fix the damage. But, you should know, it may be too late..." the surgeon said quietly.
The patient agrees to have the exploratory surgery.
He doesn't know what the surgeon is going to find or what he's going to do to try and fix the problem.
After surgery, he speaks to the surgeon.
"I found the problem...the problem was not a result of your initial trauma of putting your arm through the window and cutting your artery. Your nerve was perfectly intact at that time. The problem was that the emergency room doctor who was stitching you up, put a stitch into the nerve that controls your two fingers and part of your arm.
In fact, because he tied off the nerve, the nerve has died off. I had to cut out the stitch leaving you with two ends of the nerve unattached. I tried to get them as close together as possible in the event they are able to regrow. You should also know that nerves regrow very slowly and may take one and a half years just to come close to each other. At that point you might start to get some sensation back in your fingers or arm. I don't think you'll ever get any motion back to your two fingers though," the surgeon said definitively.
The surgeon carefully put all this information into his operative report.
His findings and observations were shocking.
Never in my career have I ever seen a physician point a finger at another doctor so clearly. The surgeon made no apologies for recording his observations.
We started a lawsuit and the only real argument the defense raised was that this was an emergency life & death situation. This patient would have died from exsanguination (where he would have bled to death) had the doctor not stopped the flow of blood.
That was a valid defense and a good point. However, remember when I mentioned above that the doctor-in-training failed to do two critical things while in the emergency room attending to this patient?
(1) He failed to assess what the patient's neurological condition was prior to finishing closing the wound and
(2) He failed to asses the patient's neruological condition after he had closed the wound.
If he had done it, the young doctor admitted he would have recorded that information in the hospital record. A detailed review of the emergency record was completely absent of any of those two examinations.
If the doctor had done those examinations, he'd have realized the patient had a neurological injury. He then should have sent him for an immediate neurological evaluation with a hand surgeon.
Had he done this within days, there is the very real chance that the nerve that was tied off would not have needed to be cut and brought close together. Instead, the nerve would likely still be alive and it would have been possible to try and remove the stitch without needing to cut the nerve.
The treating surgeon agreed to come in and testify. He would have described what he saw and what he did. He also would have told the jury that his injuries were permanent.
Interestingly, the defense refused to acknowledge they did anything wrong throughout the entire litigation. It was only after we were assigned a trial date did the defense finally start negotiating.
The surgeon told the patient that in all his years of practice, he had never seen anyone tie off a nerve. Ever. That was clearly a violation of basic standards of good medical practice, even though his field of view was obscured while sewing the gaping wound.