The knee replacement went beautifully.
The surgery was a success.
It's what happened immediately afterward that was an absolute nightmare for this patient.
She'd been having trouble with her knee for a long time.
It hurt her while standing.
It hurt her in the morning when she would awake.
She saw a board-certified orthopedist in New York City.
A cocky, arrogant kind of guy.
Exactly the type of doctor she wanted.
He was supremely confident.
He was an attending physician at a very prestigious hospital in New York City.
He was very cut and dry.
She did not need a total knee replacement.
Instead, she needed a uni-compartmental knee replacement.
This is really a modified knee replacement.
She agreed to have the surgery.
She felt great knowing what she was getting into.
The bone doctor told her all about the alternatives and the benefits to having this surgery.
She was 62 years old.
She had never had surgery before.
She put her faith in the doctor and the hospital where the surgery was to be done.
The surgery went according to plan.
There was no excessive bleeding.
As a precaution, the doctor attached a drain to the patient's knee.
This is done to allow fluid in the knee to drain.
At the end of surgery, the doctor wrote a very explicit order that the patient's drain was to be attached to a suction device in order to remove any fluid that had built up or would build up.
The surgeon and anesthesiologist brought the patient to the recovery room.
They handed her off to the recovery room nurses.
The orthopedist and the anesthesiologist then leave.
Within 15 minutes, the patient was screaming in agonizing pain.
She was still in the recovery room.
She was having severe belly pain.
A nurse rushed over to see what the problem was.
Keep in mind that this was a 62-year-old woman.
She was not pregnant.
She was not overweight.
She was thin.
Yet, this woman is screaming in pain.
Her belly kept getting larger and larger.
She can't understand why.
The nurse had never seen anything like this before.
It looked almost as if an alien was ready to burst out of this woman's belly.
The nurse immediately called the orthopedic resident to come and examine her.
"An emergency," she said.
The orthopedic resident examined her and immediately called for a surgery consult.
Not one of them could figure out why this woman's belly kept getting larger and larger.
She was perfectly fine before the surgery.
She was perfectly fine immediately after the surgery.
This was life-threatening.
They immediately rushed her back into the operating room.
An anesthesiologist immediately intubated her and put her to sleep using general anesthesia.
The surgeon called for a scalpel.
It was a huge whooshing sound with a tremendous amount of air that came out of the incision.
He opened the patient from the bottom of her ribs all the way down to her groin.
It was a huge vertical incision.
Remember, this patient had never had surgery before that day.
Not knowing where the air had come from, the surgeon now had to investigate.
He suspected that there might have been some perforation that occurred after the patient's knee surgery that caused this massive air buildup.
After more than 30 minutes, the surgeon was frustrated since he could not find the source of this air.
He checked her other internal organs.
None of them were perforated. None of them had a hole.
He could not explain why this patient had a massive amount of air in her abdomen.
With no other solution, he closed the patient up and returned her back to the recovery room.
None of this made any sense at all.
Here's what they did know...
The knee surgery went well.
There were no complications.
The patient's belly was perfectly fine when the orthopedist finished his knee surgery.
It was only in the recovery room that the patient began to experience problems.
They asked about the recovery room procedures.
They asked what was done for the patient.
Finally, the surgery resident figured out what happened.
He was not happy.
The orthopedist was not happy.
This was a hospital system failure.
This was clear malpractice.
It was a violation of the basic standards of medical and nursing care.
It was a violation of hospital protocol.
Remember earlier when I mentioned that the doctor inserted a drain into the patient's knee?
The drain was to be connected to a suction device in order to suck out and remove any fluid that had built up.
To accomplish this, the nurse attaches plastic tubing directly to the drain and then takes the other end of the tubing and attaches it to a nozzle on the wall.
Any fluid removed by the suction device then gets put into a canister in order to measure how much fluid is removed.
Here's what the surgeon learned while talking to the recovery room nurse...
He asked the nurse to explain step-by-step what she did when hooking up this patient's drain to the suction device.
The nurse attached the plastic tubing to the patient's drain.
She then took the other end of the tubing and attached it to a nozzle on the wall.
She's then turned the handle to the on position.
Instead, it was an oxygen nozzle.
This oxygen nozzle was a device used to give a patient oxygen either by face mask or by nasal cannula.
This nozzle actually pumped oxygen out.
When the nurse hooked up the plastic tubing to the nozzle and turned the handle on, air was being pumped directly into a closed knee compartment.
Since the air had no place to go and it was continuing to flow into this closed space, the air began to travel into the different tissue planes.
The doctors call this condition crepitus.
That's where air builds up under the skin that forms little bubbles.
Unfortunately for the patient there is no place for this massive amount of air to go.
Her body was turned into a human baloon.
The air kept flowing up into her skin up toward her abdomen and inflating.
That's why when the surgeon made his incision into her belly, he heard the whooshing sound of air escaping as if he was deflating a balloon.
What was most frustrating for this patient was that nobody told her why this happened.
Nobody told her why she had air in her belly.
Nobody told her about the screwup by the nurse and the oxygen tubing.
It was only after two years of hard-fought litigation that I learned this information when I questioned the recovery room nurse during her pretrial testimony.
Even then, I had to pull teeth in order to get answers to my questions.
Shortly after this nurse testified, the hospital had no choice but to settle this case.
Remember, this incident NEVER should have happened.
It was a clear violation from good medical and nursing care.