There were two of them.
In the O.R.
Both had good medical backgrounds.
One was an attending physician.
The other was a fellow, still learning under the guidance of a senior physician.
They were both cocky.
They were both arrogant.
Maybe they had a right to be.
They saved many lives.
They were not trauma surgeons.
They were not ER doctors.
These were highly specialized surgeons.
One was a gyn oncology surgeon.
He was a super surgeon.
One who treats women with cancer.
The other was a surgical oncologist.
He too was a super surgeon.
One who treats patients with cancer.
The gyn oncologist was a new attending physician.
He had finally finished his surgical training.
He’d done four years of gynecology training as a resident.
Then he went on to do highly specialized training in the field of gynecologic oncology.
That meant he trained to do complex surgery to remove different female cancers.
That added another three years to his medical training program.
After seven years of training, he was finally ready to join a gyn oncology practice.
He joined a busy group at a very prestigious hospital in New York City.
He saw patients in the office and also performed the latest up-to-date surgeries.
The surgical oncologist had done a five year surgical residency training program.
At a very prestigious hospital.
He was now doing his fellowship.
To become even more specialized.
She was in her early 60’s.
A woman who emigrated from Russia more than twenty years earlier.
She was an engineer by training.
Five years earlier she had gyn cancer.
She went to this prestigious NYC hospital to have her uterus, ovaries and fallopian tubes removed.
Her doctor told her this would eliminate the cancer.
For five years there was no recurrence.
But…there was a problem.
Since the original cancer surgery she developed a hernia at her incision site.
That’s known as an incisional hernia.
It wasn’t too bad at first.
But over time, it got worse.
It became painful.
Her bowel became irritated when it would get caught in this hernia.
She finally decided to see her gyn cancer doctor about this.
She made an appointment to see her surgeon.
When she called, she was told that her surgeon had retired.
“Would you like to see our new doctor? He’s excellent and very well trained,” the receptionist said.
“Sure,” she replied.
He was young.
He was experienced.
He exuded confidence.
He was cocky.
He was somewhat arrogant.
He looked at her hernia.
“I can take care of this, no problem,” the gyn oncologist said.
She was Ok with going ahead.
Her husband asked an interesting question. A few actually.
“She doesn’t have any cancer, right?”
“All her gyn organs were removed, right?”
“Your speciality is removing woman’s organs that have cancer, right?”
“Her problem is that she has a hernia, right?”
“It doesn’t involve any cancer, right?”
“Wouldn’t it be better if she had this done by a general surgeon? Someone who does these hernia repairs every day?”
“No, it’s not a problem. We do this all the time,” the gyn oncology surgeon said.
He convinced them he was the right one to do this.
“While I’m in there, I can look around and make sure there’s nothing else going on,” he told them.
That was mistake #1.
Not sending her to a general surgeon to do this hernia repair.
You see, a gyn oncology surgeon has no business doing a hernia repair on a patient who does not have cancer.
That’s a general surgeon’s expertise.
Mistake #2 comes soon after and turned deadly.
She agreed to have the surgery.
They were both in the O.R.
He was the attending physician, the gyn oncologist.
Assisting him was the surgical oncology fellow.
There was another surgical resident also helping in the O.R.
During this ‘routine’ and ‘simple’ procedure, one of these brilliant surgeons punctured her bowel.
It was an accident.
It wasn’t supposed to happen.
It was a mistake.
It can happen even in the best of hands.
Ok…now that a hole was made in the bowel, what is this brilliant super surgeon going to do to fix it?
There are actually two ways to fix this type of bowel injury.
If the hole is small and it’s not a through and through perforation, the surgeon can actually sew it closed. It’s called oversewing the bowel.
Unfortunately for her, this was a bigger injury.
It couldn’t be repaired by simply oversewing.
That meant the only other option was an end-to-end anastamosis.
Imagine a long tube.
A tube with a huge hole in it.
The surgeon will have to cut the tube on both sides where the hole is.
He’s removing the hole and the surrounding bowel tissue.
But now he’s left with two cut ends of the bowel.
He can’t leave that open since the bowel contents will pour into the abdomen, where it does not belong.
Instead, he must now connect the two loose ends together.
He must make a water-tight seal to make sure that nothing from her bowel ever leaks out into her abdomen.
Here’s where he makes MISTAKE #2
Remember when I said he and his assistant were cocky?
Remember when I said he and his assistant were arrogant?
Well, these cowboys decided they could do this bowel repair.
Did these doctors know how to do a bowel repair?
They said they did.
Had they done bowel repairs before?
They said they did.
Did they call in a bowel surgeon to fix the bowel?
Should they have called in a bowel surgeon to fix the bowel?
Was there a bowel surgeon available to come into the O.R. to handle this?
Why didn’t they call in a bowel surgeon to fix the bowel perforation?
They were cocky.
They were arrogant.
They were cowboys who could do it all.
A bowel surgeon does this type of surgery every day.
Doesn’t the gyn oncology surgeon and the surgical oncology guy do bowel surgery every day?
Well, these two cowboys did this end-to-end anastamosis.
They sealed up the two cut ends of the bowel.
They used a surgical stapler to close the bowel.
They made a watertight seal…or so they thought.
They finished the hernia surgery and closed the patient up.
Then they sent her to the recovery room.
While there, problems developed.
Her heart rate increased.
She began having palpitations.
That was a dormant problem she’d had years earlier that now reared it’s ugly head for some unexplained reason.
This hospital felt she needed cardiac care and they weren’t really well equipped to handle her cardiac issues. So, they sent her to a nearby hospital with cardiologists.
The heart doctor gave her medicine.
That didn’t work.
The heart doctor gave her medicine to control her blood pressure and heart rate.
That didn’t work either.
She was getting progressively worse and worse.
Over the next 24 hours she looked deathly ill.
Someone suggested that she might have an acute belly.
They thought there was something going on in her abdomen that needed surgery.
A new surgeon was called to see her.
He confirmed that she looked terrible.
The cardiac issue was confounding the problem.
He said “I think the cardiac issue is being caused by the belly issue. She needs to go back into surgery and I need to cut open her belly. I need to see if she’s leaking bowel contents into her belly.”
The super surgeon was called.
He was told his patient was being taken back to the operating room.
He couldn’t do anything at this hospital since he didn’t have surgical privileges.
He could only watch.
And watch he did.
He wouldn’t tell me what he saw when I questioned him years later.
He claimed he didn’t remember what he saw.
He claimed he never made a note about what he saw.
The good thing is that the general surgeon did.
The general surgeon made a detailed note about what he did and what he saw.
Reading the note made me angry.
Reading the note made me upset.
The general surgeon didn’t tell her husband what he saw.
The gyn oncologist didn’t tell her husband what he saw.
When I read that surgical note, I had to tell the husband what they saw.
It was not pretty.
You should know her husband was a very smart man.
A very educated man.
An engineer by profession.
He was shocked.
He was stunned.
He couldn’t understand, from a mechanical standpoint how this could happen.
It didn’t make sense.
Here, you have two surgical experts.
Didn’t they know how to connect to ends of the bowel together?
Didn’t they know how to make it watertight?
This was unbelievable.
Here’s what the surgeon saw when he took this patient back to the operating room emergently…
That closure that was sealed tight using the GIA surgical stapler was wide open.
It looked like a zipper had been opened up.
That meant all of her bowel contents were leaking right into her belly.
Exactly where it shouldn’t be.
The bowel contents don’t belong in the abdomen.
It an cause infection.
That’s known as sepsis.
Sepsis, if undiagnosed and not timely treated can result in death.
What do you think happened here?
Why do you think I write about this years after this happened?
It’s precisely because these hotshot surgeons failed to recognize the signs and symptoms of sepsis.
It’s because these cowboys decided to fix the bowel injury by themselves instead of calling in a bowel specialist.
It’s because this woman lost her life because these two super surgeons were cocky and arrogant.
She died within a few hours after the general surgeon opened her belly to find out what was going on. He couldn’t do anything to save her.
What infuriated me was that this lawsuit was fought tooth and nail.
For more than two years, the doctors and their defense attorneys argued that they did absolutely nothing wrong.
For more than two years, the doctor and their defense lawyers argued that whatever they did, did not cause or contribute to her injuries.
Then, to add insult to injury, they argued that even if they did something wrong and that wrongdoing caused her injury and death, her life wasn’t worth very much since she wasn’t working.
During the gyn oncology surgeon’s pretrial testimony, I asked him what he saw when he observed the general surgeon open her belly emergently.
“I don’t remember.”
“Did you read his operative report before coming here?”
“Did you ever review his operative report?”
“Do you understand that the bowel was found to be wide open when her belly was explored a day after your surgery?”
“How did that happen?”
“I don’t know.”
“Would you agree that when closing the bowel in an end-to-end anastomosis you must make a watertight seal?”
“That’s to prevent any bowel contents from leaking, correct?”
“If there’s a leak, bowel contents will leak into the abdomen and could cause a significant infection, correct?”
“How do you explain how the bowel was totally open and exposed?”
“I don’t know.”
When I questioned the general surgeon about his observations, he was very tight lipped.
He wouldn’t tell me anything other than what was contained in his operative report.
He wouldn’t rat on the gyn super surgeon.
I could tell however that he knew the super surgeon did wrong.
I could tell from his mannerisms and tone that the surgeon should have called a bowel surgeon in to fix the bowel.
I could tell that if he’d been called in to repair this, the patient would not have had this horrible complication and would not have died.
Still, the defense fought this case.
They still argued the super surgeons did nothing wrong.
Until of course the case was scheduled for trial.
That’s when they blinked.
That’s when they asked if I’d be agreeable to try and negotiate this case using an impartial mediator.
That negotiation process is known as mediation.
We were only a few weeks from trial.
If we could settle this case before trial, great.
If not, we’d try the case and let a jury determine if we were more likely right than wrong that what we were claiming was true.
I had excellent medical and surgical experts.
Board certified experts.
They all agreed we had a very good case.
They all agreed there were clear violations from the basic standards of medical and surgical care. They all agreed that those departures from good care were directly responsible for my client’s injuries and her untimely death.
During the negotiation process, they again fought us tooth and nail.
They again argued to the judge that they did nothing wrong.
I explained they were wrong.
I explained the only reason the bowel opened up is because of carelessness.
The only reason it opened up within 24 hours of the original surgery is because of surgical errors.
Finally, after brutally honest argument, the defense recognized they had no defense to our argument about how the injury occurred.
Then, since they could no longer focus on arguing how the injury happened, they turned their attention to the value of her life.
To learn even more about this case, I invite you to watch the quick video below...