Bad Blood. James Baehler
a specific illness. I just want to know if this applies here.”
“I’ll say again, I don’t understand the relevance. Don’t you have to prove that my treatment did not meet the standard of care for this case? That’s what I thought this was all about. I’m well prepared to defend my action, not to discuss what another doctor may have done under similar circumstances.”
Barbutti was not to be deterred. “Do you think it would have been proper not to use heparin on Mr. Wallberg.”
“I thought I just answered that.” Cliff had become irritated and it showed.
“The question calls for a simple yes or no, doctor.”
Testily, Cliff replied, “I don’t care how many times or how many ways you ask the same question. My answer will be the same. I did what I had to do, and what I did met the accepted standard of care.”
Barbutti realized he was at an impasse; there was no way Dr. Harris was going to admit that no heparin would also be appropriate in Wallberg’s treatment thus opening up doubt in the jurors’ minds. He would have to change tactics and open up another line of questioning, perhaps returning to this issue at a later and unexpected time. “Tell me, doctor, about the argument you had with the anesthesiologist Dr. Sanjay Madhava.”
“Objection,” said attorney Stuart. I object to form. The question is argumentative.”
“Same objection,” said attorney Wu.
“Join,” said Attorney Luria.
“You can answer, doctor.” Barbutti said.
“I did not have an argument with Dr. Madhava.”
“But you insisted he give heparin to your patient when he didn’t want to.”
“Yes, I would say he was reluctant to do so, but when I explained to him the necessity, he gave it.”
“Are you saying he didn’t know anything about DIC?”
“You just said it. I didn’t.”
“But did he know anything about it?
“Objection,” said attorney Stuart.
“Join,” said attorney Wu.
“You must have an opinion about that, doctor,” Barbutti persisted.
“I do. Neither Dr. Madhava nor I are experts on DIC. Thank God I have only been subjected to this deadly condition about three times as I can recall. One was a patient in severe septic shock following trauma, the other was a patient with a metastatic malignancy, and the third was Mr. Wallberg. But I remembered exactly what had to be done in order to attempt to reverse this process. I did it. And Dr. Madhava to his credit followed my instructions. Also to his credit he demanded a reason to use heparin and when I gave it he complied. So if you want to characterize that as an argument, there’s nothing I can do about it.”
Barbutti referred to his notes and said, “Let me offer a quote of what you actually said in the operating room to Dr. Madhava. Quote, ‘There’s no time for didactics, damn it. Am I going to have to scrub out and do it myself? There’ll be shit to pay if that happens.’ End of quote. Does that sound familiar, doctor?”
Calmly, Harris replied, “Yes, I said that.”
“That sounds like an argument to me.”
His composure intact Dr. Harris said, “Yes, I could understand why anyone who heard that statement would think I was arguing, but I wasn’t. Time was running out on Mr. Wallberg. Dr. Madhava was unsure and that resulted in his reluctance. Yes, I used those words. I had to stress the urgency. If you had my entire discussion during that time you would also have me explaining my rationale for the heparin to Dr. Madhava. Once he heard that, he complied with my order. Never forget that we work as a team in surgery. Patient welfare is paramount.”
“Don’t you agree that not to use heparin could meet the accepted standard of care?”
“You’re asking the same question again.”
“Yes or no doctor.”
“All I know is I met the standard.”
In a challenging tone, Barbutti said, “What if I were to tell you that I had experts who would have never used heparin?”
“Then I would tell you that your experts don’t understand the pathophysiology of DIC and are unable to recognize the late clinical manifestations of the disease.”
“You would disagree with experts?”
“I would first need to have the word expert better defined.”
That stopped Barbutti. He was not about to put on record that his expert was a thirty-year-old general practitioner. He changed the subject. “Let’s go back to the beginning doctor. Describe your first contact with Mr. Wallberg.”
“I arrived home from work, and received a call from Mr. Wallberg. He was home and I could tell by his voice that he was in great distress. He lived next door and I went to his house to determine the problem.”
“Were you his personal physician?”
“No. I never saw him as a patient before.”
“And your findings?”
“All consistent with an intra-abdominal catastrophic event.”
“I need details of your physical findings, doctor.”
“Yes, all right. His appearance was that of a man in severe pain. Facial grimace, wrinkled brow, anxiety, bent over almost ninety degrees, belt open and pants zipper unzipped.”
“Unzipped pants? What does that tell you?”
“He was relieving the distention of his abdomen.”
“Bent over ninety degrees?”
“Same reason.”
“What was there about his abdominal findings that led to your diagnosis?”
“His abdomen was distended and his bowel sounds were high pitched. That suggests obstruction. He had vomited three times and that is consistent with obstruction as well. His abdomen was tender and he had rebound tenderness.”
“And what is rebound tenderness?”
“Press the abdomen with your fingers, release quickly and severe pain is felt.”
“What does that tell you?”
“It suggests that the peritoneum is irritated or infected. The peritoneum is the thin membrane that lines the wall of the abdomen and covers the organs in it.”
“Does that mean surgery is necessary?”
“Not necessarily.”
“What brought you to the decision to recommend surgery?”
“My clinical judgment confirmed by x-rays that proved an intestinal obstruction.”
“Do you always have to treat intestinal obstruction surgically?”
“Not necessarily. Sometimes conservative measures are effective.”
“Why didn’t you use conservative measures?”
“He had a severe obstruction proven by x-ray. For all I knew his intestine was already gangrenous.”
“But you didn’t know that.”
“But I was worried about the possibility.”
“So, perhaps conservatism might have worked?”
“Not a chance. His x-rays showed advanced obstruction.”
“How can you be so sure? Perhaps if he had been treated conservatively he’d