Bad Blood. James Baehler
Shaken out of his immobility, the anesthesiologist reached over to his tray for a vial of heparin, inserted a syringe and extracted a dose. He reached up and inserted the tip of the syringe into the portal on the IV line closest to the insertion on the back of the patient’s hand. Slowly but steadily he depressed the plunger of the syringe until the cylinder was empty. The room was as silent as a tomb; none of the OR staff could ever remember Dr. Harris in a shouting match. The blood pressure maintained at 70 over 40 for a while. The cardiac rate began to slow. Harris worked feverishly suctioning blood and continuing to explore as best he could. Vasopressors were already in, but the blood pressure stubbornly refused to rise. Wallberg’s fingers remained cyanotic, the Foley bag remained empty showing no urine output. Abruptly, the cardiac rhythm slowed further and premature ventricular contractions developed. With horror-stricken eyes the doctors and nurses watched as an idioventricular rhythm developed.The patient was slipping into cardiac arrest. The monitor screen told its relentless story as Wallberg’s heart beat slower and slower and finally, a chaotic rhythm---ventricular fibrillation, the heart beating wildly out of control. Harris and his crew began frantic cardiopulmonary resuscitative measures. Adrenalin was injected directly into the heart. Harris called for defibrillator paddles and applied them to the patient’s chest. Wallberg jerked under the jolt of electricity but that was the only response. The chaotic rhythm on the heart monitor suddenly flattened out; the spiking demonstrating the heartbeats disappeared. More chest compression, more electrical jolts but still the patient remained unresponsive. The monitor showed a persistent flat line. After more long, discouraging minutes, Harris reluctantly signaled to the OR team that it was time to cease their efforts. The patient was dead.
Silently the tubings were removed and the body placed on a cart. No one spoke. When the task was done, the anesthesiologist, Sanjay Madhava, said bitterly, “Heparin? I sure hope you know what the hell you did.”
Wearily, Harris replied, “I knew very well what I did, Sanjay. When I’m a little less tired someday, I’ll explain it further to you.” Madhava turned away with a disbelieving shake of his head. Harris was now too fatigued to do anything more than dwell on the fact that he was now involved with his first intraoperative death. He was devastated and it showed on his face. He dreaded the coming talk with the patient’s wife. Slowly, he made his way from the operating room to the Waiting Area outside the ICU. He stopped for a moment and drew a deep breath before entering. One look at his stricken face and Marilyn Wallberg knew what had happened. She made as if to rise, but slumped back instead. Dr. Harris sat next to her and said, “I’m so very sorry, Mrs. Wallberg. Your husband developed uncontrolled bleeding and everything we tried didn’t stop it. We couldn’t save him.”
She looked at him, her features frozen into an expression that Harris couldn’t identify. He put his hand on her shoulder. She looked directly at Harris. “What caused the bleeding?” she whispered.”
Harris said, “I’m so sorry, Mrs. Wallberg. I’m certain that your husband developed disseminated intravascular coagulation. It’s a bleeding complication that once in a great while appears after major surgery. There was no way to anticipate it and no way to control it.”
Still unbelieving, she said, “But…but I don’t understand. I thought it was a simple operation.”
“The surgery was relatively simple, Mrs Wallberg but your husband then developed the DIC condition I just described and despite our best efforts, we couldn’t save him.”
Beginning to show anger as her eyes filled with tears, she said, “But how can that be? Aren’t you prepared for that sort of thing?”
“I’m sorry, Mrs. Wallberg but there is no way to prepare for disseminated intravascualar coagulation. It is an extremely rare condition that appears without warning and there is no way to prepare for it.”
In a despairing voice, she said through her sobs, “I don’t understand any of this. My husband was alive and well a few hours ago and now you tell me he’s dead and there was nothing anyone could do about it.”
Harris started to speak when she broke in. “What am I supposed to do now. I have two children to take care of and my husband is dead.” Her voice rose to a wail as she buried her head in her hands and wept uncontrollably.
Not knowing what else to say, Harris could only gently pat the grieving woman on the back as she sobbed.
Finally raising her head and speaking in a low voice Marilyn Wallberg said, “Why did Victor call you, of all people? After what happened between the two of you, why?”
“I thought the same thing, Mrs Wallberg. But it just told me how desperate he had become. Just speaking to him on the phone, I knew he was helpless to help himself. He wouldn’t have been able to get to his car. He had all the symptoms of a complete intestinal obstruction. Surgery was the only thing that could have saved him, but it was too late. He developed disseminated intravascular coagulation. He bled and clotted profusely. It couldn’t be reversed. We got him too late.”
Mrs. Wallberg stared straight ahead, eyes wide, her expression frozen. She shook her head. Then she said, bitterly, “I know him. He never went to doctors. He probably developed symptoms and when they got worse he was sure they’d go away. He always did things like that. Only this time he got fooled and it cost him his life.” She broke down again.
Harris said, “You may be right. If he had gone to a physician at the start of the symptoms, this might have been prevented.”
Bitterly, his widow said, “That wasn’t Victor’s style. Everything had to be done his way. He would never listen to anyone else or take anyone’s advice. He was always so sure he knew best.”
Harris said, “We need to learn more, Mrs. Wallberg. It can’t end here. Would you consider an autopsy?”
She straightened and without looking at Dr. Harris, shook her head and said firmly, “No autopsy. I’m not going to have Victor cut up when you say you already know why he died. In any event, he thought autopsy was butchery and I am not going to go against his beliefs.
“Mrs. Wallberg, the decision is yours and I understand and respect it.”
“Thank you, doctor.”
“Would you like some time alone with your husband?”
“Yes, I would like that.”
“Come with me,” Harris said, leading her out of the room.
“Is there anyone you would like me to call?” Harris said as they proceeded down the hall.
“Not right now, thank you,” was the reply. They reached the room where Wallberg’s body lay.
Harris said, “Please let me know if there’s anything else we can do.”
“Thank you, but I can’t think of anything right now.”
“I understand,” Harris said and turned away from the widow of a patient who had died under his knife. He went back to the surgery area where he dictated his surgical report. It was detailed and lengthy. Soon he would have to face the scrutiny of his fellow doctors as this was a surgical death, and all such are peer reviewed.
Harris now realized he had no way of getting home. It was 2:00 a.m. and he was scheduled to perform a 7:00 a.m. surgery that morning. To go home he would have to call his wife, wake her up and have her come to the hospital. It wasn’t worth it. He went to the dormitory area set aside for house staff on night call. He grimaced at his appearance in the mirror. He noted his disheveled hair. His gray eyes had lost their luster. The muscles of his wiry frame that he tried to maintain with semi-regular exercise seemed flaccid. His shoulders drooped making him look shorter than his six feet. He called the hospital operator and asked for a 6:15 AM wake up call. He fell exhausted into bed, his last thought on the man he had just operated upon; a man who had raped his wife.
CHAPTER 2
As Dr. Harris was falling asleep after his most hectic of nights, his