A Work in Progress …
Preview CHAPTER ONE:
“A Mitral Valve, Flapping in the Breeze, Prolapsed into the Atrium …”
Johns Hopkins Medicine has a long tradition of prioritizing patients, and striving for the bottom rung are the anonymous poor.
If, for example, you catch a bullet on a Baltimore street corner, or your mother presents you at the ER as a feverish welfare child, then it’s open season for the med students, well meaning as they may be. They can practice on you because if your procedure results in an adverse outcome — which is to say that if you are mangled or killed — nobody will question said outcome, precisely because… you are a nobody.
At the other end of the spectrum are wealthy and prominent patients, who get treated by doctors who have already learned what not to do from the mistakes inflicted upon the lower classes.
My wife landed somewhere in the middle. We got snookered by all the hype from US News into thinking that she was going 
to be treated by the best doctor at “The Best Hospital in America.”
Hugh Calkins, MD was to maneuver tiny wires around in my wife’s heart and burn scar tissue in the wall of the atrium to stop atrial fibrillation.
The job required someone with a cool head and a keen eye, and Hugh Calkins, MD, FACC, FAHA, FHRS, Professor of Medicine, Director of the Electrophysiology Lab at Johns Hopkins University School of Medicine — and graduate of Harvard Medical School — assured us that he had done plenty of these procedures, and, he said, “experience counts.” So we knew we were in the best of hands. What we didn’t know is that Professor Calkins – according to what he later told colleagues – follows the practice at most teaching hospitals wherein “the attending shows up to be there during the burn.”
What he meant by that was this:
The patient is sedated and wheeled into the laboratory. She is placed on a table and administered a twilight anesthesia (conscious sedation). The trainees begin. As part of their training, they perform and are responsible for various routine aspects of the procedure. According to all the rules, this is to be done under close supervision. A trainee practices finding the femoral vein in the patient’s groin, probing and piercing the skin with a large needle. Once this is accomplished the trainee inserts a catheter sheath into the vein and up into the pumping heart. The catheter is then inserted. Here is where one would expect the experienced attending physician to step in because it is a very tricky business to navigate a thin wire around in a beating heart guided by cloudy X-Ray imagery.
But since he only “shows up to be there during the burn,” Hugh Calkins was presumably relaxing with colleagues down in the doctor’s lounge or out selling TASER guns, and a young electrophysiologist trainee by the name of Richard Wu - whom we’d never met – was fumbling around with a new type of catheter.
And it appears that young Wu wasn’t sure into which chamber of the heart the catheter was supposed to be inserted.
He went for the left ventricle (it says right on the box to not do that) and the catheter got tangled in the muscles of her mitral valve. Her chart read: “only the first 50% of the circular portion of the catheter tip could be withdrawn into the sheath and pulsatile motion could be appreciated.” Pulsatile motion. They were trying to cajole the catheter back into its sheath, but it was tugging right back, like they’d hooked a five pound bass. A nurse noted here that the “patient is waking and moving around, with chest pain @ 7/10.”
Imagine that.
