AA“Doctors love to patronize and dominate. Their arrogance and indifference to the philosophy of informed consent is widely known. Surprisingly, most residents and doctors in teaching public hospitals tacitly endorse such reservations against information sharing. To most of them getting informed consent is a needless nuisance, to be delegated to a raw resident whose sole responsibility is to get the patient’s signature on the dotted line.”
Journal of Medical Ethics, October 2000
“A Mitral Valve Flapping in the Breeze, Prolapsed into the Atrium …”
AA 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.
Various docs gave it a shot and they wrangled for about 45 minutes, but the catheter would not give, so they called in an expert, Jeff Brinker, who apparently decided to just roll the bones and give the catheter a good hard yank. (It says on the box to not do that). According to the record, the catheter is “suddenly free.”
The tip of the catheter wire was designed to coil into a loop as it came out of the sheath. When it was fed through the mitral valve and into the lower left chamber of the heart, (whether by choice or chance we’ll never know) it curled around the valve muscles over and over until muscles and catheter were tightly knotted together. So when Jeff Brinker yanked on the catheter he essentially ripped the valve muscles out by the roots.
By that time, Hugh Calkins had shown up and he reported for the record that Pam’s valve was “flapping in the breeze and had prolapsed into the atrium.” So there stands Jeff Brinker, looking at bits of flesh clinging to the tip of the catheter. And there’s my wife—her name is Pam—half awake and in a lot of pain, with plummeting blood pressure, wearing an oxygen mask because she’s dying from acute congestive heart failure.
But this is a teaching hospital and the patient is neither rich nor powerful, and apparently is therefore expendable because they decide to continue with the ablation procedure.
Finally she is sent to the ICU for observation, where the surgeons inform the bumbling cardiology staff that she will die if they don’t immediately perform open-heart surgery to repair the valve. This presents another teaching opportunity, so they find someone who has never actually repaired a mitral valve. He opens her up and decides upon seeing the mess that he will just replace the valve, sentencing Pam to the high wire balancing act of taking the blood thinner warfarin for the rest of her life.
Warfarin is commonly used as rat poison.
∞
I was with Pam in the ICU in the time between the botched ablation in the EP lab and before she was taken for open heart surgery. She was not conscious because of the extra pain killers and anesthetics she’d finally been given. When someone’s yanking on a wire tangled deep in the muscles of your heart, being only half asleep doesn’t suffice.
From behind the curtain, Hugh Calkins appeared. With him came a scrubbed-up young man I’d never seen before who was shaking like a French soldier. Calkins said to me that he was so sorry, but the mapping catheter had gotten sucked into the mitral valve because he—Hugh Calkins—had turned momentarily away from the procedure to switch catheter sheaths.
At that point I felt kind of badly for him. “It’s O.K. Doc,” I said.
And I feel kind of badly for him now, because all of our lives would have been far better off if he had only told the truth from the very beginning. As it was—at the time—I couldn’t figure out why the young man with Hugh Calkins was so nervous, because as far as I knew he wasn’t involved in any way. But I had more important things to worry about — like how to break certain news to Pam once the Versed wore off.
It was difficult, but I told her and she braved open heart surgery. They were then in such a hurry to sweep her off the premises that they took her off life support too quickly. She started dying again, so they had to shove the oxygen tube down her throat again and put her back on the ventilator. They forgot to monitor her blood pressure, which caused her to have a stroke and go into a coma. Then, despite repeated requests from her family, her eyes were not lubricated until it was too late. She wound up with scarred corneas. They tied her arms to the bed, leaving her elbow resting on the rail so long that her ulnar nerve was damaged. It feels like the white hot electric buzz you get when you hit your funny bone — only it never stops.
So much for the culture of safety.
And the venerable Johns Hopkins refuses to take responsibility, telling my wife she should have known all along how risky the procedure was. She should have known—and she would have known—had Hugh Calkins told us what he really thought about the procedure, which is what I found out on the Internet years later.
∞
Despite the best efforts of the administration at Johns Hopkins, I eventually found out about Richard Wu, this physician whose initial contact with my wife came as he was snaking a catheter up her groin, taking his first tentative steps up what Calkins would later describe as the steep and rocky learning curve of a procedure with unprecedented risk.
I’ve heard that the saying at Hopkins med school is “see one, do one, teach one” and by the time I caught up with Wu, he was teaching the procedure at the University of Texas Southwestern Hospital in Dallas. I called him for an explanation. He told me that he’d actually spent a lot of time with Pam and me before the procedure. He said to me that he’d sat down with us in the weeks leading up to the procedure to explicitly detail the risks involved. He said that he’d spelled out very clearly how dangerous it would be. He was adamant that he had indeed informed us that he would be performing vital aspects of the procedure.
And then he denied having been involved in the “complication.”
But as young Richard Wu was struggling to alter past events for my benefit, there was something he didn’t know, which was that his mentor and accomplice had already let the truth slip out.
