VERITAS
Whatever it is that drives some people to become doctors is one thing. What drives some of those people to become the top doctor in a given field is something else, some extra-powerful combination of ambition and ego. That combination, along with intelligence, money and connections, can get you into Harvard. But, in my experience at least, the risen cream relentlessly churned out by Harvard is often 
less than Grade A Produce—if you believe that a university education should result in a well rounded individual.
Every Harvard grad I’ve ever met shares a cognitive defect: Common Sense Deficit Disorder. All of them have a blind spot, some blank space in the prism of their personality which prevents them from seeing some aspect of the obvious. Whatever flair the best and the brightest may bring to the fields of science, politics or the humanities, your typical Harvard grad will be flummoxed, say, by the prospect of having to change a light bulb. Or, as sometimes happens, a gang of them will ascend to the highest levels of government and plunge the nation into war.
The motto at Harvard, where Hugh Calkins attended medical school, is Veritas. As a serious and determined young physician in the making, the future Professor of Medicine at Johns Hopkins University (Veritas vos liberabit), must have laid eyes on that motto thousands of times – so often that he probably stopped seeing it after
a while, its impact literally diminished by degrees until it became intellectual white noise. What likely did stick in his mind was the Statue of Three Lies. It is a bronze sculpture of a founding father type looking out over Harvard Yard. Everyone supposes it to be a likeness and tribute to the founder of all things Crimson, John Harvard, since that is what is engraved in stone on the base of the statue: John Harvard, Founder, 1638. But the nickname has it right. Each finely chiseled line is a lie. The likeness is not that of John Harvard, who did not found the institution, which was not founded in 1638.
And it would have been there in Harvard Yard at the the Statue of Three Lies where, as is the custom, a young Hugh Grosvenor Calkins rubbed his hand on the bogus founder’s shoe for luck before turning to take on the world.
∞
Thanks to court ordered depositions, we have a permanent and public record of how Wu & Calkins recall the events of the day.
On the subject of who was actually performing the procedure, Calkins puts forth hazy scenarios. Contrary to his customary “showing up to be there for the burn,” as he confided to colleagues at the FDA hearing, on this particular day he would have scrubbed out after the procedure was set in motion, leaving the trainee at the wheel. “I would descrub when it’s time to analyze the figures to find out if the vein was isolated. This isn’t just looking at something. It’s very tricky to do this. This is the critical part of the procedure. That’s the part I was performing. That’s what I was doing and then the catheter got entrapped.”
So the catheter went and got itself entrapped. How did that happen?
“If you ask how is it possible for this catheter to get caught in the mitral valve, the answer is it is possible. It occurred. And you may ask, ‘How can that possibly be?’ And the answer is, One, the atrium is a small structure. And B, (sic) all the pulmonary veins are relatively close to the mitral valve. Three, we don’t have our hands in the atrium. As a surgeon, we’re working from the leg, we’re four feet away. So you have a small structure, the heart’s beating, you have a catheter in the heart, the structures are all relatively close together, and obviously the mitral valve dipped back and caught on the catheter. One way or the other, we know for sure the Lasso catheter was stuck in the valve. So it happened.”
This is perhaps the reason that Hugh Calkins is not a surgeon, despite his Freudian desires. All the experts—and quite a few laymen—stand solidly behind the principle that it’s physically impossible for a heart valve to make a lunge for anything.
Did the catheter get caught in the mitral valve during repositioning to another site?
“It’s hard to know if it was during the positioning, the repositioning or exactly when. What was the question? I don’t know exactly when. I don’t know how the catheter got caught in the valve. That is unknown to me. I know that it did. That’s a fact. How it got caught, I don’t know.”
And who actually repositioned the catheter?
“I don’t know for sure, but I suspect that it was Dr. Wu.”
That was a pretty good hunch since Calkins wasn’t even scrubbed in when Wu blundered in to the wrong heart chamber. And despite all the hemming and hawing and the dancing, Hugh Calkins knew exactly how the catheter got caught in the mitral valve. He wrote about it two years earlier, two years before he swore truthfulness at a deposition. “Entrapment of the mitral valve apparatus by a mapping catheter results from inadvertent positioning of the catheter into the ventricle with counterclockwise rotation,” he wrote in 2007.
At last, a simple true statement.
Richard Wu must have had help with his orchestration of the day’s history.
“How many times, before Mrs. Walter, did you participate in a similar procedure in which you were the primary operator… “
“I know I did about 500 procedures…”
“How many where you were operating the catheter …”
“I did somewhere between 250 to 300…”
“How many where you were were the primary operator…”
“I think between 30 to 50…”
“With you as the primary operator? Is that what you’re saying?”
“Less than 30.”
I would point out here that ZERO qualifies as fewer than thirty, and that you or I could legitimately claim likewise. Mr. Wu does admit that he first laid eyes on Pam Walter on the morning of the procedure. “I have records stating that I wrote a history and a physical for Ms. Walter at 7 a.m. on March 25th 2002,” he said. He’s not necessarily swearing to the facts, just to what the record states. By design, reality and the record are two different things.
Pam’s daughter Kristi and I were with her at 7 a.m. in a patient receiving area. I stayed until Pam was taken to the pre-op room, which was at 7:30, according to nurses’ notes. Kristi went with her and stayed with her in the pre-op room until 8:10, when according to the record, Pam was taken to Room One at the EP Lab. She was in the lab at 8:20 and by 8:27 had she been administered narcotics. None of us saw Wu or Calkins that morning.
Did you discuss the risks of the procedure with Pam Walter?
“Yes. We went over the consent form before the procedure and we discussed the risks of the procedure. There on the consent form it lists pain and infection and bleeding, damage to blood vessels which may cause a blood clot or require surgical repair, nausea or vomiting from the sedation. The other things we discussed were perforation of the heart or lung which may require emergency intervention, respiratory risks that may require intervention, stroke, myocardial infarction or death. We also specifically discussed a unique complication of the procedure know as pulmonary vein stenosis. I specifically discussed this with Mrs. Walter because she had a pacemaker…”
And how long did it take you to review the history, give her a physical examination and ensure that she had given properly informed consent?
“About a half hour,” says Dr. Wu.
