Friday, June 1, 2007

Backstory # 4. Complications are Complicated (AKA "Why I Didn't Sue Anyone ...)

It is an (American) legal corollary of Godwin's Law: the bigger the medical complication, the greater the chance that at least one doctor will be sued. It doesn't really matter if it was true malpractice or not. It only matters if something went wrong. Therefore it's no surprise that I have been asked by numerous people if I was going to sue the OB who perforated my uterus during my D&E surgery or the anesthesiologist for my D&E and emergency laparoscopy.

When people learn I didn't sue anyone, they either express shock at my naivete, or conclude I must have found Jesus. Never mind that I'm the same old agnostic cranky pants I always have been outside of this subject. Cut me off in traffic and I want to cut you off right back, and my kids in the backseat probably just learned a new swear word, too. As for being too trusting or naive ... I'm an editor, for chrissakes. We aren't exactly known for our rosy world view.

The truth is, I thought about suing after my D&E went wrong. I think it was reasonable to do so. Usually a pregnancy termination for medical reasons is the last sad chapter in a particular sort of heart-breaking story. A dilation and evacuation (D&E) doesn't typically effect future fertility at all. While the emotional recovery takes a long, long time, from a physical standpoint, the procedure has a quick recovery time.

But with me the D&E was not the end, but the kickoff to any even more difficult set of experiences. Before the uterine perforation, I had sailed through a vaginal delivery for Big A. But the perforation placed me in the high risk, c-section-only category for future pregnancies. Then, during the laparoscopy done to repair the perf, the general anesthesia failed. I heard conversations going on about me in the OR, struggled with the pain of incisions being cut and instruments being placed, and felt like I was suffocating from the intubation tube. And since I was paralyzed from the anesthesia, I was unable to let anyone know what was happening. (See my "Backstory 3" post for more details on all that.)

Finally, while I was told that another pregnancy was likely safe so long as I waited 3-4 months to conceive, avoided labor, and had a planned c section, this turned out to be incorrect. Little A shoved her feet through my perf scar during the 35th week of pregnancy. It happened at home, before onset of labor -- an extremely perilous situation. In addition to nearly killing Little A and me, the uterine rupture also effectively ended my ability to have more children.

So ... My point is that the doctor's slip of a hand with a surgical instrument during my D&E had terrible implications for me and my family. In light of that, thinking about the possibility of suing somebody in the first raw days after my injury was just spectacular. It really, really helped me cope. I highly recommend it to anyone in a similar situation.

Any medical professionals reading this are now recoiling in horror. But, I'll say it again -- I did not sue. I'm not advocating that patients always sue. I'm just saying that the energy burst that comes with the desire to sue is good. It can wrench you free from the haze of hurt and shock and compel you to have real conversations with your doctor.Unfortunately, the type of conversations patients crave when they have bad complications scare the bejesus out of most medical professionals. But I think talking openly after an accident actually benefits the doctor as much as it does the patient. Most of the time, the patient discovers that the people working on them struggled with incomplete information. They learn that the procedure was tricky, and that what occurred was a rare but honest mistake. In those circumstances, I think the majority of people eventually come to the conclusion that they had crappy luck, but ok medical care. This is a scenario most people can ultimately forgive.

By contrast, the thing that fills you with vindictive resolve is the sense that someone is more concerned with covering their ass than helping you. If people had refused to talk (or talked down) to me after the perforation, things might have gone differently in the lawsuit department. Here's the thing health professionals need to realize: patients will assume the way you are treated after a bad complication exactly mirrors the way you were treated during the procedure that had a poor outcome. So a lot of honesty is in order. And a little bit of sympathy and niceness goes a long way, too.

The doctors who were involved in my D&E did not all behave perfectly afterwards. But, they behaved quite well. I never caught anyone in an obvious lie. Most of the time, I felt my questions were not ducked. For instance, Dr. Surgeon told me "I perforated you" rather than "Your uterus was really thin because of pregnancy, and it tore easily." Both statements are true, but the first one showed that Dr. Surgeon was not trying to deny her part in the damage. She also said, "Ultimately when something like this occurs, it is operator error." That's probably the polar opposite of what lawyers would advise a doctor to state, but let me tell you, that sentence alone really made me want to give Dr. Surgeon the benefit of the doubt.

Still, Dr. Surgeon didn't help me track down my anesthesiologist (whose name I initially couldn't recall) after I told her that I woke up during the procedure. In fact, her demeanor changed markedly when I described what I remembered occurring. She froze up, and I could almost see the thought balloon over her head that read "Oh shit, she's crazy! She's gonna sue everybody!" Dr. Surgeon told me she couldn't remember my anesthesiologist's name, which struck me as implausible, given that my perforation was a rare occurrence (first perf in ten years of the surgery, she said) and therefore likely a memorable experience. I'm sure she could have at least looked that detail up, but she never offered to do so.

Worse, Dr. Surgeon never apologized. To this day that stings. Saying she was sorry wasn't required for me not to sue. But, it would have been the decent thing to do. She caused a lot of damage. On purpose or not, it was permanent damage.

The anesthesiologist did better. I wrote him a letter describing what I'd experienced. I told him I needed to know what happened because I now had a full-blown anesthesia phobia and this was a wee bit problematic, given that I wanted to get pregnant again and was staring down a mandatory c section.

Dr. Anesthesia called me two days after I mailed him the letter. The first words out of his mouth were, "I remember your case well, and I'm so sorry. We all just wanted to help you, but it sounds like we made things worse!"He said he recalled my blood pressure was quite unstable shortly after the D&E converted to an emergency laparoscopy after the perforation. He said he had to change types of anesthesia at the onset of the lap, and then he had to immediately lighten the drugs to stabilize my BP. Dr. Anesthesia guessed that was when I was likely awake. He was ordering my chart to refresh his memory, and would call me back to talk things over again when it arrived. He said he'd try his best to help me piece together the chain of events and also give me pointers on how to relate my medical history to other anesthesiologists, so something like this wouldn't occur in future surgeries. And before he hung up, he said he was sorry once again.

The night the anesthesiologist called me was the first time in the month since the D&E when I didn't suffer from insomnia or anxiety attacks. I don't think this is a coincidence. Finally somebody who was in the room with me when everything went to crap was expressing sadness and sympathy about what happened. Even better, Dr. Anesthesia didn't try to minimize my trauma. He got that I was suffering, and unlike Dr. Surgeon, nothing in his statements or demeanor made me feel that he thought I was crazy or a wimp for feeling the way I did. He sounded like he was suffering at the thought of it all, too.

And that is how I started to move away from the idea of suing anyone. It was incremental. I got more and more information, and none of it indicated carelessness or negligence. I could slowly step away from the need to blame someone for what happened. Little by little, I accepted the notion that sometimes accidents happen. It is the most terrifying of ideas -- the concept that full control of any situation is more myth than reality. But in this case, I do think I was mostly just ... unlucky.

Complications like mine are complicated to live with. Time passing and having a healthy baby now, despite the terror and difficulties that came with that, certainly help me feel a bit better when I look back on what happened last year. But, the truth is I will never really be completely over what happened. I was permanently changed, both physically and emotionally by what occurred. It cannot be erased.

Sometimes I wonder if the doctors involved in my case ever think of me. If they do, I hope they realize that as much as it is possible for me to do so, I have forgiven them. I really do wish them well.

I also pray they are never so unlucky again with a patient as they were with me.


Marie-Baguette said...

I read your blog and I can't believe what you have been through. I am glad you posted pictures of your kids. They look fantastic!

thrice said...

Thank you for sharing your story. I'm still reeling from the med mal that was done to me. I'm thankful that my children are safe and well, but my heart has permanent damage due to two very idiotic doctors diagnosing me, but not treating me.

I too mix between feeling very blessed and very cursed. It makes for many frustrating days.

C. said...

I've decided if any doctor or medical professional every quotes "unliikelihood" statistics at me or tells me something has never happened in his/her whole career again, I will immediately commence running.

Sorry you have your own stories in this regard, but I really appreciate you sharing them.

C. said...

I'd also add that having someone to blame for a little while is a great comfort when you're in the midst of hell.