All the fashionable people

(I admire "fake but accurate" journalism and seek to emulate it as often as possible. However, while I've changed all the names in this post, the details of the story are true.)

We deal with death and its apparent injustice all the time, yet the death of a medical colleague in the prime of his career always presents itself as a gross anomaly, like waking up one morning and seeing the sun come up in the west. Some would say that physicians believe themselves immune to the laws of physics and biology, and perhaps they are right. Doctors aren't supposed to die until they've retired and moved away to the golf course-side condo where they play every day until they become too senile to keep score and everyone has forgotten about them and then we read an obituary about an elderly gent with an M.D. after his name who sounds vaguely familiar but that's about it.

That's what's supposed to happen, so it was a shock when one of the endoscopy nurses asked me what I knew about Dr. Tom Wandzilak, an ER physician my age who died this past week.

I knew nothing. I spend as little time in the doctor's lounge as I possibly can, and although that spares me from all the incessant whining that goes on, it also leaves me outside the loop when it comes to news and gossip.

I entered "Dr. Tom Wandzilak" into the very same search engine that markets freedom-surpressing software to the Chinese, in hopes of learning what happened to the poor man. There was nothing about his death, but there were many other citations, several of which had to do with malpractice suits.

I came across this doozy:

Med-Mal Defense Verdict in Failure to Diagnose, p. 1
Several doctors failed to diagnose 38 year old housewife's cancer of the lymph nodes; ER doctors and internist chalked it up to psychological problems. After 10 months of being told she was crazy, she found out the real diagnosis and that it had spread - she died 13 months later leaving husband and children. A variety of defendants were targeted who treated a healthy housewife with no history of mental problems as if she had mental problems. Prior to trial, plaintiff/estate (including consortium claims for husband and children) had settled with three defendants (Dr. Sam Fredericks(ER), Dr. Susan Underwood and Dr. Jack Niles (post misdiagnosis psychiatrists). Two other doctors were in for apportionment purposes (Dr. Tom Wandzilak (ER) and Dr. Raymond Smithers(ER). Which doctors were left? Dr. Abdul Nafty (internist); Dr. Jim George(internist) and Dr. Louis Goldstein (psychiatrist). Psychiatrists were faulted for failure to pursue an organic component of the problems and therefore did an incomplete exam of the patient. The settlement was unknown to the jury. Dr. Benedict Arnold, Internist, testified for the Plaintiff criticizing Nafty and George for their incomplete exams. Mr. Andy Roberts did a vocational analysis since the decedent was college educated.

Plaintiff experts: Dr. Benedict Arnold (Internist); Dr. Huey Greenburg (Internist); Dr. Charles Zadok (psychiatrist); Dr. Dwight Davis (oncologist for causation); Dr. Eugene Eubanks (cardiologist and internist); Mary Margaret and Beth Sue McAllister (psychology for children's claims); Andy Roberts (vocational expert)

Defendant experts: Dr. Hiram Hildebrand (oncologist); Dr. Jack Louis (internist); Dr. Karl Jung (oncologist); Dr. Peter Rogers (psychiatrist); Dr. Elizabeth Reardon (psychiatry).

Prior to suit - Dr. Fredericks, Underwood, and Niles had settled.

Damages? Estate - $5 million; children- $2.5 mill each; husband - $500,000.

Settlement negotiations were spurred at trial after talking to the alternate juror - she had opinions regarding apportionment, fault and damages (millions). Nafty and George settled for an undisclosed amount.

It's a good bet that none of the physicians used the term "crazy" in their description of the patient. We're trained to use no subjective word in our descriptions. For example, instead of describing a patient as "hostile and threatening" we would document that he "looked me in the eye and said 'I'm going to beat your head in, sue your ass off, and feed your entrails to the buzzards.' " Direct quotes are not subject to misinterpretation.

What really struck me about this case is that all of the fashionable people were involved. I know, or know of, all the defendants. Not only are they NOT threats to the public welfare, but they are all excellent. I never dreamed that these folks would be dragged into a massive lawsuit. That kind of thing only happens to wretches like me.

There are times when The System fails. In complex cases involving multiple specialists, especially in academic centers, there can be horrible miscommunication which cause a patient to suffer. Sometimes the patient can be caught in a struggle between two (or more) towering egos, egos which refuse to acknowledge the possibility of making a bad judgment.

But what about cases where everyone gathers all the information and comes to a conclusion which is perfectly reasonable (or else they wouldn't have all reached it together) but is just flat dead wrong? Physicians are not, in theory, expected to be perfect in all things. They are supposed to be diligent and make reasonable judgments. We're not supposed to have our asses sued off just because our judgment is wrong. Can physicians be found to be below the standard of the community when the community itself is wrong?

Let's review the case:

Prior to suit - Dr. Fredericks, Underwood, and Niles had settled.

Damages? Estate - $5 million; children- $2.5 mill each; husband - $500,000.

Settlement negotiations were spurred at trial after talking to the alternate juror - she had opinions regarding apportionment, fault and damages (millions). Nafty and George settled for an undisclosed amount.

I can't blame them there. Being faced with a $5 million judgment will give you pause.

Verdict - zero - defense verdict. Jury came back - all three (including Nafty and George) had prevailed.

And I suppose justice was done.

Dr. Tom Wandzilak, rest in peace.

The lawsuit graveyard

One of my favorite movies of all time is Saving Private Ryan, partly because of the cool blood and gore war scenes, but mainly because of the tribute it paid to the American soldier and everything he did to preserve our freedom. One the most poignant scenes in turn is the one in which the elder Ryan wanders about the military graveyard in Normandy: rows upon rows of bleached white marble crosses, with an occasional Star of David, each cross or star bearing silent testimony of the life that was given during that awful campaign.

Wandering about military graveyards will make you ponder. You ponder the ultimate sacrifice of the soldier. You ponder that the sacrifice was surely made over the objection of the individual. You ponder how death represents the ultimate reality unless the eternal existence of the human soul is a greater reality. It provokes a terrible melancholy, and I deal with it the same way I deal with most of the great issues of our time.

I try not to think about them at all.

I'd rather think about biking, or my son's lacrosse games, or rooting for my daughter when she runs the minimarathon this weekend. I have such a melancholy personality that I fear if I ponder weighty issues too much, I'd withdraw from the pain of existence, living my days curled up in the proverbial fetal position under my bed.

One web site I visit from time to time is www.MalpracticeWeb.com. Looking for a good plaintiff's attorney? This site might just be for you. Not sure if you really want to sue your doctor? Want to get worked up about all the malpractice injustice of the world? Help yourself to the summaries of the lawsuits (I believe in the greater Chicago area) that have either been settled or have had a judgment for the plaintiff.

Pulling up these capsule summaries to me is the web equivalent of wandering about the graveyard, with each little summary representing what was a titanic clash between an aggrieved patient or his estate and his attorney and all of his expert witnesses versus the doctor and his family and his defense counsel and all the expert witnesses that they marshaled. Each represents a family in anguish, a patient in pain that won't go away, an anger that can only be quenched with a generous monetary judgment. Each represents a doctor who for three or four years looks at himself in the mirror each morning and wonders if the world wouldn't be better off if he just retired, the doctor who wishes he had made a better judgment in the middle of the night, or wasn't distracted by eighty thousand things demanding his attention causing him to miss the one detail which might have made a difference in the patient's course.

In this pediatric surgery malpractice lawsuit, the husband and wife plaintiff's claim that during bilateral inguinal hernia surgery (hernias where intestines bulge through a canal to where the testes descend) the above defendant doctors also removed E. B's left testicle and then didn't tell them about it. Dr. X settled for $75,000. This sounds like a bargain when you consider the fact that men consider testicles to be priceless. Dr. Y and Mt. St. Elsewhere Hospital were dismissed.

I suppose that this represents a bit of levity on the part of the authors, the equivalent of learning that a fallen soldier died because he mistook a claymore antipersonel device for a can of beer and tried to open it. Oops.

In her podiatry malpractice lawsuit filed in 1997, this plaintiff alleged, among other things, that on October 26, 1995, Dr. Evil performed unnecessary bunionectomies with osteotomies on both feet in spite of pre-operative x-rays that were clearly within normal limits. She claims that since the surgery she has not been able to play racquetball anymore, as she had played 3 to 4 times a month, cannot do step aerobics, cannot walk more than 1/2 mile without pain, and cannot walk around the house barefoot due to swelling and burning pain in the balls of her feet. On August 31, 2000, Dr. Evil was dismissed and his corporate entity, Dr. Evil, Ltd. made an undisclosed settlement.

I'd love to know what really happened in this one. Did the patient hound him and badger him into performing a surgery of dubious merits? Was he falling behind in alimony payments and churned a bit? Did he give up just enough money to make her go away? Once the case was dismissed, did the plaintiff use the settlement money to renew her membership at the local racquetball club? This information never shows up in this kind of capsule summary. Never will.

In his dental implant malpractice lawsuit filed on March 5, 1999, Mr. P., born in 1929, claimed that after having an allegedly negligently placed subperiosteal implant implanted into his lower jaw in 1991, dentist Dr. Nasty allegedly failed to provide proper care over the course of several years which allegedly resulted in an infection, nerve damage and bone loss that necessitated implant removal and hospitalization, and medical bills totaling over $94,000.
Dr. Nasty claimed that Mr. P., among other things, failed to maintain proper oral hygiene, used a metal pick to clean the implant when he was told not to, and delayed having the implant removed in March of 1997 when he was told to have it removed. This suit was settled for an undisclosed amount on January 9, 2003.

Let's see: the event in question happened in 1991, the lawsuit was filed in 1999 (that's a heck of a statute of limitations) and settled in 2003. Inmates on death row get a more merciful and swift execution than that. Any chance the plaintiff's attorney came up with delay after delay, leaving the dentist to twist in the wind until he was willing to give up some insurance money to make the whole mess go away?

Maybe I'll email the webmaster and suggest that they chronicle the methods the attorneys use to ply their trade. It's just a thought.

Questions

I have quite a few, actually.

Since I enjoy quality time with my daughters so much, why don't I schedule more of it?

Why is reading the Tao Te Ching relaxing and reading the Koran not? Why do I see the image of an angry Pharisee flash by whenever I read the Koran?

Since I don't see myself thriving in private practice, and as one malpractice suit would render me unemployed and unemployable, why don't I cut and run now?

Why has gastroenterology seemed more like a hobby to me for the past few years, in spite of the fact that I'm keeping up with things and that I'm pretty decent at it?

How can anyone in their right mind believe in the eternal existence of the human soul?

I know lots of Jewish folk that are better people than I. Is it fair for me to go to Heaven (assuming that it exists) and not them just because I'm a mediocre Christian?

Why do I keep trying to get mountain biking down in spite of the fact that I'm probably going to get really hurt doing it? After all, a broken finger is no biggie, but a trashed rotator cuff would be pretty darned inconvenient.

Why do I, when faced with these weighty issues, find myself wanting to blog about some mindless aspect of biking instead?

And why ask why?

Hammerheads and Nails

(The following is my latest attempt to gain acceptance with the local mountain biking community).

To hammer—(vi) to pedal as hard as you can for as long as you can.

Hammerhead—(n) one who hammers. Likes to vomit during or after riding.

“There are two types of people in this world: those who like to divide everyone in the world into two types, and those that don’t”. --ancient Jebusite saying.

The biking community likes to divide the world into two types of bikers; either you’re a serious biker who some day hopes to qualify for the national championships, or you ride a junker with coaster brakes and a little basket attached to your handlebars in which to carry your groceries on your jaunts to the local Save-a-Step.

This is too bad. There are a lot of bikers who would never be caught dead on a Huffy but just don’t think that riding until you puke is any fun.

I work everyday with lots of these riders. They decline my invitations to go biking with this universal response: “I was once invited on a ride and all the riders said they were going to ‘take it easy’, and then they sped off and left me all alone. It was humiliating, and I’ll never do it again.”

These folks have obviously never ridden with me, but I digress.

We need a group of riders who occupy the middle ground, who like to ride adventurously but don’t care if they finish in front of anyone else in the world. I’ve taken it upon myself to form such a group: the NAILS, a group of riders who are almost the exact opposite of the hammerheads. We are Non-Athletic Intelligent Lazy Slugs, and proud of it.

Not anyone can become a NAILS. The selection criteria are very strict. Below is a partial list of qualifications:

You might be a NAILS if:

--all your bike stuff, including the bike, costs less than $500.
--nothing you own is made of titanium.
--people talk to you about splines and gear ratios, and you stare blankly at them.
--someone asks you what kind of bike you own, and you reply “a red one”.
--the only race you’ve ever been in was to see who could get to the park bathroom first.
--you like to ride last so you can copy everyone else’s line.
--you approach a large hill and you look to see if there is a bike friendly bus-stop nearby.
--bike shoes strike you as being a huge waste of money.
--you have no idea what ‘periodization’ means.
--you’ve never used the terms ‘gnarly’, ‘shred’ or ‘rail’ in proper biking context.
--you use ‘Hammergel’ to lube your chain.
--you’ve owned clipless pedals for over six months and stopping your bike still fills your heart with terror.
--you wake up one Saturday morning, it is 68 degrees and sunny outside, the ground is dry and firm, the Wild calls to you by name, and… you brew some coffee, settle into your favorite chair, and read a book all morning.