The Scar

He walked towards me rolling his small black carry on bag. An odd scene in the halls of a state Superior Court hallway lined with its heavy brown wooden doors, outcoves of sitting areas and carpet lined halls. Was he walking towards me? He was. What would he have to say to me? Had he not just under oath lied not only in the court that day, but also during his deposition? Both occurrences leaving me with a lower and lower opinion of this man who I had once held in high regard. As he approached me, I stood stone still and confused. With what appeared to be sincerity, he stood before me and said, “Kelly, I am sorry that this happened to you.” I could only stand there in shock and disbelief. I was unable to think of a thoughtful response. The only words to leave my lips, “I am not a doctor anymore because of it.” With that, I walked past him to the comfort of my family.

Scares come in a variety of forms. While some are visible, oftentimes our most painful scares are not observable, but lay deep within us. An emotional scar left by someone or some event in our lives that has changed us forever. I have an observable circumfential scar along the lower edge of my right breast. It lies along the plain where a bra wire would encapsulate the breast's lower edge. The original incision, made by Doctor James 6 years before had dimmed to a light pink over the years. It being evidence of my first open heart surgery to remove a benign tumor in my heart.

I first meet Dr. James on September 17th of 2013. I had been awaiting his visit after being admitted to the hospital earlier in the day. Dr. James had been described by his colleagues as a brilliant heart surgeon who had a surgical technique which would be less invasive than having my chest cracked open. The diagnoses of a large heart tumor earlier that morning had send fear and internalized panic though me. This ball of "tapioca pudding clusters" was wildly flailing around with each heartbeat as blood was forcefully pumped out of my heart to provide oxygen to the rest of my body and brain. The tumor, known as a myxoma, had grown on a stalk from the muscular fibers of the heart chamber. It had been during a heartbeat the night before that a piece of the tumor had broken free and traveled to my brain. This piece of tumor, or clot from the edge of the tumor, had plugged a major artery in the back of my brain, thus rendering all of the brain tissue fed by the artery oxygen deprived. Starved for oxygen, the brain began to die resulting in an ischemic stroke. What lies there now on the left side of my brain in a honeycomb of missing brain tissue, the most important function lost – vision on the right half of each of my eyes. No other part of the brain could compensate for this delicate and highly complex process of sight. It was gone forever.

But, I did not know what was occurring when I arrived at the hospital within 15 minutes of my onset of symptoms. I had a similar episode 7 months prior while seeing my own patients in this same hospital. That time I had been diagnosed with new onset migraines by a neurologist who specialized in strokes. Recanting the earlier story and diagnosis to the ER doctor the night I arrived with symptoms again, I had been placed in an observation room for overnight monitoring for a presumed migraine, despite having new symptoms of a numb right hand and face with blurry vision.

The morning events of a diagnosis of a stroke, 15 hours after arriving at the emergency department, and a heart tumor requiring surgical intervention had left me in shock and terror as I contemplated having open heart surgery. The stroke did not present any major concerns to me at this time as I did not grasp the extent of my brain injury. The visual loss appeared like my contacts were snugged. I did not notice the missing half of the room. My parents called from California after my husband called with the news. I relayed to my parents, who were frantically packing and heading to the airport to catch the first flight out, that I was completely fine. In their panic and fear, I reassured them that I would be okay, but the looming idea that I was to undergo open heart surgery the next day engulfed my own thoughts.

Less than 2 year before, I had completed a rotation in cardiothoracic surgery at the end of my neonatology fellowship training. The sound of the saw cutting down the middle of the sternum followed by the rib spreaders being cranked open to separate the rib cages and reveal the underlying heart came back in a fluid of visualizations and sounds as if the experience had been yesterday. Undergoing open heart surgery was on my list of experiences that I never wanted to endure, and as the cardiologist had told me the diagnosis of a tumor, I knew the required treatment. The tumor had to be removed and this only could be accomplished through open heart surgery to prevent further brain damage or even death. There were no other treatment options.

The cardiothoracic surgery team had been consulted. One of the surgeons had visited us earlier in the day. He informed us that there was a surgeon on the staff who had a technique where surgery could be completed laparoscopically without the necessity of opening my sternum. He was presently in surgery and would be visiting us later in the day. So, we waited for the verdict. Would he be willing to take me to the operating room and use his technical expertise to remove my tumor laparoscopically? Or, would he sentence me to have a classic open-heart surgery? He would be the judge.

Sometime in the late afternoon, Dr. James came to my room. A middle-aged man with a mane of wild grey hair and a mustache lifted up my hospital gown and inspected the right side of my groin, the area where the cannulas would be inserted to run to the heart lung machine thus keeping oxygenated blood flowing to my brain and body while my heart was stopped during surgery. He hemmed and hawed as he audibly contemplated whether he would consent to doing the surgery. I prayed there in my hospital bed with a silent prayer in my heart that he would say “yes”. A heart surgery would be completed whether he consented or not, but I needed his expertise. Relief washed over me as he finally decided that he would take me to the operating room the next day.

As I awoke in the Cardiac ICU hours after the completion of the surgery, I was alone. I took inventory of my status. I had a breathing tube inserted into my throat. I could not speak. My vision was pixelated like a television screen without adequate reception, and without my glasses, even my remaining vision was hazy and out of focus. The right half of my vision was now not the swirl of colors it had been earlier in the day, but was pitch black.

When my family arrived later in the morning, the post-operative cardiac surgery protocol was already in motion. My breathing tube had been removed, and I was sitting in a chair. Moving out of the ICU to a post-surgical room required me to walk to my new room. This was the hospital that I currently practiced medicine at, but the process of walking down a hall presented new challenges. Overwhelming feelings of frustration boiled up in me. It was hard to hold back the tears from physical pain and the emotional pain of realizing that something catastrophic had occurred. Had I not just been in great health just 3 days before? How fast the world changed.

I felt trapped in my brain. The first time I was allowed to eat, the realization that I could not read the words on the menu first surprised me and then filled me with dread. How could I not read? As I walked the halls of the hospital, I walked past Dr. James working on his rounds. I was teary as I spoke to him. I was so overwhelmed by my current condition. I was worried about not being able to go back to work. I was the sole provider for my family, as my husband had stayed home over the past year to care for our young children. I finally had realized my dream. A dream now that stood in peril. The status of my career and the future was completely overwhelming. He reassured me and then consulted psychiatry to come and see me. They just put me on a new pill for depression. Well, that would not “fix” my life.

As I sat in my hospital bed, I knew that I could either be angry for what had just happened to me, or, I could decide to strive to endure it well. The stroke made the misdiagnosis of 7 months before overwhelmingly evident. I knew and my family knew that the stroke had been 100% preventable. Even my nurses thought I was having a stroke when I was wheeled to the ER during my first mini-stroke episode. What had gone wrong? Was there something in the standard of care that had been skipped? I contemplated these questions as I lay in my hospital bed. I knew that medical malpractice was not a road that I wanted to travel. My brother in law, who was the radiologist at the hospital who had called to tell my husband that I had suffered a stroke even before I returned from the MRI scanner, had told me that I would be run out of town, if I filed a lawsuit. My sincere desire was to return to the profession that I loved. I had spent 10 years in training and had only practiced for 1 year. I was not ready to give up and say goodbye to the career that I had sacrificed so much time and effort to achieve. Now that I faced the knowledge of a malpractice situation, I was not open to pursuing it.

I was seen by Dr. James for a follow-up appointment a couple of weeks after being discharged from the hospital. Photos of a few sections of my brain MRI that revealed the extent of my brain damage were on my cellular phone. The areas where bright white lay in stark contrast to the remaining grey were humbling. He looked at the pictures on my phone and looked at me. He told me that I was very lucky that the tumor had not caused more damage or gone to other areas of my brain. I was grateful to him for completing my surgery with his minimally invasive technique. Development of a high esteem for him and his skill swelled in me. I placed him on a pedestal of sorts in my mind. And, I would sing his praises to others when we discussed my surgery or they noticed that I did not have the tell tell sign of a scar down the center of my chest.

I was on medical leave for one year. I came back on unpaid probation the following September. I was overwhelmed. While I had learned to read again over the past year, it sometimes was difficult as brain fatigue set in. I had to remind myself to pay attention to the right side of my world as now my brain failed to recognize that the right half of my visual world still existed. I started having severe headaches as I assumed the pressure and responsibility to taking care of ICU patients. There was a questions of seizure activity. But, after 6 months of probation, I was going to return to taking care of the babies independently.

I was informed by the HR manager on a phone call that I would continue to be unpaid for my work. As I talked to her, I could not hold back my tears. I told her that it was illegal to make me work for free. As the sugary coating of her interaction melted into annoyance she said, “What did you expect Dr. Adams? ” I knew at that moment I had made a mistake in not exploring a medical malpractice case sooner. My parents were right. The tears overflowed and I stood in the aisle of the supermarket. I could not answer her back. She told me to call her, when I decided what I wanted to do, and then she hung up.

It was all about money. The fanned interest in my recovery was wrapped up in one of their neurologists, Dr. Franklin, who had treated me after my ER visit in January until I had the stroke, potentially being liable. No other neurologist that I saw post-stroke would support me in returning to practicing my specialty, but he did. He wanted to protect himself. Dr. Franklin was a senior partner in the group. Then, there were the large sum of monthly payments the practice was receiving from my injury and pain. I was just a source of income who also could file a malpractice lawsuit. But, in that instant where the surgery coating had slipped and the claws had surfaced, I regretted not listening to my lawyer father sooner. It was time to seek legal counsel.

I had envisioned by stroke like a locomotive changing to the wrong tracks. I believed that I would be able to get back on the right track at some point. All I had to do was work hard. I knew how to work hard. What I perceived as “failure” would not be an option. But, it just wasn’t possible. The stroke had been a full train derailment. The extreme fatigue and headaches did not improve like I hoped. The brain wasn’t a simple muscle that could be exercised and regain its strength. It was a complex organ. Parts of it were now missing, and while some improvement could and would be made, it was not completely repairable. I was on a new journey. A journey where the career that I had hoped and dreamed for was gone. I would never be returning to full time practice. Being a doctor was a part of the fibers of my being and identity, how could I just give it up and stop? I did not know how to do this.

As part of the eventually filed lawsuit, my medical team gave deposition testimony. Dr. James. was one of the physicians who were deposed. I attended his deposition. We sat in a small conference room. My team on one side of the table. The defense team on the other. The defense team avoided any interaction with me. Their annoyance at my presence was palpable. A videographer and court reporter sat on one end, and the person giving their swore testimony at the other end. Dr. James was asked questions about the source of my stroke. As I sat across from him, he gave sworn testimony that I had been distraught and made him perform an elective surgery even though the tumor was an incidental finding and had nothing to do with my stroke. I was shocked. The pedestal that I had placed him on crumpled and came crashing down in my mind as he fell from a height of esteem to disgust. Had we not taken the same oath to do no harm? Didn’t we both understand that physicians make mistakes and that is why we have malpractice insurance?

He knew I was a ticking time bomb for those 7 months and that my children could have been left without a mother. We had discussed it in my clinic visit. His hospital notes said that I had suffered a cardioembolic stroke. Now I was just a hysterical woman demanding a complex and risky operation because I couldn’t deal with the knowledge that I had a benign tumor in my heart that was not causing any problems? Really? I wondered if he would have given the same testimony if I had been a male physician or a pretty, thin and younger physician. But, he sat there and calmly lied to protect the hospital and the hospital employed neurologist. Dr. Williams, who had made the diagnosis of a migraine and skipped the echocardiogram. This same neurologist who was an expert on the standard of care for evaluation for mini-stroke, or transient ischemic attacks. Dr. Williams had even published an article on the standard of care/work-up evaluation that he expected other physicians to do as a complete work-up. The work-up evaluation which included looking in the heart, in patients who were like me. How calmly and authoritatively Dr. James lied under oath. Certainly, he had been coached by the defending attorneys, but wasn’t there a place for integrity? Wasn’t there a time and place for holding a physician accountable?

In June 2019, the lawsuit finally went to trial. By this time, Dr. James was in a semi-retirement situation where he had a home in Utah and would spend as much time as he could out West, but was still performing surgery in the South. He arrived from the airport to give his testimony. While on the stand, he abandoned his deposition testimony of a distraught female who forced him for whom he completed an elective heart surgery. This time he proclaimed that if the tumor had caused the stroke, that it would have traveled to a different part of the brain. Again, a lie as a stroke in the part of my brain where it had occurred is oftentimes due to the heart. Simply, that is why you look in the heart as part of the initial evaluation. But, Dr. James had done his job for the hospital. He had been part of a group of physicians who had circled the wagons to protect the physician who had committed the malpractice. Dr. James was not the physician being sued, but since his employer had a “dog in the fight”, he went along with the defense team’s wishes. Where was the integrity of doing the “right” thing?

As he walked up to me that day, I wish I could alter my response. What I would have said is, “Not enough to save your integrity.” But, we do not get do overs. Just like I cannot travel back to January 30, 2013 and scream at the stroke neurologist that his diagnosis did not make sense to me. We rarely get do overs in medicine. Part of my brain is gone, important parts. The organ that had served me so well during the years and years of education. The brain that had helped me take care of critically ill babies and to be a support to their parents during difficult times.

That mistake in the ER had impacted my life, my family’s life, and the countless lives of patients and their families who I would have treated. I was good at my job. I did what I needed to do. I read up on issues to make sure I was doing what was expected and required for them. I did not want to make a mistake that would have a detrimental and lifelong impact on my own patients lives. Why had my providers not done the same for me? And, why when the mistake was glaring and evident, did the idea of “do no harm” suddenly become optional? It is easier to have your car repaired by an insurance company after an accident than it is to be awarded a malpractice verdict and collect malpractice insurance. The car is repairable or replaceable. An unrepairable human body leads to a lifetime of disability and pain.

Dr. James left me with a seemingly perfect scar where he had skillfully performed a complex operation to remove the tumor that had forever altered my life. Three days after the trial verdict was handed down, I would be given the diagnosis of a reoccurrence of the tumor and within weeks would have another open-heart surgery performed by a different doctor at a different hospital, a hospital that I would learn Dr. James had been sued at by the nurses for his treatment of them.

The scar on my chest was revised as the same location was used to remove the new tumor growth. The scar is not as perfect looking as it once was. It is longer and pinker. But, in my mind, it has erased the surgical scar from Dr. James. Maybe one day, the shock and disappointment of his character and lack of integrity will also change, the emotional scar also becoming dull and faded. Because sometimes the worse punishment in life is just being yourself. And, maybe, just maybe, that is what he has to live with now.