thirty minutes from the time of arrival in the emergency room Dr. Harris was making the initial incision into Victor Wallberg’s belly. Harris would need plenty of room, so a large vertical incision was made. He was not surprised when he identified a normal appendix. He would have to search for the affected part of the small bowel. A brief exploration revealed that about twenty-four inches of it was blue and gangrenous caused by an obstruction that had shut off the blood supply. He would have to remove the affected area and anastomose the two viable ends together. The obstruction was caused by a volvulus, the intestine had twisted upon itself affecting its blood supply. To his surprise Harris also discovered a congenital band, an accident of embryonic development that produced a band of fibrous tissue about four inches long creating a tunnel into which the intestine protruded, twisted and trapped itself thus blocking its blood supply. This was a first for him. As he deftly worked, his mind filled with thoughts long buried. Most patients could live with a congenital band and never know they had one, but complications often made its presence known. One such complication was a volvulus causing an obstruction when the intestine pushes through an opening made by the band and then gets stuck. This was the problem that Cliff Harris faced as he worked on Victor Wallberg. Harris now applied the technical competence that had caused the operating room personnel to dub him, The Wizard. The analysis of the patient’s condition was over and his mind shifted into a mechanical mode. He worked silently; the scrub nurses accustomed to his style did their best to anticipate his needs. Rarely did his eyes leave the open incision. The only verbal utterances were calm, clear calls for instruments, and simultaneously with the call, his right hand, palm up, moved toward the instrument table. The instrument was slapped into his hand, and brought to its task in Wallberg’s belly. Harris’s surgical assistant was well trained and together they collaborated like two dancers, moving in unison, scarcely missing a beat.
The gangrenous bowel segment and the congenital band were removed and the two viable ends of the small intestine joined together. Then Harris performed a full abdominal exploration. Liver, spleen, pancreas, gallbladder and ducts, stomach, remaining small intestine, colon, mesentery were all normal and pink. The anastomosis was tight with sufficient space inside to ensure against future problems. The repaired area showed no signs of blood leakage. The abdominal cavity was free of blood. Harris was satisfied. He closed Wallberg’s incision they took Walberg directly to the intensive care unit that served as a recovery room in the late evening, staffed by the ICU nurses cross-trained in recovery room procedures. Blood transfusions had not been necessary. Dr. Harris wrote his post-operative orders for the ICU nurses, and spoke briefly to them. He stepped into Victor Wallberg’s room and stood for a moment at the foot of the bed realizing that for the first time in his life he was looking at a man he had once threatened to kill. He took one last look at Wallberg, thought about the power of an ancient oath that would cause him to do what he did tonight, and left the room and walked toward the Waiting Area farther down the hall to see Wallberg’s wife.
Marilyn Wallberg had gone from a reasonably attractive forty-year-old to someone who seemed to have little concern for her appearance. She was above average height, her unlined face wearing a perpetual frown. Her dark eyes showed little vitality and her dark, unkempt hair evidenced the first barely visible signs of gray. Harris had noted that as some wives aged, they put on weight or they lost their animation or they neglected their appearance. Marilyn Wallberg had managed to touch all three bases. Not for the first time Harris thanked the stars that his wife, Laurel, had retained the look and enthusiasm of youth. In fact, with maturity, he now considered her even more beautiful than when they had first met in college.
The Wallberg’s had moved to Barrington Woods when Wallberg assumed a position as CEO of Technical Dynamics Inc. three years earlier and moved next door to the Harris’s. When Harris walked into the waiting area Mrs. Wallberg was sitting quietly in the waiting room.
As Dr. Harris reported his findings at surgery her expression never changed. She listened intently with her eyes fixed on Harris’s face, her features registering no visible response. “He should do well now,” ended Dr, Harris.
“Thank you so much for your help, doctor. I know it must have been difficult for you and I appreciate it.” She gave him a grateful smile.
“No thanks are necessary, Mrs. Wallberg. Your husband required immediate medical care and I provided it.
“Well, anyway, I want you to know I’m grateful.” Harris gave her a reassuring smile.
Harris returned briefly to the ICU where he told the nurses that Mrs. Wallberg was in the Waiting Area and that when Wallberg awakened she might want to see him. Harris went back to the surgical locker where he helped himself to a glass of orange juice and was exhaustedly contemplating the day’s events when he received the cell phone call, and the chain of events unfolded that resulted in the massive bleeding, the second operation, and the death of his patient.
CHAPTER 3
All clinical departments of a hospital have a department chairperson who has full responsibility for the medical affairs within the department. This is a physician usually appointed by the Board of Trustees whose job description is fully detailed in the medical staff bylaws. In essence the four most important responsibilities of any department head are education, credentialing, peer review, and performance improvement. The latter is ongoing and involves physicians and all hospital employees in a collaborative effort to develop systems promoting patient safety and quality of care.
Over the years it has been recognized that most tragic occurrences in hospitals are more often than not a system failure rather than a physician’s error. This is not to say that physicians do not make errors or mistakes in judgement. They do, and it is for this reason that in all accredited hospitals, a peer review committee reviews the performance of each physician. Criteria are established for each department mandating peer review for certain untoward events. A hospital death, by rule, must be reviewed, and an intra-operative death receives particular scrutiny.
At Barrington Community Hospital Victor Wallberg’s chart was immediately placed on the death review list of the Department of Surgery. The surgical peer review committee consisted of seven members who took turns on a monthly basis reviewing the charts of surgical procedures that did not meet pre-established criteria. Each procedure was detailed in a case review form. Deaths and other unusual incidents would then be reviewed each month at a meeting of the surgical committee. Cases were either cleared or set aside for further review. Those set aside required either a written response from the surgeon or a personal appearance before the committee. In an intra-operative death a personal appearance was mandatory.
The evening after the death of Victor Wallberg, Cliff and Laurel sat in their living room discussing Cliff’s expected appearance before the review committee. Cliff was obviously tense and Laurel sought to alleviate his anxiety. “I’m sure the review committee will find you did everything possible to save Victor Wallberg’s life.”
“Ordinarily, I wouldn’t have any concerns,” Cliff said, “but I did get into a shouting match with Sanjay in the OR and the use of heparin in treating a case of DIC is not that well known. If I have to educate the members of the committee about it, I may have a problem.”
“I’m sure they’ll understand once you explain it to them,” Laurel said with certainty.
“I hope you’re right. I’ve never been reprimanded by the committee before and I would hate to have that black mark on my record now.”
“I can’t believe it would come to that,” Laurel said shaking her head with conviction.
Gloomily, Cliff said, “It could be worse. They could order me to take some remedial training and suspend my hospital privileges until I was, in effect, recertified again.”
Laurel
