An Unexpected Death

 

I have been in practice more than twenty years and I can count on one hand the number of times a patient of mine has died unexpectedly. Each time it has happened the one thought in the forefront of my mind has been, “I wonder if I’ll get sued!” Sure, I had concern for the patient’s family and the pain they were now experiencing but, immediately I would begin to think about all the things I had done for and to the patient… did I forget anything?, did I do anything wrong? When I perform elective surgery I expect all the patients to do well and leave the hospital within a day or two. So when the unexpected occurs, and everyone is in a state of shock, me included, everybody wants to know, “what happened?” That’s when I would begin to wonder if the patient’s family will ask questions and when the answers are unclear, if they will hire a lawyer because now the feelings of grief turn into anger.

Just the other day, Theresa Marsden, a patient that I had operated on less than a week before had a massive heart attack and died. But this time I felt different…

Theresa was a very pleasant woman, a retired nurse who had already survived one cancer, a melanoma as well as several other ‘brushes with death’. So when I told her she had a brain tumor she was upset and initially cried but she summoned up the strength to look forward, determined to fight it and win as she had in the past. Her husband of thirty years, Ed, was a character. After I had reviewed her brain MRI with them in her hospital room, he looked at me and said, “I’m gonna ask you a question that I have asked her surgeons in the past, and it always seemed to throw them off”, “I ask it because it tells me a lot about your character”… “Are you as good as you think you are?” Most times I get asked how long have I been in practice, or how many times have I done this surgery and most of the times when I get asked the question at all, what is my success rate? But never quite like Ed put it. He did throw me off a bit! So, I looked off a second or two, thought about it and then looked at him the eye and in front of Theresa’s nurse and Chad my physician assistant I said, “I am blessed to have the skill that I do”. As I looked at Ed, his face screwed up, somewhat surprised by my answer, and he nodded and stammered, “Well that’s why I asked it because I wanted to know what kind a person you were”. Now it was Ed’s turn to be thrown off! He then continued, “so when are we doin this?”

I explained to them we would have to transfer her to Morton Plant Mease hospital in Dunedin because that is where we perform all of the neurosurgery and that likely it would be Friday afternoon.

The tumor was located in Theresa’s occipital lobe on the left. She was an avid reader, reading three books a week but recently had suddenly stopped. When Ed asked her what was wrong she told him she couldn’t understand what she was reading anymore. As it turned out not only did the tumor damage her ability to see anything off to her right (the occipital lobes decode the signals from the eyes and creates the image we ‘see’), but the tumor had extended towards her ‘speech area’ (which decodes the words we see into meaningful speech) as well. And by the looks of the tumor on the MRI it was not only large but very likely a highly malignant brain tumor, an astrocytoma.

The surgery went well, though initially when I cut into the tumor, I discovered it had so many abnormal blood vessels I thought for a second it wasn’t a tumor but a congenital abnormality of blood vessels called an arteriovenous malformation. But as soon as the pathologist reported that it was indeed a malignant astrocytoma, I settled in and began the systematic removal of the tumor. After I was satisfied with my resection of the tumor, I inserted the chemotherapy wafers in the brain and then closed.

After surgery, Theresa was unchanged. She still could not see off to the right, and her ability to read still was mildly impaired. She recovered well, was transferred out of the intensive care unit on post-op day number two, and was up and walking in the hall on the second floor feeling quite good. In fact I remember seeing her on Wednesday as she had just finished eating dinner. I asked her how she was feeling and all she could do was remark how hard the broccoli was and that she couldn’t eat it like that. I then remarked “well, I guess if you are able to complain then you must be doing OK”. I promised I would speak with the administrator about the broccoli and walked out figuring she would be ready for discharge in day, or two at the most.

So, when Chad called me Friday morning to tell me Theresa just had a cardiac arrest and the code team was trying to bring her back, I was stunned! I told him I would be right there. As I drove in my thoughts drifted to Ed and how he must be feeling. He was losing his lifelong partner and friend, and not over the course of months as we thought it might be, but, right now. I didn’t think at all about what I might have done wrong.

I stood at the foot of her bed as the nurse performed chest compressions and the intensivist ordered more drugs to be given, and Ed paced back and forth in the hall outside the room. But to no avail. After 30 minutes of this, the intensivist looked at me and shook his head. Ed came in, asked how long we had been ‘coding’ her, and then asked everyone to stop as he said “you’re not going to bring her back”. He went immediately to her side, bent over, put his arms around Theresa and cried.

As he walked away from her bedside, I looked at him and told him I was sorry as he grabbed me, hugged me and thanked me for everything I had done.

I am indeed blessed to have the skill I do, and having asked for God’s guidance before her surgery, I knew I did everything that was in my power to do.

…but to set the mind on the Spirit is life and peace. Romans 8:6

 

 

Comments

[Ashley Colbassani]

if only there were more surgeons in this world like you...

[Danielle Stewart]

I'm so proud of you Hal. I love you.

[Hal Colbassani]

Just grateful to be able to share and hopefully inspire. HP

[Sheri Mullen]

I know this must be very hard for you. I have no doubt that you did everything you could possibly do to give her more time. Have faith that she is in a higher place and is at peace. I believe all things happen for a reason and it was her time. Maybe, God took her before she suffered. Maybe, he did it for all the good that she has done in her life. Maybe, Ed and her needed to meet you, or maybe you needed to meet them. Sometimes there is no explanation for what happens, you just need to find peace in his decision. God Bless.

[Hal Colbassani, MD]

Sheri, Thanks for your support. Yes, I too believe things happen for a reason. Sometimes all we can do is try to find something positive out of what otherwise may seem like a sorrowful and painful time. And yes when all else fails, we need to just trust in God's plan for us. HP

[Maureen Murray]

One of my mantras is, "Nothing, absolutely nothing, happens in God's world by mistake." Because I believe that absolutely, I never question why, I just accept. Acceptance doesn't mean I have to like it. I just have to understand that there is a far greater Power than me in charge and I may not now or ever understand the reasons for things. And this has made all the difference in my life, Hal. If I ever need neurosurgery - you're my doctor. I admire your ability to feel, despite what your training might have taught you. Thank you Hal.

[Hal Colbassani, MD]

Maureen,
You are welcome, and thank you for your kind words. I agree with you 100% and that's the power of faith...it helps us to accept God's will, regardless of the 'earthly' events!
Be well,
Hal