The Aladdin Trial

by Abi Silver

  Ahmad cleared his throat.

  ‘Being a doctor is not easy. You work hard. You see terrible things, especially in Syria, at the end. But you can help. And when you help there is no better thing on earth to be.’

  He wiped his hand across his eyes.

  ‘Would you like a moment to compose yourself?’

  ‘No thank you. I can continue.’

  Brian, recently returned from his outing to North West London, shifted awkwardly in his seat at the back.

  ‘When you moved Mrs Hennessy’s medical notes, did you ever read them?’

  ‘I did move them to clean, like I said. But sometimes I would read the patients’ notes to see what drugs they were prescribed.’

  ‘Did you read Mrs Hennessy’s notes?’

  ‘Yes.’

  ‘Why?’

  ‘I was interested to see if British medical practices were the same as ours. And I didn’t want to forget things, just in case…’

  ‘And the caution you received in May last year, which Dr Wolf mentioned. Can you tell us about that, please?’

  ‘There was a patient on the private ward. Can I say his name?’

  ‘Yes.’

  ‘He was called Timothy Morrison. He was young, twenty-five years of age. One day I came in to clean his room and he was rolling on the bed from one side to the other side. He was very breathless. I went to him and he held tight to my arm. Then suddenly he let go, his heart stopped, all the monitors stopped. I pressed the emergency button but no one came.’

  ‘What did you do?’

  ‘I pulled away some tubes and I did CPR. No one came for so long. So I carried on. It took two or three minutes but then it was OK. He coughed and he started to breathe.’

  ‘And then what?’

  ‘A nurse came in and said what should she do? so I said she must get Dr Wolf. But when Dr Wolf arrived he pushed me away. He said I had “interfered with his patient”. He was very angry. Asked me how I knew CPR. I didn’t want to say I was a doctor. I didn’t want to lose my job. I said I had seen how to do it on an American TV show. I am not sure he believed me. But he told me that this would go on my record, but we had to say he saved Mr Morrison in the case report. He said it would stop me from getting into any more trouble.’

  Mr Chambers rose with less verve than he had exhibited yesterday.

  ‘Can anyone confirm what you’ve just told us. Any of it?’

  ‘When he left, Mr Morrison told me he knew I had saved him. I’m sure with the great power of the media you can find him today and ask him. Timothy was his first name.’

  Chambers retreated into his seat. Judith glanced theatrically up at the clock, which was showing nearly 3pm.

  ‘Your honour, can we take a break now, please? I understand it may be possible to hear from Dr Wolf again today if we do, rather than tomorrow. He has now finished his schedule for the day. I hope to be quick with him so that we can finish in good time this evening.’

  51

  David Wolf climbed the steps into the witness box a second time, his forehead a mass of perspiration.

  ‘Dr Wolf, were you in court just before the break?’ Judith asked.

  ‘No. I arrived about twenty minutes ago and I waited outside.’

  ‘Thank you. Has Mr Chambers acquainted you with the evidence my client gave just before we adjourned?’

  He played with his moustache before answering.

  ‘I know that the defendant says he was a doctor in Syria, if that’s what you mean.’

  ‘Yes. Thank you. Did Mr Chambers tell you what Dr Qabbani said about the incident with Timothy Morrison, the cardiac arrest? You told us yesterday that he received a reprimand?’

  ‘Yes he did.’

  ‘Is there anything you would like to add to your evidence of yesterday, by way of clarification?’

  ‘It was some time ago but it is true that your client told me at the time that he had administered CPR. But he wasn’t a doctor, I mean, I thought he was a cleaner.’

  ‘You didn’t believe him?’

  ‘My priority was to ensure the patient, Mr Morrison, was stabilised. I wasn’t focusing too much on what Mr Qabbani may or may not have done.’

  ‘So you did believe him?’

  ‘I was called by a nurse, I came running, I saw Mr Qabbani standing over a patient with lots of his tubes removed, some of his monitors were fine, some were not. I had no idea what had happened.’

  ‘Do you believe now, given that you now know that Ahmad was a qualified doctor in Syria, do you now believe that he saved Mr Morrison’s life by administering CPR?’

  ‘I can’t say whether he saved the patient’s life, but I believe that he may have administered CPR correctly and the man lived, yes.’

  ‘Thank you. There are some documents we located since you gave your evidence yesterday. If you view the screen to your right, you should see the documents to which I am referring.’

  ‘Yes. I will try to be of assistance.’

  Judith put up the admission form for Mrs Hennessy, blown up extra-large and took Dr Wolf through the information on the form.

  ‘Can you see that the pages are numbered one to nine at the bottom of each page, but there appears to be no page 7?’

  ‘Yes. You’re right. Perhaps it was on the back of page 6 and did not copy.’

  ‘Perhaps.’

  Judith brought up the next document.

  ‘This second document is important. This document appears to be a consent form. Can you see that, at the top, it says “consent form”?’

  David remained silent, rigid as stone. Constance shuffled noisily behind Judith’s back.

  ‘This isn’t a trick question, Dr Wolf. Do you agree that this is some kind of consent form?’

  ‘Yes… Yes, you’re right… It is,’ he stammered.

  ‘Now this form is part of the standard admissions pack at St Marks, which your secretary helpfully provided. You can take my word that when you count through the pages – the various things which the incoming patient must read and sign – this consent form appears at page 7.’

  ‘Yes.’ David frowned.

  ‘But, if you recall, Mrs Hennessy didn’t have page 7 among her forms.’

  ‘No, she didn’t.’

  ‘Can you read out the words in the bottom line of this form?’

  ‘Yes, it says “Aladdin Trial”.’

  ‘And now the words in the penultimate line of this consent form, for everyone in court, please.’

  ‘Yes. It says, I, the undersigned, confirm that I give my doctors permission to use the Aladdin process currently being trialled in addition to or in place of conventional processes, at their absolute discretion.’

  ‘It seems we have a bit of an Arabian Nights theme here, too. What is the “Aladdin process”, or the “Aladdin Trial”? Do speak up so we can all hear please.’

  David cleared his throat.

  ‘I was confused momentarily when you said there was a missing form. I wouldn’t have seen Mrs Hennessy’s admissions forms because Dr Mahmood admitted her. But this consent form, page 7, is standard. It allows us either to operate ourselves or to use robotic help. The patient, technically, has to agree to this on admission.’

  ‘Robotic help?’ Judith enunciated the words slowly, like a spider playing with its helpless prey.

  ‘Yes. The Trust invested in a machine last year which can help with most surgical procedures.’

  ‘That sounds a little Brave New World.’

  ‘Not at all. The technology has been around since 2001, and used in tens of thousands of operations. It has many benefits.’

  ‘Tell me about them.’

  ‘Well, in some cases, it means we can go into a patient through a very small incision, leading to quicker recovery time. Also, in long operations surgeons do suff
er from fatigue. The robotic hand is very steady and doesn’t tire. Prostate removal is one area where it has been used extensively. It is a very inaccessible part of the body but using a robot we can make much smaller incisions and manipulate the instruments with more ease.’

  ‘What about how quickly the operation is completed?’

  David reddened.

  ‘Yes, that too.’

  Judith sensed his reticence.

  ‘Are operations performed more quickly with the robot?’

  ‘Usually, yes.’

  ‘And why the name “Aladdin”?’

  ‘That’s its name. The first model was called Da Vinci, after the man, because of his knowledge of the human anatomy, I believe.’

  ‘But St Marks doesn’t have a Da Vinci?’

  ‘It’s very expensive. The latest Da Vinci model costs around £1.5 million. The version we are trialling is from China, more cost-effective and even more advanced.’

  ‘Ah. Hence the name, so nothing to do with magic lamps, then?’

  ‘No, well, some people might think it makes their wishes come true, I suppose.’ He attempted a smile which Judith ignored.

  ‘Can you describe for us what this robot looks like?’

  ‘Certainly. It’s a big piece of kit in a number of sections. You have one part which holds the instruments. It has a number of arms around a central spine and you can attach the instruments to each of those. There is also a separate…I suppose you would call it a “console”. It’s the place from which the surgeon can direct Aladdin what to do. But one extra feature which sets Aladdin apart is its ability to constantly monitor the patient during the operation and adjust quantities of various drugs if needed.’

  ‘Do you use Aladdin?’

  ‘Yes.’

  ‘Did you use Aladdin on Mrs Hennessy?’

  ‘Aladdin was used on Mrs Hennessy to manipulate the instruments.’

  ‘Is there any other feature which makes Aladdin more advanced than the previous robot models?’

  David paused.

  ‘Can you answer my question, please? I can certainly adjourn to find an expert on your Aladdin machine if you are having difficulty explaining things for me.’

  ‘Aladdin can operate autonomously.’

  Judith’s eyes widened. ‘Autonomously?’

  ‘Yes.’

  ‘You mean, on its own?’

  ‘Yes. Aladdin can be programmed to carry out the operation with the surgeon on hand, to intervene only if necessary.’

  ‘You say “on hand”, so, theoretically, the surgeon could even leave the room and the operation would continue.’

  ‘Yes, that’s right.’

  ‘What about other staff?’

  ‘The other theatre staff may be there; clearly it’s less crucial, and, in time, their involvement will almost certainly be reduced as well.’

  ‘So with Aladdin you can potentially carry out many more operations with fewer staff?’

  ‘Yes, and as you know, Ms Burton, we are under pressure to cut through our backlog.’

  ‘Is it explained to patients that a robot will do their surgery?’

  ‘Yes. We give them the forms to sign, like the one you asked me to read out. And we explain it’s a trial.’

  ‘And are patients happy with that?’

  ‘Almost all patients I have talked to have indicated they are happy to participate. And the results have been extremely favourable. We have patients with quicker recovery times because the surgery is so much less intrusive, leaving same day rather than needing a two or three night stay in hospital and almost always less surrounding tissue or nerve damage, so, essentially, a much better result.’

  ‘Does everyone share your love of the new technology?’

  ‘No.’

  ‘Who doesn’t like it?’

  ‘Some doctors are a little reticent; it tends to be the older doctors.’

  ‘Why is that?’

  Chambers was half standing to object but Judge Seymour waved to him to sit down.

  ‘No, Mr Chambers, I want to hear this. Dr Wolf, please answer Ms Burton’s question.’

  ‘Some people see Aladdin as usurping the surgeon’s expertise. You know, you spend years honing your skills only to find a machine can do things better. But it must be better for patients if that’s the case, and that’s what’s most important.’

  ‘Isn’t there a risk that if, for some reason, the equipment malfunctions on a particular day, the surgeon who has relied on it for so long is then on his own, without sufficient practice?’

  ‘It’s a risk, but no more than the risk of a human making an error, which does happen from time to time.’

  ‘Can you think of any reason why that form, the form consenting to the use of robotic surgery, the Aladdin Trial form, should have been removed from Mrs Hennessy’s files?’

  ‘No. I can’t explain that. Sometimes copies of papers do go astray. We’re all human.’

  ‘If I told you that the metadata, the trail left on the hospital computer regarding Mrs Hennessy’s admission forms, shows you, using your log-in, as the last person to access the forms, one week after Mrs Hennessy died, can you explain that?’

  Dr Wolf froze. He stared out blankly across the courtroom. Then he composed himself.

  ‘No, I can’t explain that. I can only confirm that I personally had no involvement in deleting the consent form.’

  ‘Just recapping on the evidence you gave yesterday regarding Mrs Hennessy’s mobility after her operation…’

  ‘Yes.’

  ‘Given you used Aladdin, is it possible that she had less pain than other patients and conversely was more mobile than those who had the traditional operation?’

  ‘It is possible. I didn’t discuss with the physiotherapist how easily she coped with walking when he attended. But every patient is different in terms of pain relief and recovery times, so it’s hard to say.’

  ‘But, given your comments about smaller incisions and the like, it is possible?’

  ‘Yes. It is possible that she had less pain than she might have had if Aladdin had not been deployed, and that might have enabled her to walk more freely. That’s the best I can say.’

  ‘I see. Thank you, Dr Wolf. No further questions.’

  ‘Ms Burton, given the time, I think we should adjourn now and your client can continue his testimony tomorrow.’ Judge Seymour gave his direction with his spectacles clasped in one hand and left the room more quietly than usual, leaving their case behind on the desk.

  Andy Chambers leaned over towards Judith as she tidied her papers.

  ‘God, they told me you were the queen of the red herring,’ he said, ‘but I didn’t realise quite how many hours of irrelevant rubbish I was going to have to endure.’

  ‘You’re just cross you didn’t know about it first.’

  ‘Oh come on, Judith. Unless you are going to find some evidence from China of Aladdin, the robot, going berserk and flinging a dissatisfied patient off a building, this has all been a fascinating but pointless diversion. When we get to the rings, which you have studiously ignored so far, that’s when the fun will start. What’s your client going to say about those, then?’

  ‘I couldn’t possibly divulge.’

  ‘Can I give you a small piece of advice?’

  ‘I suspect you intend to do so with or without my consent.’

  ‘For Mr Qabbani’s own good. He should plead guilty to the theft. Otherwise I will turn him into toast on that part of his testimony alone and, once I’ve done that, the jury are unlikely to see the uncharred version of your client again.’

  52

  ‘Am I hopelessly out of date, having concerns about robots conducting surgery, Connie?’ Constance and Judith had taken some time to reflect in one of the court break-out rooms.

/>   ‘He’s an experienced doctor and he says it’s very good.’

  ‘But it must assume that all patients, all bodies, are the same. And if there’s an emergency, time is of the essence, and if the surgeon is elsewhere, it must be more risky.’

  ‘But you balance that against three times as many operations, and a consistently steady hand, even after operating back-to-back. And all those other things he talked about.’

  ‘Yes, you do. Can we use it to our advantage? I don’t see how the fact that a robotic arm helped with Mrs Hennessy’s operation has any connection with her falling off a building.’

  ‘Is that what Chambers was saying to you at the end?’

  ‘Hmm. Well, essentially, yes. And he’s not wrong.’

  ‘Well, there’s what you said to Dr Wolf, about her improved mobility?’

  ‘Yes, there is that. It’s not my best argument but I can feed it into the mix. Remind me what happened to the physiotherapist?’

  ‘He was Italian; gone back to Italy. The police have tried letters and emails. You told me to prioritise other things.’

  ‘You’re right; I did. His departure is a little convenient, perhaps.’

  ‘We did get Wolf’s acceptance that Ahmad probably saved Timothy Morrison’s life.’

  ‘Yes. That’s true. That was good. I’ll use that in closing.’

  ‘Although you let him off the hook,’ Constance said. Judith raised an eyebrow. ‘I’m sorry. I know why you did it, but he lied, didn’t he? Not only at the time, but again, in court when it was really important. Or maybe you think you should protect him because he’s a doctor?’

  ‘I gave him enough of a hard time with the missing document. And our focus has to be on Ahmad and his defence and how best to conduct it, not totally annihilating Dr Wolf.’

  ‘Do you think Dr Wolf really didn’t know who erased the consent form?’

  ‘I have no idea. He appeared genuinely surprised but, as you say, he has not been a wholly candid witness.’

  ‘Were you happy with how it went with Dr Lewis?’

  ‘Yes, on balance I was. I think his evidence supports the possibility of Barbara falling rather than being pushed and we might get the jury to accept the argument about Ahmad’s hair. But I think that largely depends on Ahmad and how he stands up to the scrutiny, the pressure and Chambers’ no-doubt Rottweiler-like cross-examination.’