by Sanjay Gupta
“I’m sorry, ma’am, your son didn’t make it through surgery” were the words the social worker had spoken that day three decades earlier. Ty didn’t know what that meant. Was Ted back in the hospital room with the cool bed and the TV bolted to the wall? Ty hoped so. He never told his parents, but he had hoped his brother would get to stay in the hospital forever. Whenever he visited his brother, Ted would ask if he had an E Ticket. Ty would hand him a make-believe Disneyland ticket and climb up on the bed, and Ted would hit the buttons to make the sections of the bed rise and fall. Watching his mother, he knew something much, much worse had happened, though he wasn’t sure what. He could not imagine life without his big brother. The notion of Ted dying was not even in the realm of the possible for young Ty, who idolized his older brother to the point of mimicking his pigeon-toed gait and squinty stare.
The tragedy devoured his parents’ relationship. His father would disappear for long stretches. When he was home, he said little. He wandered around their small home as though he were lost. His mother dove into work. She was a realtor and spent most weekends driving clients around Southern California. She specialized in first-time home buyers even though the commissions were smaller and financing was often a problem. Ty wondered if she somehow liked being around the hope these young couples carried with them. His parents’ marriage didn’t last long after Ted’s death. Maybe a year or two. Their bond eroded and then collapsed under the burden of the grief.
When Ty was a teenager, his mother and father reunited briefly in another ER for another family tragedy. They were in their late forties but looked much older. Even though they were both remarried, they hugged for a long time when they saw each other. They shared a rare and horrible bond: a parent’s grief multiplied now over two children. Ty’s sister Christine was already in the OR undergoing emergency surgery when they arrived. Christine had been standing in line at a convenience store waiting to buy a Coke and some gum. All of her friends were outside waving to her when they had seen a man enter the store in a hurry.
“It seemed like just a moment had passed when we saw a few bright flashes of light and heard a loud noise,” those friends of Christine had told Ty’s parents. The gunman had never been found. He had left two people dead at the scene and Christine with a devastating bullet hole in the back of her brain. The prognosis was not good.
When the young neurosurgeon emerged, he informed Ty and his parents drily that Christine had lived but would be in a vegetative state for the rest of her life. His tone was so clinical, so cold, he could have been a service rep at the local car dealership telling them they needed new tires. In that moment, whatever flicker of life remained in his parents extinguished. They breathed, their hearts beat, but the spark of life was gone.
At the time, though, the news had the opposite effect on Ty. It transformed him, awakened his drive, gave his life purpose. His brother’s death years earlier triggered in Ty an outrage at the callousness of the surgeon and a fury at the unfairness of the world, a rage that made Ty a volatile teenager. He was easy to anger and indifferent about school. His sister’s state sparked in Ty something else entirely: a desire to be a neurosurgeon who could save patients and render them functional when others could not. From that moment on, Ty approached life with a single-minded purpose that made him a top student and eventually one of the best neurosurgeons in the country. Ty never forgot about the way his family had been treated, though. Doctors had ducked out when they should have been talking to Ty’s mother. He never forgot how much a doctor’s lack of compassion had added to his mother’s pain. It was no surprise, then, that while Ty could be remarkably arrogant to his colleagues in medicine, with his patients and their families a remarkable humility and compassion emerged.
Standing in front of Allison McDaniel with the worst news he could give her, Ty’s thoughts returned to those California hospitals: the news of his brother’s death delivered casually by a hospital bureaucrat, his sister lying in a sterile long-term care facility, and his subsequent vow to be the surgeon who could save the impossible cases. Ty had become aware tears were burning a path down his cheeks. “Things didn’t go so well in there, did they?” Allison asked softly. Ty cleared his throat. “No, ma’am,” he replied softly. “I am afraid we lost your son tonight.” Allison started to sob, and Ty took her hands into his own.
“I know you did all you could,” Allison said. Ty was too choked up to answer. Allison McDaniel walked over to him and gave him a hug. Ty found the embrace comforting and somehow unnerving: Chelsea General’s star surgeon needed comforting from the mother of the patient he had just killed. That was how he saw it. Allison slowly collected her belongings and started to walk out of the room. Just before leaving, she turned. She wiped away a tear while looking at Ty and said, “I know what happened in there must’ve been so hard for you.”
Around the corner, nurse Monique Tran had also been in tears. She was calling her boyfriend from a quiet corridor.
“I’ve decided to keep the baby.” With that, she couldn’t say any more. She hung up.
CHAPTER 5
M
itchell S. “Mitch” Tompkins checked the notes on a yellow legal pad and fingered a diamond-crusted gold band on his right hand. He gave a little tug on his Italian suit coat and turned a set of too-shiny white teeth toward Tina Ridgeway. Tina sat upright, legs crossed, her elegant hands folded in her lap in an effort not to show how uncomfortable the deposition was making her. She wore scrubs, sneakers, and her spotless white coat.
Now, Dr. Ridgeway, before the surgery, did you tell Mary Cash exactly how you planned to destroy her sense of smell?”
Tina returned the stare, winced slightly, and took a deep breath.
“Of course not. We didn’t plan anything of the sort.”
“You did it anyway, though. Didn’t you?” Tompkins pressured.
Tina paused, and tried to choose her words carefully. “No operation is without risks.”
Tompkins paced the conference room on the twelfth floor of Chelsea General when he talked. Like the rest of the floor, the room was elegant, with a cherry-and-oak table and high-backed leather chairs all around. A few of Hooten’s paintings hung on the wall, along with gold-plated light sconces. It was perhaps the worst place to hold a malpractice deposition, but Tompkins had insisted and the hospital lawyers had relented. Tina closed her eyes and tried to remain calm. If Mitchell S. “Mitch” Tompkins planned to rile her up, he was succeeding. She had seen the man’s name before. It was on the back of every phone book, above a picture of him surrounded by concerned-looking patients. HAVE YOU BEEN WRONGED IN AN INJURY? HAVE YOU HAD A BAD MEDICAL OUTCOME? Tompkins didn’t look as good as the picture. In the photograph, he gazed at the camera with a confident air and the hint of a smile. Somehow, the picture made him look tall. In person, he was medium height and build. His handsome features were a little puffy, his face pale, with dark circles under his eyes, but he had swagger, and he was using it right now.
He was perched under an expensive chandelier. “You say no surgery is without risks. So then of course, before the operation you told Mary Cash about the risks?”
“Yes.”
“You, personally—”
“All our patients sign a consent—”
“Did you see her sign the consent? Did you personally see her sign the consent?”
Tina looked over at the hospital’s lawyer, who was reading his BlackBerry. The stenographer looked at Tina, waiting for her answer.
“Usually, that’s the responsibility of the resident, to go over the risks with the patient and have the patient sign the consent form.”
“So for all you know, Mary Cash didn’t even sign the consent.”
“I’m sure she signed it.”
“But you didn’t see her sign it. How can you be sure that’s her signature? It could be anyone’s.”
The hospital attorney looked up, interested the way he might find someone walking down the street with a black eye interesting, and
then returned to his BlackBerry.
“Yes, but—”
“For the record,” Tompkins said, looking at the stenographer. “You are telling me you have no idea what risks—if any—Mary Cash was told of before this surgery.”
“We could ask—”
“Yes or no? Do you have direct personal knowledge of what risks Mary Cash was aware of before her surgery?”
Again, Tina looked to the hospital attorney. A four-hundred-dollar-an-hour mute, she thought. Shouldn’t he object or something? Was she supposed to endure this meekly?
Tompkins leaned close to Tina. He was enjoying every minute of this. He folded his arms in a practiced way, like someone on Broadway who wanted to make sure the folks in the back row didn’t miss the gesture.
“I have all day, Dr. Ridgeway. Yes or no.”
“No,” Tina said, deflated. “I did not personally hear what Mary Cash was told before her surgery.”
Tina tried to imagine what her father, the renowned internist Thomas Ridgeway, or grandfather, Dr. Nathaniel Ridgeway, a crusty family practitioner in Vermont, would do with the plaintiff’s attorney now in her face. She couldn’t picture either of them sitting where she was at all. They would have gotten up and walked out without a second thought.
Her thoughts turned to Mass General. One of her favorite memories of childhood was playing hide-and-seek with her father and older brother in the Ether Dome, a semicircular surgical amphitheater where anesthesia was demonstrated for the first time. Her father was always “It.” They would scatter to different curved rows and crouch behind the white, wooden partitions, trying not to squeal or giggle as his footfalls approached. Afterward, when the vapor lights had come back on, her father would take them into his adjoining office in the Bulfinch Building, crouching to fit his six-foot, four-inch frame under the arched doors built when the average American was a good deal shorter and the hospital received patients by boat. There the eminent Dr. Thomas Ridgeway would reach into the large square freezer next to a lab bench and pull out paper-wrapped ice cream sandwiches for his children from among the tissue samples.
His co-workers would make a fuss of Tina and her brother. They’d always ask her brother, “Are you going to be an important doctor like your father?” Over time, she became increasingly annoyed that the lab techs and other doctors never asked her this question. Maybe her resolve to become a doctor began then. Even if it hadn’t, the burden of continuing the family’s legacy in medicine fell to her as soon as her brother dropped out of college. From that point on, her father and grandfather assumed Tina would be going to medical school and becoming the next Dr. Ridgeway in the family.
The deposition was now entering its second hour with no letup in sight. The facts were straightforward, but the lawyer appeared determined to wear down Tina, to get her to say something careless. Something he could have her read out loud at the trial, no doubt, Tina thought. She’d watched enough legal dramas on television to know how this would play out if she lost her cool and so, apparently, had Tompkins.
Mary Cash had arrived at Chelsea General with a meningioma, a benign tumor that could be removed surgically. One of the possible risks was damage to the olfactory nerve that ran near the cancerous growth. If that was nicked or cut, the patient would lose the sense of smell. The patients who heard about this potential side effect often dismissed it without a second thought. Compared with a tumor growing in their brain, smell was nothing, they reasoned. But smell was perhaps the least appreciated of the senses. For the unfortunate few who did lose it, the change could be dramatic. They’d lose the ability to smell the bloom of flowers or the smell of bread baking or fresh-cut grass. Possibly most upsetting, though, was the realization that when you could no longer smell your food, it never tasted as good. As a consequence, many would eat less, lose weight, and appreciate life less.
That’s where Mitch Tompkins came in. He was suing Chelsea General, Dr. Tina Ridgeway, resident Michelle Robidaux, and every other doctor or nurse who had so much as looked at Mary Cash. If it weren’t for the outrageous sum Tompkins was demanding, the hospital would have settled by now. Tompkins wanted twenty-two million dollars: one million for failure to adequately warn Mary Cash of the risks, one million for damaging the nerve, ten million for lost earnings, and ten million for loss of “hedonic pleasure.” Hedonic pleasure was a catchall phrase referring to life’s enjoyment. Plaintiff’s lawyers used it if the outcome of their treatment left them unable to walk, see, play golf, have sex. You name it. There was even the case of a woman who had a small bone lodged in her throat that escaped the attention of the ER doc. She claimed the injury sustained resulted in her inability to perform fellatio, proving that any and all of life’s pleasures could be included as Exhibit A in a malpractice suit.
Unless the hospital came close to his demand, Tompkins promised to take the case to trial and slather on the sympathy for Mary Cash like butter on corn bread. His ace in the hole: Mary Cash was a James Beard Award–winning chef. She needed her sense of smell to work. A chef who couldn’t smell was like an artist who couldn’t see. Cases this strong came along once a decade.
“When I get through with this hospital, people bleeding to death will drive an hour out of the way to avoid Chelsea General,” Tompkins promised the hospital attorney after he filed suit at the Oakland County courthouse. “And forget about the bonuses for the hospital executives. That money’s going to pay off the suit. Remember, the jury isn’t limited to awarding twenty-two million.” A third of twenty-two million dollars, of course, was seven million and change. That was Tompkins’s cut. Like shooting fish in a barrel.
In the conference room, Tompkins paced, barely able to contain his glee. He ran his fingers over the expensive hand-screen-printed wallpaper.
“Now, Dr. Ridgeway, tell me how Mary Cash’s career was destroyed. Walk me through this. How do you go about cutting someone’s olfactory nerve?”
When she was growing up, doctors were revered in the community. They were healers, civic leaders, wise men—and they were mostly men. They didn’t make as much money as many specialists these days, but patients treated their word as the gospel. They didn’t Google their symptoms and arrive at the doctor’s only after the supplements or other pop remedies failed. And if something went wrong, it was God’s will, fate, or simply bad luck. Tina couldn’t remember her father facing a single malpractice suit in his forty-year career.
Tina narrated the operation step by step for the plaintiff’s attorney. She had explained the procedure dozens of times for med students, so it was second nature. After the patient’s head was immobilized, an incision was made on the scalp and the skull was exposed. Then a burr hole was perforated behind Mary Cash’s right eye. The hole allowed a larger hole to be sawed in the young woman’s skull, which gave the surgeon access to the brain. From there, it was a matter of gently cutting away the outer layers of the brain and then resecting the tumor. Because a meningioma can sit so close to the olfactory nerve, there is always the danger of nerve damage.
Tompkins was sitting during Tina’s narration. Now that she had finished, he was standing again.
“Very interesting, Dr. Ridgeway. Fascinating, really. You described it so well, I almost feel as though I can do the surgery myself.”
Tina said nothing.
“Now, when you say, ‘A burr hole was made,’ or ‘The tumor was resected’—who was doing the cutting and resecting on Mary Cash? I’m assuming it was you. After all, you are an attending physician, the surgeon of record, and you wouldn’t want to give this talented, James Beard Award–wining chef second-class treatment.”
Tompkins paused and looked at the hospital attorney. The attorney tried to give Tompkins a what-me-worried look, but he did look a little worried. Tompkins turned back to Tina.
“So, you were performing this surgery, right?”
“No,” Tina answered.
“No?” Tompkins feigned surprise. “All right then, who was operating on this young, talented, attrac
tive chef with a whole career ahead of her, a rising star in the culinary world?”
“Dr. Robidaux.”
“Dr. Robidaux?”
“Yes, Michelle Robidaux. A resident in the Department of Neurosurgery.”
“You mean, you allowed a doctor in training, a student if you will, to operate on the brain of this young woman, lying defenseless on the table, as she was, her trust entirely with you?”
“This is a teaching hospital, Mr. Tompkins.”
“So, what you’re telling me is that Mary Cash was cannon fodder. Someone for Dr. Robidaux to practice on.” Tompkins almost spat the name Robidaux. “My client was a guinea pig, if you will? Sort of like the Tuskegee syphilis experiments.”
Tompkins was in full trial mode now, even though it was just the four of them in the room with him, the two lawyers, Tina, and the stenographer. His inflection wouldn’t show up in the deposition transcript, but the plaintiff’s attorney was giving the hospital’s counsel a heaping taste of what his courtroom questioning of the esteemed Dr. Tina Ridgeway might sound like if the case went before a jury.
Again, Tina looked over at the hospital attorney. He was paying attention now. No more messaging on his BlackBerry. Still, he remained mute, making a few surreptitious notes on a legal pad. Tina wasn’t sure which was worse, indifference or concern.
“Dr. Robidaux is a competent doctor.”
“Competent,” Tompkins repeated as though he were clearing bile from his throat. “Competent. When I go to get my brain operated on, I don’t know about you, Dr. Ridgeway, but I want more than competent. I want an outstanding surgeon operating on my brain. Competent. Huh!”
Tina was flustered now.
“What I mean to say, Mr. Tompkins, is she is perfectly—”
