Even in Treatment, You
Just Can’t Win
Daily Observer
S.Q. Lapius was wearing his smoking jacket instead of
his old bathrobe. “Why so formal,” I
asked.
“That orthopedic fellow, what’s his name, Dr. Pes
Planus is supposed to come over. I told
him I’d call as soon as I had finished editing this article. Give him a ring, will you Harry?”
“What’s his number?”
“It’s in the phone book,” Lapius said graciously,
while he stretched out on his recliner and lit a long black cigar. I found the number and dialed Tibia 7-0234. Planus answered.
“The great one is ready, Pes. You can come over any time now.”
Twenty minutes later the doorbell rang.
It was Planus. He was
disconsolate. I showed him into the
living room. Lapius bestirred himself,
and struggled off the recliner to shake hands.
“A drink?”
“Yes thanks, if you’ll add some cyanide.”
“Mix Pes a drink, Harry.”
“Okay Pes,” I said to the morose man, “Should I add
liquor or do you want it straight?”
Pes ignored me and turned to Lapius. “Simon, you know a lawyer named Gautier,
don’t you? Felix Gautier.”
Lapius was instantly cautious. “A mere acquaintance, my boy, why?”
“Do you know him well enough to act as an
intermediary?”
“Perhaps.
What’s the trouble.”
Pes looked troubled.
He was momentarily tongue-tied.
“Here Pes, here’s your drink.
Straight cyanide.”
“Thanks,” he said and took a long gulp, like Socrates
downing the hemlock. When nothing
happened, he recounted the tale of the molested orthopedic surgeon.
“Fellow came to me with severe back pain. I made a presumptive diagnosis of slipped
disk and did a myelogram. Had no trouble
putting the dye into subarachnoid space.
I put the needle in between Lumbar vertebrae 3 and 4. But because the needle sometimes obscures the
x-ray I removed it. After the pictures were
taken I pondered whether to reinsert the needle and withdraw the dye. There are two schools of thought. The English usually leave the dye in. But here, and now I know why, the practice is
to consider the dye a foreign body, and remove the dye. Anyway, the lesion proved to be a disk and I
removed it. The patient didn’t do too
well. After an initial period of apparent recovery his pains started again,
with definite nerve root problems, radiation of pain, loss of function. I figured he had unstable back or perhaps
even another disk.”
Lapius was listening sympathetically. “Was it?” he prodded.
“We’ll never know.
He never came back.”
“Went to another doctor?”
“No. To a
lawyer. The lawyer, this same Gautier,
sent him to another doctor, a radiologist.
The x-rays showed dye in the spinal column and they are suing me now.”
“On what grounds?”
“On the grounds that the dye caused the subsequent
pains. They say he probably has an
arachnoiditis, and that it was due to the dye I left in.” “Ridiculous,” I interjected. “They’ll never be able to prove that.”
“They don’t have to prove it,” said Lapius. “All they have to do is to get a jury to
believe it. That should be easy with
Gautier hammering at the jury, pointing to the x-rays set up on a light box in
the courtroom, where everyone will be able to see the white dye in the spinal
column. Then there will be a few experts
to sonorously pronounce the dangers of retained dye. Pes, I think you are in for a bad time.”
“Frankly, Lapius, that case is only half the
problem. It’s the other case I’m worried
about.”
“The other case!
Harry, get poor Pes another drink.
Quickly.”
Pes didn’t wait for the refill. “When the next disk came along I became
canny. I introduced the dye at a higher
level so I could leave the needle in, without its interfering with the x-rays,
so I could remove the dye. That’s better
than repeating the lumbar puncture to try to get the dye out. Sure enough the fellow had a demonstrable
disk, and I spent the next hour removing the dye. Of course a few times I pulled a nerve trunk
against the needle point, and caused some sharp but temporary radiation’s of
pain.”
“I presume you retrieved all the dye, Pes?”
“Absolutely every drop.”
“Admirable.”
“That’s what I thought. But after surgery the patient continued to
have back pain. He tried to get in touch
with me but I was at a meeting in
“Did the other doctor have any constructive
recommendations other than that?”
“Sure. He
introduced him to Gautier. It turns out
he’s one of Gautier’s experts. He will
testify against me.”
Lapius whistled.
“Let me get this straight, Pes.
You are being sued by Gautier for two cases. One because you damaged the patient by leaving
the dye in and the other because you damaged the patient by removing the dye.”
“Correct.”
“What do you want me to do?”
“I thought maybe you could testify in my behalf.”
“Which case?”
“Both. I want
you to say in one case that it is preferable to leave the dye in, and in the
other that it is preferable to remove it.”
Lapius brooded over that for a moment. “I can’t do that Pes. Maybe I’ll do you one better, though. I’ll be willing to testify that arachnoiditis
can be caused by the lumbar puncture itself, that the back pain can be the
result of the original condition, that surgery is no guarantee of cure in all
cases. That’s the best I can do for
you.”
“I’ll take it.
And thanks a lot Simon.”
Lapius was melancholy. “I don’t like to see medicine prostituted by
third parties. More and more doctors are
forced to practice defensively, so that the patient’s welfare is diluted by all
sorts of considerations that have nothing to do with the case. Because lawyers stand in the wings ready to
pounce on the one case in ten thousand that gets arachnoiditis if the dye is
left in place, doctors like poor Pes Planus have to do handsprings to get the
dye out, and in so doing, perhaps cause more damage than if he didn’t
bother. It’s getting so a doctor can no
longer concentrate on what he’s doing for a patient, but rather must consider
how his procedure will stand up on a court of law.”
The phone rang. I answered. “It’s Gautier, Simon. He fell down a flight of stairs and thinks he
broke his ankle. Wants to know can you
recommend a good bone doctor.”
“Tell him to stay put. I’ll send one over right away.”