The Promise and the Lawsuit, Part One

            I had promised myself I wouldn’t quit. If I ever got sued in my medical career, regardless of whether I did something wrong or not, I would not quit. I would keep my joy and my purpose.
            After all those long years of training—after driving through red lights in my post-call exhaustion; after dodging HIV-infected stool being hurled at me by angry patients dying of lymphoma; after resuscitating dead people with epinephrine and seeing them rise again—I would carry on. After delivering twin babies at twenty weeks gestation—too young to survive—then passing the wriggling preemies to their mother for the last few moments of their lives, I would keep going. After all those family conferences, deliberating about hospice care, I would persevere.
            Helping people. Practicing medicine.

*          *          *

            I had made my share of mistakes, especially in the early years. Every doctor has. More than once, the medicines I had chosen had contributed to gastrointestinal bleeding. Many times my interventions had led to electrolyte disturbances, such as low sodium. Low sodium causes confusion, seizures, and falls, sometimes resulting in head injuries, broken hips, surgery, nursing home placement, or even death.
            Sometimes an incorrect or delayed diagnosis was my fault. How many times had I missed an atypical heart attack or a pulmonary embolism (PE)? Perhaps I could have recorded the number, had I not been so tired. For the worst of those errors, upon discovery, riveted themselves into my brain.
            “Face it,” said one of my senior colleagues, a specialist in Critical Care. “You didn’t think about PE. You missed it.” He could have said, “This happens sometimes—to all of us. Now learn from it and do better.” But he didn’t.
            “You missed it,” he said.
            I recall the dimly lit stairway where he stopped me, where we spoke for just twenty seconds. It was on the second floor in the hospital, near the intensive care unit, where the stairway door is extra-wide and poorly placed. There was a metal gate inside the door made of brown pipe, a silver spring, and a creaking hinge. The gate had no purpose.
            Thirty years later, the gate remains. A shiny new elevator has been added across the hallway from the stairs. I used to live here and sleep here, half a lifetime ago. I bypass the elevator to see if I remember the ancient passageways. The old stairs still smell like spray paint. Nothing has changed. Seventeen steps between floors. It’s like I’m wandering into a childhood home from ages past, a twilight zone of black and gray.

*          *          *

            The mission of medicine was always bigger than I, bigger than any one doctor or nurse. It was greater than any single setback. That’s why, long before the Event, I had made my promise: if ever a lawsuit came my way, I would endure it and continue. I’d turn my face into the driving wind and press on.
            Then, one day, a green and white envelope appeared on my desk—certified mail—with a label printed thick and dark:

Letter of Intent to Sue

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