Assume the Position: Memoirs of an Obstetrician Gynecologist (19 page)

     Many have asked me why as a physician I even participated in this awful system.  The system was going to continue whether or not I participated, and there were indeed physicians out there doing some rather unbelievable things to patients in a substandard fashion that was clearly wrong.  Somehow they had to get the message to change their ways otherwise their substandard care would continue uncensored.  I had no problems telling them that at deposition or trial, since they weren’t hearing it from anyone else.  Which is why many of the cases I accepted settled out of court, because during my deposition the physicians heard what I said under oath, and didn’t want a jury to hear it.  For those that were obstinate, a jury did hear it. That was within their control, but they chose to fight on.

     In another case in upstate New York the elderly lawyer who retained me appeared to me to be slowing down mentally, but he had a good case if he could get the facts in front of the jury.  Over the years I learned important questions that needed to be asked by the attorney to get relevant information to the jury.  I told the plaintiff’s attorney in no uncertain terms the questions he had to ask me, since there was no other way to get the important facts in front of the jury for them to hear unless he asked the questions.  I couldn’t volunteer the information in answer to un-related questions.  That would trigger an objection from the defense attorneys.  Clearly the other side wasn’t going to ask the questions if the plaintiff’s attorney didn’t.  He agreed to ask the questions.  By the time we were given the only break while I was on the witness stand he still hadn’t asked the relevant questions, so I reminded him during break one last time how important it was.  When I went back on the witness stand he again didn’t ask.  He went blank.  As a result this lawyer lost his own case. I knew it the minute I got off the witness stand.  Some things were out of my control in the courtroom, for sure.  There are many reasons why defense lawyers will take cases to the jury even when the facts are not on their side; knowing who their opponent is can be one of them.  It is difficult to win a malpractice case against a physician.  Juries are usually prone to side with the physician.  There were times while I was being questioned by the defense attorney during trial in a case, even though there were no facts to support his side, the only defense for the physician was to make me look bad by attacking me as the expert.  Of course, I had nothing to do with the patient’s care and had only been retained as the expert witness. 

     Early in my malpractice expert witness career, in an effort to distract the jury from the facts of the case, one small town lawyer picked apart my resume discussing periods, commas, dates etc. that had been incorrectly typed, pointing out to the jury that I, too, made mistakes which I couldn’t deny.  He didn’t ask me a single question about the case and won the case. I went back over my resume afterwards with a fine-toothed comb. It was unfair for the jury to decide this case against the plaintiff because a lawyer ridiculed me on the stand and didn’t spend a moment on the medical facts of the case, but sometimes that is the way things worked out. Such was the nature of the beast. If the facts aren’t on your side, attack the plaintiff’s expert. At least the physician heard what I had to say from the witness stand.  That in itself may have contributed to better medical care for his patients in the future.  It wasn’t always about who won or lost in front of the jury.

     In one other case in Arizona, the defense lawyer told the jury that I said something in my earlier pre trial deposition that I knew for a fact I had not said since it was against my medical opinion and training.  I was so outraged that without thinking and without knowing if I could even do what I was about to do, I swiveled in my chair from the witness stand and addressed the judge.  I told him face to face that the attorney had just lied.  There were a few moments of silence.  Then the judge told the lawyer to go to my deposition, read the 10 lines before and 10 lines after the statement in question to the jury out loud.  The lawyer was red faced, had lied as I said, and the case was over. No one believed any thing the lawyer said after that.  This was courtroom drama, the kind of things juries loved – the unexpected.

     I, too, had one case against me during my 25-year career that I authorized a payout from the insurance company on my behalf.  A woman had come to me for an early first trimester pregnancy termination that was successfully completed by visual inspection and documented.  She was given written instructions to follow before her return to see me in three weeks for a final checkup.  Prior to that checkup she went to San Diego with her family and camped out.  She felt ill. Her family left her alone and went to McDonald’s to get her some food thinking it would settle her stomach.  When they returned the woman was in cardiac arrest and undergoing care by the paramedics.  She hemorrhaged into her abdomen from a ruptured tubal pregnancy.  She had both a combined intrauterine pregnancy that had indeed been terminated, and a concurrent tubal pregnancy that later ruptured.  Due to hemorrhagic shock from blood loss, she suffered brain damage but lived because of good care she received at the hospital in California.  The family sued me for missing the tubal pregnancy.  In medical parlance she had what was called a combined heterotrophic pregnancy, which means a concurrent tubal and intrauterine pregnancy, a 1/40,000 occurrence.  But it happened under my watch.  My lawyer, one of the best defense lawyers in Phoenix at the time, gave me a 95% chance of winning the case in front of a jury and a 5 % chance of losing with the small risk of an award exceeding the $1million limits of my insurance policy.  Given those good odds, I asked the insurance company to cover me in excess of my limits should that be necessary and we would go to trial and in all likelihood win.  They refused.   I authorized settlement. She and her family were awarded money from my malpractice carrier, perhaps as it was intended.  I was initially distraught about the fact I felt backed into a corner and my insurance carrier would not accept my request.  As time wore on I came to realize that this is why we as physicians have malpractice insurance. We needed peace of mind so that we could go on caring for patients on a daily basis and not have to worry about outcomes that we cannot predict and at times cannot prevent.

     The other side of the coin was that female plaintiff’s malpractice attorney’s were women and needed obstetrical and gynecologic care like every other woman. Many OB GYN physicians just would not accept them as patients.  Once I accepted one they seemed to flock my way. It was a small closely knit community that self-referred.  After all, as women they required obstetrical care just like anyone else, as per my medical philosophy, so it was never an issue for me.  One particularly notorious and successful plaintiff’s attorney showed up on my doorstep to interview me to see if she wanted me to be her obstetrician.  I must have passed the sniff test. She was a control freak.  I told her that when she was in my office she was not controlling the shots.  I asked her what she did when she got on an airplane, whether or not she sat in the passenger seat or flew the plane?  She understood the analogy.  The attorney was over the age of 35, had a fibroid uterus, and she needed a genetic amniocentesis, which I performed in my practice. She was not married, and revealed nothing to me about the father of the baby.  When she was lying on the exam table preparing for the ultrasound prior to the amniocentesis, I pulled down her panty hose with her permission and assistance to thigh level, sterilized the abdomen and draped her, drew up a local anesthetic into the syringe that I held above her thigh.  As I unscrewed one needle from the syringe to replace it with another, I literally dropped the needle 90 degrees straight into her thigh where it took root. If I had taken aim at a bull’s eye on the dartboard with a dart, I had a better chance of success than repeating what I had just done. There it was for all to see, no less with blood running down her thigh under her panty hose.  Rather nonchalant, I said, “Look, if you are going to sue me just get it over with now.”  She laughed and we got on with it.  Months later she came into the office in labor.  I called over to Labor and Delivery to inform them that Nan was on her way over and in active labor.  “Make sure Nan gets put into a room right away and on a fetal monitor,” I said.  I explained to the labor and delivery nurse with 25 years of experience that this patient was a malpractice attorney.    The nurse said “ We are busy, we have no rooms available right now, she will have to labor on a gurney in the hallway until a room is available, and I don’t’ give a shit who she is.” It was just one of those days.  She actually delivered on the gurney without complications.  Against all hospital rules, I saw her later that night walking the halls with her Mom each sipping champagne from glass flutes.  She was back in control, and I was happy all had ended well for her and her baby, and that she would forever be on my side.

     One day when making hospital rounds, I sat at the nurse’s station next to an elderly obstetrical colleague of mine who told me he had just been named in a malpractice suit.  He was severely depressed as it was, his wife having recently died from ovarian cancer; this lawsuit did not help his mood any.  What made this case interesting was that a gentleman who had just turned 20 years old, a man whom my colleague had delivered 20 years earlier, filed the lawsuit against him.  Arizona, as happens in many states, has a law that says if a minor sustains a medical injury, he retains the right to file a law suit up to two years past the age of majority which means two years past the age of 18.  Thus one week before his 20
th
birthday he filed this lawsuit against my colleague claiming injury to his arm resulting from a difficult shoulder dystocia injury at his birth 20 years earlier.  It dawned on me that this, too, could someday happen to me.  Which meant that if I stopped delivering babies when I was 50 years old, I would remain liable until I was age 70!

( El Valle, Panama, 2015)

     During my last year of medical school I met my future wife who was then a student at the Hahnemann school of Allied Health. We met in front of a spiked punch bowl.  I struck up the short-lived conversation that must not have been too impressive, because Julie doesn’t remember the encounter.  The next time we met was in a pub near medical school called Doc Watson’s.  I was having a few beers one night with classmates as she flew in and out.  I made some comment to my friend about how ‘hot’ she was, and with the aid of a few beers under his belt he took the opportunity to blurt it out in public, to her embarrassment and mine. She does remember that encounter. Thank goodness for beer!

     One evening a friend of hers called and told Julie to hurry to the medical school library where I was studying late one night.  We had both been ‘eyeing’ each other at Hahnemann where she was a laboratory technician student before beginning her first career in special hematology and oncology research.  In the library that night we connected after the hastily arranged meeting.  Interestingly, we learned that we were both half Hungarian by birth and genetics, one of many things we would later discover we had in common. We were both of the same religion.  We both wanted a family. We both were involved in health care professions and cared deeply for others above self.

     Unfortunately I was juggling a few other women at the time, and it took longer than I would have liked to get back to her, which I did in due course.  We dated most of my 4
th
year of medical school and fell in love, me first, she later. I can’t say why she fell in love with me because I was difficult and focused on my career.   But for me, aside from the obvious physical attraction, as we came to know each other better, I loved her sense of humor, her warmth, her effervescent personality, her smile, her scent, her drive and independence, her maternal instinct, and the way she carved a path for herself in life despite rather overwhelming family odds.  Julie, on the other hand, needed more time where I was concerned.  I was patient and waited for her, and gave her time and freedom to do as she pleased.  We finally became engaged right before both of our graduations, she from the Allied School of Health Program at Hahnemann Medical College. We struggled to maintain some normalcy in our relationship during our one-year engagement while I interned at Pennsylvania Hospital and she worked with oncology physicians at Jefferson Hospital.

      I would never encourage anyone to start a relationship during a year of medical internship.  It was a brutal year, on call and up every third night all night for basically 36 hours straight, asleep immediately after and sometimes during dinner the next night, then one night off and awake before doing it all over again month after month for 12 months.  She was a trooper putting up with my life, but such is the training for an OB-GYN physician and life to come. It took a special kind of woman to put up with the lifestyle.  My feeling was if we could make it through internship year, we would make it through most anything else.  37 years later, three kids, one grandchild and another on the way, countless dogs (9 I think), living in four different States, career changes for both of us, subsequent bachelor and Master’s degrees for her we are still thriving.

     Julie is a very independent, strong willed, caring, gentle and loving person with an ebullient, effervescent personality.  Stubborn, too, as am I, but we both think that can be a good thing and is from the Hungarian genes in us both.  Her father was born in Budapest, Hungary and at the age of 13 wound up in Bergen-Belsen concentration camp for 4 years.  He never much discussed those years with me, but one can only imagine the life long affect it had on him, which was obvious to us both in many ways.  There has been much written about the children of Holocaust survivors, and indeed my wife was part of that community. Life with her father was not easy for her.  Her mother was the daughter of Russian immigrants.  Julie’s parents lasted together for only a few years mostly because the only thing they had in common was dancing and music. Her childhood and upbringing were difficult and unstable, but to her credit, she made it work for herself from the time she was young.  Thus her fierce independence and never say die attitude.  I have always admired and loved her for her sense of independence, her undying spirit, her humor, her fortitude and perseverance, all of which were required to put up with me. Independence was necessary when married to a physician, especially one with a demanding career. We both wanted a family but put that off until my medical education was over.  We correctly figured that it was best to spend a few years with each other before bringing kids into the world, knowing how our lives would change after children.

     My wife and I had been trying to get pregnant for over a year, unsuccessfully, during the fourth and last year of my residency training.   She only ovulated a few times a year so timing was a bit difficult, but we sure had fun trying. Fortunately we only lived a block from the hospital, so when ovulation happened, I ran back and forth.   She saw one of the infertility doctors on staff before we left Philadelphia, and his advice was prescient.  “Forget about it for awhile,” he said. “ Get set up out there in Phoenix, and if no luck see someone then.”   So we forgot about it! I left my long white coat, a symbol of the East coast academia, behind.  We were heading west.  My Chief of Service gave me a cowboy hat at a year-end party!   Off to Arizona we went, nomads that we were to become, with not much other than plants in our car and our heads full of medicine to start a new life, hopefully a new family, and care for women in Arizona.  There was no way to predict what was to come! But it was an exciting time.

     I had never driven across country.  We had two weeks before I was expected at work, a new townhouse to set up, and a new city to learn.  So we kept the medal to the pedal, as they say, which is the way I prefer driving anyhow.  We took the southern route down the east coast, across the South, straight through Texas into New Mexico, then into Arizona.  We drove about 8 hours each day, sometimes more.  Texas was particularly difficult, never ending, and quite boring.  As we headed in the westerly direction, the sun was constantly in our eyes and brutal.  No surprise that as we look back on it, likely in Abilene, Texas where we stopped for some R and R, we conceived our first child.  For a while after we had arrived in Phoenix we thought it was just the two of us until the nausea for Julie set in one day in the supermarket.  Her periods were highly irregular anyhow, so it took us a while to figure it out.  There was always more to learn about pregnancy no matter how much one thought he knew.

     As expected, Phoenix in early July was hot.  As the Phoenicians say, “ But it is dry heat!”  It kind of reminds me of opening a 400-degree oven door and being hit with a wall of dry heat in the face.  Over time one does get used to it.  For us, living there without access to a pool was unthinkable.  Fortunately our townhouse complex had one.  We were in the pool every day.  We learned that all errands had to be completed quickly by 11 AM.  We also learned to be careful when touching the car door and leather car seats.  Air conditioning was an essential godsend to live in the desert.

     So I assumed the position of attending Obstetrician and Gynecologist in private practice.  I had a three-year contract leading to a buy-in as partner at the end of the third year if all went well.  One of three physicians in this young practice, I immediately delved into the patient population affording my partners immediate time off to travel.  Each went to Europe for three weeks, one right after the other, which essentially left me on call every other night for the first six weeks.  But we all bonded well and I was happy.

     Julie switched careers after a four-year stint in the oncology offices in Philadelphia.  In addition to being a full time actively involved mother she went back to school and got a degree in Studio Art at Arizona State University, chipping away at it one course at a time, year by year.  She had always had an interest not only in making art but also becoming an art therapist which she did later in life after getting a Master’s Degree in Counseling and Art Therapy.  Interestingly Hahnemann Medical College, where we met, had one of the first Art Therapy programs in the United States.  Although interested when we were there, she learned that she didn’t have the pre-requisites at the time. 

     My oldest son Jason was and still is a most interesting kid.  From the onset of a difficult labor through birth by Cesarean requiring all of my skills to extract him, he was a challenge.  As first time parents, we had no idea what to expect.  He did not come out with a manual at the time of birth, and even though I was an Obstetrician, and a physician, and could take care of the sickest of sick babies at birth and in the NICU, it didn’t mean that I knew anything about being a parent.  We just assumed all babies were like him.  We struggled to figure him out.  Fortunately we are both mild mannered most of the time because he was impossible to figure out. I just remember being exhausted all the time.  Night call was bad enough, but then throw in a kid who doesn’t sleep and complained in one form or another about most anything, at all hours of the day and night, and well – it was a challenge.  At 2 AM, when screaming for unknown reasons, the only thing that worked was to put him in his car seat and take him for a car ride.  He fell asleep immediately but as soon as I pulled back into the garage, the screaming started all over again.   We used to tell people we wanted four kids, and after him we narrowed it down to three.   We loved him from the get go, and he was loads of fun, smart, challenging, inquisitive, and demanding.  We gave him all of our attention, perhaps even too much of it, but who knew?  He had so many varied interests and talents growing up that we had no idea where he would wind up or what he would do, but safe to say he is now a happy and content adult, with a great job making a difference in renewable energy and public policy, good friends, and no surprise, a fierce sense of independence for which we are more than half responsible. He is also a talented artist with his own studio producing wonderful works of art.

    Our middle child Katie Rose is a girl.  Everyone should have a daughter, but particularly an OB- GYN physician.  There was always something to learn from every female in life.  She was an absolute delight as a little baby, cute as a button, and sweet.  She had me from the moment of birth.  And everyone loved little Katie.  She, too, was as independent as they come from the time she passed go, and put up with nothing from her older brother.  Whatever he dished out, she gave right back.  As a little girl of three or four I can still picture her walking around in our back yard in her cowboy boots with no clothes on.  My Mom used to beg us to “Do something with her hair” because she never let anyone touch it, so it was always wild.  Finally, one day I just told my Mom that if it bothered her, she could do what she wanted with Katie’s hair.  She learned!  Somewhere around this time we got a call from the day care center telling us they wanted to talk to us about her. They were concerned because she was telling all the kids in her class how the egg and sperm met and that was where babies came from.  I asked them if they knew whether she got it right.  I was proud of her then as I am now. They thought we needed to talk to her and I explained I already had which was why she was educating the rest of her preschool class.  She clearly has figured out now, as she had then, how to give us grandchildren!

     Katie loved the back yard swimming pool and took to it like a fish.  The drain in the deep end of the pool was at 10 feet depth. She used to put her little arms around my neck, and we would go down there and just sit with my fingers placed in the drain to hold on until I couldn’t breath any longer, then we would come back up together. She had an amazing set of lungs that she would use to belt out a scream that could shatter a glass.  We also used to take her to a community pool with a high dive.  People thought we were nuts to let her climb up by herself, which she did as a little 4 year old, then stand at the end of the diving board all by herself.  When she was ready, she jumped.

     Later in life I had occasion when she was in middle school to talk to her class about what it was that I did in life.  I began by asking someone to come up to the board and try to write ‘Obstetrician and Gynecologist’ on the blackboard.  Seeing no volunteers, I of course picked on her.  She almost got it right, spelling ‘Gynacologist’ incorrectly. She still has not forgiven me for correcting her in front of her classmates.  After the session was over she informed me all the boys in the class came up to her and told her how cool it was that I got to look at naked women all day long. I don’t think she was too happy about that either.   In their minds, that is what I did. Boys will be boys!  I didn’t have the heart to tell them that not everyone looked so good naked.  That was for them to find out some day. She also has a great story about her first pelvic exam, but we need not go into that one.