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Jim then walked out to find our patient. He said, “There doesn’t appear to be anyone here.” Apparently, his staff was so determined to get out early that they’d all left the building and told Stephan to leave as well.

I had Tamara’s cell phone number, so I thanked Jim and reassured him that I would locate Stephan. Tamara answered the phone driving home on the freeway. I told her what we had found and said, “You have to turn around and go back to the hospital,” which she did.

The neurosurgeon operated on Stephan the following morning, removing a section of bone from several consecutive vertebral bones (a laminectomy) and cleaning out the pus-filled abscess. When I went to see him later in his sixth-floor room with a sweeping view of San Francisco Bay and the Golden Gate Bridge, he was asleep, but Tamara met me in the hall, gave me a long bone-crushing hug, and thanked me. She had dark sleep-deprivation raccoon rings around her eyes but assured me she was okay. “I know I’m overdue for an appointment with you, but I’ll see you soon.”

The next day I found Stephan sitting upright in the company of friends and enjoying the view. He introduced me and said to his friends, “I have to give the doctor his props. He was the one guy who right from the beginning knew where the problem was. I gave him a bad time, but he was right.”

I asked Stephan how he felt. “The pain is almost gone,” he said. He pointed to his surgical wound, a vertical line down the back of his neck to shoulder level, with a gentle indentation in the space that the spinous processes of his vertebral bones had formerly occupied. “I can deal with this.” The sense of relief he projected exceeded mine, but not by much. I allowed myself a wide smile. “I’m so glad” was all I could say.

A few days later, he stopped by the Berkeley office. Previously, he’d never shown us any face other than pride and anger. He shocked us all with hugs for everyone in the office, calling Carol his “angel” while weeping in gratitude, prompting her to pull me aside to confirm that “This is what makes all that we do worth it.”

Almost a month later, with Christmas just a few days away, Stephan came back for a follow-up appointment, during which he shook me firmly by the hand and informed me that he now was almost pain free without any medication and that he had full strength in his left arm and hand. He had even resumed lifting weights.

While he was in the hospital, Stephan had opened discussions with his surgeon and with me about where the abscess had come from. “Shooters,” what physicians call people who use intravenous drugs, get spinal abscesses from the bacteria they unintentionally inject into their bloodstream, but these abscesses are otherwise rare. “The neurosurgeon said it probably came from some dental work I had done a month ago,” he’d told me when I came to see him in the hospital. Deep cleanings and procedures involving injury to the gums can cause some of the hordes of bacteria living in the mouth to disseminate into the bloodstream and cause infections in other parts of the body. The chances of an otherwise healthy person getting a spinal infection from a dental procedure, however, are similar to the probability of lightning striking one’s spinal cord. Perhaps the stab wound to his chest so many years ago had left some scar or pocket that the bacteria had invaded. In any case, this was one of those “bad things happen for no good reason” scenarios that we see often in my line of work, and I was thrilled to see that he had made a complete recovery.

“I want to make you aware of something so you’re not caught off guard,” he began, and I sensed the end of the happy part of our conversation. “I have consulted three attorneys, and I just want to warn you that they want to see your records. They don’t want anything having to do with my colonoscopy or matters like that. They want any records that might show a delay in diagnosis so they can sue you. I want to sue the dentist, but the attorneys want to look over what you did also. I’ve told them, ‘I think that all you’ll find is that he was the guy who found the problem and ordered the MRI so that I could see the surgeon.’ You are the reason I am standing here today, the reason I’m not dead. I do not want you to be named in the lawsuit.”

I thumbed through the chart, gathering my thoughts to come up with a careful answer. His words surprised me only a little, and I chuckled inside the way one does after locating a lost wallet only to find it empty. This is our world, and I have been around long enough to know that pulling out all the stops to save a life does not mean you won’t later have to face lawyers.

I said, “I have to tell you that to me this would be an extreme miscarriage of justice. Especially when you look at what everyone here did for you.”

He acknowledged that. “I don’t want you to be involved, but the attorneys said that they have to review your records. I told the attorney about how you even saw me when I did not have an appointment, during your break when you were going to go to your other office.” Thanks, I had forgotten that, but malpractice attorneys do not have any interest in whatever beneficence a potential physician defendant might have shown; it is their goal to make as much money as possible, and the more professionals they can name in a lawsuit, the more money they stand to make.

“You realize that if you sue me, I cannot continue to be your physician, or Tamara’s physician.”

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Comments

towelheadedcameljockey June 13, 2008 @ 3:46 p.m.

It's good to hear he decided not to follow through with the suit. People always want to put blame on someone for things which are not necessarily human error.

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creativemnds July 22, 2009 @ 3:22 p.m.

People never really get to see the physician's side of story. Thanks for the insight! :)

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SDaniels July 22, 2009 @ 3:41 p.m.

Thank you, Dr. Eichel, and I will be sure to read your other blogs! I am looking for books written from a doctor's point of view; just finished Paul Austin's "Something for the Pain" about life in the ER, but would like to read a physician-authored book or two more focused on the actual medical practice, rather than the doctor's personal life (in Austin, an ER doc, it is understandably all about finding ways to sleep).

As a patient with a serious lifelong condition, I am constantly If you have any recommendations, I'd much appreciate it.

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SDaniels July 22, 2009 @ 3:44 p.m.

Oops. Meant to say that I am constantly and of necessity finding myself navigating the healthcare system, and it would be enlightening to read about doctors' thoughts about sending patients to the ER, pain management, and the evolution of one's bedside manner, as well as all aspects of one's daily practice.

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