Feeling Good - The Story of Sam & Henry

Chapter 33 - Marilyn

"And you feel responsible?"

"I am responsible, she died because I didn't see the injury to her superior mesenteric artery."

"Did you look for it?"

"Yes, we didn't see anything."

"So you didn't miss it. You looked, and it wasn't there."

"Well, obviously it was, because it clotted off and her bowel died."

"It's not within the realm of possibility that whatever happened wasn't visible or that it happened after surgery?"

"Well of course it's 'in the realm of possibility,' but given the extent of the damage it should have been apparent at the time of her surgery on Friday."

"But you just said that it wasn't. You looked, there was no sign of damage."

"I get what you're saying, but I don't think you understand. I operated on her. It was my job to assess her for damage. She had this small hematoma on her duodenum, which meant that she clearly had sustained some intraabdominal trauma. The injury to the SMA was there, I just didn't see it."

"You didn't see what was invisible?"

"Sam... I can't explain it any better than this. I should have seen it."

"Why?"

"Because that's my fucking job!"

"It's your job to see things that aren't there?"

"No, it's my job to fix people when they get clobbered in a head on motor vehicle accident. It's my job to make sure that I've excluded every possibility, that I've looked under every stone." 

"Knowing what you know now, and that her whatever..."

"...her SMA..."

"...right, her SMA was injured, what would you have done differently in the operation on Friday? How would you have figured it out?"

"We could have done an intraoperative perfusion study to see if she had a clot in the SMA."

"What if the clot wasn't there yet, what if it formed later when she was laying in the hospital bed after surgery? Would you still have been able to detect it?"

"Well, no, I mean, there could have been a filling defect I guess, but no, if the clot wasn't there at the time, we wouldn't have seen it."

"Was there any indication to do the other study? Would everyone have thought you were crazy if you'd told them to do it?"

"I don't know, probably. My attending had scrubbed out at this point, but he examined the duodenum and SMA with me and didn't think there was anything else there."

"So someone who has more experience than you also thought that she was ok and basically told you to finish?"

"Well, yeah..."

"And you still think this is your fault?"

"Sam, she died with my hands in her gut. I killed her. If I'd seen the injury to her SMA, she'd be eating leftover birthday cake right now."

"Maybe. Or maybe not. Maybe the car was traveling 5 miles an hour faster and she would have died on impact, or in the ambulance. Or maybe you decided to do the perfusion study and detected the clot and while trying to repair it something else happened and she bled out. Or maybe another clot formed somewhere else or traveled to her lungs or to her brain and she died that way. Or maybe you didn't hear your phone while we were at the movie, so you didn't go in, and yeah, she still died, but it didn't happen while you were there. You'd feel differently, right? All I'm saying is that you're holding yourself to a ridiculously high standard. 'To see what isn't there?' Really? If that's your goal, you're setting yourself up for disappointment, and probably alcoholism."