Early Sunday morning, August 30th, I received a visit from a doctor I had never seen before. He says that his name is Dr. Suzuki and that he is an EENT (Eye, Ear, Nose and Throat). His tone is brusque, but not actively unpleasant. He does not ask me how I am feeling, whether I can breathe or eat, or whether I can swallow normally. In the space of about 45 seconds he looks at the CAT scans of my face, tells me I do not need a facial reconstruction, and leaves the room. My husband and I are stunned by this. Where is Dr. Bell? Why havent we seen him?
We had made arrangements by phone before we left Idaho to see Dr. Bell, my EENT of many years and a good guy, "as soon as we arrived at the Baptist." Lampros Minos had written into my "physicians orders" a consultation for me with Dr. Bell. One of the main reasons we had come to the Baptist rather than go to one of the other hospitals to which we had access was so that Dr. Bell could do my facial reconstruction -- after all, he knew what I looked like before I was hurt. We had no idea who Dr. Suzuki was or why he was there, and given his unknown provenance, I certainly didnt accept his medical opinion that I didnt need surgery on my face. I suspected privately some kind of shenanigans on Dr. Karlsons part.
We were to discover after we filed the lawsuit and my attorney went over my medical records in great detail to prepare the interrogatories, that Dr. Karlson had, without informing me or anybody else, countermanded the previous orders and substituted Dr. Suzuki for Dr. Bell.
A little while later, Dr. Karlson himself came to visit. He did not examine me or inquire after my welfare. He did not mention the incident of the previous day or my having refused to let him operate on me, which my husband and I both thought was very strange. He seemed angry, but more in control of himself than he had been in the X-ray room. As he was turning to leave, I asked him about my consultation with Dr. Bell. "Youve already had a consultation with Dr. Suzuki," was his curt response. "Yes, I understand that, Dr. Karlson," I said, "but Dr. Bell is my EENT. Hes expecting to see me." His anger flared once again, and he replied in a tone somewhere between a reprimand and a shout, "Youve already seen one EENT, you dont get to see another!" Then as he turned to leave, he told me was arranging for my discharge to home the next day.
Although some people's interpretations of my medical records show Dr. Karlson recording this as a query, he made it quite clear to both my husband and myself that he was having me sent home on Monday. You can have a look at it yourself. (MR) He certainly did not present this to us as something that was in question. Keep in mind that at this point in my recovery from the accident that almost killed me, I still could not walk without being held up by another person, sit up in bed unsupported without falling over, breathe on my own at night without supplemental oxygen, chew, or swallow anything but liquids. I had not received the emergency elbow reconstruction surgery I needed, and I was in severe and growing physical pain from being undermedicated while I was at the Baptist.
The terror and shock of both Dr. Karlsons manner and his pronouncements are difficult to convey. But when he told us that I was not going to be permitted to see my own EENT, a penny dropped for me. Somewhere in what was left of my mind I had an instinctive understanding that there was something very wrong with this, and that it spelled danger for me. I was also extremely shocked and horrified at the thought of being discharged to home the next day.
What I figured out intellectually later was that I had correctly interpreted a very serious warning sign that is given to women who are in abusive relationships with men. When your boyfriend or husband first starts trying to prevent you from seeing your friends, from visiting your family, or attending PTA meetings, or other events where you might come in contact with authority figures who, if they knew about the abuse, would be able to protect you from the abuser, you know that your abusive relationship has reached a new and more dangerous level. "Keeping a woman from seeing her friends" is the beginning of the end game in an abusive relationship. I had done volunteer work for the Coalition of Battered Women's Service groups, and even though I had never been in an abusive relationship, I had been trained in recognizing the stages that an abusive relationship goes through.
It seemed clear to both me and my husband that Dr. Karlson had substituted Dr. Suzuki for Dr. Bell so that no physician at the Baptist who was sympathetic to me would have a chance to hear my story.
Later that day, Dr. Rivkin came to see me. In sharp contrast to the other doctors and staffers I had seen so far that day, he was warm and friendly to me. He gave me a brief neurological exam, asked me about my symptoms, and reassured me that my head injury would most likely resolve over time. And then he did a very curious thing. He took out one of his business cards and he wrote his pager number on it, and he sat on the foot of my bed and handed me the card. Saying, "This is my number. If you ever need help with anything you just call me. You can reach me at this number any time of the day or night." He said this very definitively while staring directly into my eyes. And then with his best wishes for my recovery, he left. "What a great guy," I thought, and asked my husband to put his card into my handbag.
It was only months later when I was sitting and telling this story while holding the card that he had given me (MR) that I realized what he had meant. He must have known what was going to happen to me, and he was trying to tell me in a way that was too subtle for me to interpret in my head -injured state that when the shit hit the fan, I should call him. Later that day, and on Monday, when it did, I didnt think to call Dr. Rivkin, but I realized months later that, as they had done for Reggie Lewis, the folks at Brigham and Womens would have taken me in if I had only thought to ask. By that time I was too frightened and too confused to think of this, and so was my husband.
While we had been trying to arrange my elbow surgery from Idaho, one of the names we had gotten was Dr. Lucas Brodsky*, a very senior hand surgeon at Newton-Wellesley hospital. He had been friendly and helpful on the phone. It was now turning into Sunday afternoon, and I still had no elbow surgeon at the Baptist. As I was facing being discharged to home with no surgery the next day, we called Dr. Brodsky, and reached him. He was, as before, friendly and helpful on the phone and suggested we speak to Dr. Andrew Terrono, one of the members of the Baptists Hand and Upper Extremity Service first thing on Monday. Dr. Brodsky was willing to perform my surgery, but he was concerned that it would be unsafe to transport me again, considering the severity of my injuries. He recommended Dr. Terrono to us as, "a good guy." And he reassured us that if Dr. Terrono refused to do my surgery, he himself would do it.
We felt better after this, but as the afternoon wore on and preparations continued to be made for me to be sent home on Monday morning, I began to get very frightened. How was I to see Dr. Brodsky or Dr. Terrono if I was being sent home? How was I to get up the stairs to my house? How would I breathe at night? What about my facial reconstruction? How could I survive outside a hospital environment? It seemed insane and retaliatory to both my husband and me for Dr. Karlson to have me sent home the next morning. How would I even get there? I couldnt sit up in a car; Id just fall over, and with a broken neck this could be very dangerous.
Eventually, we became so concerned that the nurses noticed and called Dr. Parazin. He came to see me and reassured me in a general way but didnt explain, for example, how I was to stay at the hospital long enough to get the surgeries I needed or to recover enough to survive outside a hospital environment. When he left, we asked the nurses, who were in my room, how they thought we could get someone to perform my elbow surgery, and one of the nurses said, "Dont worry, tomorrow is Monday, and all the doctors will be back to work. You can just call around tomorrow morning and find someone to do your elbow surgery."
Note here what the nurses didnt say: They didnt suggest that I just sit and wait quietly for someone on the hospital staff to solve this problem for us. If thats what they thought, they would have told us to just sit tight. They understood, as did we, that if we had done nothing, there was a good chance I might simply have been rolled out of there in a wheelchair on Monday morning and left at the curb.
We eventually called my friend Clara, who had been to see me the previous day, and had been quite shocked by the story we told her about Dr. Karlson and the bladder catheter (see the picture on the Fascinating Documents page). She had worked as a medical secretary at both Mass General and Spaulding Rehab and was simply horrified at the idea that someone in my condition would be discharged to home. She told me to ask the nurses to speak to a hospital administrator, and to calmly and politely lay out the problem to that person. "Im sure someone further up in the administration of the hospital will see that this is ridiculous," she said.
And so began the odyssey of trying to get help from someone in authority at the Baptist on a weekend.
We told the nurses, politely and calmly, that we would like to speak to a hospital administrator about my being discharged to home the next day and about Dr. Karlson. The nurse left the room and came back a few minutes later, telling us that we were, "not permitted to talk to a hospital administrator." Stunned, we repeated our request. She said again, with increasing irritation, that patients were not permitted to speak with hospital administrators. If we had a complaint, we needed to talk to the "patient advocate". If thats the best we can do, we replied, wed like to see the patient advocate. She left the room again.
After a fifteen-minute wait, another, older woman, with an irritated expression and angry body language appeared in my room. We told her we would like to talk to a hospital administrator or the patient advocate. She told us in a very frosty tone that we were not permitted to speak to a hospital administrator and that the patient advocate was not available. She said that, "talking to me is just like talking to the patient advocate." We asked again, politely and calmly, to speak to someone in authority with the hospital administration. She replied, shortly, "Im it. Im the only person you get to talk to."
So, reluctantly, we told her about our problems with Dr. Karlson and my fear of being discharged to home the next day. We held back at first, not wanting to badmouth Dr. Karlson to another member of the staff. But after she refused twice to take him off my case, we were forced to tell her the whole story: Dr. Karlsons assault on me, the attempt to remove my bladder catheter, Dr. Karlsons refusing to allow me to see my own EENT, the planned discharge to home without surgery the next day. We had actually prepared a written list in case an extended conversation should become necessary. We gave it to this woman. It subsequently disappeared, and was never seen again, despite requests for document production. Her demeanor changed from irritation to alarm as we told these stories. And she then agreed readily to "transfer me out of Dr. Karlsons care." I felt slightly reassured by this concession. But my relief evaporated at her next sentence. "But who," she asked us, "should be your attending physician now?"
We were prepared for this as well. We had a written list of requests for a new attending physician. At the top of the list was Dr. Rivkin. "How about Dr. Basilico?" she asked. "Thats not a good idea," I countered. I had had dealings with Dr. Basilico before and found him caustic, judgmental and unrespectful of patient privacy and confidentiality. He had been barely civil to me during his brief examination of my heart earlier in the weekend and he did not strike me as the kind of person who would relish having this kind of problem dropped in his lap. "I think Dr. Basilico is a good choice," she said. "No he isnt," we replied. "I dont want him to be my doctor. We dont get along." Then the three of us went though the list. She rejected immediately Dr. Rivkin, the neurologist, Dr. Parazin, the spine surgeon, and Dr. Jenis, the other spine surgeon. At that point, we asked for my case to be handled by any of the residents at all. "No," she said. "Dr. Basilico will be your new attending physician." Once again, we refused, and she became irate. "You dont get to decide. I do, and I have chosen Dr. Basilico. I'm going to contact him right now." Then, without a further word, she got up and stomped out of the room. She never addressed my questions about being discharged to home the next day.
If you read the Massachusetts State patient bill of rights (see Patient Rights at the Baptist) you will see that one of the rights most clearly specified is the right to refuse to be treated by a certain physician. Whether or not you are in a "private referral hospital," you still have this right. It was violated on this occasion, as were several other of my patient rights, such as the right to respectful treatment, the right to choose your physician, and the right to have your concerns addressed by the hospital administration in a timely way. This incident also violated my patient rights under JCAHO standards.
I was terribly frightened at the end of this conversation. The combination of fear and anger that I saw on the face of the nurse, who had been substituted for the patient advocate, who had been substituted for the hospital administrator, did not bode well. I suspected that her refusal to assign me to any physicians who were not financially connected with ProSports Orthopedics (see The Iron Triangle) was a very bad sign. I also suspected that this nurse would lie to Dr. Basilico and tell him that I had asked for him to be assigned to me, in order to divert his anger from her onto me. I found out later, during the interrogatory process, that this suspicion was correct, and that, at least according to Dr. Basilico, she had told him when she called him that evening that I had asked for him specifically. Interestingly, she made no note of this in my medical record and utterly failed to document what I told her about my condition, about my concerns, or about Dr. Karlson.
Although this nurse had assigned Dr. Basilico to my case in the late afternoon, Dr. Basilico did not call or visit me on evening rounds. This struck me as another bad sign. Although I did not realize it at the time, that night marked my second full day at NEBH where, as a bed-ridden, head-injured, multiple-trauma patient, no one examined me, checked on my pain levels or made any adjustments to my medications. I went to bed that night frightened and not knowing what Monday morning would bring. But at least I felt I had escaped from the clutches of Dr. Karlson, and he could no longer hurt me.
Little did I know.