Chapter 10 Chapter VII

Massachusetts, Boston Tuesday, June 6, 2006 Six in the morning: forty-eight Jack first realized that someone was arguing in the distance, and then there was a loud slamming door.For a moment, he thought he was dreaming, but he felt that the dream did not make sense.He opened his eyes, not knowing where he was.He looked at the small fountain bathed in bright sunlight outside the window, and at the inside of the study, and he remembered them all at once.In his hand he held a copy of Georgina A., a nurse at Newton Memorial Hospital.O'Keeffe's testimony must have fallen asleep while rewatching it.

Jack packed up all the malpractice files on the desk in Stanhope v. Berman and put them in brown paper envelopes.It's not easy to put in.He stood up, dizzy for a while, and had to stop. He didn't know when he fell asleep.He'd gone through all the files and was revisiting the parts he found most interesting when his eyelids began to twitch.To his surprise, he was captivated by the material from the start.If it hadn't been for the indirect involvement of his sister in the case, he would have found it a good soap script, with every character alive and well on the page.The talented and hard-working but arrogant adulterer physician, the young angry widow, the laconic and sad widower, the knowledgeable but disgruntled expert witness, assorted other witnesses, and the apparently hypochondriac victim.This was a comedy of human frailty, but unfortunately it involved human life, and eventually turned into a malpractice lawsuit.As for the possible outcome of the lawsuit, based on the data alone, Jack felt that Alexis' worries and pessimism were justified.The self-righteousness and arrogance that Craig displayed in the final stages of his forensics only added fuel to the fire.The plaintiffs' lawyers have subtly tricked Craig into sounding like he's pissed that his clinical diagnosis is being questioned.That's very unflattering for a jury.On top of that, Craig implies that his wife's fault for having an affair with his secretary.

Whenever Jack is asked about the meaning of the profession of forensic medicine, his answer always speaks for the dead, depending on the questioner and the occasion.As he read the Stanhope v. Berman case file, he found himself thinking about the victim most of the time.Unfortunately, she apparently won't be able to testify in court.He secretly wondered how it would affect the case if she could participate in the trial.Thinking about it this way, he felt that she was the key to winning the lawsuit.He felt that if the jury believed that she was indeed the hypochondriac Craig was talking about, then no matter how severe her final symptoms were, even if Craig was really narcissistic, the jury would find the defendant to win.But this line of thinking has a fatal weakness, that is, there was no autopsy at that time, so there was no forensic doctor in the defendant's witness list to explain the real situation of the deceased.

He tucked the manila envelope under his arm and stole across the corridor, trying to make his way down the main staircase to the basement.He hasn't washed yet and doesn't want to be seen.He was just about to go down the stairs when he heard another girl upstairs yelling, followed by another slamming door. Jack shaved quickly in his room, showered and changed.When he came upstairs, he found that Boman's family was in the dining room, and the atmosphere was tense.Three girls eating cereal at the dining table.Craig sat on the couch, his face completely covered by The New York Times, and a mug of coffee stood on the coffee table in front of the couch.Alexis stands at the console, busily helping the kids make sandwiches for lunch.The TV above the fireplace was showing the local news, but the volume was so low that it was barely audible.The sunlight streaming in through the curved windows made it almost blinding.

Good morning, Jack, Alexis greeted cheerfully, finding him standing in the doorway.Did you sleep well downstairs last night? Very comfortable, Jack said. Good morning to uncle, Alexis greets the children, but only Christina does. Why can't I wear that red top?Megan grumbled. Since the clothes belonged to Christina, she told you better not touch them, Alexis said. Is that plane your daughter is on fire on fire?asked Christine. Enough is enough, Christina!Alexis said.In order to take care of Jack's emotions, she also rolled her eyes.There is fresh juice in the refrigerator and fresh coffee in the coffee machine.What do you usually have for breakfast?

Fruit and cereal will do. It has both here.Do it yourself. Jack went to the coffee machine, looking for a cup, when a mug slid across the marble counter, pushed by Alexis.He poured a cup of coffee, added a spoonful of sugar, and a little cream.While stirring, he observed the situation in the room.Christina and Alexis are talking very seriously about their after-school plans.The other two girls said nothing, and seemed still angry.Craig was still reading his paper, which to Jack was blatant defiance. Jack was not to be outdone.He felt that the best defense was offense.He went to the mantel and stared at Craig's paper.And Craig holds the newspaper aloft like a barrier.

Any interesting news?After Jack finished speaking, he took a sip of the boiling coffee. The top edge of the newspaper slowly lowered, revealing little by little Craig's puffy, slack face.His eyes were like bull's-eyes, with dark circles and bloodshot conjunctiva, and he looked like a drunk who had spent the night partying.Although his face is sad, he is wearing a freshly ironed white shirt and a conservative tie. His sandy hair is neatly combed and shimmering slightly, indicating that he has applied some pomade. I'm not in the mood for chatting right now, Craig said angrily. I don't want to talk either, Jack replied.At least on this point we have reached a consensus.Craig, let's put our ugly words first!It was my sister who asked me to come.I'm not here to help you, but to help her, and I might help you by the way.But I also want to tell you that I think it is abhorrent that you should be accused of malpractice.From what I know of you, you are the last person to be accused of medical malpractice.Of course, from my point of view, you have other disgraceful aspects, but those have nothing to do with this case.Speaking of the case, I read the file and got some thoughts.If you want to listen, you can listen, if you don’t, it’s up to you to decide.As for whether I should live in your house or not, that is up to you, and I hope that you and your wife can agree on this issue.I could move to a hotel anytime.

Except for the TV broadcasting the news in a low voice and a few birds chirping outside the window, the room was dead silent and no one dared to move.Craig put down the newspaper with a slam, folded it carelessly and set it aside.After a while, the sound of knives and forks colliding with cereal bowls was heard again on the dining table, the faucet of the sink began to rattle again, and the room began to make noise again. It's good to be clear at the beginning, Craig said.Now, his voice sounds more tired and sad than angry.I was very angry when I heard you were coming.With so many things happening, I don't think it's appropriate for outsiders to intervene at this time, and besides, you have never visited us before.To be honest, I don't want to give you the illusion that you rushed in like a knight at a critical moment to save everyone.You just told me that you don't think so, and I feel better.I welcome you, but I'm sorry, but I'm really not in the mood to entertain you.You said just now that you had some thoughts on the case, which I should like to hear.

I didn't expect you to entertain me either, you've got enough to worry about now, said Jack.He sat down at the coffee table, just diagonal to Craig.The conversation went better than he had imagined.He decided to praise Craig before discussing the case further.In addition to the case file, I also saw several papers you published recently.I am very impressed.Of course, if I can understand it, I will admire it even more. My lawyer intends to use this as evidence that I am committed to medicine.The plaintiff's lawyer has already said in the opening statement that he intends to prove that I am an incompetent doctor.

There's no harm in putting it in anyway.I can't imagine how he handles these papers. I don't know much about lawyers.But I have to say, Craig, I admire you.You are amazing.Physicians I know basically want to do both clinical and research.In medical school, we have this as the ultimate goal, but you are one of the few people who can really do both.And this is real research, not a so-called typical case report pretending to be a research paper. There is no doubt that this is real scientific research, and Craig seems to come alive again when the topic comes up.Now we have more and more in-depth research on voltage-gated sodium ion channels in nerve and muscle cells, and they have been applied clinically.

The paper you published in the New England Journal of Medicine mentions that there are two sodium channels, one cardiac and one neural.What's the difference between the two? The structures of the two are different, and our current research has reached the molecular level.The difference between the two is reflected in the different responses to tetrodotoxin.The difference is huge and fascinating. Tetrodotoxin?Jack asked.Someone in Japan ate the wrong sushi and died of this kind of poison. Craig couldn't help laughing.you're right.That's because the cooks were inexperienced and slaughtered puffer fish for sushi during the spawning period, causing poisoning to diners. Amazing, Jack commented.Craig's spirits are much better, and Jack wants to get down to business.Interesting as Craig's research was, it was too esoteric for him.He immediately changed the subject, saying that he felt that the deceased Patience.Stanhope is at the heart of the malpractice case.If your attorney can indisputably show the jury that this woman is indeed a hypochondriac, the jury will find the plaintiff against the case. For a few seconds, Craig stared at Jack, as if the subject had changed so quickly that his brain had to restart.This, he finally spoke.I'm glad you said that, me and Randolph.That's what Bingham said. Yes, that's right, we thought of going together, which shows that this idea makes sense.What does your lawyer say? Didn't say anything, I remember. I think you should mention it again, said Jack.Speaking of the deceased, I couldn't find the autopsy report.I guess no autopsy was done.Right? No autopsy was done, Craig said.The laboratory results of physiological indicators proved that the diagnosis was correct.He shrugged.No one thought of a malpractice lawsuit at the time.If they wanted to fight at that time, the medical examiner would choose an autopsy, and I would have asked for it. There's something else that I find odd, said Jack.There is a nurse in the emergency room of Newton Memorial Hospital named Georgina.O'Keeffe, who was seeing her at the time.She wrote in the notes that the patient was severely cyanotic.The reason I noticed her was because she didn't mention it when the evidence was taken.I checked again.Of course, the reason why I am more sensitive to this issue is because you said in the evidence collection that you were shocked to see the degree of cyanosis in the patient.And on this point, you and Mr. Stanhope differ greatly. There was a lot of disagreement, Craig said in his own defense, his voice getting a little sombre again.Mr. Stanhope mentioned on the phone, and I am quoting here, that she looked blue, but when I got there, she was severely cyanotic. Ms. O'Keeffe called it central cyanosis, what do you think? Is there any difference between hub and edge here?Her heart failed to pump blood to her lungs in time.She has a lot of deoxygenated blood throughout her body, which is the main cause of cyanosis. What is discussed here is the amount of cyanosis.I agree with you that deep cyanosis does indicate that the lungs are not getting enough blood, or oxygen.But if it is marginal cyanosis, it means that the blood is concentrated in the extremities, so it is not easy to see the cyanosis, or the cyanosis is not balanced. What do you want to say?Craig asked defiantly. To be honest, I don't know myself.As a forensic doctor, I feel that anything is possible.Put it this way: was the deceased on good terms with her husband? Kind of weird, I think.At least not in public.I suspect they are not very close, he never told me about his wife's hypochondriac. We forensic doctors have seen too much, so we are naturally more suspicious.If I do this autopsy, considering the cyanosis, I will look for signs of suffocation or strangulation, and rule out homicide. Ridiculous, Craig said angrily.This is by no means a homicide.OMG! I didn't say it was murder.I'm just saying it's a possibility.There is also a possibility that she has a right to left atrial shunt, which was not diagnosed. Craig ran his hands through his hair impatiently.In doing so, his appearance changed from tired and neat to tired and disheveled.It is unlikely that she has a right to left atrial shunt. how do you know?You find out that she has a problem with her stress test and ask her for non-invasive cardiac imaging, which she doesn't.Also, I couldn't find the problematic stress test report. We didn't find that EKG in the office, but the test results are there.But you are right.She refused all cardiac examinations. That is, she may have a congenital right-to-left atrial shunt, but it was not diagnosed. And even if she did, does it make any difference? Then she has a serious structural problem with her heart or major blood vessels, which involves contributory negligence, because she refused to do relevant examinations after the stress test.What's more, if she did have a serious structural defect, it would have been the same result if she had been rushed to the hospital immediately.That way, the jury will find you guilty and you will win the case. These ideas are very interesting, but they are all empty talk to me.No autopsy was done at the time, so there was no way of knowing if she had any structural abnormalities. Not necessarily, Jack said.It was true that no autopsy was done at the time, but that doesn't mean it can't be done now. You mean exhumation?asked Alexis from the kitchen.Apparently she's been listening. As long as it's not cremated, Jack added. Not cremated, Craig said.The body is still in Pike.Maidow Cemetery.At that time Jordan.Stanhope also invited me to the funeral. Is he the one who sued you about the insufficiency of treatment? Of course.That's another reason why I was surprised when I got the summons and indictment.Why did he invite me to the funeral when he was going to sue me?None of this makes sense. did you go? I went.I think I should go.I mean, I couldn't get her back, and I still hate it. Been buried for almost a year, any difficulty with autopsy?Alexis asked.She came over and sat on the couch.It sounds scary. Not sure yet, Jack said.There are two factors to consider.First, how well the corpses were embalmed.Second, whether the interior of the tomb is dry, or whether the top cover of the coffin is intact.These two points cannot be confirmed until the tomb is opened.But no matter how decomposed the body is, there is still a lot of information to be found. What are you talking about?Christina shouted from the table.The other two girls had already gone upstairs. It's nothing, baby, Alexis said.Go and get your stuff.The school bus is coming soon. That's probably all I can do, Jack said.I'm going to look up the procedures for an exhumation in Massachusetts, and then do an autopsy.Apart from pure moral support, this is probably the only way I can help in this lawsuit.But it's up to you to decide.I listen to you. Alexis looks at Craig.What do you think?she asked. Craig shook his head.To be honest, I don't know what to do.I mean, if the autopsy proves that she does have a serious congenital heart defect, then the failure to get her to the hospital in time will not affect the rescue outcome, then of course I agree.But how likely is it?I think this possibility is very small.Besides, wouldn't it be a disservice if the autopsy found that her myocardial infarction was worse than we expected?I think it's quite risky. Well, said Jack.I'll do it.I'll ask for the details first and then let you guys know.At the same time, you have to discuss it carefully.How about it? I think so, Alexis replied.She looks at Craig. Okay, Craig said, shrugging.I have always believed that more information is better than less information.