So, over the next few weeks, I had to meet with my lawyer again several times mostly to go over exactly what happened in the case - again it was hard to read all the chicken scratch and figure out whether the notes by the docs and RN’s were timed correctly to put everything into a nice time ordered succession of events. At the end of all this she said that based upon the fact that I had written that I was suspicious of SAH and admitted the patient, I had a good chance of being excused from the case - but I should not hold my breath. The hospital might want me to stay in the case - although not as a defendant but as a witness to what happened. Great. Fingers were crossed.

Time passed slowly and I began receiving huge reams of paperwork at my house - depositions and other trial materials I was expected to read. The amount of trees killed in a trial is beyond comprehension I soon began to realise. One by one, I got the depositions of the plaintiff and her family, the MD who saw here in his office, the neurologist, two radiologists, the two residents, and the neurosurgeon. I read through them all - and with the exception of the neurosurgeon’s, they were tortuous to get through. The questions were all over the place, the answers from the plaintiff and her family even more so. It was nearly impossible to figure out the way the patient really felt when she came to the ED and how she felt on discharge - she kept changing her story and I am sure some of it was lost in translation owing to her lack of English speaking skills. Thank God I admitted her! The residents basically claimed they were following their attending’s and the neurologist’s orders and that the patient “felt better” on discharge. The reason the neurosurgeons was so easy is that all he said was that he never consulted “officially” on the case - he never saw the patient during the admission and it was only a “recommendation” he provided to me over the phone. They did not have much more to ask him. The neurologist stated in a circuitous fashion that the patient’s symptoms were likely not due to the any impending aneurysm rupture since the LP results were ultimately read by the lab as “supernatant clear” indicating no xanthochromia and thus a negative, traumatic tap. Of course this is possible but hard to prove. But my subsequent research has netted me some interesting data.

If a patient has a positive tap (xanthochromia or non-descending numbers of RBC’s in subsequent tubes), the only way to fully exclude an aneurysm is to do a full-bore interventional radiologist - performed old school angiogram. Although obviously if you see one on CT angio or MRA, you have your answer but a negative scan does not fully exclude them. In fact, if the angiogram is negative, you are obliged to RE-TAP the patient - if it is still positive, you have to do another angio! Some neurologists might go through THREE rounds of this to feel comfortable enough with diagnosing a cerebral venous bleed (as apposed to an aneurysm leak) for which there is nothing really to do. I never realised how much chance MD’s are taking by banking their luck on CT’s and MRA’s. Of course most people with a negative scan don’t have an aneurysm but sooner or later you are going to miss one if you don’t do the whole prolonged work up. Again, all this just made me hate headaches as chief complaints even more.

One of the interesting things you find out when you read a deposition given by an MD is a record of all the lawsuits they have had against them. I was shocked at the number of cases the neurologist, radiologists, and especially the neurosurgeon had against them. I was not looking forward to that aspect of my career.

Then, 8 months later, I received yet another letter from my lawyer, opening it, I assumed it was the date when I was supposed to give MY deposition (which I had prepared for by memorising the medical record). However, I was rewarded by a shock. I was dismissed from the case by the judge after they received my lawyer’s request! What was so abundantly clear to me was suddenly clear to the person that mattered and I was off the case. No more paperwork came , no more calls, - just back to the grind waiting for my seven years to pass when I should on average get my next lawsuit!

Kind of anticlimactic I know, unlike Whitecoat’s trail which has me riveted!