Been through some rough times lately.  Things were going okay, in fact I was looking forward back in April to running Phillie’s famous Broad Street Run on May 5 .  With only a week before the race, I was coming off a week of hospital call.  That always requires some recovery time.  But this week, which ended April 21, was particularly rough.  In a short phrase, there were a lot of sick folk.  The following week, I seemed to be coming down with a virus.  I developed shaking chills, fever, muscle aches, in other words all the typical viral symptoms.  Oddly, though, they also seemed to come and go.  One half of a day I would be in the grip of the ague, then a few hours later, I’d feel back to my normal self.  By the end of that week, it seemed to have passed.

That was just hopeful thinking.  The following week, the virus changed it’s tactics and decided to attack my intestinal tract.  While I no longer had the shakes and chills, I couldn’t eat anything without it seeming to pass through me in two hours, and not stop to get absorbed.  So, I stopped eating, took only tea, and managed to make it through the next few work days without cancelling anything.  At the same time, my trial was about to start.  As a physician, I was being sued by one of my patients for allegedly going outside the standard of care and causing her harm.  This trial had been scheduled originally last September, then October, then November, and then February.  Each time I was told I needed to cancel all my usual clinical duties and be present at the courthouse.  I would need to testify, but also be present to listen to all the other testimony of expert witnesses.  A colleague of mine was also named in the suit and would likewise need to suspend all his activities.  Each time the trial was scheduled it was cancelled for the lawyers’ or judge’s conflicts with other trials.  This time, starting Thursday of the week when I’m in the throws of my GI hullabaloo, I was told it was definitely going ahead, since it was the oldest case on the judge’s docket.  Thursday was jury selection day.  I presented to the courtroom as instructed, and jury selection commenced.  It took a full day, but a jury of eight was chosen.  Meanwhile, I was getting a bit weak, having no real food for two days.  Not wanting to run in and out of the courtroom, I didn’t dare try to eat something that day.  The actual trial was not to start until the following Tuesday.

By Friday, the evil GI virus seemed to have run it’s course.  I was able to take in solid food again, and start to rebuild my strength, which had taken a real dive.  By Saturday, I was still feeling a bit dizzy and washed out.  But the Broad Street 10 miler was coming up Sunday, and I really wanted to run it.  It’s a big event in Philadelphia, with over 40,000 registered.  It’s the largest 10 miler in the country, and a big celebration.  This year, it would also stand as a tribute to the Boston Marathon and the awful events that took place there a few weeks earlier.  So, Saturday morning I went to the expo to pick up my number.  Sunday, I joined my fellow club members at 5:45 AM to carpool to the race.  It is a point to point race starting at North Broad Street, and heading straight down 10 miles to the end of Broad Street at the Philadelphia Naval Yard.  The only turns are around the Philadelphia City Hall, which sits in the middle of Broad Street between the five and six mile points of the race.  It’s known for being a fast course, and many of the speedier, younger runners look for a sub-one hour time.  We parked near the end of the race in the sports arena parking lot, and joined our fellow runners on the Broad Street subway heading north to the start.  It is an interesting site to see several thousand runners cramming the subway trains in their running shorts and singlets, numbers on.  It is not the usual workday subway scene.

The organization of the race was superb.  It went off on time, the corals were well organized, and even the increased police presence was organized and really not intrusive.  I could tell though, that this was not going to be a record setting year for me.  I probably should have listened to my body, as they say, and not run, because of being so ill the week before.  I was never really able to get into gear and push myself, and as I was coming up to mile nine, one of my friends from another club passed me and said I looked like I was “hurtin’.”  I made it across the line in 1’23”, much slower than I predicted.  But it was a nice day for a race, and I joined my club members afterwards on the grounds of the naval yard, to drink water and have a nice, fat Philly pretzel.  Our goody bag after the race also included a couple of Tastykake bars and some Peanut Chews (designed to pull fillings and destroy dental caps), all products of Philadelphia.

Some of our SJAC club members at the Naval Yard after the Broad Street Ten Miler, 5/5/13

The following day, Monday, was not a trial day, so I had cases scheduled all day in the OR.  At the end of the day that day, I noticed my hands and ankles seemed to be swollen.  I woke up the next morning with the swelling even worse, and I seemed to be having a hard time walking.  I went to our usual Tuesday morning conference at the hospital, then headed to the courthouse for the trial to start.  Everything felt tight.  My watch, which usually dangles a bit on my wrist, was stuck in one spot and making an impression on the skin.  My shoes felt tight.  When I made a fist, my skin looked taught over the tendons, and I couldn’t see them clearly as I usually would.  My co-defendant and I sat through the first day of testimony, paying attention to the plaintiff, taking notes, and discussing things with our lawyer.  That afternoon, though, after court adjourned for the day, I headed back to the hospital to make rounds.  I found my own physician on rounds, and told him about my week of GI bug, the race, and now the swelling.  He thought it could be some acute kidney injury, or a post-viral syndrome, and had me get a few blood tests.  I actually carried through with the tests, although as a doc, one must write one’s own prescription for these things.  The following morning I found out that my BUN and creatinine, measures of kidney function, were above normal, and my CPK, a measure of muscle breakdown, was on the high side of normal.  Texting this info to my physician, I was told it looked like I had suffered a bit of acute kidney injury, probably from racing after a week of little or no food, and that with proper hydration and time I would recover.  This is very scary.  I should have known better, and not run the past Sunday.  I was definitely foolish, but had gotten drawn in because of the commitment to run and the nature of the race.  I did as told, stayed well hydrated, and slowly recovered.  By Friday we had heard most of the experts testify, and it was now our turn to take the stand.  My co-defendant went first and did a good job answering sometimes difficult and lengthy, convoluted questions.  I looked forward to being able to give my story.  I hoped the jury would not only believe me, but feel I had done the best for the patient.  This is an anxiety producing position to be in as a surgeon.  I feel perfectly comfortable in the OR, but not in the courtroom.

That weekend was Mother’s day weekend.  My wife and I took a short trip to visit a friend in Mt. Kisco who is leaving for the West Coast, and a new job in Silicon Valley.  It was a very relaxing two days.  I got in a run on Sunday, in the hills near the Hudson River. We visited my younger daughter and son on the way back home, and drank a happy Mother’s day beer.

Kat and Dan at his house in Mt. Kisco.

We were back in court Monday for the last of the expert witnesses.  Tuesday was the day for the attorneys to give their final arguments.  It took the judge about two and a half hours to give the jury their instructions, which were fairly complex.  They had to consider whether they thought my co-defendant and I had deviated from the standard of care, each of us separately.  If so, they would need to decide to what percent her pre-existing conditions contributed, how much her pain and suffering were worth in dollars, to what degree we had contributed to that, and several other issues of reward should we be found at fault.  As it turned out, they took about an hour to decide that both my co-defendant and myself had, in fact, done the right thing, and were not guilty of negligence or failure to perform according to standard of care.  I had already left the court because I needed to get back to the hospital.  When I got the call from my lawyer that we had won, I was elated.  I was not happy because we had beaten the other side.  I was very disappointed the patient felt we had not done well by her and that she needed to sue.  I was happy because we had successfully shown to a lay jury that we had done, at the very least, an acceptable job within the standards of care.  Was this a Pyrrhic victory?  This comes from the Greek King Pyrrhus of Epirus, whose army suffered considerable losses in defeating the Romans in 279 BC.  He felt that if he had to fight another battle, he could not, as the toll extracted would be too great.  For me, taking the two weeks away from my usual work does not really harm me, other than the anxiety it produces.  The patients that depend on me have to wait, a number of surgeries needed to be postponed, and it’s not possible to make up for that lost time.

With a strange virus that took a long time to run it’s course, causing mayhem in the process, to a “touch” of acute kidney injury perhaps brought on by my own foolishness, to having to defend myself in court, it has been a tough few weeks.  I know I’ve learned a lot from the experiences of the last several weeks, I just haven’t figured out what I’ve learned so far.  Now, though, I can return to my usual schedule, get back to work and get things done.  That is, after I return from a trip San Diego to see my oldest daughter graduate from her MBA program.

Frank K.