Could she have lived?

August 13 2001

Could she have lived?

August 13 2001

Could she have lived?

In 1998, 73-year-old Betty Hawaleshka died in the Montreal General Hospital,

18 hours after being hit by a van while crossing a street. It is unclear whether her life could have been saved, given the severity of her injuries. But her son,

Maclean’s Associate Editor Danylo Hawaleshka, is troubled by a coroner’s critical appraisal of the treatment she received in the hospital.

I DON’T KNOW IF THERE’S A GOOD WAYTO DIE. I JUST know the way my mother died was awful. And I’m not the only one who feels that way. A coroner investigating her death concluded that staff at the Montreal General Hospital badly botched my mother’s care after her accident. My sister, Doris Hawaleshka, gave me the report about a year ago, but I couldn’t bring myself to read it until recently. The coroner stops short of blaming my mother’s death on the doctors and nurses because her injuries were so severe, but boy, were there some knuckleheaded mistakes.

Doris and I called our mother Ma, but her given name was Berta Schnurch. Everyone else called her Betty. She was a shy, hardworking, stay-at-home mom who kept the house spotless and loved to bake cakes and cookies. Originally from a German-speaking part of Czechoslovakia, my mother immigrated to Canada in the early 1950s to marry my dad, Gabriel Hawaleshka. I came first, then my sister.

As much as I want to, I expect I’ll never forget Saturday, March 28, 1998. On that gloriously sunny spring day, my mother headed off to the grocery store on foot as she often did. While crossing Angrignon Boulevard, a six-lane thoroughfare in southwestern Montreal, she was struck by a Ford Econoline van. I hate to say it, but she shouldn’t have been crossing there. She was 30 m from the intersection, not a good idea for a woman losing her eyesight to macular degeneration. Because of her deteriorating vision, my mother wore heavily tinted sunglasses outdoors. I kept the shattered frames for two years after the accident.

When the ambulance arrived at 1:37 p.m., my mother was conscious, lucid and alert. She said her hip, heel and arm hurt. Her vital signs were normal. They braced her

neck with a cervical collar and sped her off to the General’s emergency department, arriving at 2:03 p.m.

The trauma team that day was headed by Dr. Al-Jubab Abdulwanab, a fifth-year resident who would later return to Saudi Arabia without testifying at the coroner’s inquiry in May and June of 1999. Al-Jubab was assisted by Dr. Stephen Kantor, a second-year junior resident at the time. They noted my mother was stable and alert.

They sent Ma for X-rays at 3 p.m. While in radiology, she passed out when they took the oxygen mask off to turn her on her side, but revived when the oxygen was readministered. Al-Jubab and Kantor wrote in her file that Mas pelvis at first appeared normal, but based on the X-rays, later noted it was fractured. Coroner Robert Giguère writes that the General’s staff returned Ma to emergency at 3:30 p.m., instead of sending her to the trauma ward where she would have been under constant watch. Her blood pressure was good, but her heart rate, at 106 beats per minute, was a little high and a possible indication that she was bleeding internally. An elevated heart rate can be a sign of shock setting in. This is where things went to hell in a handbasket.

In the official report, Giguère notes my mother was left “parked” in emergency, unattended for an hour during a shift change. This is astonishing considering she had multiple fractures of her pelvis (which often cause bleeding), several broken ribs, a fractured left leg, had lost consciousness, and at the time was taking an anti-coagulant called Coumadin for a heart condition. The Coumadin would only make the bleeding worse.

At 4:30 p.m., head nurse Josée Maurice, who had just started her shift, came around and discovered my mother had vomited a large amount of undigested food. She was unresponsive and her jaw was tightly clenched. Ma was slipping into a coma. (In fact, she never regained consciousness.) Over the next 90 minutes, my mother’s blood pressure plummeted, and fluids were administered to try to improve her deteriorating condition. While still unstable, she was shipped to the surgical intensive care unit, where Dr. Ali Majeed Asgh Hussain would preside over my mother’s final hours.

At the time, Hussain was assigned to the orthopedics department, but was standing in for a colleague in intensive care. There was no senior resident on hand, which Giguère considers “unjustified.” Ma’s

A coroner’s report leaves a Macleans editor wondering if errors cost his mother her life

hands and feet were cold and blue when she arrived at about 6:15 p.m. Hussain realized she might be bleeding internally and planned to revive her by administering more fluids (too much, as it turns out) and blood. Throughout the night, though, my mother’s condition worsened. She suffered a cardiac arrest around 11:20 p.m. and another about 80 minutes later. Xrays taken at 2 a.m. showed a massive amount of fluid in her lungs. Blood tests an hour later indicated poor circulation. She was in very bad shape and fading.

Hussain consulted the doctor on call and they decided, after talking to me and my family, that if her heart stopped again, she should not be resuscitated. Her brain would have been too badly damaged when the blood flow stopped during her previous cardiac arrests. Betty Hawaleshka died at 7:35 a.m., March 29, 1998, with her husband, my sister, my wife, Stavroula Logothettis, me, and family friend Peter Melrose at her side. It was another beautiful, sunny spring day, and I never felt worse. At the time, I had no

idea how abysmal her care had been.

The final picture is not good. Everyone who testified at the coroner’s inquiry relied on Mas incomplete hospital file to recall the events of the prior year. They only vaguely remembered my mother—understandable I suppose given how much time had passed. Still, it hurts to think such a violent, needless death can be so easily forgotten.

In his report, Giguère states the way the doctors and nurses maintained Mas file was “far from being exemplary.” He points out how notes were often illegible, the hour was rarely mentioned, no notes were entered during critical periods, prescriptions were administered but not recorded, and notes were added after the fact without the author’s initials. Gaps in the record, he said, made it impossible to recreate what happened precisely.

Still, some things are clear. Giguère concludes that my mother was abandoned for an hour during a shift change in the emergency ward; she was unstable when she was sent to intensive care; neither Kantor nor Hussain was able to properly diagnose the magnitude of her hemorrhaging; she was given too much fluid, in a ratio of 13 parts fluids to one part blood (an expert witness testified that the proper ratio is closer to 3:1); and that Hussain did not seek help in time from the on-call physician.

Giguère says he cannot conclude my mother’s death was avoidable. “Indeed,” he writes, “even if the shock had been better treated and sooner, it is far from certain that we could have stopped the hemorrhaging.” The question that raises—could the hemorrhaging have been stopped?— will never be answered. My family and I will just have to live with that. E3