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Communications at the hospital break down, and a teen-age girl dies


May 04, 1992|By Dan Rodricks

Finally, Tiffany got the CAT scan. Debbie and Mark Troch believe it was between 6:30 and 7 p.m. that the examination took place -- 90 minutes to two hours after Tiffany arrived in the emergency room.

"Why this took so long we still don't know," Debbie Troch says. "It seemed like we were waiting forever for the CAT scan. Tiffany said she was cold. They finally took her in for the CAT scan and suddenly, right in the middle of it, the door swung open and the technician running the CAT scan stopped everything and said, 'Get this girl in the OR [operating room] immediately, she has a lacerated liver!'

"I helped them put her back on the stretcher," Mark Troch says. "And they wheeled her back into the emergency room."

(A specialist in emergency medicine, not affiliated with St. Joseph, said in a separate interview that it is common for doctors to "watch and wait" in their treatment of lacerated livers. Two factors -- the liver's snug position in the body, and blood filling the tiny cavities around it -- create an internal pressure that can arrest hemorrhaging. Not every lacerated liver is remedied by surgery, the doctor said. But a patient needs to be carefully monitored for the slightest changes in condition. The body, the doctor said, is under tremendous stress as it compensates for the trauma to the liver. Emergency medical centers and shock-trauma units are best equipped to handle this type of injury, he added.)

The Troches say no suggestion was ever made by anyone at St. Joseph that Tiffany be moved to another hospital, even after the CAT scan confirmed the lacerated liver.

"Finally," Debbie Troch says, "a doctor in blue surgical gear came out to the emergency room. He had been doing an appendectomy on a pregnant woman. He was the only surgeon on duty. He came out and listened to Tiffany's stomach."

"He said that he thought a hematoma [a swelling of blood] was developing against Tiffany's liver and that that was keeping the liver from bleeding more," Mark Troch recalls.

"He said he wanted to call in another surgeon, a pediatric surgeon, to look at her," Debbie Troch says. "And he just said she should be monitored. . . . By now, Tiffany had olive-colored skin. And that surgeon, he just walked away. He went back to the other operation. . . . I was with Tiffany and she was getting worse. Her body stiffened. She was getting scared. I said, 'Try and calm yourself down.' I've been with two people who have passed away, and I know the look. But they were still telling me everything was fine."

After the surgeon left Tiffany's side, the emergency room doctor said, "I'm tired of hospital politics. Your daughter needs surgery now." Both the Troches remember hearing those exact words.

The emergency room doctor offered to call in another surgeon who lived near the hospital. In the meantime, a nurse started giving Tiffany blood transfusions.

When the second surgeon arrived -- the Troches believe it was within 30 minutes -- he calmly leaned to examine Tiffany with a stethoscope. He listened to her abdominal area. His demeanor changed radically in seconds.

Suddenly, the Troches say, the doctor was pulling off his sport coat, ripping back the privacy curtains in the emergency room and shouting commands to nurses. "They tore down the hall with Tiffany," Debbie Troch says. "And they threw me all the papers [consent forms]. I was dumbstruck."

"The doctor handed me his card and said, 'I'm going to try and save your daughter," Mark Troch says.

It was 8:20 p.m. -- the Troches know because they looked at a clock in the waiting room -- when surgery commenced. Three hours and 20 minutes had gone by since Tiffany Troch arrived in the St. Joseph Hospital emergency room. That's what angers the Troches -- the time that elapsed. One moment, Tiffany was being "monitored" under the orders of a surgeon, the next moment another doctor was rushing Tiffany into surgery. The Troches wonder if doctors responded fast enough, if St. Joseph made the proper diagnosis, if the first surgeon who examined Tiffany should have responded more aggressively.

"They were in surgery for two hours," Debbie Troch says. "The [second surgeon] told me they drained eight pints of blood from her abdomen."

"They had to give her eight pints of blood," Mark Troch says. "How many pints of blood in the human body? Eleven?" (Actually, there are about 10 pints of blood in the average adult.)

Tiffany was moved to a recovery room. The surgeon said she had stabilized.

"But we waited and waited and waited," Debbie Troch says. "I knew something was wrong. Three hours later, two nurses came out and said the doctor wanted to see me. We followed them. We spoke with the doctor. He had tears in his eyes. He said Tiffany was no longer bleeding internally, but there was another problem. He said she was suffering from "shock lung."

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