Mr. King’s (not real name) surgeon went to a weekend course and learned how to do a laparoscopic cholecystectomy on a pig. He enthusiastically returned to his practice to begin using this surgical method on his patients. One of his first victims was Mr. King. Surgery did not go well and Mr. King was left with a tract that connected his gall bladder bed with his abdominal wall. Bile drained into his abdomen and onto his skin. He developed a painful inflammation of his abdomen called peritonitis and wound infections. Mr. King spent the last three months of his life (September 9 to December 2, 1985) in the hospital, dying inch by inch. When Mr. King’s attorney called me, he requested that I prepare a summary of the medical records. There were voluminous and filled with medical terms charted by his doctors, nurses, and therapists. Mr. King’s attorney explained that under the rules of evidence, a healthcare expert could prepare a summary of medical records (FRE 1006 and FRE 702.) also know as pain and suffering report. I did not realize this pain and suffering report would change my life.

On Friday of this week, 22 years later, I had a chance to share Mr. King’s story with a group of top-flight medical malpractice attorneys, who were learning about the role of a nurse to present pain and suffering.

In the report, I focused on five major areas: intramuscular injections, intravenous and intra-arterial sticks, nasogastric tube insertions, suctioning, and comments Mr. King made. Here are the highlights from Mr. King’s last 3 months.

Injections
Although today many more medications are given intravenously, in Mr. King’s time, intramuscular injections were common. Mr. King had 256 injections into his arms, legs, buttocks and abdomen, including 90 Heparin injections into his abdomen.

Intravenous and Intra-arterial Sticks
Mr. King underwent 8 insertions of central intravenous lines. The skin is numbed with Lidocaine, but the patient still feels the pressure as the doctor pushes the needle through the skin. Mr. King removed 3 of his central lines. He also underwent 3 insertions of needles into his femoral vein in his groin. He was stuck in his radial artery and femoral artery for blood gases. The artery is more sensitive to pain because it has nerves close to it, so arterial sticks are more painful.

Nasogastric Tube Insertions
Insertions of nasogastric tubes are uncomfortable because the tube stimulates the gag reflex. As the tube is irrigated to keep it open, the patient is aware of the fluid passing through the tube. The tube irritates the nose and back of the throat. Mr. King found his nasogastric tube distressful. He removed it on 4 occasions. It was reinserted each time. Mr. King was not permitted to eat or drink for 83 of the 89 days he was in the hospital. He lost 25 pounds.

Suctioning
Mr. King spent 5 periods on the ventilator. He was suctioned to remove the build up secretions in his lungs. Patients find suctioning uncomfortable because the suction catheter stimulates the gag reflex, causes the patient to not be able to breathe while the tube is in the airways, and creates a gasping, coughing reaction. Mr. King was conscious for most of the time he was on the ventilator. His sleep was interrupted every 1-2 hours for his vital signs to be taken around the clock. Patients who cannot sleep for 90 minutes at a stretch begin to show the accumulation of fatigue and may become confused and hallucinate. Mr. King became confused for periods when he had the least amount of sleep.

Comments
I finished the report by quoting from statements Mr. King made to his nurses and doctors. Each quote had a date. His suffering was exemplified by comments in which he begged to go home, asked for his dog, and expressed his fear he was going to die. He suffered up to the day he died when he pushed away from the nurse who was trying to suction him, and he pushed off his oxygen mask.

Mr. King’s attorney asked me to come to court to explain his suffering. I testified based on what was in my report. When I glanced over at Mr. King’s wife and daughter, I saw tears pouring down their faces. I realized the power of this role. Mr. King’s family was awarded a substantial amount by the jury.

Mr. King was the first of the patients whose attorneys recognized the need to bring in a nurse to explain the medical records and what the patient went through. We continued to provide this type of pain and suffering report service today. I am awed by the number of ways people can be injured and the suffering that results.

Med League legal nurse consultant prepare Federal rule of evidence 1006 summaries/pain and suffering report from medical records. Call us for assistance.