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Old 01-15-2013, 10:35 PM   #1
daneyuleb
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Surgery - lethal knife slip in routine surgery?

Any medical experts out there have a suggestion on what relatively routine surgery would be the most plausible candidate for a single knife slip to result in death to the patient?

I'm talking a serious slip--think "surgeon has a seizure" kind of thing.

This would be some procedure that brings the scalpel close to the aorta or carotid, maybe, where one very bad slip at just the wrong time could sever an artery and cause bleeding that could plausibly kill the patient on the operating table. And the more presumed "safe" the procedure the better--not talking "removing a brain tumor" or "reconstructing the aorta" kind of thing, which would already be very dangerous, high-mortality affairs. Rather, a 50 year old man goes in for a routine, non-emergency surgery and never makes it out.

Thanks!
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Old 01-15-2013, 11:30 PM   #2
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My uncle recently had a heart valve replaced. From what I learned - it's open heart surgery and obviously a significant procedure, but at the same time it is common enough that it's pretty routine. Risk of death or complications is pretty small, although it has a lot to do with the patient's health going into the surgery. (i.e. an obese couch potato probably isn't going to fare as well as a marathoner who happened to have a heart attack.)

In fact, I would bet that bypass surgery would have similar outcomes - depends on the patient's health going into the surgery, and of course it's a serious surgery, but it's also pretty close to "routine".

Don't know how it works for your story, but there's also a boatload of regular complications that could occur with any surgery - bad reaction to the anesthesia, infection, etc.
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Old 01-15-2013, 11:44 PM   #3
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Why do you need a "knife slip" to be the fatal event in surgery? Those I suspect to be exceedingly rare in comparison to other unanticipated surgical events that prove deadly. I had a friend die during routine gall bladder surgery about five years ago, due to an unexpected allergic reaction to the anesthesia. A famous football player (Mack Lee Hill of the Kansas City Chiefs) died on the table back in the 1960s during routine knee surgery, due to an embolism. All manner of things can go wrong during any surgery.

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Old 01-16-2013, 12:00 AM   #4
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This would be some procedure that brings the scalpel close to the aorta or carotid, maybe, where one very bad slip at just the wrong time could sever an artery and cause bleeding that could plausibly kill the patient on the operating table.
Seems highly unlikely to me. I expect that any operating table is going to have clamps, hemostats, and suture materials there. One bad slip means the assisting surgeon/nurses leap in and clamp it closed, sew it back together, and give the patient a blood transfusion, yes?
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Old 01-16-2013, 01:29 AM   #5
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Quote:
Originally Posted by daneyuleb View Post
This would be some procedure that brings the scalpel close to the aorta or carotid, maybe, where one very bad slip at just the wrong time could sever an artery and cause bleeding that could plausibly kill the patient on the operating table.
Does the person have to die on the operating table? If so, I agree with what others have said--a reaction to anesthesia is a more common complication. Is your goal here to create a life-altering event for the surgeon? I'm not a doctor, but how about slicing the bowel and releasing its contents into the abdomen? Couldn't this result in fatal peritonitis?
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Old 01-16-2013, 02:32 AM   #6
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Thanks for the replies!

I prefer a "dies on the operating table" scenario but dying shortly thereafter may have to work. Or something less routine--like a bypass.

What I'm really looking for is suggestions for a "safe" operation with little risk factor on an otherwise healthy individual. Some common operation that brings the knife near a vital artery.

Anesthesia or other things like infection/allergic reaction won't work--it's got to be the doctor's doing--and abrupt.

The very simplified gist of the situation: Desperate surgeon fakes a seizure-type episode during surgery at just the wrong time in order to intentionally kill patient and avert blame---or at least avoid conviction.

Just from googling on it (Not recommended--really depressing stuff) I've come across a fair number of horrible stories of people bleeding out on the operating table due to a severed artery--it does happen--but the details can be vague. Evidently, if it's a major artery and the cut is severe, it can happen in minutes, with little that can be done even in a roomful of professionals.

So what's the most feasible common operation where you're working right next to one of the major blood carriers? Something on the thyroid maybe? Not sure what that would be, though.

I have to lie down now. Just reading about this stuff makes me light headed.

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Old 01-21-2013, 06:16 PM   #7
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My sister had an operation to remove some gallstones and she nearly died. They cut into her bile duct by accident and then she started to haemorage and they took a long time to stop the bleeding. She was in the ICU for 2 weeks.

It was only supposed to be a minor keyhole day surgery affair. It turned into a massive operation that she had to get stapled back together from..
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Old 01-21-2013, 09:09 PM   #8
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Sadly I had one distant relative pass away from such. He was going in for what should have been fairly minor surgery for a bowel obstruction and something in his intestine got cut that shouldn't have and he died a few days later from internal bleeding...

I wouldn't say a bypass surgery is ever routine...

If you want the 'knife near vital artery' scenario, there the femoral artery along the inner thigh/under the pelvis that can bleed out pretty quickly. Perhaps the patient is having some sort of benign but sizable cyst removed from around there.
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Old 01-22-2013, 03:08 AM   #9
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Like some of the other posters mentioned, the death would most likely be after the surgery; for example, going in for a gallbladder removal, aorta gets nicked, and the person gets sutured up. Later that day in recovery, the patient would start having blood pressures fall(hypotension), feel weak, and the heartrate would rise (become tachycardic). The abdomen would become slowly firmer, and the patient would experience increasing generalized pain to the abdomen. If no one figures it out, this patient could die of blood loss (hypovolemic shock) in as little as a few hours.

I've seen it quite a bit, but I spent years as an ER nurse in the most dangerous city in America. Lots of hypovolemic shock from GSWs. HTH
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Old 01-22-2013, 11:58 PM   #10
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This is an interesting, but horrific way, to murder someone.

The reason details are sparse in your research...well, *&%$ happens. All surgery is risky.

Teaching hospitals in particular have probably seen cases of accidentally cut arteries. It is a cut artery that will lead to death on the table, especially if the doc is having a seizure--fake or real. Someone has to stitch it back stat and time is short. So your idea is realistic and a real, but hopefully, a rare event.

OP-It's really hard to fake seizures in front of medical people, but the resulting confusion will help the bluff. I'd suggest your doc pee in his scrubs to be super convincing.
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Old 01-23-2013, 03:04 AM   #11
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Wow. Interesting discussion and ideas. I'm a family physician and I think it's a very workable angle. I would have a couple of suggestions:
1. If the surgeon was working in a setting with fewer other medical people around (think office or minor surgery center), a quick cut to an artery could bleed out before staff members could respond.
2. A simple surgery like removing a mole on the neck (by the carotid artery) or on the leg (by the femoral artery) could allow access to a vital vessel that if gouged, could kill in a matter of 1-2 minutes.
3. I agree with the difficult to fake a seizure comment. It's really hard for people to fake this believably. But doing the procedure in a clinic might be the sort of setting where no one would see it -- you could also fake an insulin reaction a lot easier (and this would also have a loss of consciousness).

In most operating rooms, there would be fail safes that would allow other physicians to step in and stabilize the patient -- not so in outpatients centers.
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Old 01-23-2013, 03:35 AM   #12
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I like Plains Pen's idea of using an outpatient surgery center. This also goes well with your idea of a "safe" procedure. Make it a surgery center that is not attached to a hospital, and even if they do everything right after the knife slip, it's gonna take 5-10 minutes to get him to a hospital.

Something to keep in mind... I think in general, with any "minor" surgery, they're not going to be cutting you open in a big way. It'll be more like laproscopic, working in teeny-tiny cuts at the most.
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Old 01-27-2013, 11:32 PM   #13
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As someone with >20yrs experience in a hospital transfusion service, where we do >9000 surgeries a year, here are my observations about your preferred scenario:

1) The patients who have “bled out” because of surgery fell into at least one of the following: they bled after surgery (as noted by the ER nurse); they had major surgery; or were high risk patients to begin with. (The latter two especially do not fit your patient profile.)

2) Any surgeon with a seizure or blackout episode in OR will be immediately benched until a cause for the episode can be found and the likelihood of it recurring can be determined. I find it difficult to believe that your doctor, who is trying to pass off a murder as a mistake, is really ready to immediately sacrifice his/her career in that way. (Besides, as already noted, seizures are hard to fake and the investigation would very likely prove intent.)

3) Intra-op deaths are subject to much stricter accrediting agency guidelines, reporting protocols and follow-up investigations – lots of paperwork. A horrible practice, but one that does occur, is to wheel the patient out of OR as soon as it becomes apparent they will not survive the surgery so it can be documented as “post-op complications”. A surgeon unethical enough to use surgery to kill someone is also more likely to be unethical enough to use this practice to prevent the paperwork, deeper investigation, and messing up his/her statistics. (And don't underestimate that statistics motivation!)
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Old 01-29-2013, 07:32 PM   #14
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Thanks so much for the feedback! Lots of things to think about.

I like the idea of a mole near the femoral artery, something like that might work. I don't mind it being a bit of a stretch, just not 100% implausible.

The faking a seizure bit would be difficult normally, but there will be some extenuating circumstances in the story I didn't go into, so it should work in the context.

I love the idea of wheeling 'em out to avoid paperwork and deeper investigation. Hmmmm....

As for sacrificing his career, this is a desperation move at this point, so he's willing to risk it.

Thanks again for all the info and ideas!
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Old 02-06-2013, 10:12 PM   #15
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As for sacrificing his career, this is a desperation move at this point, so he's willing to risk it.
Just one more comment on that. Have you ever heard of a "god complex"? I wish I had a penny for every time I've heard "But I'm a doctor" as if that M.D. after their name changes all rules of society and even physics for them. Surgeon is typically one of those professions where losing the ability/right to perform the job equals a total loss of identity. Not being able to be a surgeon, even for a little while, would be worse than going to prison - and yet your doc is trying to hide a murder so he doesn't get convicted. If your doc isn't desperate enough to accept that he will be convicted, he's not desperate enough to get his license yanked.
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Old 02-07-2013, 12:17 AM   #16
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Quote:
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Any medical experts out there have a suggestion on what relatively routine surgery would be the most plausible candidate for a single knife slip to result in death to the patient?
None. People die from anesthesia issues, but never from a "single knife slip."

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Old 02-07-2013, 12:30 AM   #17
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One more thing: some states (but not all) will suspend a person's driver's license for a few months after a seizure. You might want to check the law in the state where your book is set just to make sure, especially if your character is driving around a lot after his "seizure."
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Old 02-07-2013, 12:57 AM   #18
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I had a minor thyroid surgery on the 16th, so I didn't read this thread until today -- but my thought would have been a removal of thyroid and if the surgeon sneezed, it could cause a slip. Easy enough to fake.

Now if I could only not think of this thread as I go into my next biopsy surgery scheduled for later this month !
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Old 02-12-2013, 11:29 PM   #19
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Surgeons can not make enough income to pay their bills unless they are doing surgery. Depending on the location a single siezure will take away the surgeon's driver's licence for 3-12 months and probably bar them from the operating room for the same. If they are in a group, they might cover the others' office while the others cover his or her cases and call things even, unless the partners don't get along and they might cut their loses.

Also a siezure means a work up and failing to find a cause means suspicion of foul play.

Contrary to what some have said, there most likely is not anyone to "jump in and fix a severed vessel." If the surgery is not on video (eg laparoscopic) then realistically only the surgeon can see what's going on and the only way an assistant would know that there is a problem is when suddenly they are suctioning out copious blood and then the anaesthesiologist announces that, "pressure is dropping!"

If you want it to be a bleeding out scenario, you need to look at a surgical atlas and find a large vein near the site of surgery. Veins are much more difficult to repair than arteries. The Aorta is not going to normally be visible during a gall bladder operation and an injury to that would be considered outside the norm and result in an inquiry. However an injury to the hepatic vein during during a GB would be difficult to repair and would be within the scope of the surgery. Also surgery centers would unlikely have the necessary supplies to repair it. The surgeon would have to pack the wound and transport the patient to a hospital. He could simply not pack it properly and the patient would bleed to death en route and then blame jostling for dislodging the packing.

Another common procedure near a big vein would be a tubal banding, where the iliac vein might be injured while performing the elective sterilization
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Old 02-14-2013, 10:53 AM   #20
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Rather than knifing the patient, how about something a bit less bloody? Patient have any allergies? How about exposing him to an allergen while he's knocked out? If he has a drug allergy, possibly deleting that info from the medical files? Or smearing some peanut butter/peanut oil on the instruments?
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