Seventeen days after his liver cancer surgery my husband died, to the surprise of
everyone including his liver surgeon. Seven weeks later I took the surgeon to lunch in
New York City to ask what happened.
I was thirty-seven-years old and suddenly a single mother of a four and two-year-
old. As patients and their loved ones often do, I had given my total confidence to
whom I call Dr. Dan Accudia. Dr. Accudia was a petite dynamo in tailored Italian
suits. He had brown hair, alert brown eyes, precise language and a warm manner. He
had studied medicine in Italy and France. He turned to Italian poetry when conflicted.
He believed in aggressively cutting out cancer along with the lymph nodes where
cancer hides. Before the operation, Dr. Accudia told Bob and me that he had never
lost a patient, but that the numbers would catch up to him. He said that while any
surgery involved risk, in terms of being in trouble Bob was a 7, and he was used to
operating on 14’s. He put the risk of Bob’s death at 1%.
Dr. Accudia estimated that Bob’s operation would take four to six hours. It lasted
eleven. After the surgery a clearly exhausted Accudia explained, with a trace of
disgust in his voice: “There was so much faaaaaat!” Bob was overweight, but the
surgeon knew that going in. I felt anger, but made an effort to let it go, figuring that he
was used to working on patients hollowed out by their disease – all those “14’s.”
After the surgery Bob’s recovery was slow, but I always believed he would pull
through. Eighteen months before, Bob’s colon surgeon had nicknamed Bob “the iron
man of colon cancer,” because of his speedy recovery from that earlier operation. But
on St. Patrick’s Day morning I received a wake up call from the hospital, “We are
keeping him alive until you get here.” By the time I arrived Bob wasn’t able to
communicate. I covered his hands with mine, kissed his unmoving lips, pressed my
cheek to his and whispered into his ear, “I love you and I’ll take great care of
Rhapsody and Bucky.”
Dr. Accudia did not come to the hospital that morning. I didn’t understand this,
called his service and he called me back from home. He said he was sorry for my
loss. As I stood in an empty hospital corridor I wanted to say, “Where are you?” but I
didn’t. I had a habit of going silent when conflicts arose. For a minute he listened to
my silence while I listened to his crying toddler. I swallowed my anger. I had
entrusted Bob’s life to this man. I still wanted to believe in him. Two days later I faxed
him a letter saying, “I know you work hard. I know you care. I know sometimes
you can’t drop everything, you have a personal life … But I want you to know
when the next Katie goes through a moment like this - be there and hug her -
because you are the last person who touched and knew a love of her life…Fate
allowed me to hug Bob’s favorite nurse, but I also needed to hug you, his
doctor.”
I waited two days and heard nothing. I was so tired of chasing him and the hospital
for dialogue and support. The third day I left him a voicemail. Still no response. Every
time the phone rang I found myself holding my breath. I thought he might come to the
memorial service. He didn’t even send flowers. What did I want from him? One
morning while Bob was still alive, Dr. Accudia had reassured me after a disheartening
setback: “I don’t normally say this, but I feel it’s going to be all right.” Now I was
feeling the need to see him. Two days later I drove to his Greenwich Village office.
Bob, who had been fourteen years my senior and a former Broadway scene shop
owner, used to say, “Surprising someone is a good bullshit detector.” I knocked on
Dr. Accudia’s frosted glass door, “Come in,” he said. Seated behind his desk his eyes
popped, then shrank. I saw fear close up.
He came around from his desk and hugged me. He asked me if I knew I was a
writer. He had been impressed by my fax (although apparently not enough to
respond). No, I didn’t know; I had been a budget analyst, computer programmer,
Director of Guest Services, and Vice President of Ticketing, and had taken one
playwriting course years ago. I noticed the happy pictures of Accudia’s wife on his
wall. I wanted to shred them.
I told him, “Bob and I had a love people immediately saw and wanted.” Dr.
Accudia groaned and drummed his fingers on his desk. Then he said, “This has
changed me. I think I know why Bob died.” I went into my silent mode, waiting for
him to tell me his discovery. Instead, he said, “I wasn’t supposed to be in the office
today,” then he added mysteriously, “but maybe I was.” I wondered if he was trying
to gauge my state of mind, calculating the odds that I might sue him for malpractice.
He said he wanted to take some time to help me “understand,” but he couldn’t that
day. He was “empty.” He held up a liter water bottle sideways, showing me there
was nothing left. “Like this, see?” He was going to go the gym to replenish and asked
me if I understood this concept.
I told him I was angry. His fingers covered his lips as we looked at each other.
Then he removed his hand and said, “Your anger … is at the hospital?” I looked at
the floor. I heard a siren outside. An image rose in my mind: the Brillo-haired head
nurse with the clipboard who wouldn’t let me sleep in Bob’s room because he wasn’t
“terminal.” “Yes,” I said, barely aware that he had diverted my anger away from him
and towards his institution.
Dr. Accudia asked if I had family nearby to support me. My parents and siblings
lived thirty minutes from my home. He told me how helpful counseling had been for
him, and asked if I had considered it. I told him I had been to a psychologist on and
off for ten years. Then he told me how he sometimes felt his deceased grandfather’s
spirit by his side when he needed guidance. “Have you ever experienced anything like
that?” he asked me. I hadn’t. “No one close to me has died until Bob,” I said. Dr.
Accudia said he would get back in touch with me soon, during a week when his
surgery schedule was lighter. We would take our time going over what happened till I
“understood.”
The day after my surprise visit to the doctor’s office I wrote him another note:
Dear Dr. Accudia,
I needed to see if you were a man or a shell. I like that you turn to poetry to
help you understand, Bob turned to Buckminster Fuller and I choose Stephen
Sondheim.
Enclosed is a parking ticket I received while waiting to meet you. You had
promised to always call back within twenty-four hours. You didn’t. This is what
prompted me to show up at your office. Karmically speaking, this ticket is yours
(and physically too). In the future, I promise to always make an appointment.
Warm regards,
Katie
Weeks went by. Sometimes his assistant called to say, “Not this week.” When I
prodded her, she assured me he’d get in touch soon, but he didn’t. I had already
spoken to all the other doctors on his team; none of them could, or would, tell me the
exact cause of my husband’s death. Dr. Accudia had always returned my calls when
Bob was alive. Was a surgeon’s job over when the patient died? As angry and
frustrated as I was, I found myself making excuses for him: “Look,” I told Bob’s
parents, “he has been paid by the insurance company. He's a busy man, and the
conversation is not something he is looking forward to, but I believe it will happen.”
One morning I woke up with the shameful thought that maybe I had a crush on him.
“He’s a cutie,” Bob’s sister had said at the hospital. I felt such relief when she spoke
this. “He’s a small man with a big presence,” my best friend had said. He was sexy in
his hospital greens. It was certainly true that part of me wanted him to be my friend
and help me through my grief. In a way, he was my link to Bob’s last days. I needed
something from him. I would only know what it was when we met again face to face.
I emailed him, “Is there another parking ticket in your future?” Six and a half weeks
after Bob’s death the phone rang and I heard his voice, warm but somehow distant,
like an aloof yet loving parent. We agreed to meet the next day for lunch at Capsuto
Frères in Tribeca.
I rode the boat over from Hoboken to Battery Park and walked up along the
river, clutching my big black leather Coach bag with the six pages of questions I had
prepared. I put my lipstick on while looking at my reflection in a glass building. Dr.
Accudia was standing outside the red brick restaurant when I arrived. He was in
khakis and a dark green Izod. He looked an ordinary man, not a super hero doctor
who colleagues said, “in surgery, the knife dances in his hand.”
Bob had taught me you have to ask the tough questions. I had always been more
like my mother, the good girl who collected facts and smiled a lot. In my experience
confrontations always involved yelling. I didn’t like yelling. But today I was
determined to try Bob’s way.
We spent the first two hours talking about life. His life. Dr. Accudia’s grandma
had taught him patience. She’d say, “Dried shit doesn’t stink,” so he learned to leave
some things alone. His wife was Scandinavian. They had two daughters and ate
goose dinners at Christmastime. He was the cook for his family just like Bob had been
for mine. He picked up the milk walking home after a day of surgery, and once a
month shopped at Costco. “Paper towels are cheaper,” he said. His family lived in
the West Village and he complained about the flagrant gays. I laughed.
At the beginning of the third hour, with the entrees cleared away and the
Pellegrino in our glasses going flat, I reached into my bag and took out my six pages of
questions. In honor of the McLaughlin Group, which Bob had watched every Sunday
morning and now I didn’t have to, I said, “Issue One,” and paused for dramatic effect:
“What did you learn from Bob Kaiser?”
Accudia looked at me and groaned. His fingers started drumming on the table,
and when he spoke he emphasized the key words with a firm tap: “That tap-- is
exactly tap -- the right question tap -- to ask tap.”
When I was a little girl, I had to raise my hand at my parents’ dining room table to
speak. My mother would shush everyone, and seven sets of sibling eyes and two sets
of adult eyes would turn toward me, waiting for little Katie to say something
worthwhile. It was hardly surprising that as an adult, I had trouble making myself
heard in company. But sitting across from Dr. Accudia, I felt like a grown up. I had
spoken up and the famous surgeon was telling me I had asked the right question.
This was his answer: “I no longer perform two surgeries in one day. It is too difficult to
isolate the variables when there is a problem. I cut the only blood supply to your
husband’s first-surgery colon stitches and that part of his colon died. I now perform
the lymph node and liver surgery six weeks apart.”
As the words sank in, I felt as if all the air had been knocked from me. I doubled
over. My arms wrapped around my waist and I rocked back and forth in my chair. I
hadn’t thought ahead about what his answers might be. I had thought only about having
enough courage to ask my questions. He had just told me he was responsible for Bob’
s death, and I didn’t know what to do with this information.
Dr. Accudia looked distressed. He asked if I could go on. I took a few big
breaths and told him I could. On the back page of my questionnaire he drew a picture
of Bob’s colon and liver. “There,” he said. “I cut there and that was the only blood
supply when usually there are many.” I couldn’t believe my husband was gone
because of one tiny misdirected snip. Bob had said many times, “I want a miracle or
an exit. I don’t want a slow drip death.” Had Dr. Accudia done him an unintentional
favor?
For another hour we sat at the table as I went through all the other questions on
my list. We talked at length about the care Bob received in the hospital. But
everything else seemed so inconsequential now. It struck me that the famous surgeon
had come to this meeting without a lawyer, willing to talk about his fatal mistake. Was
this a sign of supreme confidence? In himself? In me?
Leaving the restaurant, I grabbed some matches. Dr. Accudia said, “You collect
them too?” He got in a yellow taxi. I watched it drive away. I wondered if he’d ever
cried about Bob.
For the next two days one word kept surfacing in my mind: intent. Dr. Accudia
didn’t intend for this to happen. He’d done the best job he could that day; I was
convinced of that. But I also knew that a person’s “best” changes from day to day.
The only possible constant is our ability to learn from experience. Was that letting him
off too easily? Or was my forcing him to confront me with his confession a harder
challenge than a lawsuit that could at worst increase his malpractice insurance? I
wondered if he would ever forget the expression on my face when he answered my
first question.
Two days later I sent the surgeon another note:
Dear Dr. Accudia,
I chose to address this letter using your formal title instead of Dan because
what you did on Friday deserves respect. Bob treasured the truth. You honored
his spirit by revealing it. I honored him by asking for it. It was as good as it gets
for us mortals.
When Bob and I went to California in February he went to the Regusci
Winery specifically to buy you wine. Your strength, integrity and generosity with
me earned this wine. Bob was a big roll-the-dice kind of guy. Maybe you were a
gift to him making his exit quick and because you learned, you’ll be a gift to the
next guy who wants it slow. It is all in how you look at it.
Drink to Bob, a fabulous spirit, who will live on in the lessons we’ve learned.
Warm Regards,
Katie