Practice, Delaware Valley Hospital
Delaware Valley Hospital, where I had served my internship, was growing. Ed Carroll was chief of medicine and Tony Cilliberti was his partner. They did standard internal medicine as it was practiced in those days. They were looking for someone to do endoscopy and at that time DO internists trained in endoscopy could be counted on one hand with a finger or two left off. I had an added advantage in that I could implant transvenous cardiac pacemakers. They asked me to join them in practice and the contract they offered was extremely lucrative. Going back to Pennsylvania and being near family was an added incentive so I took the job and we moved.
We bought a lovely home in Newtown Pennsylvania and the girls enrolled in some very good schools. The hospital was only 15 minutes away and was very convenient for me. The hospital was a step up from Traverse City and had a full complement of ancillary specialists if we needed consultation. I was happy doing general internal medicine and all of the endoscopy. Ed Carroll handled all of the politics and I was delighted not to be involved. Practice was fun and I was having a great time. I developed a large following of loyal patients and was content with the arrangement.
Several years went by and I accumulated a barrel full of money. I would probably still be there if it weren’t for the following event:
It was a Saturday evening. I was home with the children when the phone rang telling me to come to the emergency room stat. Ed Carroll was brought in with chest pain, falling blood pressure and critical. In those days we did not have cardiac monitors so what we did was to set up an electrocardiogram and monitor the rhythm on a standard lead two. The admitting 12 lead electrocardiogram was classic for myocardial infarction. I started an IV and gave him morphine for pain and ordered an oxygen tent (we didn’t use nasal oxygen at that time, only oxygen tents). After 30 minutes I thought he began to stabilize when suddenly the cardiac rhythm showed multiple premature ventricular beats. Within moments the rhythm became erratic, an ominous ventricular tachycardia and then went baseline. Defibrillators were a new device and we had one in the emergency room. By this time he was unconscious and we had to move fast. An endotracheal tube was inserted; the lungs were inflated with an ambu bag. I put the paddles across his chest, pressed the button and delivered the electrical counter shock. After a few erratic beats, normal sinus rhythm began and continued.
I don’t know how long he was anoxic from the time the cardiac arrest to the conversion but it must’ve been long enough to cause some cerebral dysfunction. He remained unconscious for three days. There was no such thing as intensive care so we set up a private room with everything we needed. I had a cot brought in to sleep on and I stayed with him for the next three days. The morning after the episode I called Dr. Bernie Siegel, preeminent cardiologist at the Hahnemann Hospital in Philadelphia and asked him to come and evaluate Ed Carroll. Ed was still unconscious but Dr. Siegel examined him thoroughly, looked at the electrocardiograms and read the nurses entries and the progress notes. He asked me several times how long it was from the beginning of the ventricular tachycardia to the conversion. I told him I honestly didn’t know. No one was looking at the clock but I was sure that it was at least five minutes, maybe more, before I got the paddles on. Dr. Siegel took me aside and gave a boost to my ego that I really needed. He said “Charlie, you did everything you could do and what you did actually saved his life. How much cerebral anoxia is uncertain and we won’t know until he regains consciousness, but regardless, you did a great job and he is still alive.” His recommendations on the chart were to continue what we were doing and to wait until he regains consciousness.
He came to on the fourth day and from that time on refused to speak to me, insisted that I be removed from the case and be restricted from entering the room. My partner, Tony, did not want to take any responsibility given the condition he was in so we had another internist take over the chart work. Actually I wrote the orders and somebody else signed them. We asked a psychiatrist to evaluate him but Ed refused to be seen. He remained in a darkened room, mute, for the next three weeks and there was nothing any of us could do about it. He went home and remained for four months, refusing to speak to any of us, particularly me.
I got a call to come to the director’s office and when I walked in, the entire board of directors was sitting there along with the hospital administrator. Ed Carroll contacted an attorney and was going to file charges against me for attempting to kill him. He also informed the board of directors that I was no longer to have staff privileges and that my presence in the hospital was repugnant to him and that he, as chairman of the Department of Medicine, ordered my dismissal. The Board of Directors thought the charges were ludicrous but there was nothing they could do to interfere.
The electrocardiograms shouted “res ipsa loquitur”. Ed’s lawyers decided there was no case but it didn’t end there. He told the Board of Directors, that under the terms of his contract as chairman of the Department of Medicine, he had the authority to dismiss me from the staff and the Board felt obligated to follow his directive. I had no choice but to hire an attorney. Charles V. Stoekler was a prominent and very high priced lawyer with palatial offices in the PFSF building on Broad Street. He asked for a $7,000 retainer and took the case.
Two weeks later he called me to the office, said the hospital and Ed Carroll didn’t have a leg to stand on, there was no way we could lose and he was prepared to continue. Then he said something strange, “You saved a man’s life and this is the way you are treated. The Board of Directors is gutless; I can get you back on the staff, sue for damages and win. Say the word and we go for it. But Charlie, why do you want to stay there. It’s a cesspool of mediocrity and you can do much better somewhere else.”
Probably the best advice I’ve ever had.
I was content at DVH and was making a go of it, sure that I would be solidly entrenched in the community.
It all fell apart the night Ed Carroll had the coronary. A snippet of added info in that regard: his was a classic 'John Garfield' coronary. He had just finnished a romp in the hay with one of the nurses when he got the first chest pain. I was going to ignore that item but hey, what the hell, it's too good to pass up.
I began again to find a place to start practice and be happy. Given my emotional state at the time, it was a tall order.