Haskell pleaded for an experienced doctor, but the residents and nurses never summoned one. When her son's blood pressure became too faint to read, inexperienced first- and second-year residents concluded the monitoring devices were broken, and after a few hours, Lewis died. He had bled to death internally.

Haskell watched in agony as he "went from perfect health to death in a few days due to a basic lack of communication. I think everyone was reluctant to disturb the chief doctor at home because they were afraid he'd get angry."

In medicine "there's a pecking order and a sink-or-swim culture that creates a climate of fear," says Rosemary Gibson, a leading healthcare innovator and the coauthor of Wall of Silence: The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans. And that anxiety often prevents residents from seeking help when they are in over their heads.

Elizabeth Grimball has lifelong paralysis because of another insidious aspect of the medical culture-the arrogance of some doctors who don't listen to their patients. In 1997, when she was 8 years old, Elizabeth told her doctors, who were from the University of South Carolina School of Medicine, in Columbia, that her kidney cancer, which had been in remission, was back. They didn't believe her. Though the girl insisted the pain in her legs was severe, and an MRI was ordered, the doctors dismissed her complaints as psychological and canceled the test.

Over the next three months, Elizabeth's symptoms worsened and she lost 20 pounds. Frantic, her mother, Leila Grimball, continued to call the doctors. "Every time I told them she was getting worse, they kept saying it was psychological. I began to think my child was going crazy. I thought the doctors would rule out the chance of relapse with a child who had a history of cancer, so I accepted what they said."

Elizabeth was ultimately admitted to an outpatient psychiatric unit where, after she had seizures, an MRI proved she'd been right. The cancer had spread. A tumor in her brain was causing the seizures; another in her spine was putting pressure on nerves and creating the pain in her legs. A lawsuit against the medical school asserting that the delay in diagnosis resulted in permanent paralysis from the waist down was settled a year later. Elizabeth, now 15, is confined to a wheelchair for the rest of her life.

"And for what?" she asks rhetorically. "I'm having to suffer through no fault of my own. The doctors made me feel like I wasn't there. My body was telling me one thing, and the doctors were saying something else. If they had just listened to me, they would have found the cancer. They know they made a mistake, but they can't acknowledge or really accept it."

In Lewis Blackman's case, the surgeon in charge did take full responsibility, for which Helen Haskell is grateful. Still, none of the residents said they were sorry. "Where the anger comes in," she says, "is when doctors don't apologize, don't explain, and implicitly trivialize the life of the victim."

One doctor who dared to break the professional hush and speak the truth about a mistake he'd made found something remarkable and unexpected. In 1999, at Brigham and Women's Hospital in Boston, anesthesiologist Frederick van Pelt, MD, prepared to administer a combination of powerful drugs to his patient Linda Kenney. The 37-year-old mother of three was having ankle replacement surgery.

Inadvertently, Van Pelt put the anesthesia into a vein. Kenney had a seizure and went into full cardiac arrest. Doctors barely saved her life and worried she might have brain damage, but she eventually made a full recovery.

Van Pelt says, "I felt so terrible about what had happened that I wanted to be accountable and open about how it had affected me." Kenney's husband, furious at Van Pelt, kept him from speaking directly with his wife, as did hospital administrators. "They try to minimize communication between doctors and patients, not necessarily to hide an error but because of the fear of litigation," Van Pelt says.

So he wrote Linda Kenney a letter. "I said I was sorry and apologized for causing the outcome. I told her that the event had had a dramatic impact on me as well. It really shook me up." Van Pelt invited her to call him, giving her his home telephone number, but it took six months before she finally did. When they met at a coffee shop, Van Pelt recalls, "I basically asked for forgiveness, and she gave it to me." Kenney, who decided not to sue Van Pelt or the hospital, says, "That's when the true healing began."

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