Ray Knudson | Atavist Magazine | December 2023 | 1,950 words (7 minutes)
This is an excerpt from the issue. 146, “Damages.”
1.
*An asterisk indicates a pseudonym.
Debra* wanted That her medical nightmare was over. In 2009, she was diagnosed with breast cancer that had spread to her lymph nodes. The disease was estrogen positive, which meant it was feeding on her reproductive hormones. After six months of chemotherapy and a double mastectomy, the cancer was declared in remission. To keep things going, doctors put Debra on tamoxifen, a hormone used to prevent certain types of breast cancer. She expected to keep this job for about five years.
Debra has a big smile, dimples, and thin arched eyebrows. She likes high heels and she likes to talk. She used to work as a hairdresser, a job suited to someone who easily strikes up conversations with strangers. She is also a mother of two boys and she always wanted more children. Patients taking tamoxifen are advised not to become pregnant. Debra, who was in her early 40s when she started taking the drug, planned to become pregnant once her treatment was complete.
Then, about halfway through her tamoxifen doses, Debra received a letter in the mail with bad news. It turns out that her recent Pap smear results were abnormal. She underwent surgery to remove cells from her cervix during a routine visit to the Veterans Affairs Medical Center near her home in Portsmouth, Virginia. (Debra served in the Air Force from 1988 to 1992.) An abnormal cervical cytology can indicate the presence of cancerous or precancerous cells. Follow-up testing is usually recommended.
Debra knew that even though she was taking tamoxifen, there was a risk that the cancer would probably come back in other parts of her body besides her breasts. Oncologists call this a distant recurrence. So she took the cervical cancer test results seriously. When the Veterans Administration referred her to her two gynecologists, Debra contacted both of them. One she had a month waiting list, but her other one became available immediately. His name was Javaid Perwaiz.
Dr. Perwaiz’s main office was a small red brick building near a strip mall in Chesapeake City. There were 14 spaces in the parking lot, including one for people with disabilities, and cars came and went one after another. Mr. Perwaiz had a reputation for being quick at work. An established patient can expect to arrive at her appointment time and be back in her car within 15 minutes. The waiting room was small with a vaulted ceiling, lots of windows, and walls painted a muted mauve. Many of Perwaiz’s patients were black women on Medicaid. Debra fit that profile.
When Debra met Perwaiz in July 2012, she felt confident in him as a doctor. He was in his early sixties, short, with a thick, well-groomed white mustache, bushy eyebrows, and a comb. He wore a white coat during the meeting. He was indifferent, but not cruel. He remembered the patient’s personal life in detail and asked about his loved ones.
Debra said that after several tests, Perwaiz told her that she had precancerous cells in her cervix that could develop into cancer. He said there was no medication she could take to stop it. Given her history of breast cancer, he recommended a hysterectomy.
Debra was shocked and scared. She didn’t want to lose her ability to have more children. But she also wanted to live to watch her sons grow up. She said she then met with Perwaiz and after having her further examined, she agreed to undergo surgery but did not want her abdomen to be cut open. The doctor who performed a Caesarean section during the birth of her first son used “beautiful subcutaneous sutures” to close the incision, leaving a faint scar. “I had no idea I had ever had surgery,” Debra told me. She wanted her stomach to stay like this. Debra said Perwaiz assured her that he could perform the surgery through her vagina. No abdominal incision is required for her.
Debra believed what Perwaiz said. From their conversation, she understood that he would only remove her ovaries because reducing estrogen in her body could reduce the risk of the cancer coming back. In fact, a hysterectomy by medical definition involves the removal of the uterus. But Debra didn’t know about this during her surgery, she said, because Perwaiz didn’t explain it to her.
On the morning of Dec. 29, Debra arrived at Chesapeake Regional Medical Center and filled out the necessary paperwork for the surgery. One of the nurses was someone I knew from church and seemed friendly. Debra was then prepared for the operating room and given the sedative propofol. When she saw Perwaiz, her hospital staff were moving her down the hall on her stretcher.
“What time should I tell my friend to pick me up?” Debra asked him.
“That’s not the surgery you signed up for,” she remembers Perwaiz replying.
She didn’t know what that meant. The propofol made her sleepy. Then everything went dark.
When Debra woke up in the recovery room, she knew something was wrong. She put her hand on her stomach awkwardly. She found her incision covered with tape. She couldn’t understand Debra. she started crying.
She was discharged from the hospital the next day, and only then did she completely subside. Perwaiz performed an invasive surgery that involved cutting into her abdomen. Within a few days, Debra felt persistent, painful pain in her lower abdomen. The area also became swollen and tender. Debra spent most of her time alone. Her eldest son had already left home, and her younger son went to school during the day. She had difficulty getting out of bed.
Debra called Perwaiz’s office and asked for a prescription for pain relief. When her medication stopped working, she called again. Debra said she spoke directly to Perwaiz. “Women all over the world are going through this,” he told her. “She’ll just have to get used to the pain.” She was so upset that she ignored the comment. “I didn’t have the strength to bite his head off,” she told me.
One day, a friend called to check on her and was surprised to hear Debra swearing unintelligibly. Her friend drove to Debra’s house and, since no one came to the door, convinced her landlord to open the door. Debra was lying inside. Her skin turned blue and her belly swelled to the point that she looked nine months pregnant. Her friend called 911 and an ambulance rushed Debra back to the Chesapeake area.
Debra thought she was dying. In her head, she could hear the hymns her grandmother used to sing.
I know it was blood, but
I know it was blood, but
I know it was in my blood.
One day when I got lost
he died on the cross
I know it was in my blood.
At the hospital, Debra learned that Perwaiz had not only removed her ovaries, but also her uterus, cervix, and fallopian tubes. Her diagnostic scan revealed a large amount of fluid accumulating in her abdomen, and her lab showed she had severe acute kidney failure. She also had perforations in her bladder, but it was later discovered that one of the six had been made during surgery. She was suffering from sepsis.
Debra was hospitalized for several days. She faded in and out of her consciousness. At one point, she thought she saw Perwaiz at the foot of her bed. He looked nervous at her. His hands were clenched. “He may have been praying, ‘Please live,'” Debra said.
Debra knew about the history of forced sterilization in America, where doctors persuaded women of color to undergo unnecessary hysterectomies or performed surgeries against their will. She couldn’t help but see her own case in that context.
she was alive. She had to wear a catheter for several weeks, but her symptoms improved. Her long recovery has given Debra time to think about what she wants to do against the man who hurt her. “I’m going to get this son of a bitch, that’s what she thought in her head,” she said. “You don’t want anything to do with me. You’re teething. You threw up sulfuric acid.”
She requested medical records and was stunned to find discrepancies with what Perwaiz had told her during his examination. Most notably, there was no mention of precancerous cells in her cervix. The tests Perwaiz performed on her came back normal. Debra said, “If I was normal, why did I have the surgery?”
There were other contradictions as well. Her one on the reservation form stated that Ms. Debra was complaining of pain in her back and pelvis, but she told me that had never happened. Another document from the day before the surgery stated that she “insisted that the ovaries be removed through an abdominal wall incision rather than vaginally” and that “consent was obtained after full counseling with the patient.” [was] For abdominal hysterectomy. ” In fact, she had requested the opposite surgical approach, but she did not remember having such a conversation with Perwaiz. The only time she spoke to him before her surgery was when they passed each other in the hospital hallway.
Debra was convinced there was a case of medical malpractice. She consulted several lawyers, but none of them would take her on as her client. “So many male“One person after another said, ‘You’ve been well cared for, that’s all we can give you,'” she said. Simmering with her karma, she came up with her new plan. “I said, ‘Okay, I’m going to learn how to sue this guy myself.'” (Perwaiz declined to comment for this article.)
Debra enrolled in the paralegal program at Tidewater Community College. She learned how to research case law, write briefs, and file lawsuits. She didn’t have an internet connection at her home, so she turned to a nearby university’s law library to access everything she needed. She carefully highlighted important phrases in her medical records and took notes in elegant cursive. When requesting materials related to her own case from her medical provider, she signed her email “respectfully” but said she was sorry to inconvenience anyone. It wasn’t. She followed up. She was persistent. She knew that in order to accomplish anything, she had to rely on herself. “I realized that you can’t trust people,” she says.
Like much of the United States, the statute of limitations for medical malpractice in Virginia is two years from the date of occurrence. Debra filed the lawsuit on December 23, 2014, six days after termination. She sought $1.5 million in punitive damages and compensation for loss of enjoyment of life, loss of fertility, diminished sexual intimacy, as well as lost wages and medical expenses.
Someone told her to file a lawsuit in state court, but Debra refused. She knew about America’s history of forced sterilization and how doctors persuaded women of color to undergo unnecessary hysterectomies or performed surgeries against their will. She couldn’t help but see her own case in that context. She believed the case belonged in federal court because Perwaiz violated her most fundamental rights.
The judge disagreed. In January 2015, Debra was asked to explain why her case should be a federal lawsuit rather than one decided in a lower court. She responded by filing a document explaining her position, but her May suit was dismissed for lack of jurisdiction. She appealed this decision, but one day she missed her filing deadline. Debra said she didn’t receive the paperwork she needed to fill out until the day before the deadline, and there was no way for her to get it to court on time.
And just like that, her legal effort to hold Perwaiz accountable ended. But there were many more patients like Debra, and many more women whom Perwaiz had harmed. There were many points waiting to be connected. Someone had to come along and do it.