By all accounts, what happened to Paramjit Singh during heart bypass surgery has never happened to any other patient anywhere on the planet.
A medical monitoring device inside his right ventricle, the part of the heart that pumps blood to the lungs, malfunctioned and overheated. Temperatures in the catheter’s copper element hit nearly 500 degrees, causing it to melt.
The ventricle cooked, turning white from the damage. The tissue was left beyond repair. But surgeons were busy working on the outside of his heart. They didn’t realize there was a problem until the end of the surgery, when it was time to restart his heart — and it didn’t respond.
The surgical team then scrambled to save his life.
“This is the one and only case in the world that I’m aware of,” said Dr. Frank Nieto, the Everett surgeon who operated on Singh at Providence
Regional Medical Center Everett in 2004. “It was quickly decided we needed to put in the mini artificial heart.”
Family members were later told Singh probably had just a few hours to live. It was time to say their goodbyes.
Singh survived those tough first three days, and was transferred to the University of Washington Medical Center in Seattle. Special machinery kept him alive for 11 weeks as he waited for a heart transplant.
In December 2004, a donor heart was found, from a recently deceased 26-year-old man.
A lawsuit was filed against the catheter’s manufacturer by both Singh and Providence. In May 2008, a Snohomish County jury awarded Singh and his family $41.1 million, one of the state’s largest civil verdicts.
“It’s money he’d gladly exchange for his former life,” said daughter Preet Kaur, who often speaks for the family.
He must take three dozen pills each day. Anti-rejection medications have weakened his immune system. He is easily fatigued.
He has battled one round of cancer, a type of lymphoma that has been linked to the anti-rejection medications.
His kidneys have been weakened. He may need to undergo kidney dialysis or even a kidney transplant. If he lives long enough, Singh has been told, he may even need another heart transplant.
Before his heart surgery, Singh operated a restaurant and motel in Oak Harbor and a truck stop in Mount Vernon. Others now run those businesses.
With his wife at work and kids in school, he now sometimes sits alone at home, talking with friends on the phone.
Singh has every reason to be bitter about his fate.
Instead, at an event this year to honor him, he found a way to surprise and help others.
Fund in Singh’s name
On March 16, Singh; his wife; his four children; and 40 family members, some coming from Canada, were invited to the Everett County Club.
The event had been planned by Providence. Staff, including some of the surgical team who helped keep Singh alive after his heart was destroyed, also were there.
Providence’s chief executive, Dave Brooks, announced the establishment of a new $2.18 million fund. Called the Singh Family Fund for Patient Safety and Quality, Providence will use the money for training, equipment and other programs to improve patient safety.
The money came from the hospital’s proceeds from the lawsuit. “It was our choice to not just simply take that as income to the hospital,” Brooks said. “We thought the higher purpose was to create this fund.”
Singh and his family had been told in advance about having the fund named in their honor. He asked Kaur to speak to the group.
“I was really nervous to go up and talk,” Kaur said. “I wasn’t planning on talking.”
On her way to the microphone, Singh’s daughter had another surprise coming.
“OK, tell them I’m giving $25,000,” Singh whispered.
Unaware and unprepared for his spur-of-the-moment donation, the only response she could manage was: “No, we’re not!”
“He was like, ‘Yes we are!’ He was kind of annoyed because I was shocked,” she said.
When she announced the family’s decision, the crowd responded with clapping and cheering. “From the hospital side, including myself, there was not a dry eye in the house,” Brooks said.
‘A second chance’
More than two months later at their home in Mount Vernon, Singh and his wife, Harmeet Kaur, were preparing for an extended family gathering — a group viewing of the final NBA playoff game between the Celtics and the Lakers.
Singh proudly wore a black-and-gold athletic jacket with a purple Lakers logo. But his team’s allegiance had marooned him in his own household. Nearly everyone else was cheering for the Celtics, including Kaur, who wore a white-and-green Celtics jersey, and sons Harman, 14, and Arjun, 10.
This evening, though, was time for extended family to stop by, watch the game on a big-screen TV and to say goodbye to Kaur. The next morning she would head off to Portland State University, where she plans to major in biochemistry.
With the pregame television banter rising in the background, Singh and his wife Harmeet Kaur sat in their living room and talked briefly about the donation. Both seem almost embarrassed by the attention and emotional reaction it spurred.
“We help anybody we can,” Singh said. He smiled as he explained that over his lifetime, his attitude has been: “Whether I have the money or not, I borrow from somebody and give it to someone else.
“God gave me life, I think — a second chance to life, you know?”
It’s hard to imagine how much life has changed for a man who seems so carefree and outwardly happy.
“He’s resilient beyond belief. He always says, ‘I’m just doing fine; everything will be fine,’” his attorney Paul Luvera said.
His wife estimates that they spend about $1,000 a month on out-of-pocket prescription costs.
“If you’re taking so many medications and seeing so many doctors … you really aren’t well,” daughter Preet Kaur said. “He refuses to believe that.”
There are so many pills to take each day, family members have posted hand-lettered signs, including two in the entry way to their home. They serve as a constant, quiet reminder, even when they’re not home, asking: Have you had your medicine, Dad?
Side effects from the pills he takes have caused him to gain weight. He takes walks, but often gets weak from the exertion.
“He likes to get up early,” his daughter said. “He makes tea and breakfast.” Sometimes he stops by the Oak Harbor hotel the family owns to say hello to employees.
The house is often filled with family and friends, she said. “He likes to have people over.”
Singh, now 58, often jokes with his family, telling them he is really decades younger, because of the age of the person who donated his heart. “He looks wonderful,” his wife said. “No one thinks he’s sick.”
He thinks his life is the same, but family members realize it’s not. “We’re the ones that see him going through everything when he’s in pain or in the hospital,” his daughter said. “Seeing him need all those medications is hard. Medications are his life right now.”
A life of complications
Heart transplant patients must live with the reality that their body can reject their new heart. They also have more kidney problems and have a higher incidence of cancer, said Nieto, the Everett surgeon who was operating on Singh when the catheter malfunctioned.
“Between rejection, cancers, kidney problems, it’s a lot of medicine. He’ll be under close scrutiny forever,” Nieto said. “Obviously, his life is not normal and never will be.”
Preet Kaur said she remembers the day in 2004 when doctors told the family that her dad might die due to the severe damage to his heart.
“At one point, they said he had a few hours to live and we might as well go in and say goodbye to him,” she said.
Her mom didn’t allow her to go into her dad’s hospital room. He was unconscious and badly swollen from the intravenous fluids administered in the hope of keeping him alive.
Preet Kaur said the experience of seeing her father come so close to death, but survive, influenced her decision on the career she hopes to pursue.
“I learned so much from this whole experience,” she said. “After everything went wrong, physicians were the ones that saved him. “It definitely is a miracle with all the medical technology and what all the doctors can do.”
She hopes to go to medical school, either in Oregon or at the UW, but she’s undecided about what type of health care she would like to specialize in.
“I feel like I’ve always wanted to be a pediatrician,” she said. “But now, maybe a cardiologist.”
A lesson for hospitals
Providence’s new patient safety fund is part of a national effort to reduce medical errors, which can lead to patient injury or death. These efforts follow a landmark 1999 Institute of Medicine study, which said that as many as 98,000 patients a year may have been killed by medical errors.
“It catalyzed awareness of medical errors as an important issue,” said Christine Stencel, a spokesman for the Washington, D.C.-based organization.
“Rapid response teams” — specially trained medical staff that can be called in when a patient’s condition worsens, but before he or she goes into cardiac arrest — are one of the ways hospitals have responded, said Cassie Sauer, spokeswoman for the Washington State Hospital Association. Seventy-five Washington hospitals, including Providence, now have these teams.
Providence might use some of the money from the Singh fund for simulation training, where staff can either learn or practice difficult procedures, said Paula Bradlee, who oversees the hospital’s patient safety programs.
Staff could train on procedures as varied as starting an intravenous fluid line, performing CPR, handling difficult births and inserting stomach tubes.
Extra instruction and practice are part of an overall program to improve patient safety.
Providence is testing new protocols to improve communication at shift changes, called hand-offs, when important clues about the patient’s condition can be lost.
Instead of discussing the case outside a patient’s room, staff confers at the bedside so both patients and their families can participate.
The program is being used in the hospital’s emergency room with pediatric patients, Bradlee said, and will be used on all inpatient nursing units over the next year.
Singh’s case helped underscore the importance of being honest, open and direct when problems arise, said Brooks, the hospital’s chief executive.
“The health care system failed Mr. Singh,” Brooks said. “I don’t think the hospital failed Mr. Singh, but we are part of the health care system. We allowed him to be harmed when he was looking to us to care for him. That is not acceptable.”
Sharon Salyer: 425-339-3486, firstname.lastname@example.org.
How a heart cathetar works
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How a heart cathetar works
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