An Open Letter to Alfred J. Tector MD & Francis X. Downey MD

26 July 2019 marks the 25th year anniversary of my mother's very tragic death that occurred in an intensive care unit at Aurora St. Luke's Medical Center in Milwaukee, Wisconsin. My family was deeply injured when our matriarch, Alice Helen Sabaj Stahl, died, due to the apparent negligence of cardiothoracic surgeons Alfred J. Tector MD & Francis Downey MD. While I have not previously published any appreciable online content concerning this event, I feel that 25 years has provided sufficient time for enough emotion to fade such that I can provide a reasonably objective account of what occurred when Tector and Downey opened my mother's chest during the very early morning hours of 18 July 1994.

I was visitng my mother and having dinner with her on 17 July 1994 when the call came... "Your new heart is ready and waiting for you". It is impossible for me to put in words the emotions experienced by my mother and her six children on that fateful day. Alice had become progressively ill with idiopathic cardiomypoathy during the prior five years leading up to this moment. Her journey through illness was simply an extension of her unconditional love and compassion for all that knew her. Despite losing so much of her functional activity in the last six or so months of her life, she remained fiercely dedicated to her family and close friends. Nothing deterred her from evidencing her love and compassion for others, even when she experienced profound limitations.

All of those who knew and loved Alice longed for this day, for it held the promise of extending a life that we all cherished so deeply. Sadly, though, our family would learn of a devastating outcome while my mother was still in the operating room... just hours after the surgery began. Alfred Tector MD, the lead surgeon on this procedure, came to the family waiting room to inform us that the new heart failed to function, with the right side of the heart not evidencing any activity whatsoever. I have only twice in my life experienced such an intense wave of total devastation. The second instance of this overwhelming emotion would occur when my brother, Kevin, experienced a violent firearm-related death in 2001. Suffice it to say, there is no other feeling quite like this.

Dr. Tector delivered the bad news as though he was reading from an attorney-prepared script. He evidenced no emotion whatsoever, and it seemed as though we were speaking with an android. He was cold as ice, although it could have been he was supressing his own emotions in an attempt to get through this very difficult situation. He said that he would leave my mother's chest open for several more hours, in the hope that he and his surgical team could "coax the new heart in to functioning"... These very "several hours" would remain etched in the deep recesses of my mind for an eternity.

It was during this time that my emotions would abruptly sway from deep sorrow to helplessness to melancholy to anger. I kept telling myself I had to get a grip... to become the rock of stability and support for my family that my mother had always been. I went to the hospital chapel, lit a few candles and prayed for guidance, but none would come. Next, I walked several circles around the sprawling medical campus, hoping some physical activity would help, but it did not. When I returned to the family waiting room, my five siblings were in even worse shape than I. And then it became obvious to me that all any of us wanted was news... potentially good news, that our mother would somehow pull through this ordeal, daunting as it was.

So I approached a nurse manning the waiting area station and asked where the operating room was located that housed our mother. To my surprise, she not only told where it was, but said I could get to the entrance door of the OR by using a far-off service elevator not ordinarily used by patients or visitors. I immediately told my family that I would go there and await for Alfred Tector or Francis Downey to emerge from the OR with some sign of hope for Alice. While Francis Downey was the lead surgeon on harvesting the donor organ, and Tector was the lead surgeon for transplantation, Downey remained on site due to the complications experienced by my mother. Once I arrived on the floor of the OR, I found a secluded and dimly lit little covey just off to the right of the OR entrance. I sat there and waited... and waited... and waited for what seemed like an eternity.

Finally, Alfred Tector emerged with a younger gentleman in tow. This younger man was fully dressed in surgical garb, indicating he had operating privileges, but I estimated him to be in his late 20s or early 30s. Thus, in all likelihood he was either still in residency or was a young physician receiving training from Tector. Although I knew what Tector looked like, I had yet to meet Downey and knew almost nothing about him. Later, I would learn he was a young man who, at the time of this incident, was just 33 with a significantly receding hairline. Those characteristics would eventually allow me to identify Downey as the person who entered the hallway outside of the OR with Tector at his side.

Both Tector and Downey still had their face masks on when they entered the hallway, and neither of them saw me sitting just 15 or 20 feet from them. Tector immediately ripped the mask from his face and threw it in a red-faced rage. He proceeded to read this young man (Downey) the riot act, spewing a litany of expletives unfit for even the most seasoned of poker players. Tector was beside himself, and it appeared it was all he could do to restrain himself from strangling this Downey. Unfortunately, Tector would not say what exactly precipitated this outrage, but in my mind he did not need to. I do not believe I have ever witnessed such intense rage in the eyes of anyone other than Tector in my almost 58 years. I genuinely thought he was going to pulverize this man right then and there.

But instead, Tector would end this encounter by laying his hands on the shoulders of this young man and then utter, "Get out, now!". Downey turned away from Tector, hung his head and walked down the long empty corridor. Then, Tector would turn in my direction and for the first time realized I had just witnessed him at his very worst. But his eyes would say what his lips would not, for he said nothing to me. His gaze conveyed to me that he had just committed a monumental error- but not an error involving my mother's surgery. Instead, those bulging bright blue eyes communicated that I should not have ever gained access to the floor housing the OR, that I should never have been sitting where I was, and that there was no way in hell I should have witnessed what I had just observed. After hesitating and locking eyes with me, he slammed his fist into the OR door, opening it and then disappearing into the abyss.

Needless to say, I remained seated on the floor outside of that OR for about another 20 minutes, in complete shock. I could not even find the energy to stand, for I knew at that point my mother had no chance of survival. I knew the only thing that could cause a world renowned heart transplant surgeon to completely lose his cool was that someone had just executed a death sentence upon one of his patients... and that patient, I reasoned, could only be my mother. I somehow managed to pull myself together and then logically digest what I had just experienced. As a scientist, I knew that my emotions were so frayed that I could very easily jump to illogical conclusions, and so I asked myself, "What else could Tector's outrage indicate"?

I knew enough about medicine and surgery to know that someone as experienced and sought after as Alfred J. Tector MD would oversee and supervise not only a bevy of junior physicians (like, at that time, Francis X. Downey,) but that he would also manage a large group of surgical residents in training. As such, I could not exclude from possibility that there was another patient undergoing surgery at the same time as my mother, and that the incident I just witnessed could be related to someone else, as remote an occurrence as that might seem. So I returned to the family waiting area and spoke to the nurse manning the front desk. I asked, "By any chance, could you tell me if Dr. Tector is involved with more than one surgery at this time?". The nurse immediately replied, "Why yes, as a matter of fact he is. We had a patient arrive earlier who was in an automobile accident and suffered a torn aorta. He was in very bad condition when he arrived in our ER, but thanks to Dr. Tector, he survived"...

That's when everything came into focus for me. I had previously poured over the reams of paperwork my mother had signed concerning her pending transplant procedure. Part of her agreement concerned the participation of surgical residents and inexperienced physicians in training. The hospital communicated that these residents and young physicians "could participate in or perform all surgical tasks related to specific procedures, with appropriate supervision of an attending physician, as part of the training provided to junior physicians and residents at this hospital". While I had no direct evidence of what might have happened to my mother in that OR, it seemed as though the pieces were beginning to fall into place. My hunch was that Tector was called away during my mother's transplant procedure to attend to the dire needs of the man with the torn aorta, and he allowed Downey to take over for him. And then, I surmised, something went terribly wrong. What that could have been remained a mystery for many years following her death.

I would later meet with Tector and the entire transplant team, absent Francis X. Downey. Although I was promised everyone involved would attend this meeting, Downey did not, and no explanation was provided for his absence. I had prepared a long list of medical questions related to her transplant, based upon what I learned from studying the literature concerning the procedure. Tector flatly refused to answer more than 95% of these questions, only saying they were "not applicable". All he would communicate was that he was deeply sorry, and he speculated some "injury of unknown origin damaged the heart and evaded our detection prior to transplant". I was stymied, and short of filing a legal action, I would get no substantive answers. While at the time I had a bachelor of science degree in biology and chemistry, I simply was not equipped to figure out what had happened to my mother. All I knew was that the heart came from a young, healthy man, and that it was functioning perfectly prior to transplantation. Somehow or another, the entire right side of the heart failed while being transferred from the donor to my mother.

Four years later I would begin graduate studies in medical biochemistry, with a focus on cancer. I would read well over 2000 papers during those three years in graduate training. I became proficient enough to have the ability to understand publications from related medical fields like, for example, cardiothoracic surgery. During the early 2000s, I delved into that literature hoping to find an answer... and I did. It turned out that both during and after surgery, my mother experienced massive bleeding- so much so that three more surgeries were performed over five days in a desperate attempt to save her. So much blood was transfused during this time that the hospital very nearly ran out of a blood supply for her. Neither Tector nor Downey ever explained why this bleeding occurred. The reason for their silence on this issue for would become very obvious...

Massive bleeding is a potential event that occurs immediately after the clamps are removed from the arteries providing the new heart with blood. While it is not a common outcome, it is not unexpected. If and when this happens, the surgeon has a very small window of time to respond and fix the problem. If the surgeon fails to respond appropriately, the massive bleeding results in irreversible and fatal damage to the heart. That, I am convinced, is what happened to my mother. I maintain the belief that Alfred J. Tector allowed Francis X. Downey to take over for him and finish my mother's surgery while he attended to the patient with the torn aorta. When Downey removed the clamps, massive bleeding ensued and with less than a year on the job, he panicked. He either failed to respond appropriately or perhaps more likely, he choked and froze. Just several minutes of severe bleeding would render the heart useless, and it would explain why the entire right side of the heart failed, immediately. The massive bleeding likely continued unabated for days because of the initial damage done to the heart.

The last time I would see Francis X. Downey would be on the fifth post-surgical day. He was walking down a hospital corridor toward an elevator. Although it seemed as though nothing would change, I held out hope for a miracle. So I called out Downey's name and asked that he provide me an update on my mother's condition. He refused to respond and allowed the elevator door to close shut, and I would never see him again. I will never forget the look of anguish and guilt written across his face as those elevator doors closed. A picture truly is worth a thousand words, and then some.

My family never fully recovered from the devastating loss of our matriarch, Alice, and not simply because she died. We always knew death was a distinct possibility as it concerned this surgical procedure. The reason we have never fully recovered is because Alfred J. Tector and Francis X. Downey refused to be candid with us. That's just a nice way of saying they lied to cover their asses. I would go on to work in not only hospital settings with my graduate credentials, but surgical departments too. I would come to learn that yes, surgeons make mistakes, and that sometimes these mistakes cost people their lives. And yes, I would also learn that every effort is made by these surgical departments and their supporting institutions to bury those mistakes with the dead.

While I doubt sharing my experience via this LinkedIn post will do anything to complete the healing process for myself or my family, I hope that it does shed light upon similar tragedies experienced by other families.

We shall never, ever forget the person who was Alice Helen Sabaj Stahl, and her everlasting and unconditional love shall not be diminished by the negligence of two men who refuse to be honest and forthcoming. Mistakes, however, can only be forgiven after someone has taken ownership of them.

We love you Alice, and ever more so with each and every passing day. Our pain, even 25 years later, while excruciating, serves as a potent reminder of just how very special you truly were.