DAMAGE$ Inside Moves Book One:
Mommy Mommy Wake Up
by Richard Vazquez MD
Step inside the story that lifts the curtain on what really happens when medicine, money, and justice collide.
In DAMAGE$ Inside Moves — Book One: Mommy Mommy Wake Up, Dr. Richard Vazquez MD draws on decades of surgical experience and hundreds of malpractice cases to reveal the hidden mechanics of life-and-death decisions and courtroom strategy.
Read online, download the sample, or listen to the podcast episode.
Damage$ Inside Moves: Book One Mommy Mommy Wake Up
Chapter One
Memorial Hospital, Chicago Lakefront
Saturday Morning
It’s quiet on the orthopedic floor at Memorial Hospital on the Chicago lakefront this morning. Twenty-six year old first-year orthopedic resident, Dr. Julie Brendan tosses her files onto the desk and sits stretching her back from a long night on-call. Her wrinkled coffee stained green scrubs and light blue lab coat appeared rumpled and unflattering. Her eyes seemed hollow in the harsh glow of fluorescent lights humming overhead. She said “I am so glad that overflow gyne patient Sheila Flynn had a simple laparoscopic procedure.”
Jennifer McMaster, RN the young day shift charge nurse just finished taking report from the night shift. She stood at the printer filling out paperwork and she looked fresh and sharp since she had just arrived to start her day shift. Julie looked tired and irritated and constantly yawned. The whole nursing station looks like a yawn and a stretch crying for the touch of a caring cleaning crew.
Julie, “Too bad that Dr. Cohen won’t be coming by today. He’s at his temple this morning. One of his junior partners, Dr. Fishman, is on call for the group.”
McMaster tossed her paperwork into Julie’s pile and asked, “When will he be up to discharge Ms. Flynn?” Without looking up, Nurse McMaster shakes her head and said, “All of this damn paperwork to fill out and file. Wouldn’t it be great to have an electronic health record installed in this paper warehouse? And just think of the trees we will be saving.”
Henrietta Johnson, the ward secretary, tried her hand at tackling the disorderly mess adding, “I just heard from Dr. Fishman. He told me to proceed with discharging Sheila. He has been discharging healthy mothers and babies over in OB. I told Dr. Fishman that I called Sheila’s husband James Moretti and told him to come to the hospital to pick her up. He knows our rule that all post-op discharges are required to ride to the lobby in a wheelchair. And about your electronic health record, be careful about new fangled things that you wish for.”
Julie rubbed her heavy eyes. McMaster grabbed her clip board and started to walk off. Dr. Brendan blurted out, “Oh, I forgot to tell you, I spoke with Dr. Fishman at around 2:00 am. I told him I was concerned about Sheila’s restlessness and anxiety. She had no complaints of any abdominal pain, but she said that she was sweating a lot. She seemed a bit confused and thought that she had been discharged already.
McMaster inquired, “What about her vitals?”
Dr. Brendan replied, “There was just a slight decrease in her blood pressure to 90/60 and a tachycardia of 110, but she was making urine and in fact was incontinent times 1.”
McMaster, “Incontinent? Why was she incontinent?”
Julie, “I do not know why she was incontinent. She was breathing a bit fast, but her chest was clear and her breath sounds were good. Her abdomen was mildly distended, but not tender to touch. She had no rebound abdominal tenderness and had a few bowel sounds. Her urine output was 50 ml per hour before midnight, so I did not think that she was hypovolemic. To me she looked like she was having a really bad panic attack, so I decided to give her one milligram of Valium IV and 0.5 milligrams of Xanax PO over night to calm her down. She was a bit sweaty and disoriented, but she fell asleep.”
McMaster replied, “None of this makes sense. How does all of that add up to a panic attack? Did she have a history of panic attacks or have meds for panic attacks listed in her meds pre-op? Why should she be having a panic attack in her hospital bed? Can’t say that I have ever heard of such a thing.”
Dr. Brendan added, “Dr. Fishman gave me permission to request a consult from the internal medicine resident on call. I spoke with the resident but he has not yet had a chance to come to see her. He told me to examine her again and consider getting an arterial blood gas (ABG) and a chest x-ray. He was thinking about ruling out a pulmonary embolus (PE). I told him that she did not have any shortness of breath so I decided to wait for him to see her before sending off the ABG.”
“I have to grab a cup of coffee. I’ll be back in a couple of minutes.”
The Home of James Moretti
Saturday 8:00 AM
Meanwhile, Sheila Flynn’s husband James Moretti helped their six year old daughter Heather get ready to leave the house. Heather spoke up. “Daddy, look at the drawing that I made for mommy. Do you think that she will like it? I’ll show it to her at the hospital.”
The cool day, one of the first crisp autumn mornings, marked the end of Indian summer. James and Heather arrived at the front entrance of the hospital. A pleasant, uniformed security guard greeted James and handed him two visitor badges as a parking attendant valeted the car.
The security guard pointed to the elevator doors and said, “Take that elevator to the 9th floor.” They are interrupted by the overhead audible paging system: “Code blue, room 1930.” Doctors and nurses responding to the call rushed past. James held Heather’s hand while she clutched her favorite stuffed animal.
As they entered the elevator James asked, “Heather, would you please push the 9 for daddy?”
Heather smiled and pushed the right button. James and Heather exited the elevator and sat in the chairs in the 9th floor elevator lobby. James let Heather put her visitor’s pass on her stuffed animal while they waited for Sheila to arrive by wheelchair. Ten minutes passed. James picked up the house telephone and asked the operator to connect him to the nurses’ station. No answer. Another ten minutes passed and still no call back was made. He waited another twenty minutes and again received no communication from anyone. The house phone rang. The hospital operator called James back, “Mr. Moretti?” “Yes, this is Mr. Moretti.” The operator apologetically announced, “I cannot find anyone on the ninth floor to speak with you.”
James paced anxiously about the elevator lobby and then decided to make his way to the nurses’ station. He kept Heather close and held her hand firmly. As they cautiously approached the Nurses Station James had an eery feeling about how quiet and deserted it was. No one was in sight.
James heard distant sounds that caused his attention to shift to their source at the end of another corridor. The level of commotion made him apprehensive. He felt the hair on the back of his neck standing up. He did not know why he felt frightened. He clutched Heather’s hand and walked down the hallway towards the excitement.
CODE BLUE In Progress Room 1930
Earlier at 8:50 am Saturday Morning
* * *
Over a year later at the trial, the family’s legal champion, Peter Richmond, stood at the podium to examine Dr. Fishman.
The jury leaned forward as Richmond began, his voice steady but sharp.
Q: Doctor Fishman, how many glasses of wine did you drink the night of Ms. Flynn’s operation while covering for Dr. Cohen?
Dr. Fishman shifted uneasily in his chair.
A: Yes.
Each question cut deeper, exposing not only Dr. Fishman’s poor judgment but also his indifference that had cost Sheila her life. For the jury — and for Sheila’s family — Richmond was more than an advocate. He was their scalpel, carving away excuses until only the truth remained.
Q: Of course not. And at 2 a.m., when Dr. Brendan called you about Sheila Flynn’s worsening condition, you chose not to see her, isn’t that right?
A: That’s correct.
Q: And then when you finally arrived at the hospital at 7 a.m., you spent your morning discharging healthy mothers and newborns — instead of attending to Ms. Flynn.
Q: So the first time you saw Ms. Flynn that morning was when she was about to be pronounced dead?
A: Yes.
Continue reading the full chapter in the downloadable sample.
***
Buy the novel Damage$ Inside Moves — Book One: Mommy Mommy Wake Up to experience the full medicolegal drama, available soon.
And watch for Book Two: As Clips Give Way, Life’s in Play — coming in 2026.
Richard Vazquez MD8021 Brightwater WaySpring Hill, Tennessee 37174info@richardvazquezauthor.com© 2025 Richard Vazquez MD — All rights reserved. |
DAMAGE$ Inside Moves — Book Two
As Clips Give Way
by
Richard Vazquez MD
In As Clips Give Way, a healthy young mother donates a kidney to her seven-year-old son. The transplant succeeds, but a postoperative handoff failure leaves her unseen as she hemorrhages. Although surgeons correct the surgical cause, devastating complications follow. When a surgical device defect emerges, a medical tragedy becomes a legal and ethical reckoning that reverberates far beyond the operating room.
Coming 2026 — excerpt from a work in progress
Midwest Regional Health Center
Monday Morning
Dr. Stevens and one of his partners Dr. Jane Adams were making fine progress with the implantation of the kidney into Claudia Walters’ son Ryan. They had finished connecting the major blood supply artery and vein and were in the process of implanting the ureter into Ryan’s bladder.
CODE BLUE In Progress
Code Blue (cardiac or respiratory arrest) was loudly and clearly announced audibly for a patient room located in the small unit where Ryan’s mother Claudia had been sent from the PACU.
Dr. Stevens’ face flushed beet red and he immediately tensed and began to sweat. Had he correctly assumed that the Code Blue had been called for Claudia Walters? Suddenly he turned away from the operating table and stripped off his surgical gown and gloves so he could leave the OR. The nurses summoned a transplant fellow to finish up Ryan’s operation with Dr. Adams.
Dr. Stevens pleaded with the anesthesia team and operating room nurses to find him any operating room that had been set up for another procedure: to commandeer the operating room and staff for him to emergently explore Claudia’s abdomen for bleeding.
He asked the anesthesia service to set up for IV solution warmers in the new room and for the blood bank to be called to bring a half dozen units of un-crossmatched type O negative blood (Universal Donor type blood) to the operating room for Claudia.
He asked about a cell saver but none had been set up standby and getting one primed from off mode to ready would likely take too long.
The floor nurses flew into action to resuscitate Claudia. Their patient was pulseless; her skin had a blue cast. They immediately turned Claudia’s IV to maximum infusion and they started second large bore IV through which they began a fast infusion of another liter of saline IV fluid. The Code Blue team arrived as the floor nurses started CPR chest compressions. Dr. Stevens entered the room as one of the Code Blue team members from the anesthesia service placed a face mask attached to an Ambu bag on Claudia’s face to breathe for her.
Dr. Stevens’ pager went off. He looked at the pager and said, “We have an operating room ready for us to explore her abdomen. Roll it, ASAP. ”
A nurse slapped on the leads hooked up for a portable monitor that she attached to an IV pole on the gurney. Another nurse hopped onto the gurney with Claudia to continue chest compressions while they moved her gurney to the elevator.
Additional floor nurses cleared the way to move Claudia’s gurney down the hall to the elevator that they had captured with doors open.
The operating room nurses waited downstairs at the elevator door to the OR floor. They expertly relieved the floor nurses with the speed and accuracy of a pit crew.
The moment that Claudia’s bed was aligned with the operating room table, the anesthesia and nursing teams rapidly lifted Claudia on to the operating room table. The anesthesia team took charge of her airway and used the mask and Ambu bag with oxygen attached to the Ambu bag to oxygenate Claudia while they prepared to insert an endotracheal tube to secure her airway. They attached the tube to their anesthesia machine to breathe for her.
The anesthesia doctors, technician, and nurses busily attended to transfusion related issues and carefully monitored Claudia for brain and organ damage due to shock from blood loss.
Operating Room
Noon, June 14
Claudia’s abdomen was obviously distended. Dr. Stevens exposed the outside of her abdomen and quickly splashed antiseptic solution on her abdominal skin. He applied sterile surgical drapes, then removed sutures from Claudia’s abdominal wound.
As quickly as Dr. Stevens cut the sutures blood poured out of her abdomen, and fell off of the surgical field onto the floor. Dr. Stevens immediately carefully reached into her abdomen to feel her aorta near her diaphragm. He compressed her aorta against her spine. He intended this move to keep her heart full of blood to pump to her brain and to her lungs.
Dr. Stevens replaced his hand on her an aorta with a bumper at the end of a long handled tool. He gave an assistant the job of maintaining aortic compression against her spine. He identified her distal aorta below where they had removed her right kidney and compressed it against her spine. He could now see the artery to her right kidney, flaccid and uncontrolled by the clips that he had placed across it. He had applied three metal clips that looked like miniature straight metal bobbie pins across the renal artery. The clips were nowhere in sight.
Once Dr. Stevens had obtained emergency control of the hemorrhage, the anesthesia team asked for time to transfuse blood and catch up with her blood loss.
Dr. Stevens psyche, seized by fear of possibly losing the life of the mother of his transplant recipient, filtered out non-essential information. The well-known rarity of death among living related donors had fueled the growth and acceptance of LRD transplantation. A donor death—or even the suggestion of one—would not remain confined to this operating room or even this hospital. The transplant community was small, professionally incestuous, and bad news traveled with the speed of wildfire. It would move quietly at first, by phone call and whispered conversation, then by word of mouth at professional meetings around the world.
“Okay to proceed, Dr. Stevens,” the anesthesia team leader said.
The words snapped him back to the moment. There would be time later to manage the consequences. For now, there was only bleeding to stop.
Still, the outline of a countermeasure had already formed. He would take control of the narrative. He would publish the case, present it at a national meeting, and speak before rumor hardened into dogma. His attorneys would tell him to wait, to say nothing, to keep his head down. He already knew he would override that advice.
Dr. Stevens applied a special vascular clamp designed to partially occlude the aorta at the right renal artery. This allowed blood flow through the un-occluded portion of the aorta. He then securely closed the right renal artery with traditional suture ligatures. He used blue suture material that looked like blue fishing line on a curved surgical needle. He removed the clamp to allow the flow of blood to the right renal artery that he had just sutured closed. He inspected the new closure for leaks. There were none.
Dr. Stevens caught his breath. The transplant crew that had done Ryan’s kidney implantation stopped by to report that they had successfully completed the kidney implantation. The graft was making urine and had good color.
He asked his partner Dr. Jane Adams, “Please find Mr. Walters and give him an update about Claudia’s current condition. He may be in his son’s hospital room.” Dr. Adams and one of the transplant fellows immediately departed to find Mr. Walters.
Dr. Stevens thoroughly inspected the bowel and abdominal organs to make sure that they had not unintentionally injured anything else during the control of the bleeding. The operative field was now dry and he was ready to close her abdomen. The surgical team closed Claudia’s abdomen, applied dressings, and transferred her by gurney directly to a surgical ICU bed.
Continue reading the full chapter in the downloadable sample.
Watch for Book Two: As Clips Give Way, Life’s in Play — coming in 2026.
Richard Vazquez MD8021 Brightwater WaySpring Hill, Tennessee 37174info@richardvazquezauthor.com© 2025 Richard Vazquez MD — All rights reserved. |
