She headed down the hospital corridor toward her husband's room, turned the corner and saw the white curtain around his bed. She felt the nurses' hands reaching out from everywhere to grab her and heard them say, "The doctor has to talk to you."
Valerie Burns says she knew then her husband was dead.
It was almost impossible to believe. Frederick Burns Jr., 34, had died after having a toothache.
Just before Thanksgiving, he had gone to his dentist complaining about a badly decaying tooth. The tooth was pulled. Over the next three weeks, Burns visited the emergency room at Howard County General Hospital three times, complaining of a persistent headache. The third time doctors admitted him.
They put him in the psychiatric unit, diagnosing depression, with a note to consult specialists to check for any physical disorder. The next day they did a test that revealed a brain abscess. Burns died a few hours later of cardio-respiratory arrest due to the abscess.
Now, Valerie Burns contends the death of her husband was "needless, uncalled for," and she believes that even in his final hours he might have been saved with the proper care. She has filed a malpractice lawsuit against Howard County General in Columbia and against four doctors who treated him there, alleging that they were negligent in failing to recognize in time what was wrong with her husband. The dentist's treatment is not being questioned.
In its written reply to the lawsuit, the hospital maintains that the care given to Burns followed "appropriate medical standards." Hospital officials declined to comment further to The Washington Post, as have three of the physicians, who said they prefer to air their side before the Maryland Health Claims Arbitration Office, where the case is pending.
The case is not clearcut, according to two specialists who had nothing to do with the incident but commented based on information from hospital records provided by The Washington Post.
"The public frequently views medicine as if it were black or white, but in medicine there are frequently shades of gray," said Dr. Bruce Ammerman, a neurosurgeon at George Washington University.
A Washington neurologist, who asked not to be identified, said the medical judgment in Burns' case involved "a very close call." Part of the tragedy, according to this specialist, was that Burns did not go to a private physician.
"I can see this happening at a community hospital. It is the nature of such hospitals that the staff is small," said the physician, who works for a large university hospital where there are many specialists on call.
Whoever is right, the story of Fred Burns' death is the realization of everyone's worst medical nightmare: the ordinary, seemingly minor medical problem; the visits to an emergency room; the reliance on a doctor's care, and then the discovery--too late--of a deadly disorder.
It all happened so quickly that few people in the close-knit Columbia neighborhood where Burns was a community leader even knew that he was ill. The only hint was that the familiar figure in jogging clothes and Nikes wasn't showing up at the Oakland Mills community center as often as usual.
On Nov. 22, Burns, a management analyst who was RIFfed from his job at the Department of Agriculture last year, went to his dentist and had the badly decayed tooth pulled. Within 24 hours, Burns experienced severe pain at the site of the extraction and began developing a headache, which worsened in the next few days, according to the lawsuit filed by his wife.
On the Sunday after Thanksgiving, while on a shopping trip at Columbia Mall with his children, Burns began acting strangely, frightening 11-year-old Julian and 9-year-old Pasha and arousing the suspicions of a store owner who called police, according to Valerie Burns. When police questioned Burns, he insisted the year was 1926 and indicated he didn't know where he was, according to the lawsuit. Valerie Burns and the officers decided to take him to the emergency room at Howard County General.
Dr. Bruce Rosenberg, who examined Burns, noted the following symptoms in Burns' medical history: headache since his tooth was extracted, sensitivity to light and tenderness around the tooth area, according to hospital records obtained by Marvin Ellin, Valerie Burns' attorney. Though Burns was alert by the time the doctor saw him and responded positively to other tests, his previously "disoriented" behavior was noted on the chart, according to the record.
Valerie Burns said she and her husband questioned "why the total lack of memory, why so incoherent" and were told by someone in the emergency room that Burns' temperature, then a little over 100 degrees, "could account for it."
That didn't sound quite right, Valerie Burns now says, but at the time, she thought, "They're the doctors. They ought to know."
Burns was sent home with prescriptions for penicillin and codeine and advice to use a saline gargle and get a prompt dental evaluation, according to the records.
Despite the pills Burns was taking, the "headaches never let up. They slowly got worse," according to Valerie Burns, who says she was separated from her husband but saw him frequently. "Two weeks after the tooth was pulled he could not stand light. His speech started to slur."
On Dec. 8, Burns went back to the emergency room and saw a second doctor, David A. Paul, according to the lawsuit. Burns had no temperature, but he was still complaining of "persistent left-sided headache." The hospital record also notes that he was under increasing stress "recently since he was RIFfed from his job."
The diagnosis this time was "muscle contraction headache." And right above it, scribbled on the emergency room chart was a note that attorney Ellin says proved to be prophetic: "The patient seems unhappy with the diagnosis of muscle contraction headache--he wants 'more'--requests X-Rs-- patient seems unable to be satisfied and has a high probability of complaining about his visit here."
Burns was sent home again, this time with instructions to "followup . . . if necessary" with his personal physician. A friend says she asked Burns whether he had seen a private physician. Burns told her, "I lost my job and I'm no longer covered by medical insurance, but I've been to the hospital twice. They can't find anything wrong with me."
His wife says she never really knew how severe the headaches were because Burns wasn't the type to complain. "My husband watched his father die from cancer," said Valerie Burns. "He always said, 'You will never watch me suffer.' He tried to cover up."
On Monday, Dec. 13, Valerie Burns said she visited her husband's apartment and found him living in "total darkness," because he could no longer tolerate light. His usually immaculate apartment "was in chaos," she recalled, and though it was late in the day, Burns was still in his robe. She said she tried to persuade her husband to come home with her, but he wouldn't.
At about 3 p.m. on Wednesday Dec. 15, Burns once again walked into the emergency room, still complaining of headaches. By now there were other symptoms, according to the chart. The patient "cannot understand what's going on with him . . . His speech is blocked. Disoriented in time," say the scribbled notes.
Paul, who according to the lawsuit was again the emergency room physician, called in a psychiatrist. The psychiatrist, Dr. Alix Rey, diagnosed Burns' condition as depression with a psychosomatic component, and placed him in the hospital as a psychiatric admission, according to the lawsuit.
On his admission note, Rey wrote that Burns' symptoms "seemed to point to some neurological problem" and Rey called for "urgent consultation" with a neurologist. Burns spent the night on 1-West, the hospital's psychiatric unit. The next morning, a neurologist, Luke Kao, examined Burns and ordered a CAT scan, a highly sophisticated X-ray of the patient's brain. The doctors then discovered a large brain abscess, a collection of pus that was causing increasing pressure inside Burns' head.
Valerie Burns said that the phone rang on the morning of the 16th and a hospital employe told her her husband had been admitted. She rushed to the hospital, and remembers, "I saw him and almost fainted on the spot.
"He was beating on the bed. He couldn't hold his head up. He was praying to try to stop the pain, 'Oh God, please release this. The pain is so bad.' "
Valerie Burns said that after the CAT scan, Kao told her about the large mass on Burns' brain. The doctor said the disorder was treatable, the hospital had started medication and called a neurosurgeon who would see her husband soon. Kao told her Burns might be transferred to the University of Maryland Hospital after his condition had stabilized, she said.
Kao, contacted at his Columbia office, said he did everything he could have done. "I saw him, ordered the CAT scan , . . . diagnosed it the abscess . I started the treatment. I called the neurosurgeon. Unfortunately Burns had an arrest . . . before the neurosurgeon got there." Kao said hearings will ultimately show "we've done everything right."
Around 3 p.m. on Dec. 16, Valerie Burns said she left to pick up the children, after spending a few moments with her husband "just staring at each other."
The hospital progress notes tell the rest: "4:40 p.m. . . . . Suddenly onset of unresponsive and respiratory arrest. Code called . . . team attempted cardio pulmonary rescusitation for more than 30 minutes. Now no EKG activity, no pulse, no respiration . . . ."
Though no one can say with certainty whether there was a direct relationship between the tooth extraction and the brain abscess, the hospital's autopsy report on Burns said the possibility "cannot be excluded."
A neurosurgeon who reviewed the case for The Washington Post said a decayed tooth could serve as a site for infection, which then could be carried by the bloodstream to the brain. The infection would cause the collection of pus which, in turn, could cause the brain to swell so much that it would shift position, the doctor explained. At some point, the swelling would compress other vital areas of the brain, such as those that control breathing. Respiration would stop, and the patient would die.
In her malpractice suit, Valerie Burns claims that the doctor should have recognized the signs of a neurological disorder on the first visit and called in a specialist. On the second visit, "routine neurosurgical treatment, . . . consisting of drainage of the abscess and appropriate antibiotic therapy, would have prevented the tragic events" that followed, the lawsuit alleges. And by the third visit, the lawsuit argues, doctors should have recognized "the unmistakable probability of a brain abscess."
The hospital autopsy report says symptoms suggesting an abscess did not appear at first probably because of the part of the brain the infection occurred in. Signs later appeared as a result of brain swelling, the report suggests.
Paul, Rey and Kao, who have filed formal responses in the case, said they "did not commit the wrongs alleged." The fourth doctor has not yet filed his response.
The Washington Post asked several neurosurgeons, who unlike the emergency room doctors specialize in disorders of the brain, to comment on the case. None had anything to do with the incident. One, who asked not to be identified, said the doctors "did all the right things" and that "people die sometimes in spite of good medical care."
But another neurosurgeon, Dr. Bernard J. Sussman, who is on the faculty at Howard University, said the doctors were "skating on thin ice" the first time they saw Burns and sent him home without further tests on his brain.
"The history of dental work in a patient who now has headaches is supposed to be an alarm signal," Sussman said after studying the records of Burns' case. "You can't say this fellow has chosen this particular time to have psychosomatic headaches. Your responsibility, with a history like this, is to check out the most serious diagnosis."
Regardless of the outcome of her case, Valerie Burns says her feelings will not change. "My kids should still have their father," she says. "They tell you it's one of those things that could not be helped. I'll never believe that's true."