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Though there is no concrete evidence to the contrary, Weisbrod and Adriane aren't buying Godat's excused absence.
"I don't think he was on the phone with his brother," the attorney claims. "I think he ducked out of the operating suite for some personal issue...But I do know that he should've been there."
Answers Bell, "It was not inappropriate for Dr. Godat not to be present when anesthesia started. He was, in fact, on campus, but unaware that it had even started. By the time he walked in, a code for Mr. Springs was in progress."
What Godat missed was Springs suffering from unpredictable throat spasms that closed his airway while under anesthesia. By the time Abraham and emergency personnel helped re-establish the passage, Springs had gone almost a half-hour with an unsecured airway and anywhere from 2 to 4 minutes without oxygen to his brain. His catastrophic damage is the result of hypoxic brain injury due to oxygen deprivation.
While the Springs camp is critical of Abraham's inexperience and lack of investigation into the medical history before surgery, her attorney backs her actions as "wholly appropriate." Both sides agree, however, that Abraham did not discuss the type of anesthesia to be used on Springs with Godat or the patient, did not check his past surgical history (two operations were performed at Medical City), did not know the source, severity or size of the wound to be removed, and didn't even know that her patient was a transplant recipient or former football player (ironically, her Facebook page states that she is a fan of the Dallas Cowboys).
"Everything I did that day was appropriate," Abraham said in her deposition. "I wouldn't have changed approach or medicines."
Chamblee says his client was well-trained, responsible and accurate in her care. "To call Dr. Abraham inexperienced is just ridiculous."
Walls, however, can't hide his contempt for the doctor. "There was a level of incompetence that turned into a perfect storm that day," he says. "Dr. Abraham just ran roughshod over the process. From the first step, everything she did was unnecessary, and the way she did it was just disrespectful to all Ron and I went through."
Despite the tragedy resulting in subsequent litigation, less than a month after Springs nosedived into his coma, his family consented to Godat finally removing the cyst, but only with her husband's current critical care provider administering conscious sedation during the procedure. The operation went smoothly.
"Things happen," Abraham testified in her deposition. "It happened under my care, yes. What happened that day...it happened. A good outcome doesn't always come out of everything...even when you act appropriately."
At 4:37 p.m, Abraham places an IV in Springs' neck; prepares a knockout cocktail of propofol, lidocaine and fentanyl; and commences anesthesia. With Springs comfortably "under," Abraham attempts to attach the LMA over his nose and mouth and down his throat at 4:46. Unsuccessful at sliding the LMA's short endotracheal tube into her patient's airway, she manually forces oxygen into his lungs via positive pressure airway ventilation (commonly referred to as "bagging"). At 4:50—after an increase of the drug relaxant sevoflurane and a second failed attempt with the LMA—Abraham tries again to bag air into Springs.
But this time she can't depress the bag. Something is blocking Springs' airway. The worst nightmare: laryngospasm.
Undetectable if not invisible, Springs' airway is involuntarily contracting and constricting, to the point of slamming shut his breathing passage. While alerting the scrub nurse on duty to call for assistance, Abraham delivers through the IV the paralysis-inducing drug rocuronium, and atropine to combat Springs' rapidly declining heart rate.
At 4:53, Abraham is strenuously attempting to force a longer endotracheal tube down Springs' throat in a desperate effort to create an airway. By 4:54, help arrives in the form of 22-year veteran anesthesiologist Dr. Quin Gerard. (By the time Godat appeared on the scene, his patient was being resuscitated.)
At 4:55 p.m., Abraham and Gerard are able to depress the bag, halting the laryngospasm and creating an airway with a burst of oxygen. Springs is sufficiently intubated, and by 5:03 Dr. Brian Gogel starts an emergency tracheotomy to secure an unobstructed airway.
Springs went without oxygen to his brain anywhere from 2-4 minutes (generally speaking, two minutes is considered a safe time while four minutes is dangerously long). Initially convinced they dodged a bullet, the doctors are startled when they administer medication to bring Springs out of anesthesia, only to be confronted by his having high blood pressure, a low heart rate, troublesome twitching and no signs of alertness.
It's too late. The patient has suffered what is almost assuredly irreparable brain damage.
Medical records from the case indicate that Ron Springs was last awake and conscious on October 12, 2007, at 4:45 p.m.
While Springs lies and stares and sits and flinches and, once in a while, sneezes—then endlessly repeats the hollow process—his attending physicians are still practicing. Often in Dallas. Godat and Abraham even worked together in surgery at Medical City after the Springs case.
But recently, according to Chamblee, Abraham's career has been significantly and negatively impacted by the stigma attached to her involvement with Springs. "It's been a devastating event for her," he says. He refused to give details other than saying she no longer works for the Texas Anesthesia Group.
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