QB VII (45 page)

“Could you tell us what surgical procedures are used after the removal of an ovary.”

Lighthall asked for a life-sized plastic model, which he placed on the rail facing the jury. He brushed the hair back that had fallen into his eyes and he pointed his educated finger. “This is the womb here. These yellow structures the size of a walnut on either side and behind the womb are the ovaries. What a surgeon must do is cut deeply to the stump which is known as the pedicle to the place where the ovarian artery enters the main artery. The surgeon then clamps and ties to prevent the raw stump from bleeding from the main artery.”

He nipped at his water. The judge offered him a seat, but he answered that he preferred to lecture standing.

“The next procedure is called peritonizing. There exists a very thin membrane which covers the inside of the abdomen. We lift this membrane and use it to cover the stump. In other words, use of the membrane called peritoneum to cover this raw stump is done to prevent adhesions and assure that the stump will clot properly.”

Bannister looked to the jury, incredibly attentive. He let Lighthall’s words sink in.

“It’s extremely important to do this step, then. It is vital that the raw stump be covered by peritoneal flap?”

“Yes, mandatory.”

“What would happen if you didn’t?”

“You’d be leaving a raw stump. The clot which forms in the artery is apt to become infected and adhesions are apt to form from the intestine. If the stump is not properly sealed off there would be hemorrhaging and the possibility of a secondary hemorrhage at a later date of seven to ten days.”

He nodded to the associate who removed the model.

“Are you familiar with the testimony of Dr. Kelno?”

“I read it with extreme care.”

“When I asked him if it was proper to cover the stump by use of the peritoneal flap as you have just described he said there was no peritoneum.”

“Well, I can’t imagine where he learned surgery. I have been practicing gynecology for over forty years and in performing over a thousand ovariectomies I have never failed to find the peritoneum.”

“It’s there then?”

“Goodness, yes.”

“Dr. Kelno further testified that this method of tying off the raw stump was by a single cross-stitch from the so-called infundibulopelvic ligament. What would you say to that?”

“I’d say it’s very bizarre, indeed.”

The eyes of everyone were on Adam Kelno, particularly those of Terrence, who sat openmouthed and felt himself becoming numb.

“How long should an ovariectomy take from the incision to the end?”

“The better part of a half an hour.”

“Is there any virtue in doing it in fifteen minutes?”

“Not unless there is a calamity such as an abdominal hemorrhage. Otherwise I would opine that it is bad surgery to operate with such celerity.”

“Would there be any connection between speed and post-operational hemorrhage?”

Lighthall looked to the high ceiling in meditation. “Well, if one is working to the clock, one cannot do this surgical toilet which I described. One simply cannot tie off the raw stump and control the bleeding when working at such speed.”

Bannister looked at the jury as Oliver Lighthall continued to collect his thoughts. “Do you have anything further on this, Professor?”

“When I examined those four women I was not in the least surprised to hear that one of them had died the night of the surgery and another failed to recover. It is my opinion,” he said, looking directly down at the solicitor’s table at Adam Kelno, “it was due to improper tying of the stump.”

It was now becoming apparent that Oliver Lighthall’s testimony was an answer in fury over what he had seen.

“If in a series of operations the surgeon did not wash his hands or sterilize his instruments between operations, what is apt to occur?”

“I cannot conceive of any surgeon not attending to these basic principles. Since the days of Lister it would be tantamount to criminal negligence.”

“Criminal negligence,” Bannister repeated softly, “and what would be the results of such criminal negligence?”

“Serious infection.”

“And what of the condition of the operating theater itself?”

“Everyone present should be made as germ free as possible, masks, gowns, antiseptics. For example, in this court now our clothing is filled with bacteria. In a surgery it would spread through the air onto the exposed body of the patient.”

“Is one more or less likely to hemorrhage because of the choice of anesthetic?”

“Yes. Spinals are absolutely notorious for the risk of hemorrhage because of the drop of blood pressure and doubly so if the raw stump is not properly attended to.”

“How long should it take for the wound to heal after a normal successful ovariectomy?”

“A week or so.”

“Not weeks or months?”

“No.”

“In fact, if it were taking weeks and the wounds secreted pus and gave off a noxious odor, what would that indicate?”

“Infection at the time of the operation, an improperly performed operation, not enough care to antiseptic and sterilization.”

“What of the needle?”

“Well, let us see. It has been plunged through the tissues of the back. It has gone into the spinal canal and damage could occur to the membranes covering the spinal cord. This could cause permanent damage.”

“And lifelong pain?”

“Yes.”

“Would you tell us your observations in your examination of the four women?”

“My Lord, may I refer to some notes I took?”

“Certainly.”

He patted through his pockets and slipped on his glasses. “In the order of their testimony. The first lady, one of the twins from Israel. Yolan Shoret. She had a very marked deficiency of the scar. There was a gap, a hole if you please, that was covered only by the thickness of her skin between the outermost layer and innermost layer which covered the cavity of her abdomen.”

He looked to the judge and held up his hand. “For the sake of demonstrating measurement, I’d like to use the width of my finger tips.”

“Does the jury understand that?” the judge asked. They all nodded slightly.

“Mrs. Shoret’s scar was three finger tips wide and she had a hernia indicating improper healing.”

He fumbled through his notes again. “Now her sister, Mrs. Halevy, had an extremely short incision two finger tips wide or of about an inch in length. A very small incision, indeed. She also showed a deficiency in the middle of her scar where it had not healed and deep pigmented brown from the radiation.”

“The burn still showed.”

“Yes. Now the worst of them was the third lady, Mrs. Peretz from Trieste. The lady whose son translated for her. Her wound was covered literally by the thickness of a piece of paper. She had the same marked deficiency of the layers of the abdominal wall, the belly wall, and also a very small scar of two finger tips.”

“Could I interrupt,” Bannister said. “You said her wound was covered by the thickness of a piece of paper. How thick is the normal abdominal wall?”

“It consists of several layers, namely skin, fat, a fibrous layer, a layer of muscle, and the peritoneal layer. In her case there was no fat, muscle, or fiber. In fact you could put your finger almost to her spine by poking the scar.”

“Like a hole straight through to the back of her body covered by a piece of paper.”

“Yes.”

“And the last lady?”

“Mrs. Prinz from Belgium.”

Highsmith was up. “I believe we have agreed that due to her distress I had no opportunity to cross-examine her.”

“What I ruled, Sir Robert, was that it would be called to the jury’s attention. This is not Mrs. Prinz’s testimony. It is Professor Lighthall’s. You may continue, Professor.”

“Mrs. Prinz had two scars from two operations. One was a vertical scar quite longer than the other scar, which resembled the scars of the other ladies. This would indicate to me that the vertical scar was that of a different surgeon. The horizontal scar was very brown from irradiation, again had a deep depression and was a short two finger tips. It had obviously not healed properly.”

“Was the long vertical scar the right, or the left?”

“Left.”

“Mrs. Prinz testified that her left ovary was removed by Dr. Dimshits. What would you say was the general condition?”

“I found no evidence of depression, infection, or irradiation bum. It appeared to be a proper operation.”

“But not the other one?”

“No, it was like the other ladies, more or less.”

“Now, Professor, what in your experience is the normal length of such an incision?”

“Oh, three to six inches depending on the surgeon and the case.”

“But never an inch or two inches?” Bannister asked.

“Certainly not.”

“How do you compare these scars with ovariectomies you have observed elsewhere?”

“I have practiced surgery here and in Europe and in Africa, the Middle East, Australia, and India as well. I’ve never seen such scars in all my years. Even the final stitching was abhorrent. All the wounds reopened.”

As Lighthall shoveled the notes back in his pocket a sickening cloud of disbelief had descended on the courtroom. Sir Robert knew he had been damaged and had better neutralize the testimony.

“From your evidence,” Highsmith said, “you appreciate the difference between the swank comforts of the posh clinics of Wimpole and Wigmore Streets and that of the Jadwiga Concentration Camp?”

“Very much so, indeed.”

“And you are very aware that Her Majesty’s government has knighted this man for his skill as a physician and a surgeon.”

“I am aware.”

“Skills so obvious that despite different surgical procedures they would make it impossible for Sir Adam Kelno to have performed the surgery you have described.”

“I’d rather think that no proper surgeon would have done it, but obviously someone did.”

“But not Sir Adam Kelno. Now then, you are aware of the hundreds of thousands of persons put to death in Jadwiga with a single quick snuff.”

“Yes.”

“And we are in a hell, not in Cavendish Square, but an abnormal hell where all human life has been totally minimized.”

“Yes.”

“And you would agree, would you not, that if you were a prisoner/doctor working without hours and in life and death struggle that if an SS officer walked into your surgery without a gown and mask there was poor little you could do about that.”

“I must agree.”

“And you know, do you not, Professor Lighthall, that the British medical journals are filled with articles about irradiation hazards in leukemia and to unborn children and of their genetic effects and that irradiated women have produced monsters or congenitally malformed fetuses.”

“Yes.”

“And you know that doctors and radiologists have died from radiation and that in 1940 it was not the skill it is today.”

“I do.”

“Can you not conceive that a doctor torn away from the world and plunged into a nightmarish hell could not have grave apprehension.”

“I would have to concede that.”

“And will you not concede there were many different opinions about the length of incisions and the time it took to perform certain operations?”

“Just a moment now, Sir Robert, I feel a bit stampeded here. Keyhole surgery and undue speed are bad business and Polish doctors recognized it in those days.”

“Would you tell my Lord and the jury if a British doctor is apt to be far more conservative than a Polish doctor?”

“Well, I must testify with pride that we do stress careful painstaking surgery. But I have testified to the examination of Mrs. Prinz, who had surgery by two Polish doctors, one done properly and one not.”

Sir Robert bounced off both feet and his robe fell from his shoulders, “I suggest that there are so many different theories between British and Continental surgeons that you could have a convention for a year and not agree on certain points.”

Oliver Lighthall waited until the fury of the wind of Sir Robert’s blast had dissipated. “Sir Robert,” he answered softly. “There cannot be two schools of thought about the examination of those women. It was crude, bad surgery. In nonmedical terms I’d describe it as butchery.”

The silence and the glower between the two was like a burning fuse about to lead to explosion.

My God, Gilray thought, here are two eminent Englishmen going at each other like savages.

“I should like to question Professor Lighthall on certain matters of medical ethics,” the judge said quickly, to save the situation. “Would you mind, Sir Robert?”

“No, my Lord,” he answered, glad to be taken off the spot.

“Mr. Bannister?”

“I certainly think Professor Lighthall is qualified, and I think it proper of your Lordship to do so.”

“Thank you,” the judge said. Anthony Gilray dropped his pencil and leaned his face on his hand and weighed his thoughts. “What we have here, Professor, is the testimony of two doctors who said they would have been put to death or surgery would have been performed by somebody without proper skill. Mr. Bannister has strongly contested whether or not such surgery would have ever been performed by an unskilled SS orderly. However, in the circumstances of Jadwiga we may assume that the threat was truly made and might have been carried out, if only as an example to the other doctors who may have been called upon later. We are not at a point in this case where it has been proved that Sir Adam did the operations you described. What I am seeking from you is an ethical concept. In your view, is a surgeon justified in carrying out an operation with questionable legitimate medical purpose against the will of the patient?”

Lighthall once more withdrew into the sanctity of meditation. “My Lord, it is completely contrary to any medical practice I have known.”

“Well, we’re talking about medical practices no one ever heard of. Say a man in an Arab country had been sentenced to have a hand cut off for thievery and you are the only skilled physician about. It’s either you or someone will hack it off.”

“In such a case I would say to the chap that I am without choice.”

Adam Kelno nodded and smiled a little.

“Nothing,” Lighthall continued, “would have made me consider it if the patient did not agree and nothing could force me to commit crude surgery. But I believe, my Lord, as I was about to do it, I would have the strength to turn the knife on myself.”