It was a quiet, quaint afternoon in Santa Clara County, California. Dr. William Sherman was making his daily rounds at the Santa Clara Valley Regional Hospital. Everything was going normal. All of his patients were responding to the treatments he had prescribed and nothing was out of the ordinary. It was about 6:30 Pm when Dr. Sherman left the hospital to go home for the evening. As he got into his car his pager loudly went off, buzzing for him to immediately return to the Hospital for an emergency Appendectomy. Dr. Sherman was in utter shock. The last time he had performed an Appendectomy was in his third year of Surgical Residency. He immediately called the operating room and asked why he was getting paged. The nursing staff explained to him that he was the only certified surgeon available at this time. He then raced into the Hospital and began preparing for surgery. When Dr. Sherman was scrubbing in his heart started to beat faster and his forehead began to bead up with sweat. He was extremely nervous because he isn't a surgeon, he is a pediatric dermatologist with a subspecialty in surgery. But he hasn't performed any type of major surgery in over 25 years. Dr. Sherman knew that this Appendectomy was out of his league but he wouldn't cancel the surgery for two reasons. First, his ego was too big for him to back down and quit, and second, the patient would die if he didn't get immediate attention. After scrubbing in he opened the doors of the OR and stepped in. As soon as the doors opened Dr. Sherman's heart sank to the bottom of his chest. The patient was a little boy, no older than 6 years old. As he walked in there was a whirlwind of activity going on. Nurses were preparing the patient, surgical techs were lining up all of the instruments ,and the anesthesiologist was intubating the boy. As Dr. Sherman stepped over the boy to examine him, a little tear left the corner of his eye. The boy looked so innocent and helpless. The nurse came over and started reading off patient information. She read, Patient name, Cameron Smith, patient age, 5 years old, medical history, no known allergies, anemic, and below weight. These challenges made the situation even more complicated. Not only was Dr. Sherman inexperienced and lacked the knowledge to perform the appendectomy, the child was below weight which means that boy can't lose very much blood and he has low iron so his blood can't clot as easy.  “10 blade, said Dr. Sherman in a quiet voice.” As the surgical tech was handing the 10 blade scalpel, Dr Sherman said a quick prayer in his mind. Asking God to guide him through this surgery. As quickly as he could, he recalled from medical school and surgical residency how deep to cut and how long the cut should be. He couldn't remember exactly so he estimated. He pressed the scalpel firmly to the boys abdomen and slowly dragged the scalpel away from him. The soft sound of the scalpel cutting open the skin made Dr. Sherman queasy. Normally nothing made Dr. Sherman sick but this was different. There was no turning back now, he was the person responsible for this innocent little boys life. He assumed the role of God for the time being. The boys life is in his hands now. As he finished the cut, the nurse wiped the excess blood away and Dr. Sherman pried open the 4 inch cut with forceps and then inserted the abdominal retractors. He could now see the inflamed appendix and the surrounding organs. He knew that if he didn't get the appendix out now, that it would rupture and send the boy into septic shock. Dr. Shrerman started to excise some of the excess waste around the appendix, slowly and meticulously he worked his way through the proper steps of the procedure. He tied off the digastric tube and was about to remove the appendix, he was so close to finishing up the surgery. Dr. Sherman asked for an 11 blade, the surgical tech gave it to him and he angled the blade up to the digastric tube and cut. As soon as the scalpel penetrated the digastric tube, blood squirted all over the operating room. Dr. Sherman immediately recognised his mistake. He had forgotten that the splenic artery bypassed the digastric tube. He also cut way too deep into the tube. The boys blood pressure started to plummet and he was heading into cardiac arrest. Dr. Sherman and the surgical team rushed into action, Dr. Sherman barked orders to the surrounding nurses, telling them to give the boy blood transfusions immediately. He tried to stop the bleeding with gauze but nothing was working, there was too much blood for Dr. Sherman to do anything. The boys blood pressure was almost 0 and nothing was working. Dr. Sherman wasn't ready to give up yet. He told the anesthesiologist to push 15 milligrams of adrenaline to get his heart pumping faster. He then started to perform blind suturing, by blindly finding the cut and sewing it up. This was Dr. Sherman's last resort before losing all hope. The sound of flatlining is the laughter of the devil, as Dr. Sherman put it. He had always joked around with his colleagues about having a patient die, but he had never thought that it was going to be a reality for him. As the boy flatlined there was nothing that Dr. Sherman could do but watch as the boys body became white and limp. Out of the blue, one of the nurses blurted out, “What in God's name did you just do?” There seemed to be an empty void of silence in the OR. Dr. Sherman then replied, “ I hope everyone in this room knows that this boy did not die because of me, and I think that we can all agree that the boy started having involuntary heart palpitations that caused him to flatline.” “Is everyone on the same page as me because if not I will personally go to the medical board and revoke all of your licenses so you can never practice medicine again.” “Am I clear?” said Dr. Sherman in a menacing stern voice. He then started barking orders around, telling everyone to clean up the blood thoroughly so that when the medical examiner comes and investigates the scene that he doesn't see that there is blood splattered on everything. As everyone was hard at work cleaning up the mess, Dr. Sherman was busy working on his own problem. He had to find a way to cover up the cut that was on the digastric tube. He called one of his residents on his phone and asked her to bring him a dissection pig. After the student brought him the dissection pig, he began working on his masterpiece. He carefully carved sections of the pigs artery and placed in on the dead boys appendix tube. He glued the pieces in a way that the medical examiner couldn't tell that it had been altered. As Dr. Sherman was working, he felt like he was going to pass out. His nerves were at an all time high and his anxiety was through the roof. He could not believe that this was really happening. But Dr. Sherman couldn't imagine the thought of him not being able to practice medicine and going to jail for the crimes that he had committed. But it was too late to turn back now. About 45 minutes later the reconstructed splenic artery and digastric tube was finished. He then instructed the nurse to page Dr. Nelson, the Medical Examiner and the Pathologist. 10 minutes later Dr. Nelson came in the OR and the look on his face said it all. He was in shock that Dr. Sherman, a world renowned doctor had let a little boy die. Dr. Sherman explained to Dr. Nelson what had happened. He said that the boy was having severe heart palpitations that couldn't be controlled, and along with his anemia he had died during surgery. Dr. Nelson dismissed the team and explained that he would be having individual meetings with everyone that was in the OR. 

There was dead silence among the team when everyone was scrubbing out. The awkward silence was deafening to Dr. Shrerman. Normally after a surgery, scrubbing out was fun and filled with laughter, but not this time. There seemed to be a physical weight on everyone's shoulders. After everyone left the scrubbing area, Dr. Sherman broke down. He began uncontrollably sobbing and fell to his knees cursing at God for bringing this pain and suffering upon him. But deep down Dr. Sherman knew it wasn't anybody's fault except for his own. He got his emotions under control and left the hospital to go home for the evening. It was around 11 at night when Dr Sherman got into his car. He was physically and emotionally drained. As he was driving home, his phone rang. He saw that it was Dr. Nelson, the Medical Examiner. Dr. Sherman's heart skipped a beat and his anxiety levels jumped again. He picked up the phone and answered it. He said “Hello, this is Dr. Sherman speaking, how may I help you.” Dr. Nelson said, “ Hello, this is Dr. Nelson from Santa Clara Valley Regional Hospital, after thorough examination of Cameron Smith we found some unusual findings. I noticed that his digastric tube had some unusual markings. Would you happen to know what these markings are, or what caused them? Dr. Sherman was speechless. He knew that Dr. Nelson was onto him. If he had seen the marks then he had surely seen the sutures and the pigs artery. He then said to Dr. Nelson that “ He had no idea what the marks where.” He said that he didn't notice any markings during the surgery.