Grief is carved in stone

Sandra Gilbert discovered the anguish behind the bland term 'medical malpractice' when her husband died after a routine operation. But grief, she found, could be both muse and stone companion.

Exactly six years have passed since the summer day my husband and I learned he had been diagnosed with prostate cancer, and precisely five and a half years have passed since February 11, 1991, the day he bled to death - for reasons and in circumstances my children and I may never know - following a routine radical prostatectomy at the medical centre associated with the university whose English department he then chaired and where I myself still teach.

To my own astonishment, I have reassembled, renewed and redirected my life. I've written two books - Wrongful Death, a prose narrative, and Ghost Volcano, a collection of poems - in his memory, both of which have already appeared in the United States. And I have written other poems too, as well as critical prose. I have taught new courses to students he never met. I have spent nearly three years serving as an officer of the Modern Language Association, a professional organisation to which, as my elder by some six years, he introduced me when I was in my early twenties. My children and I have travelled, together and separately, to parts of the world he never saw. My grandson, his and mine, has grown from a shyly beautiful four-year-old Ninja Turtle fan into a sturdy ten-year-old artist with a blue belt in karate. I even have a new romantic companion - a kind, funny mathematician who loves many of the things I love.

And yet I feel as though my grief is carved in stone. Is a stone that journeys with me everywhere, a sometimes enigmatic, sometimes all too explicable burden I may never lose - and perhaps never want to lose. This is of course another way of saying that I have a lot in common with most other survivors of unexpected trauma: I feel myself to have been indelibly marked by a shock I still have not assimilated even while I also feel I must bear witness to the reality of an experience against which my whole self still protests.

Elliot and I had been married a little more than 33 years and he was barely 60 when he went into surgery at the University of California, Davis, Medical Center on that ill-starred February 11. He had already survived two other problematic procedures at the same hospital, the first a bone biopsy that turned out to be unnecessary, the second an attempt at prostatectomy discontinued by the surgeon when the anaesthetists botched their effort at intubation. Despite these disturbing episodes, he had no reason to suppose his life was at risk when he ceremoniously waved goodbye to me as he was wheeled towards the operating room. Yes, he had cancer, but it hadn't metastasised; otherwise, he was a robust man with no history of health problems.

When we saw him next, just 15 hours later, there was a sheet tucked up to his chin, his body was beginning to chill - to turn to granite - and it seemed to me that his mouth was curved into a rueful, slightly embarrassed smile. And for five and a half years I have carried that rueful granite smile around the world, part of the stone of my sorrow.

To be sure - and the very phrase "to be sure" is one I learned to use from Elliot - I've done what I could to speak for my husband, and specifically to tell the story of the wrong and mystery of his death. In the hope of elucidating that mystery (since we knew we could never right the wrong) my children and I brought a lawsuit against the hospital where he died. And although admitting no wrong, the institution settled almost immediately after the surgeon in charge was deposed. With the further hope of helping readers understand the terrible gravity of the phrase "medical malpractice," I wrote Wrongful Death, about the two years during which my children and I struggled to overcome not only our grief but also the stony silence with which hospital officials responded to every request for information about my husband's last hours.

How did we manage to learn anything at all about what happened? And how and why did "what" happen? These are questions I try to answer, while also examining the complex legal, social, and medical questions surrounding what doctors sometimes call "adverse events" like the one that killed my husband.

My memories of certain episodes are ineradicable - obdurate scenarios that repeat themselves again and again. Eight hours after we have been told that Elliot's surgery went well, my daughters and I are waiting in the hospital lobby, hoping that we will finally be able to visit him in the intensive care unit, when the elevator door slides open and the surgeon comes towards me, flanked by his resident and a strange woman carrying a packet labelled "Bereavement Services".

"We've had a problem, a big problem," the doctor says. "Dad's had a heart attack" - then confesses, minutes later, that my husband is dead in the recovery room, just hours post-op.

The next day, sitting in a daze at my kitchen table, I read an official obituary issued by the university public relations office, saying that Elliot died of "heart failure", not a heart attack. Two weeks later, shaky and grim, my daughters and I steel ourselves to study an official death certificate, in which yet another hospital spokesman has declared that my husband died of "liver failure". And that night I write to the medical centre, asking for my husband's records.

Ten days later, a bulky parcel arrives and we Xerox the stacks of notes it contains, puzzling over phrases that will later come to have dire meanings ("17:30. BP: 114/70. Pulse: 126. Observations/Treatments. Feeling 'Awful.' Loc Pale.") then send the materials to a close friend who is a pathologist at the National Institutes of Health in Bethesda, Maryland. Within a month I overhear my longtime collaborator, Susan Gubar, discussing the "case" on the telephone with my friend the pathologist. "Hemato-what?" she asks, pen in hand. "Hemato-crit?" "A hematocrit is a simple blood test that can reveal internal bleeding I Bleeding was the problem with Elliot," she scribbles in a notebook.

A few minutes later, I am weeping and cursing as she tells me what my friend in Bethesda learned from the records but no one at the hospital has ever revealed: my husband was given 12 units of blood before he died - a transfusion of more than half the blood in his body.

What went wrong to cause such massive bleeding that the accurate diagnosis of cause of death was neither "heart failure" nor "liver failure" but instead "acute posthemorrhagic anemia"? And how could experienced recovery room workers have failed to detect the bleeding? To this day, no representative of the medical centre has answered these questions. After Wrongful Death was published in 1995 and a story about the book appeared in the Sacramento Bee newspaper, an inquiry into the case was opened by the California State Medical Board, the agency responsible for medical accreditation throughout the state. An investigator for the board has already interviewed some of the nurses, doctors and interns who were in the surgery suite when my husband died. But it is getting harder to locate witnesses, while those who can be found are forgetful - or recalcitrant.

If my grief is so stony, my memories so ineradicable, why should I still want an explanation? What possible difference could a full description of the "adverse event" itself make at this point? From legal, medical, psychological, and sociological studies of malpractice and its repercussions - and perhaps, more dramatically, from the many readers of Wrongful Death who wrote to share their own tormenting experiences with the mystification that often surrounds medical calamities like the one that befell us - I know that accountability is both morally and emotionally crucial. A British commentator has summarised this point concisely. Noting that accountability "has proved to be [of most importance] to victims" of medical negligence and their survivors, he observes that "from the victim's point of view [this] means simply that something is done to ensure that those responsible I are required to give [an explanation] and that steps are taken to try to avoid a similar accident happening again."

Still, neither explanation nor rectification - nor, for that matter, retribution - will raise the dead or shatter stony grief. A University of Florida sociologist who has written on the meaning of the death penalty said recently that although many victims' families demanded the "closure" supposedly offered by executions, there could never really be any such resolution. "I don't even know what the term 'closure' means," he said. "Someone kills your child - there is no closure."

Someone, somehow, killed my husband. And indeed, there is no closure.

Yet that there is no closure gives special urgency to the quest for knowledge, for justice, and even for change, change not just in medical procedures but also in social attitudes towards those victims of malpractice who find it necessary to take legal action - neither out of greed nor out of gullibility (towards ambulance-chasing lawyers) but out of a passion for accountability.

And I have learned, too, in these five and a half years that even if there is no closure there is a modus vivendi called "survival," a way of living through and with grief that seemed absolutely impossible to me for months, even years, after February 11, 1991.

To be sure, my husband and I are irrevocably imprisoned in the events of that date carved in the stone that marks his grave: he is trapped in the granite of his death, and everywhere I go the stone self of my sorrow shadows some part of me, like the "monumental statue set/In everlasting watch and moveless woe" that Elizabeth Barrett Browning depicts in her powerful sonnet on "Grief".

But in these years I've learned the secret that I suppose must be known to all who have deeply mourned. One can live in the presence of that stone companion as one might live in any other circumstance, not always gesturing toward it yet not ignoring it either. Most of the time it has the impervious facticity of a massif - but now and then it takes on the terrifying beauty of a muse.

Sandra Gilbert is professor in the English department at the University of California, Davis, Wrongful Death will be published by Norton on August 28, priced Pounds 15.95.