It was a case that would haunt Mr. K for the rest of his life—a case that would cause the premature retirement of his supervising physician. But worst of all, it was a case that would have far-reaching consequences for a young mother and her family.

Mr. K, 29, had been the nurse practitioner in a three-person family practice since his graduation. The pay was good, and the regular hours allowed Mr. K to spend time with his young family. Dr. E, 59, was easy to work with, and the only other staff member was the office manager.

Mrs. C, 24, was an established patient, whose history included only minor, routine complaints. She had not been to the clinic since giving birth to her first child five months before. Doctor, nurse, and manager cooed over the baby pictures before Mrs. C went to the exam room.

The young mother complained of constipation, tenesmus, and recent blood in her stool. “Ah,” said Dr. E, while writing in the chart. “You have hemorrhoids. That’s very common after giving birth.”

He suggested she try a stool softener, such as docusate (e.g., Colace), and sent her home.

Four months later, Mrs. C was back. Her symptoms had worsened. This time she saw Mr. K, who performed a digital rectal exam and found a palpable mass within the range of his index finger. “You have an internal hemorrhoid,” he told her and recommended a different laxative.

Over the next three months, Mrs. C returned twice with the same complaints, seeing both Dr. E and Mr. K. Each time she received the same diagnosis: hemorrhoids. On one occasion, she was given an enema. On the other, she was told to use phenylephrine suppositories and take a sitz bath.

While taking the bath, Mrs. C thought she felt a vaginal tumor and went to the emergency department (ED).  After a colonoscopy, she was diagnosed with colorectal cancer. Her treatment included chemotherapy, radiation, and major surgeries to remove her entire colon and uterus.

Dr. E and Mr. K were unaware of Mrs. C’s condition until the office manager called to schedule her yearly physical. Both clinicians were shocked and looked at each other in dismay. “It’s almost unheard of for someone to develop colorectal cancer at her age,” exclaimed Dr. E. “I would never have suspected it… that poor woman!”

Three years after she first showed off her baby’s pictures, Mrs. C died. She was 27 years old.

Shortly thereafter, Dr. E and Mr. K were notified that the widower was suing them for malpractice. They contacted their insurance company, which provided a defense attorney. 

The case slowly moved toward a trial. “I’m obligated to tell you,” the defense lawyer told his clients, “that the plaintiff has offered to settle for $1 million—the limit on your insurance policy. However, I don’t advise you to take that deal. Although Mrs. C was young when she died, she worked in retail. If the jury does find for her—and I’m not saying that it will—I don’t think the economic damages will be that high.”

Not knowing what else to do, Dr. E and Mr. K followed the lawyer’s advice.