This is a picture of my dad on the day my second son was born. Looking at him, apparently healthy, vigorous and happy (and only 60 years old), it’s hard to believe that in 3 months he was diagnosed with the cancer that would kill him only 8 weeks later. What’s even more difficult to believe is that his doctors had known for months that he had cancer, but they had forgotten to tell him.

I often write about egregious behavior I have seen during my medical career. Because of patient confidentiality, I generally cannot provide the details that will confirm those stories. This story is one of the most shocking, and certainly the most disillusioning for me, and it is my story to tell. Or rather, it is my father’s story, but he’s been dead for almost two decades, and I have to tell it for him.

On November 1, my father went to his doctor complaining of coughing up blood. He had never smoked, and could not imagine why this was happening. A chest X-ray done that morning revealed a fist sized tumor in the middle of his chest. I got the message as I was finishing up in the operating room and raced to meet him at the office of the chest surgeon where he had been sent. I didn’t have to go very far. All my father’s doctors were at the hospital where I worked; they were all my colleagues. I simply took the elevator.

During the appointment, I listened as the chest surgeon explained the various grim possibilities: lung cancer, lymphoma, etc. They scheduled a biopsy procedure for two days later and the surgeon asked if my father had any questions. He had only one: How could he have a fist sized tumor in his chest if only a few months before (March) he had been in this same hospital to have bladder stones removed, and his pre-op chest X-ray had been normal? The surgeon was sympathetic; sometimes tumors could grow so fast that it they could be too small to detect even a few months previously.

The next few days have a rather nightmarish quality in my memories. The biopsy revealed adenocarcinoma with an unknown primary. The cancer was so aggressive that it had lost all the features of the organ where it originated; it might have been lung cancer, but it easily could have been a metastasis from prostate cancer, or indeed any other cancer. I went down to the pathology lab to review the slides with the pathologist. I remember looking at the bizarre and wildly growing cells and thinking that they would kill my father. Anything that aggressive was certainly incurable.

At some point during those days, I thought to look at the original chest X-ray, the one that had been done routinely in March. I wanted to see if, knowing what we knew now, the cancer could be detected in its earliest stages. It was easy to find out. I just went down to the Radiology department and requested the film. I was an attending physician at the hospital and had worked there for years. They handed over the film without question.

It is difficult to capture the sense of shock and horror that I experienced on looking at the X-ray. The cancer had been diagnosed on the pre-op film. Ironically, the diagnosis had been very skilled. The cancer was small and indistinct on the original x-ray, but the radiologist had found it anyway and prominently noted it in the written report. I immediately called my father’s primary care doctor to ask if he was aware of this. He admitted that he had known since November 1, as had the chest surgeon. The surgeon had simply lied when he had he led my father (and me) to believe that the original chest X-ray was clear.

I had two questions: How had this happened? And why did they lie about it?

Speaking with all the people involved, I was able to piece together what had happened. As part of the routine preparations for the bladder surgery, my father went to the hospital for pre-operative testing the day before. The hospital staff drew blood, did an EKG and took a chest x-ray. That night, he received a call of apology; there had been a problem with the chest x-ray. Could he stop and have another one done the next morning before he presented for his surgery?

My father assumed that the problem had been technical; perhaps the X-ray was too light or too dark. He stopped the next morning, as requested, for his repeat chest x-ray and headed off for surgery. The surgery went well. The bladder stones were easily removed and he recovered quickly and completely.

What my father did not know is that he had been asked to have a repeat chest X-ray because the original X-ray had shown a small abnormal area on his left lung. The radiologist could not be certain about the identity of the abnormality, but strongly suspect that it was cancer. The repeat film confirmed that it was indeed cancer.

Why had they failed to tell my father of his cancer diagnosis? Every doctor had thought that the job of telling the patient belonged to someone else. The radiologist thought that the urologist would tell my father, since the urologist had ordered the x-ray. The urologist thought that the radiologist would alert my father if there were anything abnormal on the x-ray. The anesthesiologist was aware that the chest x-ray showed a small cancer, but assumed that either the urologist or the radiologist had told my father. The radiologist actually sent the urologist the x-ray report, which mentioned the cancer, but the as the urologist admitted at trial years later, he had never looked at it.

Why did the doctors lie about it? To this day, I can’t figure it out. When I confronted the primary care doctor he claimed that they did it to protect my father. They didn’t want to “lower his morale.” Obviously it was because no one wanted to admit what had happened, and because they wanted to protect each other. The part I can’t figure out is how they thought they would keep it a secret. I worked at the same hospital. I had complete access to all the records, including the X-ray, yet somehow they imagined I would never look.

Despite multiple types of aggressive chemotherapy, my father died, gasping for air, 8 weeks to the day after the second chest X-ray. Before he died, my father extracted a promise from my mother that she would sue the doctors for malpractice. He trusted the justice system in a way that he no longer trusted the medical system. He was wrong about that, too.

Part 2: How they got away with it.