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“I died last week, just a month after I said goodbye to you all from this very desk. I had a long and happy life – well, as happy as a cranky old guy could ever be. 92. Not bad. And gotta say, seeing my Margie, and Walter, and all my old friends again is great.

But then I read what killed me: ‘serious complications following minor surgery.’

Now what the heck is that?

Nobody gets run over by a ‘serious complication.’ You don’t hear about a guy getting shot in the chest with a ‘serious complication.’ Sure, I didn’t expect to live forever (well, maybe only a little bit), but I was sorta going for passing out some Saturday night into my strip steak at that great restaurant on Broadway. Maybe nodding off in my favorite chair, dreaming of reeling in a 40-pound striper. You know, not waking up. This whole ‘death by complication’ thing is just so, I don’t know … vague and annoying.

Here’s something else that bothers me. This note I got a few days ago from a lady who says she’s a fan. She talked to a reporter at a national newspaper the other day. Asked the reporter, basically, what kind of complication ‘’did me in’? The reporter said ‘No idea what killed him. Unless someone dies unusually young, we don’t deal with the cause of death.’

Now I know reporters have lots to do. I was one myself before they started paying me to just say what I think. But I guess what this reporter means is, if I was 29 instead of 92, they mighta thought it was worth asking why I went in for minor surgery and died of ‘serious complications.’

Remember a guy named John Murtha? A Congressman. Democrat from Pennsylvania. He made it to 77, a real spring chicken next to me. We were talking about this the other day, and guess what he told me? He went in the hospital last year to get his gallbladder taken out. A tiny incision, they said. Laparascopic surgery. Only he died, too. The reason, you guessed it: ‘complications of surgery.’ The docs looked really sad about it but they wouldn’t give out any details. They said they couldn’t, because of family privacy, and federal privacy laws. But you know, people talk. Someone on the inside came out with it: ‘they hit his intestines.’

John figures it’s better that people know what happened. Maybe it’ll help docs figure out a way not to hit intestines when they do that surgery next time. Now what’s wrong with that?

I know what you’re thinking. That Andy Rooney – something’s always bugging him. Well, I guess it’s like my mom told me a zillion years ago, when she asked me at dinner if I knew anything about how the window in the garage got broken. I said no because I didn’t want to admit I’d been throwing a baseball with Tommy McNamara, and I guess my aim was really off. She looked at me with that look moms have … the one that makes you squirm and try to change the subject and finally offer to do the dishes if only she’ll stop looking at you like that. She said ‘Andy, just tell the truth.’

So … do me a favor. Something killed me. And it would be good to know what. You don’t have to squirm, or do the dishes.

Just tell folks what happened.”

Pat Mastors is President and CEO of Pear Health LLC. She lost her father in 2006 from “complications of surgery.”

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32 Responses for “A Few More Minutes with Andy Rooney”

  1. Kathy Day RN says:

    My thoughts are with the Rooney family. I know the frustration and anger associated with preventable medical complications/error/hospital acquired infection. Of course we do not know what caused Mr Rooneys death other than serious complication from a minor surgery. This cries out preventable error to me. I wish CBS would do an investigation into Mr Rooneys cause of death, without distressing the family of course. His death was very possibly preventable. Up to 1 in 3 patients is affected by medical error or Hospital acquired infeciton caused by hospital care. This topic needs to be explored, exposed and fixed. Most of medical errors/HAIs are preventable.

    • MD as HELL says:

      Avoidable error? How about perioperative stroke or MI? How about a Pulmonary embolus?

      The only avoidance would have been to not have surgery. Then you get to experience a different outcome. Oh, it may be the exact same thing, but it will not be associated with surgery.

  2. rbaer says:

    I think a congessional investigation is needed, as well as a criminal probe. Otherwise nothing is going to happen because I am afraid that the late Mr. Rooney’s family is from a socioeconomic strata that prevents them from effectively dealing with the legal system.

  3. steve says:

    At 92 there are many potential complications, especially if he had underlying health issues. We do not know how to make the risk zero. I do not know if we will ever reach that level. We operate on many very sick patients. Nearly every week I tell patients/family that they have a high risk of dying from their surgery, but if they think the benefits are high enough, they should go ahead.

    Steve

  4. Mr. Baer’s sarcasm notwithstanding, clear reporting on the death of celebrities helps raise the consciousness of the public about these kinds of events, just as celebrities do with causes ranging from diseases (e.g., breast cancer) to, say, the need to let everyone carry a gun at every time (Charleton Heston for the National Rifle Association).

    To take a perfectly reasonable idea and demagogue it into asking for a criminal probe qualifies you to be an opinion columnist, but doesn’t do much on this blog.

    I am reminded of the first year or two when the Medicare program released hospital mortality statistics, and one Illinois hospital explained that the average age of the patients who died at its hospital was much greater than the average life expectancy for that age group. I’m not sure that, “Hey, everyone’s gotta die of something” is a particularly comforting response.

    • rbaer says:

      There are at least 2 rational flaws in this post (aside from calling my previous post both sarcastic – I’ll take that – and demagogic in the same breath):

      1) The celebrity is dead, his family did not make a statement, and therefore his case does not qualify at all for any celebrity campaigning and is very different from the examples you list.
      2) If you want a campaign about medical errors (and you truly want to), wouldn’t you better choose someone who is (was) a little younger at the time of the injury? And maybe someone who suffered a proven medical error? Dennis Quaid (or his infant, respectively) – reasonable choice. Andy Rooney – asinine.

  5. Pat says:

    First, deepest condolences to the Rooney family, and a de facto acknowledgment we have no idea what led to Rooney’s death. But for a man of such candor – and intolerance for euphemisms – to have as his epitaph “death by complication” seems a jarring disconnect.

    Farmacia, all of us understand death is inevitable. We are lucky to make it to 92. And Steve, I hear you about sharing the risks with families before performing any surgery on an elderly person in fragile health (and leaving them the option of whether to proceed). Michael, your comment is spot-on about how the death of a celebrity can offer a pivotal moment in raising the public consciousness about a disease.

    All of you underscore the point – that we should “call it like it is”, and trust patients and families enough (even if we don’t agree with them) to make well-informed decisions.

    Where does the alternative take us?

  6. DeterminedMD says:

    And one has to wonder why health care costs continue to rise? Personally, I don’t get why this post is at this site.

    When you talk to people who had major sequelae post operatively, irregardless at whatever age, a lot of them do conclude that sometimes things are out of the control of the patient, doctor, and treating staff.

    But hey, someone has to be accountable. Has anyone sued God lately?

  7. The point is NOT that this complication was avoidable or even that, at age 92, what would be minor at a different age was fatal. The point is that complications that cause death should be examined to see if they were avoidable or if death as a result was avoidable.

    Frankly, the medical literature says loud and clear that patients are not anxious to sue and that most errors do not result in lawsuits. (Emphasis: that’s the medical literature, folks, not American Bar Association press releases.) Baseball managers know that even the best hitters fail to get on base 7 out of 10 times, yet they still look at the tapes of games to see if they can improve the team. That’s all we’re asking.

    Making this confrontational (lawsuits!) avoids the real issue.

  8. pcp says:

    Nothing spells “class” like exploiting someone’s sad death to make a political point.

    • Pat says:

      PCP, as someone who lost my father from “complications of surgery”, I can only tell you I wish I had understood in real time what was happening, and had known to ask more questions. I will always wonder if there’s more I could have done. And frankly it’s news to me that raising the issue – asking for truth – constitutes making a political point.

      • rbaer says:

        Yes, you are making a political point. You assume wrongdoing (in your father’s as well as AR’s case) without any solid evidence (not even implied evidence) in order to support a certain agenda. Your intentions may be exemplary and your agenda may be entirely reasonable, but at least be honest that you are in fact asking for policy changes.

        (Disclaimer: I am a practicing physician and I believe that we could do more to prevent certain types of errors, and that the current medicolegal system is dysfunctional, needlessly scaring too many physicians and compenstaing too few victims)

        • Pat says:

          I beg to differ. I am not assuming wrongdoing in any of these cases. In my father’s case, I simply never asked. In Rooney’s case, I have no facts. I am decrying the euphemistic, uninformative phrase “complications”, and the public’s and media’s acceptance of this as a cause of death. One can no more build a culture of excellence by having a category of deaths defined only as “complications” than one could build better buildings with a data set where problems are defined as “construction problems”. The sharing of specifics is not about assigning blame. It’s about transparency. We CAN handle the truth.

  9. rbaer says:

    “the medical literature says loud and clear that patients are not anxious to sue and that most errors do not result in lawsuits”

    The 2nd statement is reasonably supported by the literature, while the 1st one is illogical, untestable conjecture, as insightful as stating “no one wants war”.

  10. OK, logic and fact:
    1) What, sarcasm and demagoguery can’t co-exist? The former in the service of the latter. (See: “But Brutus is an honorable man” in Shakespeare’s Julius Caesar. Or Rush Limbaugh, depending on your preferences.)

    2) I did not say Rooney’s family should sue. I did say that a celebrity’s family has the power to help hospitals become learning systems. The minor complication that killed a 92-year-old might mean weeks of pain and suffering (but not death) for a 62-year-old or an extra day in the hospital for a 22-year-old. If it’s avoidable, we should avoid it for reasons of morality and economics. As a 2009 JAMA commentary noted, physicians have been calling adverse events unavoidable for many years. We need to change that.

    3) Not sure about war — I would never say that everyone hates war — but the characterization of malpractice by many physicians and others is of patients and lawyers who want a big payday. A study by Hickson et al. (JAMA 2002) that is quite well-regarded notes that lawsuits are motivated not by money, but, surprise, by exactly the kind of behavior we appear (we don’t know) to have seen with Rooney; i.e., a lack of explanative clarity.

    The reality is, as Hickson notes, “A small number of physicians experience a disproportionate share of malpractice claims and expenses. If malpractice risk is related in large measure to factors such as patient dissatisfaction with interpersonal behaviors, care and treatment, and access, it might be possible to monitor physicians’ risk of being sued.”

    I don’t want to get into a debate over malpractice. In fact, my original contention is that raising the issue of malpractice was a red herring. So is age. Anyone over the age of 50 should be aware enough of his/her mortality to endorse the idea of hospitals trying to totally eliminate all preventable errors (as Baylor in North Texas and Ascension based in St. Louis have done). If that’s not an apolitical goal, I’m not sure what is.

    • rbaer says:

      1) I give you that one (although I believe the Shakespeare quote is a wrong example). I guess I took offense at your polite invective (because there is no reason to call someone – me – a demagogue because he does not share your opinion).

      2) You modified/limited your original statement to the extent that I can mostly agree with what you write now.

      However, as you probably have read, “preventability is in the eye of the reviewer”
      http://www.ncbi.nlm.nih.gov/pubmed/11466119
      Unfortunately, many if not most individuals (incl. jury members and many physicians) are unable to understand and identify hindsight bias (also called Monday morning quarterbacking)

      3) The paper you cite does not prove your conclusion at all. In fact, the authors own discussion contradicts your claim (the somewhat vague claim – as far as I can understand – that lawsuits happen only after grave wrongdoing): “In an environment characterized by high rates of legally invalid lawsuits, medical centers and their patients can benefit by identifying the origins of invalid claims in hopes of preventing others.”

      (My quote about war was just an example for an unverifiable and untestable claim about other peoples’ motivation – similar to saying: “most people are good in their hearts”. Never mind.)

      “If that’s not an apolitical goal, I’m not sure what is.” This goal is such a generality that it is absolutely meaningless. Every physician and every medical institution will subscribe to that. The questions are how to define “error”, “preventable”, and what to do in order to detect and prevent mistakes. It’s like politicans of all colours talking being concerned about jobs. As soon as you suggest certain policies (be it Keynesian stimulus, tax policy isues, preferential treatment of “job creators”), it becomes very political. You apparently support a model of much stricter review of hospital mortality and morbidity (BTW, to my knowledge, most hospitals do have morbidity and mortality reviews, any interest to contact the hospital before smelling wrongdoing here?).
      I personally think that the energy, manpower and other resources needed are probably of much better use elsewhere in the medical system. I also think that some of the repeat offenders that you (and Hickson) talk about are already identifiable; seems to me that improving (or stopping) the performance of these docs gives you much more bang for the buck.

      • Jonathan H says:

        Rbaer: and yet, over and over again across the nation and the world people die in the hospital of errors, “complications,” and hospital-acquired infections, without a clear explanation to the family of what happened and without in many cases a systematic process to inquire why. It isn’t enough if simply “most hospitals have morbidity and mortality reviews.” That’s like saying “most car manufacturers review crash data when designing their vehicles.” I really don’t see what is offensive about this article.

        There are health systems out there that have a goal of 0% avoidable deaths from errors (operationalized as iatrogenic infections, wrong site surgeries, etc.). They have actual plans and systems set up to learn from mistakes, develop new procedures, implement them, and repeat. It is no surprise that such systems have the lowest rates of such errors. We don’t necessarily have to get six sigma about it, but continual improvement needs to be the goal or you aren’t doing your job right.

        The definition of what to measure isn’t really the problem. Those disputes pale in comparison to the institutional barriers to implementing the systems that improve care.

        As for whether precious resources could be better spent elsewhere…isn’t the number 1 killer in hospitals what is done in the hospital (surgical errors, HAIs, etc.)? I’d say that warrants some serious attention.

        • rbaer says:

          Did I ever say or imply that the article is “offensive”? ( But in fact, to some extent it is, as Margalit wrote very well below.)

          “The definition of what to measure isn’t really the problem.” It’s good to know that things seem easy if you just believe hard enough in your own approach and priorities.

          “without a clear explanation to the family of what happened and without in many cases a systematic process to inquire why” – this is all pure speculation for this particular case.

          I detect a pattern here: you lend your support for the quite preposterous original post (campaigning on hospital errors based on suspected errors in the surgical care of a very priviliged nonagnerian), and then spent your time knocking down straw men and appearing reasonable ( I am all for checklists, timeouts, systematic quality improvement efforts etc., and the hospital where I practice does many of those efforts).
          But without any further information, pretending/assuming that AR’s passing has anything to do with preventable medical errors and demanding further inquiry is just preposterous.

  11. Gary O. says:

    It is fascinating to see the responses to this post. Some respond defensively, “We don’t know how to make the risk zero,” as if that should end the discussion. Some accuse the post as being part of a “campaign about medical errors,” assuming without any evidence that Mr. Rooney’s death was caused by medical error.

    I found the post to raise important questions about the appropriate assessment of risk and informed consent to surgery. Do patients die of error-free complications of “minor” surgery? Certainly. In balancing the risks and benefits of a 92-year old, it may be that surgery which would “minor” for someone half the age, would be “major.” Notwithstanding that the surgery would be” major”, i.e., higher than normal probability of death or serious sequelae, the patient might consider the benefit to be worth it.

    I know a 92-year old WWII Marine Corps fighter pilot, currently battling terminal cancer, who recently had a successful operation for a severe hernia, against the very strong recommendations of his physicians, based on the risk outweighing the benefits. I am sure his reasons for wanting the surgery were complex — relief from pain and discomfort, vanity, machismo — but they overrode just one more of many risks of death he had to face in life. We have no idea whether Mr. Rooney’s consent was fully informed, or whether the risk could have been better assessed, or whether it made any difference to him. Sometimes the risks don’t matter.

    • steve says:

      I routinely anesthetize patients in their 90s and the occasional 100 y/o. The death rate is very, very low. However, given our current state of knowledge, there is likely a lower bound we dont know how to cross. If you know Rooney’s surgery and complications and his underlying health, by all means let us discuss it.

      Steve

  12. Ms. Mastors,
    Did it ever occur to you that coming across a piece like this (“I died last week, just a month after I said goodbye to you… seeing my Margie, and Walter, and all my old friends again is great”) could be very painful for someone who lost a dear family member a few weeks ago?
    What makes you think that you can speak for Mr. Rooney post mortem? Were you best friends? Soul mates? Did you even meet him once?

    Those who were closest to Mr. Rooney, have made their wishes crystal clear:
    “The Rooney family asks that their privacy be respected at this difficult time.” http://bit.ly/tboau7
    Considering that one of his children holds an executive position at the NLM, I think they are fully informed and their decisions are their business.

    I applaud your activism towards elimination of preventable medical errors, if that’s what it is, but by your own admission, you have no idea what, if anything, was out of the ordinary here, so what exactly was the point you were making? And was it necessary to make it in such insensitive manner?

    • DeterminedMD says:

      It is the antiphysician trolling, literally in this case, for dollars at hand.

      Ok, let’s put it out there again, why are 92 year old people having elective surgery, unless they fully foot the bill? Can anyone in this country come to the conclusion it is rather ridiculous and selfish to be expecting to live full lives after 75 or so?!

      Hey, I’m going to be calling it a day about that age. For every person who has a full quality of life after 75, at least 4 to 5 people at the same time that age are really struggling to make it. It is time for America to admit the truth, living beyond seeing your grandchildren is pushing the boundaries of our species. Accept it, or pay for it!!!

  13. Pat says:

    Margalit,

    The last thing I would want to do is be hurtful to a family in the loss of a loved one, and if that’s what happened, my most profound apologies. Andy Rooney had the gift of making me, for one, feel like I knew him, and though I never had the pleasure of meeting him, was greatly saddened at his loss. In my patient advocacy work I’ve met with many families with similar stories (where cause of adverse events is not shared), and who devote much of their lives to improving outcomes and disclosure for others. I did scour the Internet for word of a cause of death (did not see the piece you linked from CBS), could not find one, and so inquired of a major national newspaper if they had any information. The response of the reporter I shared in the piece – that they don’t deal with cause of death unless the person dies unusually young – seemed ageist and dismissive. The inadequacy of this attitude – and the “pass” it gives providers on something that clearly needs discussion – is what prompted the piece.

  14. southern doc says:

    You couldn’t find a cause of death because the family has chosen not to reveal it. Your contempt for their privacy is appalling.

  15. Dear Southern Doc: Your nastiness is only matched by your stupidity. And, unlike you, I don’t hide behind a fake name.

    How dare you call this an “invasion of privacy”? Rooney is a public figure and Pat used that to write a satirical piece making the point that we need to know more about medical errors. His death, and its cause, was public. You might say it’s no one’s business but the family’s to know more than that — that would be fair. You might say the post is completely off-base, as others have — that would be fair.

    But to call an obviously satirical piece an invasion of privacy is stupid. To call it appalling for that reason is cruel. If you can’t differentiate between, say, a Rupert Murdoch employee hacking the Rooney medical record and a blogger using his death to make a point — whether you love or hate the point — you are not bothering to read very closely before typing nasty things on your computer.

    You might find this tasteless. You might find it wonderful. But it is no more an invasion of privacy than writing about the death of Michael Jackson invades his family’s privacy.

    And since I once had a phone call with Andy Rooney about medical errors, my personal opinion is he might even like it.

  16. John Ballard says:

    People, people, lighten up. By the time I got to the second sentence I enjoyed the heck out of this post. I know death is serious and usually sad, but it is the one common final experience for all mankind.

    But just because we all have an appointment with the angel of death that doesn’t mean we should all think alike. It is a mistake to presume everyone will respond the same to this little skit. Or should. Frankly, I think Andy Rooney is responding by laughing his ass off.

    My take on the situation is more nuanced, something like the issues of abortion or suicide, assisted or otherwise. Conversations and pronouncements about causes of death need not all be identical. First of all, it is an intensely private affair for those close to the deceased, and whatever information passes (or doesn’t) between medical professionals and those they treat and their survivors, is nobody else’s business.

    Others outside that small group may have all the curiosity or suspicions they like, but I see no reason for causes of death to be advertised in detail (or not) unless and until the family approves. That doesn’t mean that police investigators, insurance underwriters, hospital ethics committees or professional business managers have no “need to know.” It does mean, however, that this is not as serious or easily resolved in a comments thread.

    I’d rather discuss something easier to resolve. Like how best to achieve world peace or reverse global warming.

  17. DeterminedMD says:

    Anyone want to start a pool to bet on when the day will be we find out the specifics to Mr Rooney’s reason for passing away? Don’t expect to hear those details if they don’t fit the agenda of the commentors who are holding those pitchforks and torches looking for doctors in the night.

    Hey, people write pieces like this, I think we are entitled to hear the truth when allegations of impropriety are being made up front!

  18. Ivor says:

    @DeterminedMD,

    “fit the agenda of the commentors who are holding those pitchforks and torches looking for doctors in the night”.

    Hmm I wonder why I feel annoyed ? Perhaps its the condescending attitude to my torch and pitch fork .. we English do not have access to guns so the pitchfork and torch serve my elderly needs.

    Its the attitude .. the bedside manner .. we know best dismissal. There are many Doctors who deserve a pitchfork .. you know where.

    I personally have been damaged on three occasions by what I am led to believe are routine procedures ., I have been fobbed off and dismissed as a trouble maker when trying to get to the bottom of what went wrong.

    What is particularly annoying is the glassy eyed gone fishing sign that signify,s the interview is over.

  19. I am so happy to read this. This is the type of manual that needs to be given and not the accidental misinformation that is at the other blogs. Appreciate your sharing this best doc.

  20. Great tremendous issues here. I¡¦m very happy to see your post. Thank you a lot and i’m taking a look forward to touch you. Will you kindly drop me a e-mail?

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