In the early hours of the night, oOn Friday, May 13, 2011, our mother (grandmother, wife and

sister), whom in this letter we shall refer to will call by her first name, Bella, walked into the St. Marys Hospital Palm Beach Gardens Medical Center in Jupiter with a complaints of an unusually strong severe headache and alarmingly high blood pressure. We can only wonder of the possible outcome of this event, had she decided to drive a bit further and admit herself to a different medical facility; or had she simply remained at her home leaving her fate in Gods hands The unchangeable fact is that Bella walked into the St. Marys hospital Palm Beach Gardens Medical Center leaving her fate in the hands of a doctor on duty, Dr. Emmanuel Olivaresiera. Unfortunately, we cannot rewind these events which would enable us to go back and edit the outcome: a week later Bella was rolled away from us in a body bag. She was sixty-two years old. Bella presented with an An unusually strong severe headache, combined with the 220240 blood pressure spiking to levels close to and well above 200, which was alarmingly high for a patient whose blood pressure has been low her entire adult life, who has a family history of hemorrhagic stroke, and who had a valve replacement surgery just three months priorsurely, can mean many things. Whether a stroke has already occurred or is impending, both

possibilities must have been evaluated and addressed immediately. One of these things can be an upcoming stroke, especially given that Bella mentioned to the doctor her genetic predisposition for a stroke. We were advised that a CT scan, which was conducted upon admission, was normal; which, presumably, indicated that Bella did not suffer a stroke at the time of admission. However, there was no follow up evaluation to determine whether Bella consequently suffered a stroke in her hospital bed as she was experiencing the worst headaches of her life until she was found unresponsive on Monday morning, May 16th. More significantly, little effort was made to monitor and control Bellas erratically high blood pressure. Yet, wWe believe that Dr. Olivaresiera did not take her complaints seriously and did only the bare the minimum required of him. Dr. Olivares failed to treat Bella as a stroke candidate. In fact, at least on one occasion he called Bellas headache a fake, said she was just anxious, on another he made and inappropriately, considering the circumstances, joked about his presence being the cause of causing Bellas headaches. During his visit on Saturday, May 14th, at the very end of his shift, Dr. Olivares did not bother to approach the patient; he simply examined her from the doorway of her hospital room, by briefly talking to her in his usual arrogant tone, clearly irritated and in a rush to leave. In addition to completely misreading the

magnitude of Bellas symptoms, when Bellas family requested that her blood pressure be constantly monitored and that an IV be started in the event that Bella may require immediate administration of medication, and, yet, on another the doctor claimed that he had no evidence of her high blood pressure being high. Moreover, he forbade Bellas husband to use his personal BP measuring device, claiming it may be unreliable. He refused to conduct further brain scans, claiming such was unnecessary. At no time did he order a neurologist, or bother to get a MR or MRA. Yet, Bella began to experience major neurological changes. Sunday evening, May 15th, she vomited, her speech was labored, and she was not able to move on her own, not even to get off the bed and take a few steps to the bathroom. The nurse on call was aware of Bellas deteriorated condition, but did nothing more than administer Zofran, and didnt even bother to notify the doctor that the patient had vomited. Bella and her husband pleaded the doctor to take more action, but all their requests were denied. It appears that Dr. Olivares did not hear Bellas complaints, nor did he take them seriously. Instead of being proactive and taking control of the spiking BP with constant BP monitoring, opening an IV line, and ordering a neurological consultation, the doctor simply reacted by giving Bella pills to mask her symptoms. On the last night of Bellas hospital stay, Dr. Olivares, in spite of Bellas concerns, ordered her to a cocktail of Vicodin, Xanax, Norvasc, and Captopril, He assured his patient that she would knock out and not have a headache that night. During one of his visits, at the very end of his shift, he did not bother to approach the patient and examined her by briefly talking with his usual arrogant tone while standing at the door step of her hospital room, clearly irritated and in a rush to leave. Moreover, he did not ensure systematic blood pressure check, and forbad Bellas husband to use his own measuring device. He did not request the visit of the neurologist. He did not hear Bellas complaints, he did not take them seriously, and he did not do anything to stabilize her blood pressure instead of acting proactively, he simply reacted to the pressure pikes with pills. On the forth night of Bellas hospital stay Dr. Oliviera prescribed Vicodin and assured his patient: You will not have a headache tonight, I promise. We will never find out whether the doctor kept his promise, because subdued and incapacitated, Bella could not bother Dr. Oliviera Olivares with her fake painheadaches; in fact, she could not even call a nurse when new signs of a stroke became apparent. She was found by the nurse in the early morning hours having vomited and unconscious. She had a cerebral hemorrhagestroke. Her brain had swollen to such a the point that, by the time she was
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transferred taken to a neurological unit at the St. Marys Medical Centerof a different hospital, there was they could no longer save her.not much that could have been done to save her. In 1955, when Bella was only seven years old and living in the Ukraine, her mother died of a hemorrhagic stroke. Bella remembered every minute of that day. She recalled how her mother went to the grocery store early in the morning, came home and cooked a meal for her family, ironed their clothes, and then suddenly experienced a terrible and disabling headache. She was never taken to the hospital and died several hours later inside her home. One would imagine, or at least, hope that 56 years later, a person who admits themselves to a hospital, located in the most medically and technologically advanced country in the world, with symptoms of an impending stroke, would have a better outcome for survival. While one may state that we do not have the medical expertise to judge this doctors treatment of Bella during the course of her hospital stay at your facility, other doctors who attempted to save her life at the St. Marys Medical Center opined that her hypertension was poorly and inadequately controlled. Undoubtedly, we may not be qualified to judge Dr. Olivieras professional decisionsAside from the question of medical negligence, but the very nature of his this doctors overall attitude toward the patient, as well as his ethics, is highly questionablecan and must be questioned. It is pointless to list numerous qualities that made Bella stand out from a human crowd for a simple reason that even if had she not been a beautiful, life-loving, giving, strong and hardworking person she would still deserve to be cared for with kindness, attentiveness and respect. Yet, there is one character trait of hers that is definitely worth to be mentioned because it clearly distinguishes Bella from her principal medical care provider at Palm Beach Gardens Medical Center-taker: she took pride in everything she did and cared for her job, her family, her friends, people and things around her A lot is being said lately about the concept of the banality of evil, which implies that evil things are often done by very common, in general terms, good people; yet, not much is being thought about the banality of good a modern-day tendency of viewing the basic human virtues as trivial and unnecessary, to disvalue and disregard responsibility, dignity, respect, and most of all, compassion. Precisely this moral inclination, at least partially, may be blamed for almost all minor mishaps and major tragedies, since the mentioned virtues are being replaced with other merits that today have a more significant face-value ambitions, prestige, financial comfort or meek convenience. Dr. Olivares and his supporting staff had the opportunity to be more proactive in this case, to utilize the full capacity of their resources, and provide Bella with quality care. They could have granted Bellas requests and transferred her to ICU for constant
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blood pressure monitoring, and started an IV, ordered a neurological consultation, a MR and/or MRA, repeated the CT scan immediately upon the onset of new neurological symptoms, and more, but chose not to. Whether their decision was due to their failure to recognize the gravity of Bellas condition, lack of interest, lack of compassion, mere convenience, or other more pressing items on the their agendas, or perhaps a combination of things is uncertain. But one cannot deny that all readily available options were not exhausted in the course of treatment of this particular patient, and that if they had been, she may still be here today. It is the reason, why there are so many people perform the jobs they are badly suited for, which they do not enjoy or enjoy for wrong reasons. And if the poor performance of a supermarket clerk might leave one simply annoyed, the misplaced teachers, pilots, police officers not to mention doctors can bring us a much significant damage beyond repair. We realize that it is human to make mistakes, and emphasize as well as we realize that the notion of a trial in error includes trying hopefully ones best and only then, perhaps, failing. The failure of an individual that did not try his or her best cannot be called a mistake; instead, it can be called carelessness, sloppiness, inattentiveness, in short, negligence. And just as it is human to err, it is human to strive, to persist, and to demonstrate empathy and compassion. What do we aim at with this letter? There is no ambitious agenda with hopes for major changes. We certainly do not expect Dr. Oliviera Olivares to change his profession, nor to attend a course on compassion given that one is available, nor to lose his sleep over just another case Besides, none of these imaginary events would bring our mother (grandmother, wife and sister) back. We cannot revise and correct the events so that Dr. Oliviera Olivares would shake off his arrogance, take his time and sit in front of Bella to tell her: I am here. I am listening. I hear your pain. We will get to the bottom of it. Because it is your life. Because it is my job. We also realize that if seeing a patient in pain did not convince Dr. OlivieraOlivares, all the words in the world will be falling on deaf ears. Yet, perhaps, just for the few minutes that it will take Dr. Oliviera Olivares to read this letter, he will put his pride away in order to hear us, to see things from a different and, needless to say, ceaselessly painful perspective, and to admit to himself simple things: I could have (should have) done more. I could have (should have) behaved differently. Because it was someones life in my hands. Because it is my job. Because in my final moments, I will want a devoted and compassionate doctor caring for me. Because the death itself might be cruel, but the maximum of effort should be made to ensure that we die surrounded by kindness and

attention. And as Dr. Oliviera Olivares walks to his car, kisses his wife, greets his children, pets his dog, and retreats to a golf course, he might try saying to himself: I could have I should have I am sorry.