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Tip of the Arrow article is from the September 2020 edition of Anesthesiology News

Be Prepared for Medical Malpractice Lawsuits

David Sherer, MD

So much has been written in the last 50 years about medical malpractice generally and liability in the practice of anesthesiology specifically that it is hard to find something new to add. But because liability in anesthesiology continues to be a source of professional, financial and personal heartache for anesthesiologists, it is useful and proper to revisit the topic periodically. For only with regular review and discussion can we remind ourselves what a great, yet largely avoidable, problem the threat of a lawsuit can be.

Through good fortune, skill or a personal hypersensitivity to the topic, I was able to completely escape the malpractice monster through an anesthesia career that spanned 1986 to 2019. When I look back on my 35- year clinical career, I thank my lucky stars that I somehow got through unscathed. Perhaps it was because I had deliberately made study of the issue a pet project of mine, and with good reason. My late father practiced internal medicine and endocrinology from 1950 to 2007, an astounding 57 years, and was sued once during that time. It took years to resolve the case and years from his life. It was a frivolous affair that eventually got thrown out of court based on lack of merit, but I remember as a teenager, all too well, the toll it took on him. He became clinically depressed, lost a great deal of weight, and for years seldom cracked a smile. Only after time had healed his wounds, was he able—partially—to retake possession of his old jovial self.

His experience motivated me early in my career to do two things. The first was to make sure I did not suffer the same plight as my dad. The second was to make sure my colleagues did not, either. After decades in practice, I eventually held an administrative position, part-time, as the physician director of risk management for a large and well-known managed care group. In that capacity, I lectured on malpractice and the avoidance of lawsuits. I continue to write about it in my books and blogs. I am grateful to be constantly learning.

One of the key points I have deduced, after years of study, is that no matter how carefully or attentively a system or culture of safety is designed, it is the end user—someone I like to call “the tip of the arrow”—who matters most. When you anesthetize a patient, you are in essence the tip of the arrow. With your actions, you realize the most profound and significant effects on the life and health of the human being who is under your care. You can have the most effect, positive or negative; it is your show and your deal. Everything rides on you.

What does that mean? It means when you are asked to give a gram of cefazolin at 11:15 p.m. per the surgeon request during a case, it is you and you alone who can make it happen. When you decide which spinal needle to use to minimize the chance of postdural puncture headache, it is all on you. When you see a patient has a potentially difficult airway and all the necessary contingency equipment is already at your fingertips, it is because you—the end user—made sure all was at the ready.

What is the point here? That is simple. You—the person who effects the actions that impact patients (not a system, not a policy, not a guideline or an algorithm)—and you alone have the power to ensure your actions achieve the desired outcome. Put another way, a system is only as good as the person who implements it.

Only you can be the one to learn, prepare, and act in a way that best optimizes the safety of your patient and the success of your anesthesia plan. The first step to take—learning—is why I hope you will read this article. After you learn the key points, then you can prepare and act in ways to minimize your chances of ever seeing a courtroom. I say “chances” because even in the best of outcomes and anesthesia planning, lawsuits still happen.

There is so much written about anesthesia and liability that there is a risk for overwhelming you. So I will be short and blunt. The way we hurt and kill people mostly falls under these broad categories, which I have collated from a 2015 Medscape report on the subject. Four thousand doctors, including anesthesiologists, were queried about the general nature of their lawsuits, and their responses were:

  • failure to save a life;
  • neurologic;
  • dental;
  • surgical;
  • in-hospital infection;
  • airway mishaps; and
  • cardiac arrest.

Expressed differently, the article articulated the nature of the most common lawsuits as reported by anesthesiologists who were asked about them. The respondents could check any number of categories that were relevant:

  • abnormal injury (47% of lawsuits);
  • failure to diagnose (9%);
  • failure to treat (8%);
  • failure to follow safety procedures (7%);
  • errors in medication administration (4%);
  • poor documentation and patient instruction and education (4%); and
  • improper informed consent (3%).

Compare these responses with the categories noted by Richard Novak, MD, an author and anesthesiologist who writes frequently on his website “The Anesthesia Consultant,” quoted from a study by Ranum reviewing 607 closed claims from one insurer from 2007 to 2012:

  • teeth or dental injury (20.8%);
  • death (18.3%);
  • nerve damage (13.5%);
  • organ damage (12.7%);
  • pain (10.9%); and
  • cardiopulmonary arrest (10.7%)

The Medscape article also revealed these diverse but telling facts:

  • By their career’s end, all anesthesia respondents in the survey had reported having been involved in litigation.
  • 91% of anesthesiologists over 70 years of age had been sued.
  • 32% of anesthesiologists sued expressed “true hatred” for plaintiff’s attorneys.
  • 17% of anesthesiologists wished they had documented better.
  • 12% wished they had never taken on the patient.
  • 6% wished they had phrased their documentation differently.
  • 9% of cases went to trial that resulted in a verdict.
  • 5% went to trial but were settled before a verdict.
  • 23% of cases were dismissed by the plaintiff.
  • 11% were dismissed by the court.
  • 38% of cases went on for one to two years.
  • 30% lasted three to five years.
  • 45% of plaintiffs got zero monetary reward.
  • 22% got between $100,001 and $500,000.
  • 6% received over $2 million.
  • 38% were settled before trial.
  • 3% were settled at trial.
  • 2% were settled in favor of the plaintiff.
  • 10% were settled in the doctor’s favor.

If we discount the dental injuries, we might deduce from the charts that the majority of significant categories that ended up in lawsuits were related to injuries, death and cardiac arrest. Under injuries we might also infer, from historical data and payouts, that nerve damage, organ damage and pain make up the bulk of the injuries sustained in those categories. It is not clear whether the surveyed anesthesiologists also considered death and cardiac arrest to be under the “injury” category.

However one might parse and analyze the statistics, one thing remains clear: Loss of the airway has been and continues to be a major driver in anesthesia liability. For it is the loss of the airway, with an inability to ventilate and/or oxygenate for a sustained period of time, that leads to neurologic injury (most seriously anoxic brain injury), organ injury, cardiac arrest and death. The second most significant area of liability relates to other injuries, particularly peripheral nerves, eyes and teeth (although many authors discount teeth in their discussion of injuries).

We know that loss of the airway can result in the most devastating injuries and highest monetary awards simply by examining past data. So great was the impact of pulse oximetry and capnography when those technologies came into common use that anesthesia-related payouts had actually decreased after those tools became the standard of care. With the advent of the American Society of Anesthesiologists’ airway algorithm in the 1990s, there was even further improvement in the administration and management of general anesthesia and further reductions in liability payouts.

Despite these developments, payouts for injuries related to the loss of the airway continue to be a problem, as do injuries to peripheral nerves. But whether it is loss of the airway; damage to the peripheral nerves, the teeth or the eyes; an infection; massive blood loss; cardiac or respiratory arrest; awareness under anesthesia; residual pain; medication overdose or error; or any of the other host of injuries we anesthesiologists can inflict, the burden clearly rests on you.

So, how do you best deal with that burden? Surely, the threat of a lawsuit is already a lot to handle over and above the normal stresses you face. The fatigue of long hours, being on call, administrative pressures, the constant stress of having people’s lives in your hands, intra- and interdepartmental squabbling … is enough for anyone (and makes me so thrilled that I do not deal with any of that anymore).

I have some advice, none of which is original. But it has stood the test of time.

  • MMAIDS! This mnemonic means “machine, monitors, airway, IV, drugs and suction.” Memorize it and use it. Make sure you have everything you need before you start a case. Check everything, every time. No exceptions.
  • Document, document, document! Write clearly and succinctly. Better to write “1 gm Ancef given per Dr Jones’s request at 1415” than to write a hardly legible “1” in the bar that runs across the page. Learn what to say and not to say. Never erase, never alter a record outside of the boundaries of acceptable practice. Use a single line through a word or phrase, date and time it with your initials.
  • Ask for help, if you think you will need it, before things go south. Realize that help may not always be available.
  • Communicate clearly with your team, the nurses and the surgeon. This is key.
  • Make sure your backup plans for the airway, the circulation and any other crucial areas of care are clear and ready to implement.
  • Establish rapport with your patients to the best of your ability.
  • If you have a less than optimal outcome, be honest and forthright. Express concern but not liability. Do not avoid patients or their families.
  • If someone in your department has a better skill set than you do, use that person, if he or she is willing to assist.
  • Be neurotic about positioning, especially in prone patients. Always check and recheck eyes, head and spine position, ulnar nerves and other nerves. When raising the foot of the table, always check that appendages are free from table manipulation. Recheck pressure points periodically throughout the case. Body parts move. Recheck them again.
  • Be anal about air bubbles in pediatric IVs.
  • Never talk a patient into an anesthetic plan that he or she rejects. All you can do is present a strong argument. You can’t force a patient into anything.
  • Use your best judgment about risks versus benefits discussions with patients. These are tricky areas. Use common sense.
  • If you think you will need pressors, have them ready to go. If you think you need the crash cart handy, have it next to you before you need it. Anticipate everything.
  • Know when to abandon your manipulation of the airway. Don’t paint yourself into a corner. It’s always better to cogently move to Plan B and C than flail away at a failing strategy.
  • Be neurotic about the airway in all its aspects and nuances. Regularly attend an airway course.
  • Have succinylcholine ready. Know where the dantrolene is kept and how it is stored and reconstituted. Know where the intralipid is and how to use it.
  • Don’t be a cowboy. Cowboys eventually ride their way into court on their own horse.
  • Carefully evaluate your personality and your practice. Do you work best alone or in a team setting? Do you like to supervise or do your own cases? How much call are you willing to take to balance your salary desires with your lifestyle?
  • Always be on the lookout for awareness under anesthesia—tearing, rapid respiration, tachycardia, movement.
  • If you think you will be needing blood, platelets or clotting factors during your case, have those arranged well in advance, if possible.
  • Keep your patient warm.
  • Remember: a-lines, central lines and other invasive stuff always come with a price tag. Weigh the risks and benefits carefully.

If you have the energy, conviction and dedication to do all these things, you will minimize, but not eliminate, your prospects of being sued. It takes a lot, on top of what you already do, to make these things a part of your daily practice. But is not “vigilance” the byword of our specialty?

Reviews

November/December issue of Bethesda Magazine

Don’t be shy about using your call button. Put an ink mark on the limb or body part to be operated on. Watch comedies to help you recuperate. That’s some of the advice that Dr. David Sherer, a retired anesthesiologist, offers in Hospital Survival Guide: The Patient Handbook to Getting Better and Getting Out (Humanix Books, August 2020) The updated version of a book originally released in 2003 covers COVID-19 and emphasizes the need to be an informed patient. “If you don’t adovocate for yourself or have someone who will do it for you, the chance of medical error happening to you goes way up”, says Sherer, who lives in Chevy Chase. “I think there should be a patient ‘Me Too’ movement… Patients need to be treatd and advocate differently than they have been.”

WASHINGTON, DC
FEBRUARY 25, 2015

STRANGER: David Sherer
LOCATION: Le Chat Noir, 4907 Wisconsin Avenue NW, Washington, DC
THEME: Dining with a writer/anesthesiologist/inventor

Dr. David Sherer is preparing to retire, and he couldn’t be happier.

Leaving behind his lengthy career in the medical sector will free him up to focus on his love of writing. David, 57, recently finished writing an autobiographical tale about his quest to reunite with the maid from his childhood home. It’s his second book, following a patients’ hospital “survival” guide that he wrote. And he’s eager to carry on composing with the written word.

“There is a third book I’m thinking about. It’s brewing somewhere in me. I’d like to write some fiction,” he said during a laid-back dinner interview in Washington, DC. We met at the French restaurant Le Chat Noir, two of less than a dozen diners that night.

Perhaps the cold weather outside had something to do with the low turnout, but it can’t have been anything to do with the aesthetics of the place. It’s a warmly lit restaurant with a few minimal pieces of decorative art inside (including an accordion hanging on one wall).

The menu features a host of traditional French dishes – including an almost-overwhelming variety of crepes. It was my first time at the venue, so while I perused the menu, David told me more about his plans to continue on his nascent second-life as an author.

He’s still toying with ideas for the third book, but in the meantime has entered a short story writing contest for Bethesda Magazine. Winning, or even placing, in that contest “would sure be a shot in the arm” that would encourage him to write the third book, David said.

With a busy career as an experienced anesthesiologist, David has had to fit his existing writing around his work schedule – something he is preparing to leave behind. And he spoke with apparent relief about being able to put the long hours and other strains of his career behind him.

“On balance, I would never have done this career,” he said. “Between the threats of being sued, the stress involved, and the fact that some people don’t take care of themselves, it hasn’t been worth it. That’s being brutally honest. But I’m pleased to say my retirement is coming soon.”

Sipping on a glass of sparkling wine, David said that he’s looking forward to spending more time with his family (he’s married with one son) and pursuing his interests such as writing. “I’m not old, and I would like to do a lot more that’s outside medicine,” he said. “I had to give up all of my artistic ambitions to become a professional and earn money. Now that I’ve earned money, I’d like to explore something else,” he added, flashing his often-present, warm smile.

Touting his autobiographical book, The House of Black and White, David said that the story has a lesson in it. “If you have something you want to do, don’t wait,” he said. “As corny as it sounds, tomorrow is a promise to nobody. If you’re thinking about tying up loose ends or contacting someone you’ve been thinking about, it’s better to not put it off.”

Acting on one’s goals and not procrastinating is an ethos David used in writing his second book, which chronicles his idea to try and reconnect with the African American maid Louise Johnson Morris.

Louise had helped raise David at his childhood home in Montgomery County, Maryland, and he said his memories were fond of her because “she was like a mother to me.”

“There was a tremendous amount of strife in our family growing up. My own mother and father did not get along well and were always at loggerheads with each other. It was a chaotic, frenetic environment. Louise had a pacifying affect, she was something peaceful to cling to,” David said.

The maid lived with the Sherer family for roughly 22 years, but in 1981, a short while after David left for college, Louise was let go — and he never really knew the reason why. Contact had been broken with the woman who had meant so much to him in his early years. The silence bothered him for decades, until about five years ago he finally decided to try and reunite with her.

“People talk about closure, tying up whatever loose ends might be out there. I felt this would be a great creative way to tie up loose ends by writing about it,” he said. The closure he needed was in part because he never found out what happened to Louise after 1981.

But where to start? “I didn’t even know whether she was alive or not,” David said, as he leaned down to pick up a bag he’d brought with him. He pulled out a sepia-toned picture of six happy children, with a stylish-looking, smiling woman towering behind them.

“This was Louise when she worked with our family, and that’s her with me and some neighborhood children,” said David.

As David reached for a second photograph, his smile grew. The adoration he still feels for Louise was obvious when he looked at a second picture of Louise, taking around 1972 outside the National Gallery of Art in Washington, DC, when she was about 50 years old.

That mean Louise present-day would have been in her 90s. David tried to think where to start in tracking her down. “I figured that the only way I would find her is through her son’s footprint,” he said. He knew the name of Louise’s son, and so he started by using the internet to try and track him down. Eventually he found an address in Baltimore and went to visit it. He knocked at the door but there was no answer. So he left a note explaining who he was and why he wanted to contact Louise. All he could do after that was wait and see whether he’d ever hear back.

He did. Louise’s son called to say that his mother was still alive and now living back in her home town of Macon, Georgia. Buoyed by this discovery, David quickly booked a flight down to Atlanta and within about a week was down South, spending several days with Louise, talking and reminiscing.

“It was an unbelievable reunion,” he said. “To see someone you hadn’t seen in over 30 years, who was like your mother, it was almost indescribable,” he added, smiling fondly.

The reunion was tinged with some sadness as Louise’s formerly towering figure was now confined to a wheelchair. And a short time later, Louise passed away (her funeral ends the book). But before that happened, the two were still able to share memories, and David said he made connections with Louise’s family members that he’s still maintaining today.

After writing about his childhood memories and his experiences reuniting with Louise, David launched a joint venture with a publisher to try and sell the book. He also hired a public relations firm to help get word out, as well as doing his own promotional work. “What you learn as an aspiring author is that if you don’t do the legwork, nobody’s going to sell your book for you. I’ve done a lot of aggressive campaigning for myself,” said David.

David’s promotional work includes dining with a stranger.

He suggested Le Chat Noir, saying it’s a place he likes to dine at once in a while. I wouldn’t expect harsh words from David, who comes across as self-effacing and friendly. And based off the starters, I could see why he had kind words to say about the restaurant.

When the waiter set down my appetizer of a crèpe savoyarde, I thought I’d made a huge mistake. The dish — a crepe stuffed with caramelized onions, St. Nectaire cheese, and prosciutto — was massive, making me worried it’d kill my appetite for the entree. Even so, I couldn’t resist eating the whole thing. The crepe was incredibly rich without being sickly, and was a great starter.

David played it healthier with his first course of the salade paysanne, featuring green lentils, bacon, frisée salad, a poached egg, and Dijon mustard vinaigrette.

While we ate, he told me that writing The House of Black and White had been an entirely different experience from his first book, the Hospital Survival Guide: 100+ Ways to Make Your Hospital Stay Safe and Comfortable. It’s a how-to for people checking in at a hospital, everything from tips on how to best zip through the waiting room to what to expect pre- and post-operations.

Example: the book talks about what David says is the “July syndrome” at hospitals. Apparently that month is the worst to have surgery done at a teaching hospital because that’s when all the new residents and interns start. “It’s the most dangerous time to be in a hospital,” he said.

What prompted him to want to compile his hospital knowledge in one book? “One reason was that I kept getting asked the same questions by patients, and thought there should a resource for people to go to,” he said. The other reason is that his sister was chronically ill from age 7 until she died age 26, and she had some bad experiences at hospitals — things David didn’t want others to go through. “This book answers every question you might have when you to go a hospital,” he said.

“I think it’s as pertinent today as when it was written in 2003, nothing much has changed except some of the technologies,” said David.

The book has won good online reviews and some accolades, including being named by the Wall Street Journal as a top-five best book on healthcare in 2005, but David said that sales have been modest. Still, he’s proud of the book whenever he hears from hospital patients who have used the book’s information to make their stays more pleasant.

While the waiter took away our now-demolished starters, I told David about my own trip to the hospital in 2009 to have my appendix removed. That experience included a painful visit from an intern who pressed down on bandages covering a fresh wound (yes, it hurt, and yes, I swore out loud) to waiting almost two hours at check-in even though the appendix could have burst at any time.

“This book tells you how to not have that wait,” David said. “It tells you the right things to say and how to work around the system. This is exactly the kind of book I wrote for people like you: you have a pain, you think it’s serious, but you’re dumped on the doorstep somewhere at some hospital. You need help but you’re at the mercy of the system, you have basically no control.”

David has thought about writing another book about the need for the human race to step back from gluttony and sloth and take better care of itself. But he dropped that plan for fear that it would come across as “too preachy” and that nobody would pay attention to it.

Nevertheless, he does have many thoughts on the current state of healthcare, which he thinks has evolved in a bad direction since he wrote his guide. He’d love to see everyone have health insurance but believes existing efforts have either been botched or, like Obamacare, had horrible rollouts. And he’s concerned about major health corporations swallowing up smaller practices, turning patient services into businesses and branding rather than focusing on care.

“I think that the trend will continue at least in the next few years, and I think you’ll most certainly see a move where medicine is strictly for business and not the more human science that my father practiced for 57 years of his life from 1950 to 2007,” said David.

His father’s career in medicine is what drove David into the same profession.

Born in Maryland, that’s where he grew up before heading to Emory University in Atlanta to pursue a BA in music. His mother is a pianist, and David loved the instrument from an early age. Although he got a degree in the subject, “I knew I would not make a living as a musician. I did not have the talent and the chances of a secure life or financial success were very low.”

And so while studying for his BA he also completed his pre-medical course requirements. He said his father touted his long career as a doctor to lean on David to enter the same profession. But David didn’t like the idea of being tied to the same office day in, day out. That’s why he chose to specialize in anesthesiology. “I could go to work anywhere and carry my skill with me, unlike my father who needed an office. I guess I was looking for an exit strategy even before I started,” he said.

He got his MD at Boston University in 1984, then did an internship in internal medicine at the Sinai Hospital of Baltimore in 1985. Then came a residency at the University of Miami Jackson Memorial Hospital in the late 1980s, at the height of the city’s drug wars.

David shook his head slowly as he recounted the scenes in the inner city hospitals, seeing patients pour in with machete and gunshot wounds far too regularly.

“It was a very dangerous city then,” he said. “There was literally blood on the walls of the hospital. One weekend the fighting between the gangs was so bad, the city was on lock-down and we had to stay in the hospital.”

It’s not hard to see why David didn’t decide to settle in Miami and instead returned to Maryland. That’s where he’s been practicing anesthesiology ever since. For me that conjures up images of the guy in the operating room who puts the mask on a patient and knocks them out. As David explained, the truth is a lot more detailed than the “Hollywood version” of his career.

It’s not just anesthetizing people to knock them out cold for surgery — it can also include localized numbing of just parts of the body. And it’s a complicated process that requires David to assess a slew of factors including how the individual patient might react to a particular anesthesia medication. “It’s easy to put someone to sleep. The trick is to wake them up,” he said.

If anyone were out cold, the size of the dishes at Le Chat Noir would wake them right up. The restaurant provides incredibly generous portions of food.

David opted for the Cornish hen stuffed with portobello and chestnuts, serveed with a yukon gold potatoe pavé, charred asparagus, and a foie gras-Madeira jus. He had nothing but praise for the dish, and I admit to some jealousy with what looked like a great meal.

To fight off the cold weather outside, I chose the beef bourguignon.

It’s a traditional French beef stew with pearl onions, bacon, carrots, and mushrooms, covered in a Burgundy red wine sauce, and served atop linguini pasta.

I found the pasta to be an odd addition that didn’t really work, and the dish had a somewhat smoky tint to it that wasn’t the most pleasant. It wasn’t a terrible dish, but it was far outshone by my crepe starter.

Still, the entree was enjoyable enough to plow through while David and I continued to talk. And the hefty portions meant that neither of us were in the mood for dessert.

Instead, we ordered drinks to finish our meal — tea for him, coffee for me.

While we sipped on our hot beverages, David also told me about another interest he’d had while toiling away in the medical industry. He’s the holder of two patents. The first was for an invention that would lead doctors through a series of algorithms that medical professionals are supposed to follow when responding to a critical cardiac event like a heart attack. The second was for a coin clip for doctors back in the day when their buzzers would go off and they’d have to make payphone calls to reach the hospital. Neither brought David millions, but he got joy out of the inventing.

“Between conjuring up these things and the writing, I guess you could say I have an inventive streak,” David said, “But it never really paid my bills.”

Not that financial matters are what drives him. Instead, he keeps his eye on his looming retirement and the expectation that he can finally fully indulge in his true passions. The freedom David will get from retiring will allow him to write his own future.

Story

A Chevy Chase doctor’s quest for the woman who most influenced his childhood: the family housekeeper

After turning 50 a few years ago, Dr. David Sherer examined his mental state and hated his diagnosis. His health was declining. His mood was darkening. He felt like a “prisoner” in a profession dictated by his parents during his Bethesda childhood.

“I got very scared, and felt my life was heading in the wrong direction,” he tells me.

Sherer did not react to his turmoil in the usual way. “I didn’t run off with the secretary or buy a Stingray,” he jokes. Instead he decided to write a book about the woman he called “Weezy,” an African-American from Macon, Ga., named Louise Johnson Morris who was his family’s housekeeper for more than 20 years.

On the surface it was a placid and prosperous household. But to young David, it was a place marked by coldness and catastrophe. Morris was his source of warmth and stability, so central to his well-being that “she gradually replaced my mother as nurturer and caregiver.”

And yet Morris abruptly left town while Sherer was away at medical school in 1981 and he never heard from her again. He never tried to find her, but he never forgot her either. And now he felt a question had to be answered, a debt had to be paid.

“If I don’t understand what happened to Louise,” he remembers thinking, “I’ll never forgive myself.”

His family was dismissive, even hostile. “The attitude was: Why are you stirring up old waters,” says Sherer, now 56. “Why don’t you let a sleeping dog lie?”

But he couldn’t do that. “I felt, well, I’m tired of being told what I have to be and what I have to do…,” he says. “I’m going to poke this dog with a stick and see if it wakes up.”

Sherer’s determination was driven by history. His father, an endocrinologist, had brought the family to Montgomery County in 1953 to take a fellowship at the National Institutes of Health. They rented in Somerset before buying a house near the Burning Tree Club, which Sherer’s mother still occupies.

Morris was so important to him because his parents were so absent. They fought constantly—over finances, fears, failures—and suffered debilitating physical problems. Whatever caregiving they managed was largely devoted to Sherer’s sisters, one of whom was chronically ill; the other, chronically rebellious.

“Louise was the great equalizer, she was like ‘The Great Black Hope,’ ” Sherer recalls. “I’ve said many times that she saved my life. She filled a place that needed filling.”

As we talk over tea one winter afternoon, I ask Sherer to describe Morris. “She was tall, about 5-10,” he replies. “She had skin like dark chocolate. It was like a Dove Bar. She was muscular but not in a muscle-bound way. She had these strong, sinewy arms that almost looked like she was a basketball player. And she had this smile like a million watts of sunshine.”

When young David got home from school, she would be waiting in the kitchen. “You’d smell Louise’s fried chicken,” he says. “The first thing I would do is just kind of grab her, and she’d start her Southern talk. ‘Where you been, Old Man? Whatcha doin’?’ The humor would start, the fun would start.”

Bethesda in the ’60s and ’70s, Sherer says, was filled with families like his—mostly professional, often Jewish, intensely focused on securing their status in a blooming, booming suburb.

“You’re constantly pushed in certain ways,” he says bitterly. “You’re pushed to be a doctor. You’re pushed to kiss your relatives. You’re pushed to wear this kind of shirt. You’re pushed to pay attention to what the neighbors think. But there’s no pressure with Louise. It’s unconditional love. It’s a safety valve.”

Sherer became an anesthesiologist, married a local woman, had a son, settled in Chevy Chase, 5 miles from his boyhood home. “Deep down I really wanted none of it,” he writes in his book. What he did want was to find Weezy, though he wasn’t hopeful.

 “I did the math,” he says. “I figured she couldn’t possibly be alive—and if she was, I couldn’t find her.”

After many false starts, he decided to look for her son, Chester, who had lived with relatives in Washington while his mother worked for the Sherers. A website called Intelius located a handful of men named Chester Lee Morris, and for an extra 99 cents provided their previous addresses.

One of them, now living in Baltimore, had once lived on Sunset Avenue in Atlanta. Sherer, who attended Emory University in the Atlanta suburbs, knew Weezy had relatives on Sunset. It has to be him, he thought.

When he called, however, there was no answer. So the next day he drove to Baltimore and knocked on the door. Again no answer. He left a note in the mailbox: Call me, it said. I knew your mother a long time ago.

That night Sherer’s phone rang. It was Chester. Yes, his mother was still alive. She was 90, living in a nursing home in Macon.

A few weeks later, in February 2012, Sherer went to see her. He wasn’t prepared for the shock of meeting an infirm old woman.

How could that be Weezy? he thought. “The last time I had seen this vigorous, strong, incredible woman. Then I see this poor stiff figure in a wheelchair with food coming out of her mouth.”

He tried talking to her but got only vague responses. “I think she knew who I was,” he says, but he can’t be sure. He is sure, though, that he has paid the debt he owed her.

When she died three months later, Sherer spoke at her funeral and recalled that debt. “Louise came into my life when I was 18 months old,” he said. “She raised me, often at the expense of her own son.”

Sherer’s book, The House of Black and White, came out in February. He never solved the mystery of Weezy’s departure from his family. The author’s mother insists she was fired for thievery. Chester says she quit after failing to get a raise.

“I still don’t know what the truth is. But you know what? It doesn’t matter,” Sherer says.

 What does matter is that he finished his journey. He found Weezy. And she found him.

“Maybe she had waited for one of us to come see her and say goodbye,” he says. “And then she let herself go.” 

Steve Roberts teaches journalism and politics at George Washington University. Send ideas for future columns to sroberts@gwu.edu.

David Sherer

Dr. David Sherer is an American physician, author, writer, bloger, medical-legal and patient safety expert.

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