Key to pseudonyms in A LIFE BEYOND REASON
A guide to the pseudonyms used in Chris Gabbard’s memoir A Life Beyond Reason: A Disabled Boy and His Father’s Enlightenment published by Beacon Press (2020). Available in audiobook, hardback, softcover, Kindle, & Nook. Order through:
This page reveals the identities of the people, institutions, companies, and products behind the names appearing in A Life Beyond Reason. Legal counsel recommended that I, the author, replace most names in the book with pseudonyms, the reason being that powerful entities in the medical-industrial complex employ batteries of lawyers and that any one of them could seek a cease-and-desist order that would effectively suppress the book. If such an order were granted, even temporarily, I would have been put to considerable expense fighting it. The pockets of these entities are deep, whereas I have no pockets. Moreover, the publisher, Beacon Press, while one of the oldest and most respected names in American book production, would not be in a position to mount a court fight. And so, discretion had to become the better part of valor.
I am Chris Gabbard, a professor of English at the University of North Florida (UNF), where I have taught since 2001. I teach the literature of the British Enlightenment, roughly 1660-1780. I earned my Ph.D. at Stanford University in 1999, the same year my son August was born.
In my memoir A Life Beyond Reason, I talk about his birth and short happy life. Everything that my lovely wife, Ilene, and I know today in 2020 about his delivery–what I report in the book and what I outline in the paragraphs to follow–was not apparent to us the year he came into our lives. It took my wife and I roughly sixteen years to piece together the story of what happened in the delivery suite on the morning of March 5. In other words, a full understanding of what took place at his birth did not come to us until two years after his death. Here is a synopsis of the story with the names of the participants uncensored.
The list of uncensored names includes Dr. Sarah Kilpatrick of Cedars Sinai in Los Angeles, Dr. Lisa Lipschitz of Scripps Health in San Diego, Dr. Jeffrey Greenspoon now practicing in Springfield MO, Charles Kelly of the San Francisco law firm Hersh & Hersh, Dr. Hector James and Dr. Louise Spierre of Wolfson Children’s Hospital in Jacksonville, FL, and Dr. Stephen Lazoff (now retired), formerly of Jacksonville, FL. The list also includes the University of California, San Francisco (U.C.S.F.), Wolfson Children’s Hospital, and Medtronic.
Up until the day of August’s birth, the pregnancy had proceeded uneventfully. Ilene herself was a medical professional, a clinical professor of Physical Therapy at U.C.S.F. She had followed all of the recommendations for a healthy pregnancy found in What To Expect When You’re Expecting and other sources. She took great care of herself, and her pregnancy was deemed to be low risk. Her doctors even allowed our baby to go eleven days past the due date before inducing labor.
From the point of view of the medical professionals who delivered our son, nothing worrisome appeared during the gestation period. Indeed, no sign of trouble came to their attention until the very last moment that August emerged from the womb–gray, limp, and lifeless. A specially dispatched rescue team resuscitated him on the brink of death, but not before he suffered severe brain damage.
We were told that August suffered from hypoxic ischemic encephalopathy, or H.I.E. Other diagnoses and labels for chronic and disabling conditions trailed after him for the remainder of his short life: cerebral palsy, spastic quadriplegia, profound mental retardation, cortical visual impairment, microcephaly, seizure disorder, osteopenia—and the list went on.
Pulled back from the brink, August became Lazarus in a wheelchair. During his fourteen years of life he was nonverbal, incontinent, spastically paralyzed, and virtually blind. He could not sit in a chair the way a typically developing child would. He needed upper trunk support, so he had to be secured in his wheelchair with straps holding his shoulders and chest in place. Propped upright, his head lolled, falling forward and backward: the muscles in his neck never developed properly. He also drooled, and this occurred because the spasticity affecting his mouth prevented him from being able to swallow his saliva efficiently. When he was lying on the floor, he was unable to crawl, scoot around, hold himself up, or even roll over. If someone were to put him in one spot and leave him, he would be found in the same location an hour later, give or take a few inches.
Why did a pregnancy that had gone so well right up until the moment of birth end in such a horrific way? Afterward, no one would answer this question. No one would tell us anything. The doctors who delivered him and the hospital’s representatives never explained what went wrong. No one would give us an explanation. My wife and I encountered a wall of silence.
August passed away on Oct. 15, 2013, ostensibly due to complications stemming from the implantation of a Medtronic baclofen pump (more on this later). But in actuality he died as a result of the way he was delivered. He nearly died at his birth, and his death, it turned out, was merely postponed for fourteen years. Ilene and I are glad that we were able to spend this precious fourteen years of borrowed time with him, and we miss him dearly. He was a jolly little fellow, the most cheerful person you can imagine, a munchkin delightful to be with.
The University of California, San Francisco (U.C.S.F.)
The University of California, San Francisco (U.C.S.F.) Medical Center is the hospital where August experienced a catastrophic birth on March 5, 1999. In the memoir it is called Loma Prieta Medical Center. Ilene was in her forty-second hour of labor when he was born at 3:44 a.m. But at 2:55 a.m., forty-nine minutes prior, he had given indications of a low-heart rate, known as bradycardia. Bradycardia signifies that a baby is in distress. When it is detected, doctors have thirty minutes to get the baby out, often by cesarean section.
Why did no one order a c-section? One reason was that the delivery doctors, Dr. Sarah Kilpatrick and Dr. Lisa Lipschitz, had grown skeptical of fetal-heart monitors, which they believed to be generally unreliable. The monitor was the source of the information about his bradycardia, and they dismissed its accuracy. Dr. Lipschitz, the resident, assumed that the reading “must be mom’s.”
Another reason had to do with the fact that U.C.S.F. was attempting drive down its C-section rate. Most C-sections are elective, but some are necessary. Because the hospital’s own and the national rates of elective C-sections were believed to be too high, the hospital’s administrators were unofficially discouraging them. The Center for Disease Control reports that in 1990 the national C-section rate was 22.8%, that by 1996 it had come down to 20.9%, but that by 1999, the year of August’s birth, it had inched back up to 22%. In 2019, the rate was 31.7%. In light of these numbers, the hospital was trying (with some justification) to bend the trend line back down.
However, in our son’s case, the failure to even mention C-section as being an option, much less offer one, led to a cataclysmic outcome.
In the days and months afterward, Ilene and I were reluctant to sue the doctors and the hospital of U.C.S.F. because we didn’t want to be “litigious people.” However, when we eventually decided to bring a case, our main objective was to receive an answer to a single question: what happened to our son? Over time we discovered that suing for an answer was naive because answers don’t pay an attorney’s bills. We also were unaware at the start of our journey that caring for August over his lifetime was going to cost in the hundreds of thousands, if not millions of dollars. The case is still floating around on the internet. Click here: August David Chazan-Gabbard et. al vs. University of California Medical Center et. al
In the end, we encountered two obstacles to even making it into a courtroom, much less winning a judgment. One was M.I.C.R.A., California’s Medical Injury Compensation Reform Act of 1975. M.I.C.R.A. placed a cap on damage awards so draconian that it had driven most personal-injury attorneys from the field. This is still the case with M.I.C.R.A. in that state: it is almost impossible for a medically injured patient to win a malpractice suit.
The other reason was that it is very difficult to sue U.C.S.F. It was and still is the biggest employer in the city and county of San Francisco and remains a powerful force in the region. It maintains a large number of attorneys on its payroll, and, for this reason, is difficult to beat in court. Its pockets are deep.
The People Involved
August was delivered by Dr. Sarah Kilpatrick (the attending physician). She is a perinatologist, a doctor trained in the subspecialty of obstetrics concerned with the care of the fetus and complicated, high-risk or complicated pregnancies. Such a doctor is supposed to be highly skilled in prenatal diagnosis. The question is, why did this experienced, highly competent, and highly respected practitioner fail to detect a major problem in the delivery room?
This is a question that she was not willing to answer. The most information she offered Ilene at a six-week regular postpartum check about August’s disastrous birth was that it was “bad luck.” In all probability, the cause had less to do with luck and more with her skepticism about fetal-heart monitors, U.C.S.F.’s discouraging of C-sections, and the fact that the hospital was extremely busy on the morning August was born (more about this last item to follow). Dr. Kilpatrick is now the Chair of the Department of Obstetrics and Gynecology at Cedars Sinai in Los Angeles. In Life Beyond Reason, she becomes Dr. Sandra Latchesik, her name deriving from the first of the three Fates of ancient Greek mythology, Lachesis.
The resident physician under Dr. Kilpatrick’s supervision was Dr. Lisa Lipschitz. In retrospect, Ilene and I realize that she was less than adept when it came to reading a fetal-heart monitor. She is the one who told the main L & D nurse that the heartbeat the fetal monitor was detecting “must be mom’s” (more about this later). She now practices medicine at Scripps Health in San Diego. Her name in the book is Dr. Lisette Atropski, a pseudonym deriving from the second of the Fates, Atropos.
A third doctor, the attending physician Dr. Julian Parer, started Ilene’s induction at 9 a.m. Wednesday, March 3rd, 1999. He had a wonderful bedside manner and was a truly delightful man. (Evidently, he died in 2016 while hiking.) That Wednesday, he went off duty later in the day and was replaced by Dr. Kilpatrick. Ironically, he had written a textbook on the subject of how to interpret fetal-heart-monitor readings. If only he had been August’s delivery doctor and not Dr. Lipschitz and her supervisor, Dr. Kilpatrick, that fateful morning. He is identified in the book as Dr. John Klothoberg; this pseudonym springs from the third Fate, Clotho.
In the photo above, Dr. Kilpatrick is on the left. Center left is a resident, name unknown. Center right is a friend attending the birth; in the book she is Joanne Sasaki. On the right is the main labor-and-delivery (L & D) nurse whose name we also don’t know. Forty-nine minutes prior to the birth, at approximately 2:55 a.m., the L & D nurse noticed that a problem was showing up on the fetal-heart monitor and said, “These vitals are not reassuring. I don’t believe the baby’s heart rate should be this low. It’s in the eighties.”
The bradycardia indicated that the baby was in distress and that the delivery team would have thirty minutes to get the baby out by C-section. Dr. Lipschitz dismissed the L & D nurse’s concern, saying that the heartbeat “must be mom’s.” At approximately 3:03 a.m., Dr. Kilpatrick stepped into the delivery suite for less than a minute. Dr. Lipschitz told her that a problem was occurring with the heart monitor. Kilpatrick didn’t respond, and Lipschitz didn’t repeat herself. Kilpatrick obviously was in a hurry. Before dashing out, she unexpectedly shouted, “We’re going to have a baby!” This exclamation seemed so out of character that I did a double take. Then she was gone. But she obviously heard what Lipschitz said because the first thing she asked when she re-entered the suite about thirty minutes later, at approximately 3:33 a.m., was, “There was a problem with the monitor?”
Dr. Kilpatrick, I should explain, was rarely in the delivery suite. Ilene and I had dubbed her “Doctor Dash Smoke” because of her habit of dashing into the room only to immediately dash out again, seemingly leaving a trail of smoke in her wake. She was rushing because the hospital at that very moment was undergoing a crush of births. A woman at the nurse’s station earlier than morning had said to me that “Everyone’s giving birth.” It can be safely inferred that the institution was understaffed with regard to accommodating this unusually high volume.
The fact that the hospital was slammed with mothers giving birth explains why our main L & D nurse had been brought in. She was a per diem–a temp worker–who had come to U.C.S.F. the morning of the previous day, Thursday, by public transportation, including a Greyhound Bus, from Sacramento ninety miles away. Being an outsider, she had the advantage of being able to see U.C.S.F.’s protocols with fresh eyes. But being an outsider also was a detriment because, not being a regular employee, she was easy for the staff members to dismiss. In the book I should have given her the pseudonym Cassandra.
The L & D nurse’s race and body type also were factors. For one thing, she was the only Black person on the delivery team. In his 2015 memoir Black Man in a White Coat, Dr. Damon Tweedy notes that the input of African American medical professionals is often discounted. For another, she was zaftig, whereas the others were svelte. She didn’t look and sound like the others with whom she was working and so, in a crucial way, didn’t fit in.
To be fair, what were Dr. Kilpatrick’s and Dr. Lipschitz’s thinking? They believed that fetal-heart monitors in general were unreliable and that the one they were using with Ilene was not functioning properly. However, belying the monitor’s supposed unreliability was the fact that forty-nine minutes later, at 3:44 a.m., August was born non-responsive. The fetal heart monitor evidently had been correct all along.
After several minutes of different team of doctors attempting to resuscitate him, August finally took his first breath. But by then the brain damage from lack of oxygen had been done.
Had Dr. Lipschitz and Dr. Kilpatrick taken the L & D nurse’s warning seriously, our son’s outcome would have been considerably different. In all likelihood August probably would be alive today and perhaps would have grown up a typically developing child.
I have forgiven all of the doctors involved in our son’s case, but years went by before I could get to the place of forgiveness. It was relatively easy to excuse Dr. Kilpatrick and Dr. Lipschitz because, at the end of the day, they were doing what made sense to them. If they did not step forward following the birth and own up to their errors, it was because they form part of a medical culture that refuses to admit mistakes.
I found it the most difficult to forgive Dr. Jeffrey Greenspoon (Dr. James Baelish in the book), who, unlike Kilpatrick and Lipschitz, had the benefit of 20-20 hindsight.
From 2003-2004, Greenspoon was the outside medical expert reviewing August’s birth records at the behest of our attorney, Charles Kelly, of the San Francisco firm Hersh & Hersh. There is strong reason to believe that Greenspoon knew Kilpatrick personally and so should not have agreed to serve as an independent medical expert.
In the late spring of 2004, he concluded that Kilpatrick had done nothing wrong and that U.C.S.F. was not at fault. Kelly’s letter to us, dated June 28, 2004, informed us that Hersh & Hersh was no longer interested in litigating our case. Greenspoon had “re-reviewed the heart rate tracing [presumably for 2:55 a.m.] and believes that the heart rate seen on the heart monitor tracing is Ilene’s and not August’s.”
Kelly’s letter went on to deliver Greenspoon’s conclusion: Dr. Kilpatrick and Dr. Lipschitz discovered at 3:33 a.m.that August was in trouble, and they got him out by 3:44 a.m. They delivered him in eleven minutes, and that span of time was within the thirty-minute window, so the hospital was not at fault.
I knew that this account was untrue because I was in the room where it happened. After Dr. Kilpatrick re-entered the birth suite at about 3:33 a.m., a short and seemingly casual conversation followed with Dr. Lipschitz about whose heart rate the now-detached fetal monitor had been reading at 2:55 a.m. Given the low numbers, Dr. Kilpatrick quickly affirmed, “Yes, it must have been the mother’s.” The two doctors were completely at ease, exhibiting no sense of urgency. Dr. Kilpatrick took her time as she gowned and gloved up.
The baby’s head began to crown at around 3:41 a.m. Dr. Kilpatrick went down on one knee between Ilene’s spread legs, and it must have been about 3:42 a.m. that I saw her eyes pop wide open. Her attention suddenly became tightly focused, like that of a pilot when a plane suddenly shows signs of trouble in flight. She called to the nearby team, “There’s an abrasion on the baby’s head!” And then, almost immediately after, she shouted, “We’re going to use the vacuum!”
Dr. Lipschitz and the D & L nurse sprang into action and swiftly readied the gear. Standing again, Kilpatrick positioned the vacuum-extraction device and told Ilene to push, and she obeyed, and then came another order to push, and on the third try there was a great whoosh, liquid gushing, and with a flood of brownish amniotic fluid, the infant tumbled out headfirst. The body that emerged at 3:44 a.m. was gray, limp, and lifeless.
The following sentence wrapped up Kelly’s letter in which he was presenting Greenspoon’s finding: “With all of the evidence establishing that August was delivered within 10 minutes of the bradycardia, we cannot establish that U.C.S.F. was negligent in its care and treatment of you and August.”
Greenspoon’s account synchronized exactly with the one Dr. Kilpatrick had given in her deposition.
Greenspoon’s judgment meant that our case would not go forward. Kelly didn’t broach the idea of seeking a second opinion–of locating another outside medical expert to review the records. Instead, he unceremoniously dumped us as clients.
Greenspoon comes with a provocative back story. In 1995, he wrote a public letter to the anti-abortion Congressman Henry Hyde in which he passionately defended the controversial procedure known as intact dilation and evacuation, or, what anti-abortion activists were labeling partial-birth abortion. Greenspoon had stepped forward to defend a deceased colleague at Cedars Sinai Medical Center who had performed the procedure hundreds of times.
Greenspoon wrote, “[a] pregnancy that is desired and planned is the foundation for the next generation of productive, healthy Americans. . . . The burden of raising one or two abnormal children is realistically unbearable.” His expertise on the subject of “abnormal” children, he indicated, came from serving as a speaker for a national Spina Bifida association.
In 2012 phone comments made in an interview with the conservative commentator Tucker Carlson, Greenspoon stated that he approved of eliminating “babies who don’t have much of a viable life.” He went on to complain that it was unfortunate that the term eugenics had “somehow” taken on a pejorative meaning over time.
Here is a link to a Feb. 21, 2012, article in Slate titled “Eugenics, American Style” speaking about both Greenspoon’s public letter and Carlson’s interview; Greenspoon comes up at the tail end of the piece. Click here: “Eugenics, American Style”
Greenspoon’s wording in his 1995 public letter and in his 2012 interview is infelicitous for several reasons, but I will focus on just one aspect. When it came to families he claimed he cared about, he certainly didn’t show any concern for ours. His reading of August’s birth records contributed mightily to increasing my family’s “burden of raising” a significantly impaired, or, in his phrasing, “abnormal” child. It made my and my wife’s task “realistically unbearable.” His reading of the birth records effectively thwarted the possibility winning a settlement, something our family desperately needed in order to care for our exorbitantly expensive child. We nearly went bankrupt as a result.
Greenspoon is currently practicing medicine in Springfield, MO.
The lawyer litigating the malpractice case against U.C.S.F. was Charles Kelly of the San Francisco firm Hersh & Hersh (Buchanan & Buchanan in the book). In the memoir he is Byron Grayscale. Granted, “Chuck,” as we called him then, had to mount a case in spite of M.I.C.R.A. (see above), but he also didn’t bother to think things through, to take the time to realize that Dr. Greenspoon’s conclusions didn’t add up.
Kelly also never deposed the Sacramento per diem L & D nurse who raised the alarm at 2:55 a.m. by saying, “These vitals are not reassuring. I don’t believe the baby’s heart rate should be this low. It’s in the eighties.” Since no note had been made of her concern at the time, there was nothing about it in the birth records. The only way to establish the veracity of the nurse’s assertion would have been to question her in a deposition. This Kelly did not do. But then, maybe there wasn’t any point to doing it because Greenspoon had already put the kibosh on it, saying it didn’t matter: the heartbeat was the mother’s. Period!
We last time heard from Kelly was on August 24, 2004, when we received an unusually terse letter from him in response to our follow up questions. He obviously didn’t want to deal with us anymore. After that, with regard to the legal realm, the rest was silence. Silence, that is, except for the holiday cards that arrived every winter for the next seven years from the law firm of Hersh & Hersh.
Nancy Hersh (in the book Nina Buchanan), is the president of Hersh & Hersh. She was supposed to supervise Chuck Kelly, at the time a junior member of the firm.
The Story Moves to Jacksonville, Florida
August moved with his family to Jacksonville, Florida, in 2001 so that I could take a tenure-line teaching position at UNF. Our son’s life was relatively peaceful there, where attended the Mt. Herman Exceptional Student Center during the day and the DLC Nurse & Learn after school and during holiday breaks. (To see video and pictures of August, go to A Boy Named August).
However, on July 8th, 2010, a Medtronic baclofen pump was implanted into him, and over the next three years this device precipitated a downward spiral that ended in his death on October 15, 2013. The operation to implant it took place at Wolfson Children’s Hospital, which in the book is rechristened Bensalem-Salomon Children’s Hospital. That long name alludes to Francis Bacon’s 1626 science-fiction novel The New Atlantis.
The Medtronic baclofen pump was supposed to decrease the spasticity associated with August’s cerebral palsy. Since 2010, this device has undergone numerous FDA class 1 recalls due to the many deaths associated with it. Headquartered in Minneapolis, Medtronic in the book goes under the pseudonym the Hippocrates Corporation of America. The drug baclofen is relabeled relaxanoid, and the Medtronic baclofen infusion pump is spoken of as the Hippocrates relaxanoid pump.
The Medtronic baclofen pump was implanted by Dr. Hector James (Dr. Achilles Joyce in the book). In 2003, Dr. James was recruited to run the first pediatric neurosurgery program in northeast Florida. A multimillion-dollar endowment made founding it possible. The internationally recognized Dr. James, originally from Argentina, had been practicing medicine for four decades, much of that time at a teaching hospital associated with the University of California. Having recently retired, he had accepted an offer from the medical school at the University of Florida to come open a clinic at Wolfson Hospital.
He headed to northeast Florida to begin building a program, recruiting other pediatric neurosurgeons from around the nation. His name and reputation were the attraction. And this is how the area’s first Medtronic implantable infusion pump program came into existence. The Medtronic baclofen pump seemed to be a piece of science fiction wizardry come true. Over time, Dr. James turned Wolfson into a mill for implanting them.
I have heard through the grapevine, but haven’t been able to verify, that Dr. James has retired and that Wolfson Hospital no longer implants baclofen pumps.
Dr. Louise Spierre becomes Dr. Lisa Sandemelir in the book. She is one of the doctors Dr. James recruited to move to Jacksonville, and she was August’s physiologist. Oral baclofen and Botox injections under her direction had been doing the job of controlling August’s spasticity quite nicely. But after a year or so of this regimen, she changed her tune and started strongly advocating that we have a Medtronic baclofen pump implanted. She told me that the pump was reasonably safe, almost as safe as riding in an airplane.
At one point I met with the rep from Medtronic. He looked at me straight in the eye and assured me that the pump was a safe product. If Ilene and I decided to go forward with it, he went on, he personally would accompany us “on each step of the journey.” Everything would go well–he would “make certain.” He would “see to it.”
Ilene and I pondered the move deeply and finally followed her recommendation, and the pump was implanted. For the next three years, adverse events piled up. The first pump became infected. After it was removed and another put in, dystonia took hold. When things went south, the Medtronic rep bailed on us. We never saw him. This video shows what the dystonia looked like:
/ Alternative link /
With regard to dystonia, Dr. Spierre didn’t seem to think that she or the pump had anything to do with it. Her job, she indicated, was to manage the pump, nothing more. August’s arching wasn’t her problem to solve.
Now retired, Dr. Stephen Lazoff, August’s pediatrician, advised us against implanting the Medtronic baclofen pump; he is identified in the book as Dr. Stephen Cohen. Leading up to July of 2010, he strenuously and passionately warned us about the complications that could ensue from implanting it: the problems to expect, he told us, were infection and problems in the back. “I have seen so much go wrong,” he said. We should have listened to him because the dangers he alerted us to did indeed came to pass.
As with Dr. Kilpatrick and Dr. Lipschitz, Dr. James and Dr. Spierre were hardly villains. At bottom they were operating from good intentions, trying to do their best to serve children. Where they erred was in allowing themselves to be misguided by their own techno-optimism.
Those interested in reading more about the issues my son’s case raises regarding the Medtronic baclofen pump would do well to read Jeanne Lenzer’s 2017 book The Danger Within Us: America’s Untested, Unregulated Medical Device Industry and / or view the 2018 Netflix documentary about the medical device industry, The Bleeding Edge .
Over twenty years have elapsed since August’s birth. My friends’ children born around the same time are now completing college. Solving the mystery—of what happened on the morning of March 5, 1999—has become irrelevant. At the time August was born I didn’t know that he would develop into a beguiling little fellow, that he would elicit great love from us and from many other people, or that like a Yaqui shaman he would introduce me to a separate reality. And I didn’t know that this separate reality was actually the world of my own heart, my capacity to give and receive love.
In light of how he helped me grow as a person, how he served as my spirit guide, I don’t care now who made what mistake at his birth. I started out in anger, wanting to burn down the house of medicine, but I have arrived at an unexpected place. It is time to forgive the doctors, as I myself would want to be forgiven for my own errors and omissions. Who among us doesn’t go into the courtroom of life demanding justice, only to find themselves humbled and pleading for mercy?
Incipit vita nova.
Praise for A Life Beyond Reason from Sandra M. Gilbert, author of Death’s Door and co-author of The Madwoman in the Attic
“A poignant, powerfully written story of a radically mismanaged delivery at a major medical institution as well as the painful yet paradoxically luminous consequences of that catastrophe. Simultaneously a timely exploration of medical error, a moving disability memoir, and an elegy for the blithe spirit of a much-loved child, Gabbard’s book will be must reading not only for investigators of medical malpractice and theorists of disability but also for all who are awed by the intensity of parental devotion.”
Available in audiobook, hardback, softcover, Kindle, and Nook