Originally published in The Medical Post, VOLUME 35, NO. 24, June 22, 1999

Original Title: Slaughter of the Innocents

This article was awarded the Kenneth R, Wilson Silver Medal for “Best One of a Kind Article” by the Canadian Business Press in June, 2000.

An Ottawa doctor reflects on the beauty of his brother’s life, the horror of his death and the need to examine just who should be allowed to drive

One Halloween several years ago, my brother Steven shaved his head, coloured himself green, put two devil horns on his head and taught his class clad in only a pair of green shorts. I’m sure they still talk about it at the University of Chicago. I keep a picture of that Halloween stunt. And I look at it often.

I’m so happy that my brother lived. But I can barely contain my fury with the way he died.

My brother loved to cycle. On a bright sunny April afternoon two years ago, Steven was cycling along one of his familiar routes in Galveston,Tex. It was a straight road with a bicycle lane on either side.

A 73-year-old woman driving her car at 60 miles per hour drifted into his lane for no apparent reason. Witnesses at the scene said her car just lined itself up behind him and struck him down. He hit the windshield full force. As he lay on the hood of the car, the driver did not stop. There were no skid marks suggesting an attempt to brake.

As my brother tumbled from the hood, he was dragged and thrown by the car. At the accident scene we could see his blood on the pavement at the point of impact and splatters of blood every 20 feet or so for the next 400 feet.

He lay on the ground, struggling to breathe. Even though he had been wearing a helmet, his head, as witnesses would later testify, was no longer shaped like a human head.

At the hospital, he was rushed into surgery, where he suffered cardiac arrest. The doctors were able to resuscitate him, but his injuries were extensive. He had a crushed jaw, fractures to the right side of his face, severe lacerations to his head and body, a torn right lobe of his liver, contusions to his lungs, a crushed right lower leg, a fractured 12th thoracic vertebrae, and brain damage. He was comatose.

His young wife, Noel, identified him only by the small mole over his left eyebrow. His massive blood loss resulted in disseminated intravascular coagulation, which made it impossible for his body to stop bleeding. He was transfused with more than 60 units of blood and coagulants with little success. Every time another unit of blood was given to him, it just poured from his wounds.

When Noel put her hand upon his chest, blood would come out of his intubation tube. She had to continually wipe the blood from his face and watch helplessly as the blood dripped onto the floor. He was given so much fluid to keep his blood pressure from falling that he became grotesquely swollen.

Even with medications to keep his blood pressure elevated, his brain was not receiving enough oxygen. Soon, there was no brain activity. Steven was gone. He would not want blood products wasted on a dying man. He was a regular blood donor and knew the value of this life-saving substance. The hospital staff were asked to stop giving him blood. They complied.

It took his heart a little over an hour to stop beating. He died beneath Noel’s fingertips. He died listening to her voice repeating his name and speaking her love for him. He was 31 years old.

It was April 7, 1997 at 2 a.m., nine hours after the accident. My life and the lives of my family members were completely shattered.

Steven had earned his PhD in Mathematics in 1996. He found a job teaching at Rice University in Houston, Tex. He was admired by faculty and popular with his students. A memorial service was held at the university in his honour on April 14, 1997. The university newspaper devoted an issue to him.

He has an identical twin brother, Joel. They were as close as two people can be. Steven had long blocked off early May in his calendar. He had plans to travel to Vanderbilt University in Memphis to watch proudly as his twin graduated from his MD, PhD program.
Muscular and handsome, Steven and Joel were the focus of a number of photographic studies. Their poses have been documented in the New Yorker magazine, the Chicago Institute of Art and in a television special titled “Twin Stories” which aired six months after Steven’s death.

Two years later, his wife Noel, remains devastated. They had known each other for six years. She is in her third year of medical school now. She showed Steven a side to life that science was not able to teach. They were to have celebrated their first wedding anniversary on April 27, 1997.

He had a busy and vibrant life. He cared for more than 200 rare and endangered cacti and succulents that were his passion. He loved to cook and enjoyed classical music. He was in the process of mastering car repair. And he was helping his wife’s grandparents build an enclosed porch on their old ranch house.

And as for the woman who brought an end to that life? Well, she continues to drive. The police department did not press criminal charges against her. A Grand Jury review in October 1997 felt that she was too old to stand trial.

She did not call to express her remorse about what she had done. She did not attend the funeral. She has wrought incalculable pain upon our family.

As a practising family physician, I witness the effects of age every day. I do not subscribe to the notion that one has a right to drive. It is ludicrous that mandatory driver’s assessments occur only after 80 years of age.

After the age of 60, one’s reflexes and sensory capacities wane. Peripheral vision and hearing falters. Given our knowledge of the aging body, I think we, as physicians, have a responsibility to take the lead in this issue. We need to bring it to our elected officials’ attention that yearly exams after the age of 60 just make good, safe sense. It is a minor inconvenience that would help reduce the number of senseless deaths.

I propose further that all persons under the age of 60 be tested every five years since there are diseases that can incapacitate younger individuals.

Physicians must report any suspicion, based on medical evidence, that their patient is not capable of operating a motor vehicle. That is the law.

Let’s exercise it in our personal lives too. Look at your parents. Were you surprised the last time you visited your father? Did he seem to have a hard time following the conversation? Speak to him, address the issue. The woman who killed my brother may well have had adult children who could have prevented my family’s tragedy.

One of the greatest difficulties we face when tragic events occur is to find meaning for it. Steven was a brilliant and pragmatic man. If he were asked for a meaning behind this tragedy, he would have said, in his matter-of-fact way, that the driver had no business driving a car. She was too old and incompetent to drive. He would be angry that she hadn’t voluntarily revoked her licence. She simply failed to do right. There would be no other explanation in his mind.

That is the meaning he would want you to take away from this. Be strong, live your life to the fullest and accept reality for what it is or can be.

That is his final and everlasting lesson.

I love you, my brother.