A doctor takes readers behind the scenes of a career-changing lawsuit

Jack Spenser isn’t his real name, but the story he writes is a true one. Like all the names in Diary of a Malpractice Lawsuit: A Physician’s Journey and Survival Guide, Spenser is a pseudonym, allowing the book to present an intimate, insider’s view of a malpractice lawsuit while protecting the privacy of everyone involved. “I had these pages of documents,” he says. “I thought that they might make a story.”

In the book, which is set in Texas, Spenser recounts the details of a lawsuit he was involved in during the 1990s. A pathologist and partner in a medical practice at the time, he was sued by Lynn Hawthorne, a woman with terminal cervical cancer. A technician in Spenser’s practice had analyzed the patient’s Pap smear, a test that can detect cancerous cells, without finding any problems, yet Hawthorne alleged that the doctors and the medical practice had been negligent. Spenser explains the difficulty in determining who is to blame:

In a sense, the Pap smear has been too successful, in that there has been a tendency to regard any death of a woman from cervical cancer who has had routine Pap smears as malpractice. This may not be fair. I have been repeatedly emphasizing to anyone who will listen that this is a screening laboratory test and, like any laboratory test, is not perfect. In fact, studies have shown that there is an apparently irreducible false negative rate of 5–10%, which means that out of every one hundred women with cervical abnormities that should be detected by the Pap smear, there will be five to ten who will be missed. Studies show that this happens at all laboratories, even the best.

As the lawsuit slowly progresses—years pass before the case is ultimately settled—Spenser learns about mistakes made by other medical professionals in the case, a cascade of errors that leads to Hawthorne’s death from cancer. He also learns more about Hawthorne, a classic hardworking single mother, and her daughter, whose future is in the forefront of his mind as the lawyers discuss the settlement. Spenser also sees changes in his relationships throughout the local medical community that he describes in detail through the veil of anonymity. 

“I thought it would be good to use a pseudonym, change locations,” he says, so he could tell the story in detail without breaking medical or legal confidentiality. In addition to holding on to documents and records from the lawsuit itself, Spenser also kept a journal. “Anytime something happened to the case, I would come home and write my thoughts and feelings,” he says, giving him plenty of material to look back on 20 years later. Kirkus Reviews calls the book “a well-crafted remembrance,” noting that “readers witness the toll that it takes on his family, his relationships with his colleagues, and his reputation in the medical community.”

Spenser first tried writing a book soon after the lawsuit concluded, but it took time for him to find the right narrative approach. “The problem was, [the first draft] was ‘just the facts, ma’am.’ ” He shared it with a friend, who told him, “You are more interesting than the lawsuit” and encouraged Spenser to expand the tangents and personal observations the draft seemed to shy away from.

It took a long time for Spenser to find his way back to the story, and eight drafts. “For many years, I owned a business,” he adds. “I just didn’t have time to write.” As he recounts in the book, frustrations over the lawsuit and the practice of medicine led Spenser to leave the partnership and pursue screenwriting. It never became a career for him, and he eventually returned to pathology part time. Medicine remains as much of a passion as writing for Spenser. “I wanted to be a physician like a [dying] person wants to live,” he says.

Spenser initially expected that other physicians would be the book’s primary audience, but that has not turned out to be the case. While some fellow doctors have read the book, it seems to be drawing a broader audience, including a number of lawyers. “I was quite astonished that they liked the book,” he says, since he does not hold back from writing about his frustrations with the lawyer who handled his defense.

In addition to sharing his passion for the practice of medicine—“I really love science; I love pathology”—Spenser also hopes that readers will find in his story a portrait of the recent past. “If I’m going to read a memoir, I want it to be a record of a time and place,” which is why his book is “a record of medicine in the 1990s…of how malpractice lawsuits were handled at the time,” and a world “before we had cell phones and email and websites.” At one point, a lawyer asks Spenser whether he should fax or mail him a newspaper article, and “some of the readers have been interested that we did all this stuff by phone calls,” he says.

Workplace technology is not the only thing that has advanced since the 1990s. Spenser explains that doctors and technicians examining Pap smears today not only look for malignant cells, but also check for Human Papillomavirus, or HPV, the infection that causes cervical cancer. He calls the new test “a huge advance in medicine,” one that may keep future patients from ending up in Lynn Hawthorne’s situation. “That incident rippled through many people’s lives,” Spenser says, which is why he decided to bring it to readers now.