[Alex Chow Inquest] Coroner’s Court Notes: A Lecture on Life and Death by An A&E Doctor
This is my English translation of an article on StandNews written by one of their journalists, dated 3rd December 2020 at 23:08 GMT+8 (HKT). Here’s the link to the original article in Chinese: https://www.thestandnews.com/society/%E5%91%A8%E6%A2%93%E6%A8%82%E6%AD%BB%E5%9B%A0%E7%A0%94%E8%A8%8A-%E6%AD%BB%E5%9B%A0%E5%BA%AD%E7%AD%86%E8%A8%98-%E4%BE%86%E8%87%AA%E6%80%A5%E7%97%87%E5%AE%A4%E9%86%AB%E7%94%9F%E7%9A%84%E7%94%9F%E6%AD%BB%E8%AA%B2/#
The court became a medical lecture hall
Dr Ray Leung Tsz-hang from Queen Elizabeth Hospital’s A&E Department came forward at court in his tie-back surgical mask — the two white knots at the back of his head, befitting his profession, stood out especially.
Dr Leung was the first doctor to come into contact and treat Alex at the hospital. In preparation for his testimony, he had drawn three diagrams to explain Alex’s injuries to the court and the audience.
The entire hearing felt like a medical lecture. Dr Leung did not simply read out his 4-page long medical report word by word, but went over each one of the technical jargon with an explanation in plain language for the public. ‘Imagine a balloon inflated inside of a water bottle and how the rubber film should stick tightly to the wall of the bottle. If the bottle endured an impact, the thorax — as represented by the bottle — could be still intact, but the balloon — which is the lungs — could break. As the air escaped from the balloon and filled the space within the bottle, the extra pressure released within the confined space would stifle the heart and stop it from pumping. This is what pneumothorax is about.’
‘The subdural haematoma in the anterior frontal region and the posterior temporal region — which is what we know as the temples — displaced the central midline to the right, meaning that the blood clot was so big that it pushed the right brain to the left…’
From Dr Leung’s talk, everyone quickly got the idea that Alex sustained three main major injuries: trauma to the brain, a broken pelvis, and a mild pneumothorax. The most serious of these was the brain — Dr Leung’s sketches showed that there were multiple bone fractures in the right hemisphere that led to an increase in the intracranial pressure (ICP), calling for an immediate operation.
He said they had to perform a craniotomy on the right side of Alex’s skull: ‘that means we had to cut an opening in the skull, and insert a surgical drain through the hole to relieve the pressure inside.’
The Coroner’s Officer invited Dr Leung to describe Alex’s condition at first sight in a few words. Dr Leung said, ‘it was dire. Very dire.’ He then pointed out that Alex might likely have endured a ‘very high-energy impact’.
As per Dr Leung, he could not distinguish whether the ‘high-energy impact’ had resulted from falling from a height, being struck with a hard object, or being hit by a car. Upon further questions from the Coroner’s Officer, Dr Leung pointed out that Alex might have been injured repeatedly — first in the head, and then in the thorax and the pelvis; but he could not pinpoint whether the traumas occurred all at once, or twice at separate times.
The most unsettling idea of the day was Dr Leung’s judgement that Alex might have already been unconscious before the injuries: When a young person falls from a height, the first instinct will be to buffer the impact with their limbs; the lack of grazes on Alex’s was deemed by Dr Leung to be ‘a rare sight’.
‘Unless he had been knocked out at the time, he wouldn’t have fallen head first.’ Dr Leung continued to say that results of physiological examinations excluded the possibility that the loss of consciousness was caused by drug intoxication, alcohol intake, or hypoglycaemia.
Dr Leung further expressed that the head injuries might not have been caused by the fall alone. They could have also come firstly from an attack with a hard object before the fall.
The verbal brawl and the doctor’s tears
The most memorable part of the hearing was the heated exchange between the HKPF’s legal representative and Dr Leung when the barrister examined him after his testimony.
Barrister Samson Hung Kin-man, representing the police force, attempted to beleaguer Dr Leung on his judgement of Alex’s level of consciousness before the fall.
Barrister Hung: Could the patient have fallen due to a sudden loss of balance which rendered him unprepared for the fall? Alternatively, could it be that his reflex (to protect himself with his limbs) failed to kick in because of the posture in which he fell?
Dr Leung: Very unlikely. Even if he fell sideways, the inner ear would still signal his brain that he was falling. If I fall to my side now sitting down like this, the reflex will still kick in for me even for such a short distance between me and the ground. Alex fell from a height of 4 metres; he had plenty of time to respond.
Barrister Hung: Is there a possibility that the person wasn’t able to respond because he lost balance or didn’t pay attention?
Dr Leung: Do you mean if the person was, like, looking at his phone? What I reckon is that a healthy young man like Alex would have a perfectly functional communication and coordination between his semicircular canals and his cerebellum.
Barrister Hung: What if he fell backwards?
Dr Leung: That’s hard to say. It didn’t look like he launched himself backwards; if so then it’d be very strange, because he was more injured at the front of his head than at the back. So I don’t think it was very likely that he fell backwards.
On Dr Leung’s idea that Alex did not deploy his hands to protect himself as that there were not any grazes on his limbs, the barrister pressed on:
Barrister Hung: Could the injuries have appeared after a delay, if we presume that he did indeed use his hands to buffer the fall and that they did get injured?
Dr Leung: Starting from the premise that the energy from the fall was enough to fracture his bones, they (bruises on his limbs) would show up within an hour; but I spent more than an hour looking at him that night and I couldn’t see any even at the end.
The final concern of the police’s barrister at the end of the series was the timing of Alex’s arrival at the hospital and if it affected his chance of survival at all.
Barrister Hung: You just said Alex’s chance of survival had already been determined the moment he was injured. In other words, does that mean that, treatment-wise, it would not have mattered if he arrived (at the A&E) 5 to 10 minutes late?
Dr Leung: I can’t make a clear-cut prediction on what would happen if he arrived a few minutes early. But if he did and we were able to reduce the ICP earlier, then he’d have had a better chance. But given the severity of his injuries, even if he survived, there was still a possibility that he’d become vegetative.
Barrister Hung pressed on: Then do you have any reason to believe that the patient’s chance of survival had been affected due to a medical error in his treatment prior to his arrival at the A&E?
Dr Leung responded softly with a low voice:
We can’t generalise this. Alex was critically injured; I don’t expect that he’d recover 100% into the young man he was before this incident… There was a chance that he’d need to chronically bedbound, and live with a feeding tube. With so many fractures at the base of his skull… he could probably be helped if we were able to reduce his ICP earlier and it probably wouldn’t influence the chance of recovery later on too much… But I wouldn’t expect him to be able to walk and run like he could before.
Barrister Hung continued: Would you agree that arriving 5 minutes earlier than he did… *pause* wouldn’t affect his chance of survival significantly?
Dr Leung: I would agree that there wouldn’t be much influence at all, because the outcome would be just as bad.
After the hearing, Mr and Mrs Chow made their way towards Dr Leung.
Dr Leung placed his hand onto Mr Chow’s shoulders, and the three got in a long embrace. We were not able to make out what they said, but could only see that the parents kept nodding hard. The mother’s face was laced with tears; Dr Leung also became emotional and shed a tear.
The room stilled into a resounding silence.
Dr Leung eventually said to the couple, ‘take care.’
Mr Chow, ‘will do, will do.’
Mrs Chow had started weeping already the moment Dr Leung stepped into the courtroom. By the time she proceeded to leave the court, she was sobbing.
Against the perfectly cloudless sky outside, the sun shone brightly down at the Magistrate today.
