AN autopsy on Marian Conlan (39) indicated that she died from haemorrhagic shock due to intra abdominal bleeding in the pelvic area. In layman's terms, the autopsy concluded that she bled to death internally.
In his evidence to the Dublin City Coroner's Court, pathologist Dr Peter Kelehan said he found more than four litres of blood in Ms Conlan's abdomen and pelvis. The average human contains five, to six litres of blood. The blood had clotted around the site of the operation, Dr Kelehan said and, was liquid in the upper cavity, where it had failed to clot. Mrs Conlan had the appearance of a healthy, well nourished woman.
Dr Kelehan said he felt the results suggested a slow continuous loss of blood from the time of the operation. "I felt it had begun a long time before (Mrs Conlan's death) and it could have begun during the operation."
Counsel for the Holles Streets consultant who supervised the operation, Dr Reginald Jackson, argued that the operation notes, showed bleeding had been stopped when the operation was completed.
Dr Kelehan said he had no evidence that the bleeding started during the operation. But he said. "It started early. It started very early. It could have been that time." He had tried to locate the source of the bleeding by flushing fluid through the system, but found only a slow seepage from the womb area.
Dr Jackson told the inquest he first saw Mrs Conlan on July 21st 1994, when she had come to him complaining of "a sensation of something coming down". He suspected a rectal, bladder and womb prolapse, which would require surgery to determine the position of the womb. He advised her to stop taking Femodene, the contraceptive pill, six weeks before the operation.
Dr Jackson said he visited Mrs Conlan in the ward on the afternoon before her operation. He assisted in the operation, which was performed by a hospital registrar, Dr Michael Geary. He said the operation went well. There was no major blood loss, but "quite an amount of oozing".
Mrs Conlan lost about 815 mls of blood during the operation, less than half the amount at which a transfusion is deemed necessary.
The operation had finished at 6.34 p.m.
At 2.30 the next morning he received a call at home to say that Mrs Conlan had had a heart attack and had been resuscitated. He did not come into the hospital that night. "I felt the problem was a medical one and the consultant anaesthetist would look after her." Under questioning he defined a "medical problem" as being different from a "surgical" one. He was told there was no sign of haemorrhaging at the stage. At 10 o'clock on the morning of the 13th he said he "arrived to be informed that Mrs Conlan had died at 5.30 a.m.
A consultant anaesthetist, Dr Breda O'Kelly, said that the operation was a "very straightforward, unremarkable, uneventful procedure, except for the fact that blood loss was slightly higher than normal". She had not informed the surgeon of blood pressure fluctuations, as these were normal during surgery. "She was awake and stable when I left her in the recovery room." Dr O'Kelly last saw the patient at about 6.45 p.m. On a risk scale of one to five, Mrs Conlan was classed as the lowest risk. She was a "healthy 39 year old lady", Dr O'Kelly said.
Another consultant anaesthetist, Dr Declan O'Keefe, said he was called by the anaesthetic registrar, Dr el-Shami, at midnight who told him Mrs Conlan was suffering from low blood pressure. "I suggested he give her blood and monitor her blood pressure," Dr O'Keefe said. "It was a fairly routine phone call. He had a concern about a patient and he was looking for advice."
Dr O'Keefe was called again at 2 a.m. after Mrs Conlan's heart attack, and when he went to the hospital he found that Mrs Conlan's pupils were "fixed and dilated", indicating a lack of oxygen to the brain. "She wasn't breathing and was being hand ventilated by Dr el-Shami." For the next three hours they tried to resuscitate her. Dr O'Keefe pronounced her dead at 5.30 a.m.
