🩸 Act II: The Collapse

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They thought it was subtle.

They thought if they moved slowly enough, if they filtered her complaints through a clipboard and a condescending tone, no one would notice what they were really doing:

Starving her, suppressing her, and sending her deeper into failure — not with violence, but with indifference.
 

Nicole entered the ER at North Kansas City Hospital on August 30th, 2019.
Her liver enzymes were stable. She was tired, yes — bloated, yes — but still upright.

They placed her on an NPO without a gallbladder, withholding food and water for the first 37 hours of her initial hospitalization, instead of taking her off of Effexor, a known hepatotoxin. Then they lifted the NPO and resumed the very medication suspected of drug-induced liver injury (DILI) — without pause, without testing alternatives, without care.

The dam cracked.

Then came the ERCP.
Then the stent.
Then the bile.
Then the emboli.
Then the heart.
Then the adrenal tumor.
Then the silence.

Nicole didn’t collapse from mystery.
She collapsed from clinical apathy, stacked high and left to fester —
until her body finally screamed loud enough for everyone to hear…
…only to be told it was all in her head.

This wasn’t a single failure.
It was a cascade — triggered not by chaos, but by cowards in white coats afraid to admit when they were wrong.

• Nicole walks into North Kansas City Hospital’s ER, complaining of RUQ pain, nausea, itchy skin (pruritus) and fatigue.
   
• ALT and AST are normal.
   
• However, she has been on her maximum effective dosage of Effexor (venlafaxine) for 99 days — a drug known to cause Drug-Induced Liver Injury (DILI), especially when metabolic function is impaired.
   

• Despite having no gallbladder, Nicole is placed on NPO status (nothing by mouth) almost immediately — without first discontinuing hepatotoxic medications to see if it alleviated her symptoms.
   
• Being NPO limits fat metabolism and slows bile flow, increasing hepatic stress.
   
• DILI was likely exacerbated by NPO, not caused by Effexor alone.
   

“Why was food and water restricted instead of pausing hepatotoxic meds first? What diagnostic evidence supported NPO?”

• Nicole remains inpatient under Dr. Robert Evangelidis (“The Great Coward”).
   
• Serial labs begin to show ALT/AST elevation starting September 1 — proof that DILI symptoms were triggered or worsened while hospitalized, not before.
   
• Hydration and nutrition were not prioritized, which would have been protective in early-stage DILI.
• September 2nd MRCP shows liver normal, adrenals normal, spleen enlarged measuring 13.3cm, and bile duct enlarged measuring .8cm.
   
• She is told she may need a biliary stent, and an ERCP is planned for September 3.
   

The Patient is told "Sometimes these things just happen." By Dr Robert Evangelidis when she asked how her bile duct got backed up.   She now has a medically relevant explanation.

Scene 1: The Admission (August 30 – September 7, 2019)

“It didn’t start with a scalpel. It started with a decision: ignore the signs, do the procedure, and then pretend none of it ever happened.”
 

Nicole was taken for an ERCP despite:

• Having no gallbladder
   
• No confirmed bile duct obstruction
   
• LFTs that only began rising after she was made NPO while still on Effexor, a known hepatotoxin
   

A biliary stent was placed — but was:

• Never properly documented as temporary or permanent
   
• Never scheduled for removal
   
• Later dismissed as an “artifact” when its presence showed up on imaging
   

Shortly after the procedure, Nicole experienced two STAT events — both occurring in her hospital room, within hours of the ERCP.

• The ERCP triggered lipid emboli that lodged in Nicole’s inferior vena cava (IVC)
   
• These emboli caused right atrial trauma, confirmed later by:
   
  • IVC diameter: 2.57 cm
     
  • Right Atrial Pressure (RAP): 15 mmHg
    (Documented on a November 8 echocardiogram)
     
• Nicole began vomiting bile daily after this procedure — a symptom that persisted for over a year
   

The damage was done.
What happened next was the real surgery — to the truth.

After Nicole’s second STAT event that day, Nicole observed a cluster of white coats gathering outside her hospital room:

• No one entered to check on her
   
• Tension was high
   
• No charts were carried
   
• This wasn’t clinical collaboration — it was damage control
   

Shortly after that conference, a suspicious surge of documentation began.

🕰️ 17:20 — The Moment of Narrative Rebirth

• At exactly 5:20 p.m., twelve backdated chart entries were logged by a single provider, all describing the same supposed event. One even claims Nicole “remained on the Med-Surg unit.”
  ➤ Problem: Nicole had already returned to her post-op room, been seen by her floor nurse, the CMA, Dr. Evangelidis—and had the STAT team called twice in that same room.
   
• The record doesn’t reflect where Nicole was.
  It reflects where someone needed her to have been.
   

Med Surg is a pre-op unit — she was well past that point.

This entry didn’t reflect reality. It rewrote it.
 

• This was the day Nicole’s body began to fail in multiple systems — hepatic, cardiac, and adrenal.
   
• But the system didn’t rise to respond.
   
• It bent to conceal.
   
• And it left behind a trail of contradictory timestamps, suspiciously identical entries, and silent acknowledgment that something had gone terribly wrong.    
• At 17:20 on September 3, 2019, medicine stopped — and strategy began.
  Twelve records.
  One provider.
  One lie about Nicole's location.
  They weren’t saving her anymore.
  They were attempting to save themselves.
   

Her labs weren’t stable. Her symptoms were worsening.
Her heart had taken a hit. Her liver was inflamed.
But the white coats were ready to be done.
 

• Bile vomiting continued daily, now worsening
   
• LFTs remained elevated, trending abnormally
   
• Pain was unresolved — migrating to the right flank and intensifying
   
• No cardiac workup performed despite:
   
  • Two recent STAT events
     
  • Evidence of embolic injury
     
• No follow-up plan established for the undocumented biliary stent
   
• Nicole remained NPO for much of the stay, despite her clear need for nutrition and hepatoprotection
   

Earlier in the day, Nicole vomited a sludgy greenish/yellow bile into the sink. She reported it to her nurse. The response?

“Should have taken a picture.”
 

Later that day, Nicole passed a visibly abnormal, fatty marbled stool — a textbook sign of steatorrhea, common in liver dysfunction or bile duct injury.

So she took a picture.

• The image was clear, time-stamped, and dated
   
• Nicole showed it to both the nurse and Dr. Evangelidis less than an hour later
   
• And yet:
   
  • No one documented it
     
  • No one ordered follow-up labs or imaging
     
  • No one acknowledged what was right in front of them
     

Nicole didn’t just report symptoms — she captured them.
They didn’t just fail to notice — they chose not to look.
 

• Dr. Evangelidis continued to avoid naming what was clearly unfolding:
   
  • No mention of DILI or hepatic stress, despite the pattern emerging
  • No mention of the two Lipid Emboli that damaged the patients right atium and IVC and were likely still floating around her cardiovascular system.
     
• Staff appeared focused on stabilizing discharge paperwork, not Nicole
   

• Nicole was discharged on September 7, 2019
   
• Still vomiting bile
   
• Still in pain
   
• Still with an active stent (never removed or scheduled)
   
• Still undiagnosed
   
• Still a walking medical time bomb
   

They let her walk out with a stent in her bile duct, emboli in her heart, an undiagnosed tumor on her adrenal gland, and an immune system already under siege.
On September 4, she took a photo of her own illness.
The hospital staff took nothing from it.
The admission ended.
The danger didn’t.

She returned two days after discharge, sicker, bleeding, and scared.
They knew what they were looking for — and it wasn’t what she was actually dying from.
 

She came back with bile in her throat, blood in her stool, and pain centered over her liver.
And they ordered a pelvic exam.
 

Only two days after her initial discharge, Nicole came back to the ER with new and worsening symptoms:

• Right upper quadrant and flank pain — directly over her liver
   
• Ongoing bile vomiting
   
• Black and bloody stool
   
• Worsening fatigue, nausea, and overall decline
   

She was clearly deteriorating.
Something was bleeding.
Something was failing.
And she knew it.

Instead of investigating the organs screaming for help —
They aimed their attention anywhere but the liver or the heart.

• They ordered pelvic imaging and suggested the blood might be gynecologic
   
• They ignored her liver — still visibly enlarged from the trauma of the ERCP
   
• They did not address her bile vomiting, despite it being documented (and constant)
   
• Most alarmingly, they started Nicole on Lovenox — a blood thinner
   

Nicole was actively bleeding.
Both melena and hematochezia were documented.
And yet, they administered a medication that could worsen any legitimate GI hemorrhage.

The only reason to do that?
They already knew the bleeding wasn’t coming from the GI tract.

Nicole had suffered two embolic events on September 3 — both caught in her IVC after the ERCP.
But she was never told.
The records were manipulated.
The events were split across days and buried.

And yet…

Six days later, they gave her Lovenox.
 

Because they were afraid of another embolism.
Because they knew what had happened during the ERCP.
Because they were treating a clotting risk they never disclosed.

• You don’t start blood thinners in a patient with unexplained GI bleeding… unless you know it’s not GI
   
• You don’t guess — unless the risk of doing nothing is tied to something you’re not saying
   
• And you don’t preempt embolic risk with Lovenox… unless someone already saw the clot
   

Nicole returned with blood in her stool.
They gave her Lovenox.
Not because they thought she was clotting — but because they already knew she had.
They just hadn’t told her.

The scan showed it all: a swollen liver, a strictured duct, and a new mass.
The radiologist saw it. Three providers read it.
None of them told Nicole.
 

Nicole underwent an MRCP ordered by Dr. Rusty Bergman due to persistent right upper quadrant pain, bile vomiting, and signs of active internal bleeding.

The scan showed:

• 📈 Liver:
   “Prominent Riedel’s lobe measuring 19.8 cm longitudinally” — clear hepatomegaly
  
   
• 🚫 Bile Duct:
   “New focal moderate narrowing involving the common hepatic duct” — dismissed as “likely artifact”
  
   
• 🧱 Left Adrenal Gland:
   “Stable mild prominence of the medial limb… likely small adenoma”
  With signal dropout → lipid-rich mass → possible hormonally active tumor
  
   

The phrase “stable mild prominence” is a clinical impossibility.
The prior scan — an MRCP as well as a CT dated September 2 — showed no adrenal abnormality.
The mass did not exist just 8 days earlier.
 

So how could it be “stable”?

It couldn’t.

It was either:

• A deliberate falsehood, used to prevent escalation,
   
• Or evidence the radiologist never compared the scans — which is gross negligence
   

And worst of all?
He left all of it out of the conclusion.

The conclusion — the one part most providers actually read — says only:
“Focal narrowing likely artifact. No choledocholithiasis.”
 

This scan was referenced by three separate providers:

• Rusty Bergman (Sept 10)
   
• Julie Camp, GI NP (Sept 11)
   
• Dr. Schowengerdt, GI (Sept 13)
   

Each of them:

• Reviewed the MRCP
   
• Cited it in their notes
   
• And ignored all three critical findings:
   
  • Enlarged liver
     
  • Bile duct narrowing
     
  • Adrenal mass
     

Instead, all three focused on one line:

“The bile duct looks fine.”
 

The scan showed the truth:
A liver in distress. A bile duct pinched. A tumor newly formed.
And four providers saw it —
Three referenced it —
And none of them said a word.

She bled. They scoped. And the answer wasn’t in the gut.
The scopes were clean. The adrenal gland was not.
 

• EGD (Esophagogastroduodenoscopy)
   
• Colonoscopy
   

Ordered due to:
 Documented melena and hematochezia

Positive fecal occult test

Ongoing pain, fatigue, and bile vomiting

 

• EGD:
   
  • No esophageal varices
     
  • No gastric or duodenal ulcers
     
  • No signs of upper GI bleeding
     
• Colonoscopy:
   
  • No diverticulosis
     
  • No hemorrhoids
     
  • No bleeding lesions
     
  • No mass, inflammation, or active source of hematochezia
     

In summary: no GI source for the blood.
 

The GI tract was officially cleared of blame.

And yet — Nicole was still bleeding.
Still symptomatic.
Still suffering.
 

The scopes proved:

• The blood wasn't coming from her esophagus, stomach, small intestine, or colon
   
• And yet, no one pivoted to the adrenal mass, liver, or vascular retroperitoneum
   

A bleed with no source is not a mystery.
It’s a missed diagnosis waiting to be admitted.
 

• Urgent reevaluation of MRCP findings:
   
  • Hepatomegaly
     
  • Biliary stricture
     
  • New adrenal mass
     
• CT angio or dedicated imaging to look for retroperitoneal or adrenal bleeding
   
• Endocrine and hepatology consults
   

What actually happened?

Nothing.
She was told the scopes were “reassuring” — as if normal results made her abnormal experience any less real.
 

The scopes were clean.
The bleeding continued.
And the tumor sat silently in the adrenal gland —
Visible for days, acknowledged by none.
Because when you don’t want to find the problem,
you stop looking where it lives.

She didn’t need an exit summary.
She needed a hepatologist, a cardiologist, and an endocrinologist.
 

• Scopes on September 12 found nothing
   
• Bleeding continued anyway
   
• MRCP (Sept 10) had shown:
   
  • A new adrenal mass
     
  • An enlarged liver
     
  • A focal bile duct stricture
     

Not one of these was addressed.

Nicole spent five more days in the hospital — deteriorating, pleading, and being passed around like a hot potato of liability.

From OB/GYN Dr. Sarah Newman’s note:

“Patient is tearful and frustrated today.
Feels as though no one is listening to her…
Concerned that there is some sort of organ damage that has been done.”
 

She was right.

She was living it.

And she was the first one willing to say it aloud.

Nicole was sent home with:

• No diagnosis
   
• No referrals
   
• No mention of the adrenal mass
   
• No plan to remove or follow up on the stent
   
• No recognition of the emboli from ERCP
   
• No mention of hepatomegaly, even after bile vomiting and steatorrhea
   
• A false reassurance that “labs are normal” despite known systemic instability
   

They closed her chart, not her case.

They knew she was sick.
They had proof on imaging.
They had evidence in labs.
They had documentation of visible bleeding, bile vomiting, and new mass formation.
 

They also knew they caused it.
So they did what institutions do best —
They discharged the danger.
Let the next doctor deal with it.
Or better yet — let the patient give up.
 

Nicole told them:
“I think I have major organ damage.”
They nodded. Smiled.
Handed her a discharge packet.
And walked away —
From the adrenal mass,
From the injured liver,
From the damage they never intended to fix.

On November 2, Nicole experienced a medical event so intense, it still echoes in memory.

That night, she became overheated—with no fever—and stepped into a lukewarm shower to cool down. The water felt like knives on her skin. A red welt quickly appeared on her right arm—circular, white-centered, and warm (101.1°F). What followed was catastrophic: sudden, full-body pain, spontaneous bruising on her upper arm and leg, and hypersensitivity so extreme that even hugs from her family were unbearable. The pain and bruising persisted for months.

This was not fibromyalgia.
This was not anxiety.
This was a systemic inflammatory storm—likely autoimmune, vasculitic, or toxin-induced. And yet it was never documented in the record.

Eleven days later, Dr. Sahar Safavi ordered an anti-smooth muscle antibody (ASMA) test—a targeted marker for autoimmune hepatitis (AIH). It returned positive at 1:160, a value that meets the diagnostic criteria threshold for autoimmune liver disease.

Instead of acknowledging its significance, Safavi dismissed the result based solely on a negative ANA, a test that is not required for diagnosing AIH and does not negate a positive ASMA. This was a critical diagnostic failure, and more than that—it was a pivot point.

Despite the positive ASMA and Nicole’s worsening symptoms, Dr. Safavi:

• Ordered viral hepatitis and alpha-1 antitrypsin labs (additional liver workups)
   
• Then prescribed valproic acid, a drug with a black box warning for liver failure
   

This wasn’t an accident. Valproic acid is among the most hepatotoxic drugs on the market. Nicole had clear signs of liver dysfunction, ongoing bile reflux, and now a confirmed autoimmune marker—and Safavi handed her a time bomb.

Nicole fell into a hepatic encephalopathic coma between December 5–8, unresponsive, non-verbal, and unable to safely ambulate. The event was never documented in her records, and no physician intervened.

If Dr. Safavi wasn’t pursuing liver disease,
why did she order autoimmune liver tests in the first place?
 

• Why order an ASMA test—a liver-specific autoimmune marker—if you’re thinking “fibromyalgia” or “psychiatric”?
   
• Why follow up a positive ASMA with valproic acid, a drug known to cause fatal liver failure?
   
• Why order viral hepatitis and A1AT labs if liver pathology wasn’t suspected?
   
• Why was there no follow-up on AIH with a liver biopsy, IgG levels, or hepatology referral?
   
• Why did Nicole’s encephalopathic coma go undocumented?
   

If this wasn’t intentional deflection, then it was clinical ignorance.
And if it wasn’t ignorance, then it was something worse.

There is no third option.

By the end of November, Nicole had a positive autoimmune marker, ongoing liver symptoms, bile reflux, and signs of systemic inflammation. Instead of escalating care, Dr. Safavi downplayed the findings, prescribed a known hepatotoxin, and rerouted Nicole’s care toward rheumatology.

What followed was both predictable and catastrophic: Nicole’s body shut down completely.

No one recorded it.
No one helped her.
And no one was held accountable.

🩺 December 9–18 — Evangelidis Returns, Truth Does Not

Nicole was readmitted to NKCH. She was pale, slurred in her speech, walking with a limp, and cognitively dulled. The attending? Dr. Robert Evangelidis — yes, again.

He knew her history. He had overseen her care during the initial collapse. And now, after a coma and a near-death episode, he said nothing.

Instead of addressing her liver or the catastrophic response to valproic acid, Evangelidis prescribed a 40mg dose of prednisone on December 17 — textbook treatment for autoimmune hepatitis. But he never acknowledged the diagnosis. Instead, Nicole was discharged the following day with a prednisone taper — and a new label: fibromyalgia.

🎯 Why This Matters:

The prednisone on December 17 was not subtle — it was standard for treating active autoimmune hepatitis.

But on December 18, Nicole was discharged without ever being told why she was given the steroid. That very afternoon, her nervous system responded: she developed a stutter — sudden, startling, and captured in a Facebook Live video recorded that evening.

Why then?

Because steroids don’t just suppress inflammation. They unmask it. The taper destabilized her already fragile hepatic and neurological systems, leading to a surge of neurological symptoms.

And still, no one looked back at the liver.

Before Evangelidis wrote the steroid order, Dr. Abdurahman Bouzid authored her official H&P (History & Physical). He mentioned ASMA but called her symptoms “non-specific.” He did not mention the coma. He did not ask about the valproic acid. His conclusion? “There is not enough to say what’s going on.”

His assessment ignored:

- A documented positive autoimmune marker (ASMA 1:160)

- A history of recent hepatic collapse

- Ongoing neurological symptoms including limping and slurred speech

Instead of investigating, Bouzid evaporated. He was never seen again.

That same day, Dr. James Trahan evaluated Nicole for “mood disturbance.” He diagnosed her with major depressive disorder, ignored the coma, and recommended antipsychotics and benzodiazepines. He called her defensive. He noted inconsistencies. He did not call a neurologist. He did not ask about hepatic encephalopathy.

His note became the pivot point — one that would be uploaded into KU’s system later under “Outside Labs” to keep the psychiatric framing alive.

Nicole was discharged on December 18. That very afternoon, she developed a stutter — abrupt, persistent, and caught on video. It had not been present before. It followed steroid treatment and weeks of hepatic instability. It was neurological. It was real.

No one investigated. The stutter was dismissed as “stress.”

Nicole’s father’s physician, Dr. James Maturo, entered the case. He saw her once. He signed off on the psychiatric interpretation, reinforcing the idea that Nicole’s symptoms were “functional.” He never referenced the coma. He never mentioned the ASMA. He never questioned the prednisone.

He closed the curtain on Act III.

To Dr. Evangelidis: If you weren’t treating autoimmune hepatitis, why prescribe prednisone?

To Dr. Bouzid: What happened to “I think I know what this is, but it’s rare”? Why didn’t you return?

To Dr. Trahan: When did a hepatic coma become a reason to prescribe antipsychotics?

To Dr. Maturo: Did you come to help the patient — or help the system close ranks?

Act III ended with a discharge.

But the collapse was still in progress.

Her coma? Never documented.

Her liver injury? Never addressed.

Her stutter? Labeled stress.

Her truth? Still screaming.

And still being ignored.

The damage had been done.
But that wasn’t enough.

Now came the edits, the omissions,
the shaping of a story no one would dare question—
until one person did.

👉 [Continue to Act III]