“The wife and I live on a farm, Doc,” said Mr. L. “We both love animals and we rescue all we can. Why, right now we have 17 cats, 6 dogs, an injured fawn, and a ferret. I normally feed them every morning, but I felt run down today so my wife told me to get my neck checked out and she took care of them. Any interest in adopting an animal, Doc?”

Dr. M, not a big animal lover, declined the offer as he examined the mass in the man’s neck. It clearly was a swollen lymph node and the physician felt concerned.

“A swollen lymph node can be a sign of cancer,” he told the patient. “I think the safest and wisest thing to do would be to remove and biopsy it to make sure it’s not cancerous.”

The patient looked worried, but agreed. Dr. M advised that this should be done as soon as possible, and that he would remove the lymph node himself. The surgery was scheduled for the following day, and once the lymph node was removed and biopsied, it showed no signs of cancer.

However, after the surgery, Mr. L was slow to heal and was having issues with his shoulder on the side where the surgery had been done. After a few weeks of the patient returning with more post-surgery issues, the patient finally sought the opinion of another physician.

The other physician, after speaking to the patient at length and running some blood tests, determined that the original cause of the swollen lymph node was “cat scratch disease” caused by the bacteria Bartonella henselae. The new physician determined that Mr. L had been accidentally scratched in the neck by one of his rescue cats, causing the swollen gland. Then, because Dr. M had suspected that the swollen lymph node was indicative of cancer, the patient was subjected to unnecessary surgery. The surgery, it turned out, had damaged Mr. L’s spinal accessory nerve causing permanent shoulder damage. (Lymph node biopsies are a common cause of spinal accessory nerve damage.) Mr. L, unable to lift his left arm over his head and suffering from nerve palsy, could no longer work at his job. Frustrated, he sought the advice of a plaintiff’s attorney.