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Friday, November 29, 2013

Esther Cohen, 33, Died from an undiagnosed stomach ulcer just five weeks after giving birth

Esther Cohen (pictured with her husband, Rabbi Cohen, and four of their children), 33, died five weeks after having her sixth child. She suffered a perforated stomach ulcer which led to septicaemia and organ failure

The young wife of a Jewish rabbi died in hospital from an undiagnosed stomach ulcer - just weeks after giving birth to their sixth child.

Esther Cohen, 33, had complained of sickness in the weeks before and after the delivery of baby Avraham Tzvi.

After being sent home from hospital following the birth, she was readmitted only to be discharged again despite her husband Rabbi Mendel Cohen fearing his wife, ‘wasn’t the complaining type’ and was still very poorly.

Mrs Cohen, whose grandparents helped found Jewish outreach activities in America and Canada, was sent back to North Manchester General Hospital after her sickness continued and she lost weight. She died a month later.

Tests showed Mrs Cohen had a perforated ulcer which had not been detected by doctors but which caused septicaemia and led to multiple organ failure.

At an inquest in Manchester, Rabbi Cohen wept as the hearing was told there is an ‘inherent’ difficulty in detecting diseases in the stomach or intestine when a patient has recently given birth - as symptoms can be attributed to the after-effects of delivering a baby. Doctors could not have detected the symptoms any sooner.

Mrs Cohen - known as Esty and described as ‘very well liked and very well respected’ - was originally from Albany in New York State but moved to the UK in 2005 with her Manchester born husband.

He headed a synagogue in Broughton Park, Salford, and ran the 60 pupil Lubavitch Jewish Boys’ School.

During her lifetime Mrs Cohen was said to be dedicated to promoting Jewish life and the mission of Chabad-Lubavitch – an organisation which helps promote Judaism and provides Torah lectures.

After marrying her husband she had given birth to her first five children Moishe, now 13, Mushka, 12, Rivka, 10, Chana, seven, and Yechiel, two. But problems arose after the delivery of Avraham Tzvi in August 2010.

Following the birth tests performed on Mrs Cohen at the hospital’s emergency unit on August 29 showed everything appeared normal and despite her vomiting, she was discharged on August 31.

Dr Tamer Al-Sayed said: ‘She spent the weekend in the emergency unit and according to nurses notes she was stable throughout. There was intermittent vomiting through the night and day but it stalled.

‘On August 31, I was asked to review the patient to see what the plan was. Her blood pressure was normal and she had been able to eat.

‘I thought maybe the best the best place for her was home given that there had been no changes throughout the weekend. She was stable and ambient.’

During the hearing Rabbi Cohen’s lawyer Ian Cohen said he was concerned that his wife had no energy and was very listless.

But Dr Al-Sayed added: ‘The sheer effect of reduction in nutrition would have accounted for her lack of energy. If a patient was presented in the same circumstances today I would follow exactly the same procedures.

‘Over and above being a doctor, I am a human being, and I would like to offer my sincere condolences.’
Dr Martin Patrick, a consultant physician in acute medication said it was not necessary to carry out an abdominal examination.

‘Because vomiting had stalled and she was eating she should go home,’ he said. ‘I saw Mr Cohen and explained this. She seemed well when I saw her and she was mobile.

‘If she wasn’t keeping down food I would have kept her in, but the notes I have are that she was eating. I know she wasn’t an “in your face” type person but that’s why I arranged to see Mr Cohen. If there had been no improvement I wouldn’t have sent her home.’

Mrs Cohen was discharged at around midday on August 31 but readmitted on September 3 where she was described as suffering ‘profound septic shock’.

Her condition again deteriorated on September 9 and by this time, surgeon Professor Derek Alderson said there was evidence of organ damage where the septic state had begun to impact on the function of her organs.

Professor Alderson said: ‘The examination of the abdomen in women who have recently given birth is one of the old chestnuts in surgery as you can miss small diagnoses like acute appendicitis when they have not long given birth.

‘We don’t understand why that is but most expert doctors have seen something like that.

‘Even if there had been something subtle there, the chances of you identifying something with a single abdominal examination are really small. You would have passed it as being normal and there is a risk you would have missed perforation.’

Rabbi Cohen’s lawyer Ian Cohen said: ‘There has been significant concern from the family that she wasn’t eating and wasn’t holding down food.

‘You have a lady who was quite passive and didn’t complain. We think that may have been interpreted as she was OK and improving.’

But recording a verdict of death by natural causes, Manchester Coroner Nigel Meadows said: ‘It is obviously a complete tragedy that you have a woman of 33 years old who is a mother of six and it deserved the fullest investigation and that is why I have gone to the trouble of consulting medical experts at public expense.

‘At the end of the day, I would hope you understand you have had a full enquiry and matters have been looked at carefully. My deepest sympathies are passed on and I know this brings back terrible memories.’

Speaking after the inquest, Rabbi Cohen said: ‘I did think that the medical care was not perhaps up to par at the time but everything has been followed up and today has clarified the care was up to the correct standard. I want to thank the coroner and the medical staff for their incredible work.’

A collection of memories of Mrs Cohen by family and friends, as well as her own childhood journal entries, have been posted on a blog

Family friend Rabbi Yossi Chazan, of Prestwich’s Holy Law Synagogue, said: ‘Esther was reserved, gracious and very God-fearing and built a beautiful family.

‘She was an aristocrat of the spirit, but at the same time very devoted and always behind her husband in the running of the shul and the school. She sacrificed a tremendous amount for these communal organisations.’

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