After Amy Lam prematurely went into labor and gave birth to their baby at home, her husband, Gilbert Kwok, thought the worst was over. Once emergency responders had arrived and loaded Ms. Lam, 34, into an ambulance, the couple took photos with the newborn and called family members, smiling and elated that — despite the unexpected circumstances — their son had arrived.
Less than 12 hours later, on Aug. 1, Ms. Lam was pronounced dead. She had bled to death after a series of surgical procedures at Harlem Hospital Center.
On Monday, on behalf of Mr. Kwok and Ms. Lam’s family, lawyers filed a notice of claim against the hospital, run by NYC Health & Hospitals, as well as more than a half-dozen doctors who treated Ms. Lam, alleging malpractice and medical negligence.
Nearly two months after Ms. Lam’s death, an autopsy from the New York City medical examiner’s office is still pending, leaving many questions unanswered. Mr. Kwok, 33, has been left to care for their premature newborn, Zachary, and their 3-year-old son, Abel, while also grappling with his wife’s sudden, inexplicable death.
“When the boys ask me what happened, how do I answer them?” Mr. Kwok said in an interview last week.
NYC Health & Hospitals would not comment on the case because of pending litigation and patient privacy laws. But Robert de Luna, a spokesman for the agency, said it is committed to ensuring patient safety and providing the best care and experience. “Our thoughts are with the family during this difficult time,” he said.
The United States is one of the few countries in the world whose maternal mortality rate has risen in recent years despite improvements in health care, according to a study released last week by the Institute of Health Metrics and Evaluation.
But the increase in recent years has been driven largely by heart problems and chronic medical conditions, like diabetes and obesity, researchers say.
Maternal deaths caused by hemorrhaging, as in Ms. Lam’s case, have been on the decline nationally, according to a study published last year in the journal Obstetrics & Gynecology.
In New York City, 38 pregnancy-related deaths were caused by hemorrhaging from 2006 to 2010, the most recent data available. More than 630,000 live births took place during those years, according to the city’s Department of Health and Mental Hygiene.
Dr. Mary E. D’Alton, chairwoman of the department of obstetrics and gynecology at Columbia University Medical Center, said maternal deaths from hemorrhaging were “still quite rare,” though, she added, “I don’t think we can say it’s a problem of the past.”
Dr. D’Alton also works with the Safe Motherhood Initiative to help decrease preventable deaths related to childbirth. Still, she said, “There are rare exceptions when, despite the best management, death may not be preventable.”
Ms. Lam and Mr. Kwok, both natives of Hong Kong, had come to New York for Ms. Lam’s graduate studies at Columbia University’s business journalism program. She had graduated in May 2015 and was working as a reporter at Brightwire Inc., a financial news agency. But what she wanted most was a younger brother for Abel, Mr. Kwok said.
The couple had planned to move back to Hong Kong, but when Ms. Lam became pregnant, they decided to wait until October to avoid taking Ms. Lam on a long international flight. Moreover, they wanted the baby to be born an American citizen, with a United States passport. They trusted that the country’s medical care was the best.
The baby was due at the end of August. Doctors told Ms. Lam her pregnancy was healthy and normal, but that the baby might come a bit early, Mr. Kwok said.
Early he came. On the eve of Aug. 1, Ms. Lam was sleeping with Abel in her bed, just like any other night in their Harlem apartment. Feeling contractions, she went to Mount Sinai Beth Israel hospital, following instructions from her obstetrician. After being examined, she was told that she was not yet ready for labor, and that she should return home.
She went back to sleep in her apartment, and woke the next morning feeling intense pain and contractions. Around 11:30 a.m., she went into labor in the bathroom, and after a neighbor helped deliver the baby, was transported to the closest hospital, Harlem Hospital.
Ms. Lam had not yet delivered the placenta, so she was transferred to a labor ward where a doctor tried to remove the retained placenta manually. The procedure was unsuccessful, and Ms. Lam went into shock, her blood pressure dropping, according to the notice of claim, which was compiled using records from Harlem Hospital.
After a delay, Ms. Lam underwent a dilation and curettage procedure in which doctors removed her placenta by scraping the walls of her uterus. Toward the end of the surgery, her blood pressure dropped, her heart rate increased and doctors suspected she had begun to hemorrhage.
Hilary Swift for The New York Times
Ms. Lam gave birth to Zachary in the bathroom of her apartment in Harlem. A neighbor helped with the delivery.
“However, the source and cause of the bleeding was not obtained and identified, nor were required steps taken to properly treat and address the internal bleeding,” according to the notice of claim filed by the family’s lawyer, Susan M. Karten.
At 5 p.m., she was admitted to the intensive care unit, where she received rapid blood transfusions. But her vital signs were worsening, and her internal bleeding was progressing. Doctors asked Mr. Kwok for consent to perform an additional “exploratory” procedure. He said he did not understand much of what was happening, and was never told just how serious her condition was.
“They said they needed to find out why she was unstable,” Mr. Kwok said.
Doctors said the surgery would take several hours, so Mr. Kwok left the hospital to pick up Abel, who had been home with a neighbor all day. Back at home, at 9:32 p.m., he posted a photo on Facebook of the couple, smiling with their newborn son in the ambulance earlier that day.
“Promise me that we will take million more selfie again,” Mr. Kwok’s post read.
At 10 p.m., after Mr. Kwok had arrived home, he got a call from the hospital. Ms. Lam’s heart had stopped.
After trying to resuscitate her multiple times, doctors declared her dead at 10:37 p.m.
When Mr. Kwok went inside the hospital room with Abel to see her, he told the toddler that his mother was just sleeping, and that he should say good night to her.
“I just wanted her to wake up,” Mr. Kwok said, crying. “I feel like my heart got ripped out.”
At Ms. Lam’s funeral in Chinatown later in August, her coffin was covered in red, white and yellow flowers and surrounded by a Hello Kitty stuffed animal and children’s toys. During the service, Abel ran around the room wearing a black funeral band on his arm, seemingly oblivious to what was happening. Next to Mr. Kwok, in the front row, lay Zachary, in a car seat, having left the hospital just a few days earlier.
“There’s so many what ifs,” Mr. Kwok said later. “What if we didn’t have a baby? What if we didn’t go to Harlem Hospital? Or what if we just didn’t come to the United States at all?”
Mr. Kwok has tried to maintain a sense of normalcy in the home, for Abel’s sake. After walking the toddler home from his summer camp recently, Abel started pointing in random directions, asking his father to keep walking.
When Mr. Kwok asked him why, he said, “I’m looking for Mommy.”
Mr. Kwok did not hesitate. “Let’s find Mommy,” he said.