Monday, April 03, 2006

One of those people

I was not on top of my game this morning. No excuses, I was just off. Way off.

So, on rounds this morning, I'm trying to relate the stories of each patient to the team. This is kinda funny, since everyone already knows what's going on, but more on that later. I started off with a patient I had just picked up and hadn't read about real thoroughly.

It showed.

I started with "this is a 2 year old male who presented with an acute exacerbation of asthma" and I didn't get any farther. My resident spoke up with "um, no..." and my attending jumped in with "this is unacceptable, you're wrong with the chief complaint."

See, this patient had actually come in because he had a seizure. No asthma, and he wasn't quite 2 either. I was reading the wrong notes.

I managed to piece something relating to him together, but I floundered, bad. "But," I thought to myself, "I have two more patients to redeem myself with."

This is what authorities refer to as "wishful thinking."

Patient number two is up, and I get a little farther. I manage to have the name and age right, and I even have her reason for being in the hospital down. I'm starting to relax, just glancing at the notes, when I say "an attempt was made to start a peripheral IV, but it failed, so she still has a scalp IV." This time the resident comes in with "I think you're a day behind. I placed a peripheral IV yesterday," and my attending, losing his patience with my idiocy, asks "did you even see the patient?"

Truth is, I had. It was just 6am, I'd had four hours of sleep, and I talked with her family for half an hour after my examination. I completely missed the missing scalp IV, and I just read what had been written in yesterday's progress note. This doesn't matter though, because if you can't be trusted to see, or rather note not seeing a tube 8 inches long taped to the side of your patient's head, you can't really be trusted for much.

In hindsight, this is funny.

The third patient actually went ok, I got everything right, but by that time, it was too late. I can only hope my attending and resident don't hold this one against me.

The whole experience has taught me that you shouldn't ever be too sure of yourself. You can always wind up as "one of those people."


MrStandfast said...

I don't know that "don't be too sure of yourself" is the complete lesson. This doesn't seem to be a divine clobbering meant to smack icarus back into the ocean. you're being WAY too hard on yourself. Everyone has off days.

I think that's closer to the lesson. Doctor's aren't allowed to have bad days, and they're training you out of them. Remember when you reached over the open surgery? You got yelled at and it won't happen again. If you miss a scalp IV again I'll be surprised. And if there isn't a little scare in you that makes you glance twice to check the dates on notes...I'll be surprised. And if you don't check your watch at night and think, maybe one more hour of sleep is more important than another hour of study...I'll also be surprised.

You're attending and intern are nto going to hold a grudge about any of that. I am certain they aren't raving about the idiocy of their third year on blogs elsewhere on this site. Take it for what it is, a dang good lesson.

December of last year, I sqautted down on the deck of an outdoor nightclub and wrote an estimate for about a half acre of damaged awnings. The total came to $90,000 dollars and I told the insured he would hear from the insurance company, smiled, and left. Turns out there wasn't coverage for awnings, and by intimating that it would be covered I almost cost Lloyds of London 90 grand. it took me two days and three letters to keep Crawford and Company from eating the bill for that little underwriting assumption on my part. Needless to say my supervisor was less than ecstatic. He could hardly say, "well we'll dock your pay 90k. 100 a month till you're dead, and then part of your life insrance policy ought to do it."

I promise you, I never get a loss that I don't flip the page to see what endorsements are there. I know dollars and two year olds are not the same thing, but the lesson is identical.

Nathan said...

I think you're right. I just felt I had to tack something on the end there and I wasn't thinking too closely about it.

However, I would bet I've become a cautionary story that at least 7 people will be telling for the rest of their medical careers. Heck, I will.

Thainamu said...

I like smart doctors. But I actually prefer well-rested ones.

gloria jean said...

It's good that the mistakes made such an impression on you. Like mrstandfast said, "bet it won't happen again". And believe me, there will be a lot more significant episodes that occur than these that will keep you talking the rest of your career. Be sure to let us know when one of the other of the 7 have a memorable day like this.

heidi said...

We liked Peds - the rounds were way later than we had on most rotations. Medicine wasn't too bad - surgery was the worst, and OB/GYN is shaping up to suck rocks too. Can't wait for Psych - that should be a breeze.

Everyone misses opportunities to shine. The trouble with 3rd year is that you have ridiculously long shifts, after and before which you're supposed to do those stupid writeups and oh yeah study for the shelf tests. Sleep gets shoved aside. Which is ironic, when you consider that it's SCIENTISTS who performed STUDIES on SLEEP DEPRIVATION.

The people you've shown a little ass to have shown theirs when they were in 3rd year, guaranteed. And Doctors DO have bad days - which is why they work in teams. Odds of everyone sucking collectively are lower that way, so the patient usually comes out alive. :)