accused of killing patient

[squame]

So I just started my internal med rotation this week after having finished only psych. I had my first call last night. We are put on the floor alone -- there is a resident in the ICU we are supposed to page for anything urgent or to get orders written. Anyway around 6pm the nurse comes over and tells me there is a pt with flank pain that needs an analgesic. At signout rounds, I was told that all the patients were stable and I shouldnt' have to worry about any of them. So, I didn't see him right away becuase I was finishing a note, and wanted to grab some dinner before the caf closed. This takes maybe 1/2 an hour. When I get back to the ward the nurse is super pissed and bitching about how the med student isn't doing anything. She keeps repeating that she wants an analgesic and I can just give the order verbally and then get it signed later. I'm like F-no I have no idea what is causing this. So I call the resident without seeing the patient and tell her what I know (btw this is not my patient so I don't know him in depth). She is like, I'm not in the hospital right now, i'm in a clinic next door, why don't you go see the patient and try to figure out what he needs. I go see the patient, the patient tells me that he has had the pain all day, the vitals are normal (BP maybe a little low). I try to look up some stuff on uptodate on what might cause this post-dialysis but still have no clue. After like 15mins I call the resident and she comes to the floor. As she arrives the pt falls out of his bed, and decompensates, vitals go through the floor. He gets a bolus and is transferred to ICU where he gets a code and then expires.

So the next day the dr. asks me about call and I go, well it was very stressful and one patient died. Then I stupidly added, I'm worried maybe I should have gotten the resident earlier. Then he's like how long did it take to get the resident and I'm like maybe an hour from when the nurse told me about the pain to when the resident arrived. A few hours later the Dr. calls me in saying he's concerned I waited too long and why didn't I realize the vitals were off etc. Then he tells me I'm a sucky med student as I'm unable to synthesize H&P into a good impression, i'm behind other students (asks me what my previous grades were), and maybe with a lot of work I can do OK.

I am so depressed and unhappy I don't know what to do. I really did my best, I had no idea this would happen. I am not the best med student but I'm not the worst either and I feel the only reason he said that is because I made a bad judgement call. I am seriously contemplating just not going back, and making up the rotation in 4th year or later. I dont' know how I can face this ignominious start for the next 7 weeks.

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[DrThom]

Why is a 3rd year med student alone on the floor without an intern while on call...that is where the poor judgment was made.

 

[Ashers]

You're allowed to give orders as a med student too?

 

[fineline]

You do have poor judgement ...for wandering around on the floors without a resident or intern. Why is it your business who is doing what on the floor? Seriously, if the entire FLOOR died at the same time and I was just a medical student and the nurses were telling ME about it? I'd just let the motherf**er burn. Then, when the attending grilled me about it, I'd be like, "call was uneventful" and hold up my hand for a high-five. Do us all a favor and tell us what medical school are you at, so everyone can avoid it like the plague?

 

[squame]

Why is a 3rd year med student alone on the floor without an intern while on call...that is where the poor judgment was made.

i have no idea. it's ridiculous. it's a smaller community hospital affiliated with the university so there are supposedly not as many acute cases. the other hospital sites don't do this, i just got oh so lucky. plus this is in canada so i guess it wouldn't happen in the US?

 

[fineline]

plus this is in canada

Suddenly everything becomes much clearer.

 

[squame]

You're allowed to give orders as a med student too?

no but I guess the nurses will start stuff sometimes if it is relatively benign like tylenol and it is obviously indicated, or will get lab tests which are later officialy signed by the resident.

 

[fineline]

Next time, just order CPR. Problem solved!

 

[JayneCobb]

So what is the take home point from this thread?

1. Everyone should be scared ****less about what they do not know and how it can kill someone, even residents like myself.
2. unsupervised medical students is a horrible idea, just as unsupervised interns and residents are a bad idea and bad for patient care
3. Never completely rely on the nurse about vitals that "have been stable all day." It's not their ass on the line if you screw the pooch. ask specifically for numbers, trends, allergies, admitting diagnoses, recent lab work. You will see that the average floor patient has a respiratory rate of 18 to 20 for no apparent reason
4. If all else fails, go see the patient ASAP.
5. Medical students should be supervised and not used as free labor for BFE hospitals

 

[fineline]

I thought the take-home point was that nurses who think medical students are the people they should call should be horse-whipped.

 

[angel80]

You are a third year medical student. The nurses should not be paging you for orders and to evaluate patients. As a 4th year sub-I, you usually have those resposibilites, but there should always be an intern/resident for backup. I think that this was a system-bases error, and that the system at that hospital is dangerous.

 

[squame]

Next time, just order CPR. Problem solved!

seriously i am so distraught about this. This morning after being awake the entire night the Dr. makes me present on a patient he assigned to me last night like an hour before this all transpired. I told him i didnt' have time to work on it so he gave me like 45 mins. Of course i was hallucinating by this point and I wasn't able to come up with most things on the problem list in the right order, or the correct treatments. This interrogation was done in a room one-on-one like an oral exam. is this normal??? All this to expose my ignorance and show i am bad at decision-making. Then I started crying when he got to the "you killed the patient part". So brutal. This Dr. is actually quite soft-spoken and not mean at all, so I can only imagine what it is like with someone else. I don't think I can go through the rest of med school being tortured like this...

 

[fineline]

Then I started crying when he got to the "you killed the patient part".

LOL, if an attending accused me of killing patient as a medical student, I'd probably laugh at him, not cry.

 

[squame]

LOL, if an attending accused me of killing patient as a medical student, I'd probably laugh at him, not cry.

well he didn't say it that way, but the implication was that i may have contributed by not making it clear to the resident right away that the patient was acute.

The pt was probably bleeding internally from a renal biopsy done a few days ago, though it's still not clear. The BP was probably going down slowly which is why nobody noticed -- still my fault though

 

[pillowhead]

Have you talked to the course director yet? Does s/he actually know that nurses are calling medical students for potentially seriously ill patients? More importantly, do the patient's lawyers know that?

If your course director is aware of how things work at this hospital and still sends students there, then you should talk to one of the deans at your school. That's just absolutely ridiculous. You can't even legally give orders.

I also think the hospital and that particular nurse should be held responsible. If the nurse was truly that concerned about the patient, she should have paged the resident.

 

[fineline]

the implication was that i may have contributed by not making it clear to the resident right away that the patient was acute.

You should be like, "I'm supposed to call the resident now? I'm a nurse? In that case, I'm over my work hours for the entire year!!" and then left. After eating all the doughnuts.

 

[AmoryBlaine]

I'm not trying to be insensitive but my BS meter is going off. I know Canada's system is a bit different but this story does not add up.

If the OP is telling the truth than s/he is in the middle of a serious ****storm and should be involving both the clerkship director and the Dean of the medical school ASAP. To suggest that a September M3 "killed a patient" is beyond the pale unless you actually occluded their ET tube or personally injected concentrated KCl.

 

[squame]

I'm not trying to be insensitive but my BS meter is going off. I know Canada's system is a bit different but this story does not add up.

If the OP is telling the truth than s/he is in the middle of a serious ****storm and should be involving both the clerkship director and the Dean of the medical school ASAP. To suggest that a September M3 "killed a patient" is beyond the pale unless you actually occluded their ET tube or personally injected concentrated KCl.

I am not BSing that is exactly what happened. I am thinking of emailing the Dean now but not sure what to say...I just really don't want to finish my rotation at that hospital. Like I said he didn't say I killed the pt but that my judgement was poor because I'm unable to come up with appropriate assessments. He said it "probably wouldn't have made any difference" if I had acted more urgently.

 

[smq123]

Then I started crying when he got to the "you killed the patient part". So brutal. This Dr. is actually quite soft-spoken and not mean at all, so I can only imagine what it is like with someone else. I don't think I can go through the rest of med school being tortured like this...

well he didn't say it that way, but the implication was that i may have contributed by not making it clear to the resident right away that the patient was acute.

Like I said he didn't say I killed the pt but that my judgement was poor because I'm unable to come up with appropriate assessments. He said it "probably wouldn't have made any difference" if I had acted more urgently.

What?? First, your attending said that you killed the patient. Then you clarify that what he meant was that you "contributed" to the patient's death. Then he flat out told you that, hey, no - it "wouldn't have made any difference" no matter what you would have done.

I think you need to calm down and figure out what is really going on. I think that you're so occupied with blaming yourself that you're putting words in the attending's mouth, and making it difficult for readers on this board to figure out what truly happened. (Or else your attending is so freaked out by the possibility of a lawsuit that he can't figure out what's going on either.)

 

[Law2Doc]

I am not BSing that is exactly what happened. I am thinking of emailing the Dean now but not sure what to say...I just really don't want to finish my rotation at that hospital. Like I said he didn't say I killed the pt but that my judgement was poor because I'm unable to come up with appropriate assessments. He said it "probably wouldn't have made any difference" if I had acted more urgently.

If you are going to bring the dean in it, do not say anything in the email beyond asking for an appointment. You would want to discuss this orally, not through email.

 

[smq123]

So, I didn't see him right away becuase I was finishing a note, and wanted to grab some dinner before the caf closed. This takes maybe 1/2 an hour. When I get back to the ward the nurse is super pissed and bitching about how the med student isn't doing anything. She keeps repeating that she wants an analgesic and I can just give the order verbally and then get it signed later. I'm like F-no I have no idea what is causing this. So I call the resident without seeing the patient and tell her what I know (btw this is not my patient so I don't know him in depth). She is like, I'm not in the hospital right now, i'm in a clinic next door, why don't you go see the patient and try to figure out what he needs. I go see the patient, the patient tells me that he has had the pain all day, the vitals are normal (BP maybe a little low). I try to look up some stuff on uptodate on what might cause this post-dialysis but still have no clue. After like 15mins I call the resident and she comes to the floor. As she arrives the pt falls out of his bed, and decompensates, vitals go through the floor. He gets a bolus and is transferred to ICU where he gets a code and then expires.

....

I am so depressed and unhappy I don't know what to do. I really did my best, I had no idea this would happen. I am not the best med student but I'm not the worst either and I feel the only reason he said that is because I made a bad judgement call.

First of all - nurses should not be asking students for orders, especially not 3rd years. What are we supposed to do? I can't even order Eucerin for a patient - you want me to put in an order for an analgesic? Sure, I'll get right on that!

Second of all - it's only a bad judgement call if you were slow in seeing the patient when the nurse said that it was a serious situation. If the only thing that the nurse said was "Oh, by the way, the patient wants some Tylenol," then forget it. When you do OB, if you drop everything that you're doing everytime a patient wants "pain relief," then you'll never get anything done. But if the nurse had said, "I'm really concerned about the patient in 308, he seems to be in more pain than usual," and you had gotten dinner despite that warning, then yeah - that's probably not so good.

Finally - as one MS3 to another - I've found that residents seem to prefer it if you've seen the patient and the chart before calling them. At least then you can tell the resident about the vitals, any PE findings, I&O, H&H, etc. This is just what I've seen on rotations so far, but that may change, depending on what rotation I'm doing.

 

[squame]

Second of all - it's only a bad judgement call if you were slow in seeing the patient when the nurse said that it was a serious situation. If the only thing that the nurse said was "Oh, by the way, the patient wants some Tylenol," then forget it. When you do OB, if you drop everything that you're doing everytime a patient wants "pain relief," then you'll never get anything done. But if the nurse had said, "I'm really concerned about the patient in 308, he seems to be in more pain than usual," and you had gotten dinner despite that warning, then yeah - that's probably not so good.

Finally - as one MS3 to another - I've found that residents seem to prefer it if you've seen the patient and the chart before calling them. At least then you can tell the resident about the vitals, any PE findings, I&O, H&H, etc. This is just what I've seen on rotations so far, but that may change, depending on what rotation I'm doing.

The nurse said she wanted an analgesic because the pt was in a lot of pain. What does that mean?? Then I went to get the resident at the ICU (but she wasn't there, she was in clinic). After speaking with her on the phone, i stopped for a sandwhich in the caf before seeing the patient myself (ate in like 5mins). I should have seen the patient right away, it's true. But I thought it would be better to get the resident if it was serious. Unfortunately she just told me to go see the patient since she wasn't in the building.

 

[edmadison]

this is in canada so i guess it wouldn't happen in the US?

Suddenly everything becomes much clearer.

Worst thing is that the guy had to wait 6 months to die!

Seriously, as a medical student you have no responsibility. Zero, Nada, Zilch. Your intern should have evaluated the patient. You informed the intern of the problem (twice). Ultimately, it's the attending's responsibility. Your attending is blaming you because he/she knows where the responsibility lies, and it feels better to blame others for one's own shortcomings. Talk to your dean.

Beware. The amount of Axis II pathology in Medicine is unparalleled in other professions. In order to survive, we all need to learn how to deal with irrational colleagues.

Ed

 

[smq123]

The nurse said she wanted an analgesic because the pt was in a lot of pain. What does that mean??

Never mind - that's too vague and means nothing.

It sounds like it was just "one of those things" that happen and you got caught in the middle of it. The nurse wasn't alarmed, the patient didn't seem unstable when you saw him, and he clearly was stable when the day team left. I don't know why you're attending is coming down so hard on you.

 

[squame]

Never mind - that's too vague and means nothing.

It sounds like it was just "one of those things" that happen and you got caught in the middle of it. The nurse wasn't alarmed, the patient didn't seem unstable when you saw him, and he clearly was stable when the day team left. I don't know why you're attending is coming down so hard on you.

I suspect the resident told the attendings I didn't report the vitals to her to justify her lack of action and save her own ass. It's true I didn't because I hadn't seen the patient.
Sigh. I'll never live this down. If I manage to finish this rotation I'm working against a below average mark.

 

[Ypo.]

If the OP is telling the truth than s/he is in the middle of a serious ****storm and should be involving both the clerkship director and the Dean of the medical school ASAP. To suggest that a September M3 "killed a patient" is beyond the pale unless you actually occluded their ET tube or personally injected concentrated KCl.

I STRONGLY second this. Squame-you should DEFINITELY get the clerkship director involved, the dean, someone higher up at your school. Just present the facts and tell them how you feel. This is absolutely wrong, wrong, wrong. And you should not be suffering all this psychological trauma. If this is all true, then you are being abused. You are not responsible for this patient's death.


Oh, and let us know how it turns out.

 

[oldbearprofessor]

Dear squame;

You have received a lot of reasonable advice that as a faculty member I think you should consider in terms of reporting this situation to someone higher up in the system. It is a bit difficult for us to sort out the details of your chain of command being in a different health care system, but you should engage that chain as soon as possible.

I wanted to add something else though. You appear to be bashing yourself and being very distraught over the possibility that your actions, or inactions led to a bad outcome for a patient. If you continue to be overwhelmed with these feelings, please seek out a sympathetic faculty or professional counselor. These feelings are common among residents and even attendings at time, and should be dealt with beyond your friends on SDN.

I remind you and those reading this forum that many if not most of us will be involved in situations during our training or as attendings when we were asked to evaluate a situation but didn't get to it right away and a bad outcome happened. This is inevitable if one cares for very sick patients. It doesn't make us guilty of the patients bad outcome, or make us bad people. It does provide us a chance to rethink what happened, decide if we did the best we could or if there is a way in which we would like to handle the situation better the next time.

As an attending, I often (very often..) get calls or am told on rounds something of the form "OBP, I'm very upset that I missed X [finding, lab, x-ray, etc] and it turns out the patient had.... happen." I always respond with, "Okay, we can talk about what happened later, but what I want to know is how we'll proceed to care for the patient." Then, later I go back and privately talk about what happened and the lessons that might be learned.

I can remember clearly several major mistakes I made as a resident (well over 20 years ago) that were part of the process leading to a worse outcome for the patient than if I hadn't made those mistakes. I'm not obsessed with them, but I remember them. This is part of becoming a physician who takes care of very sick patients.

Best of luck to you. Please keep us informed and you are welcome to PM me if you need some [moral] support.

Regards

OBP

 

[Tired]

Then he tells me I'm a sucky med student as I'm unable to synthesize H&P into a good impression, i'm behind other students (asks me what my previous grades were), and maybe with a lot of work I can do OK.

Everyone is skipping over this part, but it's probably the key to your story.

Basically it sounds like you aren't doing very well on this rotation, and this incident kind of brought things to a head.

From what you've said, no one accused you killing a patient, they told you that in the future, when you are aware of a problem, go see the patient quickly and then make a phone call to someone higher up. Good. We've all learned that lesson the hard way at one point or another.

 

[squame]

Everyone is skipping over this part, but it's probably the key to your story.

Basically it sounds like you aren't doing very well on this rotation, and this incident kind of brought things to a head.

From what you've said, no one accused you killing a patient, they told you that in the future, when you are aware of a problem, go see the patient quickly and then make a phone call to someone higher up. Good. We've all learned that lesson the hard way at one point or another.

yes, i realize that now. see the patient, then call resident with all the info.
The doctor told me the day before yesterday i was doing fine! i have only been doing this rotation for four days, have written only a few impressions, how can he be so sure I suck so early on?

 

[squame]

thanks obp that is very helpful to hear.

 

[Arsenic]

wow OBP, that was an excellent post from an attending's perspective.

 

[tr]

Squame:

This is completely beyond the pale of any kind of reasonable behavior on the part of

a) the nurse (wth is she doing paging you instead of the intern, and why didn't she tell you the bp had been going down rather than 'give him an analgesic')

b) the resident whose patient this was (who gave you crappy signout - and btw this patient had flank pain and his pressure was dropping slowly all day? smells like an intraperitoneal bleed to me - how come the day team didn't notice this at PM rounds?)

c) the attending (whose job it is to teach you, not to blame you for failures of the system)

d) the system (whoever heard of unsupervised med students on their 2nd clinical rotation having any responsibility for ANYTHING on the floors? You guys are ALONE? And nurses are paging you for problems with patients?? I can't even express how incredibly WTF??? this is)

I will say that your judgement was not great in a) not asking the nurse for a few more details (is the pain new, how are the vitals) rather than finishing your note and waiting half an hour befor exploring the matter further, and b) not seeing the patient before you called the intern.
BUT
It is not your job to have good judgement at this point in your education. You are a third year med student at the beginning of the year, you don't know jack and you aren't expected to know jack. Good judgement comes from experience, it doesn't spring full-fledged from the head of Zeus.

You did the right thing in paging the intern. Anything beyong that is Not Your Responsibility. Even paging the intern in the first place should have been done by the nurse - not YOU. This is a total failure of the system.

And it's a pretty ****ty-ass hospital if this patient bled his ENTIRE BLOOD SUPPLY out into his peritoneum without anybody noticing. That doesn't happen in an hour, it takes a long time. I love the way they blame the med student who happened to bumble into the crosshairs in the last few moments after nobody noticed this patient circling the drain all day.

You should go to your dean with this story. The system you describe is completely inexcusable.

Also you should describe to the dean what the attending said to you (calmly, clearly, and in as much specific detail with quotations as possible) and ask to be moved to another team. This attending has scapegoated you for his or her own responsibilities. You are never going to get a good grade from this person because that would involve his admitting to himself that he and his team fvcked up.

Above all: DO NOT BLAME YOURSELF. THIS IS NOT YOUR FAULT. You got caught between a screwed-up system and an idiotic nurse, and then blamed by an unethical attending.

 

[ForbiddenComma]

Usually, we MS3's at my house are not allowed to even wipe our own butts without supervision. Sometimes, though... things happen. And I could have easily wound up in the OP's position. Like the time where everybody was gone -- the attendings, the chief resident, the NPs, everybody -- and it was just the intern and me, the student, covering the whole unit.

Rules were broken that day. Oh yes.

To the OP: It is not your fault that you were placed in this situation. Like people have said, get your side of the story told to the higher-ups before that attending and resident throw you under the bus to save their own skins. The patient was their responsibility, not yours. You did not do anything to actively harm the patient, and on a brand new rotation you cannot be expected to manage patients. (or even if you were at the end of the rotation.)

And thanks for the words of wisdom, OBP.

 

[fineline]

What's a resident doing signing out to a medical student. If I was the resident and was going to sign out and a medical student showed up, I'd be like, "what is this, a joke?" But then again, it's Canada.

 

[funkless]

I am not BSing that is exactly what happened. I am thinking of emailing the Dean now but not sure what to say...I just really don't want to finish my rotation at that hospital. Like I said he didn't say I killed the pt but that my judgement was poor because I'm unable to come up with appropriate assessments. He said it "probably wouldn't have made any difference" if I had acted more urgently.

Don't email the dean.

Don't go to work tomorrow.

Go directly to the dean's office and spill your guts--every detail.

 

[funkless]

If you are going to bring the dean in it, do not say anything in the email beyond asking for an appointment. You would want to discuss this orally, not through email.

Yeah, but I personally wouldn't solicit an invitation. This is no time for a paper trail, and the death of a patient is a barge-in-worthy event.

 

[headabovewater]

This is a medical student's worst nightmare...I am so sorry you had to go through this. I am a M3 in Canada, and I can assure you that leaving a med student completely unattended is not routine procedure. Like you say, you unfortunately got unlucky. Whatever you did or did not do is NOT an issue here. You are a STUDENT, and as such, your primary role is to LEARN, not to make critical decisions or orders. You are not responsible for what happened, at all. I mean, how easy is it for us to all judge you when we weren't the ones in your situation huh? I don't know what I would have done, but I probably wouldn't have reacted much differently. The nurse clearly shouldn't have relied solely on your opinion if she was that worried. But what bothers me the most is your attending's reaction. You just saw someone pass away, thinking it's your fault, and all he finds to tell you is that you're "behind other students"?!?!?! He should have shown the empathy or compassion he pretends to show to his patients. And "threatening you" subtlety by saying that you will have to catch up to do ok? What does that mean? Sounds like he knows his a** is on the line and he is trying to manipulate you into thinking that you are the culprit in this whole situation. Like so many have already said before me, go to your dean ASAP. This situation is unacceptable; what kind of hospital leaves their patients in the care of an M3, especially at the beginning of the year? It's like leaving a Boeing 737 in the hands of a teenager who's read a couple of books on how to fly an airplane! Don't wait! And switch sites...I'm sure it is possible; this is an exceptional circumstance. Good luck, and let us know how it went. I really hope everything goes well for you. Take care.

 

[RockShox]

I don't get it? Why do the craziest stories come from people with like 1-10 posts in their SDN histories? Anyway...I am going to have to assume that this story is true. Before you freak out just understand that there are several parts of it that are so outside the norm of hospital policy and supervision that to qoute Hillary you do have to suspend some level of disbelief. I go to a pretty liberal school in the states but even I in my 4th year can't give a verbal order to anyone. Let alone for a narcotic (which really is the only pain med likely needed in this case). Additionally I have never written admit orders that said..."notify med student for...."

If this is true...well you got sandbagged and its not helping your cause by taking blame for things that are not your fault. The nurse was stupid to ask you anyhow....the resident was slow (and what in the hell clinic is going at 6:30-7pm at night anyhow?), lastly from what you describe at your level of training I don't see how you could have known (unless there are parts of the story that you are omitting) that this patient was on the way out. Anyway, the appropriate move is to simply let this situation go away quietly. Most attendings are bright people and not dumb enough to blame a med student for their patients demise.

 

[Old_Mil]

When people start dropping and it's you, a nurse, and a janitor its time to give it the old college try...even if you're giving chest compressions with a copy of Ferri's in one hand and Cecil's in another.

Remember, even as a med student in 2007, you know a heck of a lot more than Hippocrates, Galen, and every doc who lived before around 1900. Combined.

...and do what Funkless said. You don't want to end up hanging for something you shouldn't be hanging for.

 

[PeepshowJohnny]

Okay, first of all this story is so bizarre to me. A medical student...alone...one a floor. Wow. Ok.

But anyway, if you're being honest this does sound like they're trying to sandbag you. You show a bit of weakness and "Oh of COURSE it's the med students fault that the patient died!". I agree you need to go over the head here and plead your case.

 

[cbass1350]

You are not to blame. First off, it is your first medical rotation. Second of all, the nurse should not be asking you for orders (that's what the interns are for). Finally, your attending is a jackass.

 

[OddNath]

And it's a pretty ****ty-ass hospital if this patient bled his ENTIRE BLOOD SUPPLY out into his peritoneum without anybody noticing. That doesn't happen in an hour, it takes a long time. I love the way they blame the med student who happened to bumble into the crosshairs in the last few moments after nobody noticed this patient circling the drain all day.

My heart goes out to you, Squame. Honestly, I didn't even know how to write a SOAP note on my 1st week of medicine, much less recognize the significance of a downtrending bp in a patient who I hadn't met before. That is ALOT to ask of a new MS3. I cannot believe you were essentially put in charge of the floor with no back up. We're not even close to being MD's yet, that is the reason that us MS3's should not ever be put in charge...

Please talk to your dean. Take care of yourself, good luck.

 

[Snuffleupagus]

Squame,

it's not your fault. really, it isn't. the reason they are blaming you is because you are an easy target and you are TAKING IT. but you shouldn't, because you are in no way responsible, as everyone has already established.

i realize the atmosphere in canada may not be as litigious as the united states, but here is what I would do (and others can advise if i am wrong):

1. Stop posting about this on SDN.
2. Stop accepting responsibility for what happened. You've already stated your concern but what happened is NOT YOUR FAULT.
3. Set up a meeting with your dean via email and meet with him/her in person as soon as possible.

If everyone is still blaming you for this, if they are threatening you with any demotion/expulsion, etc, I would even consider

4. Consult a lawyer.

Not to scare you, but if the going gets rough, you need to take care of yourself.

Good luck. It's not your fault!! It really isn't.

 

[Top Gun]

I have to agree with the other posters on here. First of all, you're a third year med student who just started his/her second rotation. At this point, you're not supposed to have a sense of when a patient is going south. Second, you are supposed to be supervised by a resident or intern. The nurse should not be coming to you with requests for orders. In addition, your resident basically left you to the wolves. She did not show up the first time you called for help. I suggest you talk to your dean.

 

[Tired]

My heart goes out to you, Squame. Honestly, I didn't even know how to write a SOAP note on my 1st week of medicine, much less recognize the significance of a downtrending bp in a patient who I hadn't met before. That is ALOT to ask of a new MS3.

I hear a lot of med students here saying this, and it leads me to a very important question.

Are you all a bunch of idiots?

You didn't know that a declining blood pressure is an ominous sign? You don't know what constitutes a normal blood pressure? What the hell did you do the first two years of med school?

I agree, this was not the student's fault. But for the love of God, even a first year nursing student knows the difference between normotensive and hypotensive. To suggest that an MSIII shouldn't be expected to know what constitutes normal blood pressure is just dumb.

I can assure you that, even in July, every one of my MSIIIs knew what a normal blood pressure was, and if they didn't, they would crushed on rounds.

 

[OddNath]

I can assure you that, even in July, every one of my MSIIIs knew what a normal blood pressure was, and if they didn't, they would crushed on rounds.

Yes yes, we knew the normal limits of blood pressure during the first week. But I wouldn't have been sensitive to blood pressure trending down within normal limits, which I have now seen alot. Or the guy who normally runs in the 180's who's in the 130's and is now orthostatic. I've seen it now, so I know now.
I mean, on my 1st week of medicine I would recognize an 80/50 or whatever. But from what the OP is saying, it sounds like it may have been more subtle than that. I don't know, I wasn't there. Just trying to be supportive.

 

[cbass1350]

I can assure you that, even in July, every one of my MSIIIs knew what a normal blood pressure was, and if they didn't, they would crushed on rounds.

I agree but this event is much more about the utter failure of the system than anything else. For the staff to blame a wet-behind-the ears MS3 in the middle of this cluster **ck is laughable to say the least.

 

[Gem134]

Seriously, as a medical student you have no responsibility. Zero, Nada, Zilch. Your intern should have evaluated the patient. You informed the intern of the problem (twice). Ultimately, it's the attending's responsibility. Your attending is blaming you because he/she knows where the responsibility lies, and it feels better to blame others for one's own shortcomings. Talk to your dean.

Beware. The amount of Axis II pathology in Medicine is unparalleled in other professions. In order to survive, we all need to learn how to deal with irrational colleagues.

Ed

Consider talking to a lawyer, privately. Don't take on the blame for this, a new MS 3 is not responsible for this mess and if your attending is going to try and fail you for this then you need to actively protect yourself emotionally and professionally. Go and see the Dean and the clerkship director, go in person to make the appointment as secretaries are often excellent filters/purveyors of 'between-the-lines' stuff to their bosses. Be confident and stand tall, learn from all this, but do not let the blame stick to you. The Dean and the CD need to know what has happened and to be involved in the process as it evolves - they will want to know.

 

[chagall]

Yes yes, we knew the normal limits of blood pressure during the first week. But I wouldn't have been sensitive to blood pressure trending down within normal limits, which I have now seen alot. Or the guy who normally runs in the 180's who's in the 130's and is now orthostatic. I've seen it now, so I know now.
I mean, on my 1st week of medicine I would recognize an 80/50 or whatever. But from what the OP is saying, it sounds like it may have been more subtle than that. I don't know, I wasn't there. Just trying to be supportive.

Agreed. The point I wanted to make clear is in response to what the OP was critcized for: "Then he tells me I'm a sucky med student as I'm unable to synthesize H&P into a good impression, i'm behind other students (asks me what my previous grades were), and maybe with a lot of work I can do OK."

That's what experience is for...by the end of 3rd year, I was much better at this, and by the end of internship, I'm sure I'll be much better still. You have to see a lot of patients to know that someone just looks "bad," even if their vitals are relatively stable right now. That's why a new 3rd year med student shouldn't be left to take care of patients by him/herself...we just don't have that experience to form good judgments yet. The best you can do is call your intern/resident (which you did, twice) and see the pt if there is something at all concerning. So as everyone else has said, this is not your fault.

 

[Hard24Get]

I agree with the fact that this is a outrage that a med student was left alone to make decisions the intern should be making. But I think everyone is missing a critical part of the story:

I go see the patient, the patient tells me that he has had the pain all day, the vitals are normal (BP maybe a little low).....As she arrives the pt falls out of his bed, and decompensates, vitals go through the floor. He gets a bolus and is transferred to ICU where he gets a code and then expires.

Not sure what "a little low" BP is to the OP, but if the vitals were ok before the patient fell out of bed, the lead point in this whole fiasco seems to be the patient falling out of bed. That easily could have triggered him to start hemorrhaging internally from his site, decompensate, and subsequently code. Unrelated to the pain which should have been treated, but was not particularly alarming or unexpected. Is it supposed to be your fault the patient fell out of bed, too? The nurse should have assessed whether he was safe to ambulate and controlled that situation...