Guilt

[Deferoxamine]

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The little ~80 year-old lady they gave furosemide to this afternoon, hours before her discharge. I was supposed to listen to her lungs for one last time to make sure there was no ZOMG flash pulmonary edema.

After several periodic checks this afternoon, I forgot to check her lungs just one last time for snap, crackle, and/or pop before I left today.

Am I going to the 9th circle of hell next to Judas Iscariot, Kanye West, and Lindsay Lohan?

 

[Depakote]

Yes, it would have been good if you'd checked her lungs, but have they actually based a clinical decision on your physical exam without verification this rotation? Did no one else listen to her before she went?

 

[Deferoxamine]

Yes, it would have been good if you'd checked her lungs, but have they actually based a clinical decision on your physical exam without verification this rotation? Did no one else listen to her before she went?

I very highly doubt my judgment had any influence on the outcome in this particular case (residents and attendings were checking her during the day/afternoon), but it's just that weird feeling... you know how it is. I think I remember saying something like "I'll be back to see you before you leave tonight."

Remembered this while cooking dinner tonight...

 

[MSmentor018]

I very highly doubt my judgment had any influence on the outcome in this particular case (residents and attendings were checking her during the day/afternoon), but it's just that weird feeling... you know how it is. I think I remember saying something like "I'll be back to see you before you leave tonight."

Remembered this while cooking dinner tonight...

this is where you thank god for a good nurse

 

[Rendar5]

The little ~80 year-old lady they gave furosemide to this afternoon, hours before her discharge. I was supposed to listen to her lungs for one last time to make sure there was no ZOMG flash pulmonary edema.

After several periodic checks this afternoon, I forgot to check her lungs just one last time for snap, crackle, and/or pop before I left today.

Am I going to the 9th circle of hell next to Judas Iscariot, Kanye West, and Lindsay Lohan?

why were they concerned that giving lasix would lead to flash pulmonary edema?

 

[michaelrack]

Guilt is part of being a doctor. There is always something more/something different you could have done for a patient.

 

[Scaredshizzles]

why were they concerned that giving lasix would lead to flash pulmonary edema?

Why are some people so literal? Obviously he meant they were concerned of discharging her because apparently she had fluctuating levels of edema, and didn't want to discharge her if her lungs were filled with fluid again.

And dude, relax...Patients know themselves better than anyone. She's not gonna die. If the edema is coming back, she'll be back in the ER tonight. And no one will blame you, everyone knows frequent fliers like her can deteriorate quickly.

 

[Tiger26]

why were they concerned that giving lasix would lead to flash pulmonary edema?

that was kinda what I thought . . .


regardless--you're a med student, so under almost all circumstances what you do or examine shouldn't really matter because someone should be observing or verifying anyway

 

[Scaredshizzles]

that was kinda what I thought . . .


regardless--you're a med student, so under almost all circumstances what you do or examine shouldn't really matter because someone should be observing or verifying anyway

Well even if they didn't double check in this case, it really doesn't matter. This is not a validated criterion for admission or discharge for CHF exacerbations. You can't hear alveoli on physical exam, it isn't going to be an accurate reflection of her condition anyway. There are people with chronically horrible sounding lungs who oxygenate well and aren't dyspneic and vice versa.

 

[Deferoxamine]

why were they concerned that giving lasix would lead to flash pulmonary edema?

No no no, and no.

I wasn't checking to see if pulmonary edema was present as a consequence of the lasix. My job was to check her lungs before discharge as she had gone into flash pulmonary edema in the ICU the week prior. My wording in my post was whack, kthxsry.

 

[MattD]

The way you worded your post it sounds like you checked her several times that day. Are you feeling guilty because you didn't tackle her as she was being wheeled to the lobby and check her lungs ONE LAST TIME?

Did the patient actually have a bad outcome, or are you just beating yourself up for forgetting to do something you meant to do? Either way good for you for taking ownership of your patient!

 

[cartoondoc]

I've felt guilty before over accidentally not doing something that had no consequences. But as a med student, it's a waste of energy. If the team was trusting you and you alone to make a determination if this woman should go home, they are the ones who are bound for hell... or more likely, the malpractice suit.

 

[kyley3k]

The little ~80 year-old lady they gave furosemide to this afternoon, hours before her discharge. I was supposed to listen to her lungs for one last time to make sure there was no ZOMG flash pulmonary edema.

After several periodic checks this afternoon, I forgot to check her lungs just one last time for snap, crackle, and/or pop before I left today.

Am I going to the 9th circle of hell next to Judas Iscariot, Kanye West, and Lindsay Lohan?

If she has dyspnea, she'll come back again... and it wont be your fault. I'm sure you'd been monitoring her I/O's care fully any way for several days. They make sure those patients are as close to euvolemic as possible before they send them on there way (assuming she has heart failure).

 

[spicedmanna]

I very highly doubt my judgment had any influence on the outcome in this particular case (residents and attendings were checking her during the day/afternoon), but it's just that weird feeling... you know how it is. I think I remember saying something like "I'll be back to see you before you leave tonight."

Remembered this while cooking dinner tonight...

I know how you feel. I think we've all felt this way, that we could, would, or should have done something for a patient. It's a good trait, but try not to lose too much sleep over it (I know, easier said than done, because I've gone home and obsessed over things, too, when everyone else already let it go; even now there is a thing or two I'm thinking about). Probably no matter what we do, there's more that can be done and sometimes we miss things (especially since we are students). We just try not to miss or forget the really critical/important things. I doubt your one last check would have made a difference; you already checked several times that day and everyone else from the PCA on up probably checked as well. Your team probably got a repeat CXR at some point before d/c and decided the patient was stable to go home. On d/c orders, the usual is to provide instruction to go to the ER, if any concerns or problems occur, which generally covers such emergencies.

I applaud your ownership of the patient, but don't beat yourself up over it, especially if it isn't likely consequential. One thing that can be learned from this is that it is a good idea to put check boxes on your patient list for a given task so that you can periodically review your list to see if you've accomplished it. I think it's a good habit to develop for when we become interns in...about a year (*gulp*).

 

[werd]

i agree with above...

1) it's all good, she's almost certainly fine

2) checky-boxes. if you don't checky-box your to-do list, you'll forget things.