I F'ed up

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TaoistDoc

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I want to start a thread on things 3rd year medical students commonly screw up on. Maybe the rest of us can learn from each others mistakes and try to not make the same one.

-So far, I have inadvertently place a ppd subcutaneously instead of intradermally. I had never done one before so I asked a 2nd year medical student who has and was told that it went subcutaneously. So when I stuck that needle in a bit too far and didn't see a dome swell up, I was ****ed. I told the attending and he told the patient it was fine, but I think we both knew that the test was not going to be accurate. I still feel really lousy about the whole situation.
 
Sounds traumatic.

I have a friend who dropped a baby in OB/gyn. It came out faster than he expected and was all slippery with blood. The baby must have felt really welcome.
 
Sounds traumatic.

I have a friend who dropped a baby in OB/gyn. It came out faster than he expected and was all slippery with blood. The baby must have felt really welcome.

😱 Is that like an automatic go find a new job, mistake?
 
I want to start a thread on things 3rd year medical students commonly screw up on. Maybe the rest of us can learn from each others mistakes and try to not make the same one.

-So far, I have inadvertently place a ppd subcutaneously instead of intradermally. I had never done one before so I asked a 2nd year medical student who has and was told that it went subcutaneously. So when I stuck that needle in a bit too far and didn't see a dome swell up, I was ****ed. I told the attending and he told the patient it was fine, but I think we both knew that the test was not going to be accurate. I still feel really lousy about the whole situation.

are you f-ing kidding me? When people act all dramatic and say I f'ed up, I'm expecting something that actually matters. Not to sound harsh, but a poor ppd placement--big f-ing deal
 
When I put a cast on a patient in the OR after surgery, she continued to complain of post op pain. Took the cast off later and severe pressure ulcer with full thickness eschar present over her heel and a good portion of the lateral foot after cast removal. Now that's a bad deal, took over 4 months for those wounds to heal adequately...and I felt like crap.
 
😱 Is that like an automatic go find a new job, mistake?


There's a long-running story at my institution about a med student who dropped a baby in the biohazard bin during delivery. Didn't hear about that person failing, but I'm sure they got a nice reaming from the attending. As a result there are some OBs who don't break down the bed for med student deliveries.

Also heard about a guy on an ENT rotation who was just observing a cochlear implant surgery, not scrubbed or anything. Apparently went over and picked up the several thousand dollar implant with his bare, unsterile hands - that one was apparently an automatic failure.
 
There's a long-running story at my institution about a med student who dropped a baby in the biohazard bin during delivery. Didn't hear about that person failing, but I'm sure they got a nice reaming from the attending. As a result there are some OBs who don't break down the bed for med student deliveries.

Also heard about a guy on an ENT rotation who was just observing a cochlear implant surgery, not scrubbed or anything. Apparently went over and picked up the several thousand dollar implant with his bare, unsterile hands - that one was apparently an automatic failure.

1) It's true--she's about to start her EM residency

2) That guy is ******ed
 
are you f-ing kidding me? When people act all dramatic and say I f'ed up, I'm expecting something that actually matters. Not to sound harsh, but a poor ppd placement--big f-ing deal

Yeah, I know it wasn't a big deal, a false negative PPD is not the end of the world or anything. I still felt bad for screwing it up though, so I just needed to get it off my chest and say I f'ed up.
 
During my ortho rotation I spent a very long period of time holding a limb up in the air - the whole limb was prepped in and the foot wrapped up. After probably an hour or so, I went to adjust position, and ended up having a minor foot-face contact. I felt like Turk on Scrubs...

Ultimately didn't matter, but the scrub nurse was not too happy about reprepping the foot.
 
Sounds traumatic.

I have a friend who dropped a baby in OB/gyn. It came out faster than he expected and was all slippery with blood. The baby must have felt really welcome.

Correct me if I am wrong, especially Ob/Gyn's, but I had heard that when babies are just born, their bones and especially their head and everything are much more malleable and dropping one just as they are born would most likely not result in any permanent or really even temoporary serious damage, just piss off the resident/attending.
 
Correct me if I am wrong, especially Ob/Gyn's, but I had heard that when babies are just born, their bones and especially their head and everything are much more malleable and dropping one just as they are born would most likely not result in any permanent or really even temoporary serious damage, just piss off the resident/attending.

You're not likely to actually fracture anything but there isn't much bone protecting those squishy parts inside.
 
PPD placement being incorrect is weak! Don't worry about that even a little!!!

Mine (which some admittedly aren't too bad)...

-Ob-gyn/ almost dropped my first delievery! I did not have as good a hold as I wanted too and the resident stated it looked like I almost dropped it (which I denied, of course 🙂 ).

-Apparently did not advance a IUD far enough, even though the attending had an ultrasound and was telling me exactly what to do and when to "release" it or whatever and I had told him how far it was advanced when he did (which was short), but whatever. As a result, it was loose and he removed it then and replaced it. Did not "seem" pissed, but gave me a ****ty eval, though that was the ONLY half-day I had worked with him. Oh, and IUD's are about 150+ bucks or something.

-A few minor (3) lip lacerations in anesthesia. The attendings always tell you to be more aggressive to get the airway quicker.

-Maybe 1 or 2 esophageal intubations

-Classic venous blood gas instead of an ABG of course, that was last week!

-Accidentally/ignorantly locked a subcuticular stitch in ortho that was going to be pulled out in clinic

-Had an ICU patient in trauma surgery, who was breathing a little too fast and uncomfortably for my liking when prerounding. I told my team and senior, BUT I did not really express my true worry and should have been more aggressive to a resident to check it out ASAP (my senior had to present at grand-rounds in 5 minutes or so, but the 2nd year stayed). Then a code blue was called on the patient in about 30 minutes or so later... so yeah...

-Attending asked me to give a 10 min talk on diabetic foot ulcers specifically and gave a talk on diabetic foot "lesions", which are apparently different
 
You're not likely to actually fracture anything but there isn't much bone protecting those squishy parts inside.

But with regards to damages that would be incurred...

Not that I'm going to L and D to run around dropping newborns to test it out or anything.
 
1) It's true--she's about to start her EM residency

2) That guy is ******ed


Regarding #1 - that's interesting.. the one I was referring to was referenced in my JMS survival guide. And if the person you're talking about is starting EM, that means she was in my class... hmmm....
 
PPD placement being incorrect is weak! Don't worry about that even a little!!!

Mine (which some admittedly aren't too bad)...

-Ob-gyn/ almost dropped my first delievery! I did not have as good a hold as I wanted too and the resident stated it looked like I almost dropped it (which I denied, of course 🙂 ).

-Apparently did not advance a IUD far enough, even though the attending had an ultrasound and was telling me exactly what to do and when to "release" it or whatever and I had told him how far it was advanced when he did (which was short), but whatever. As a result, it was loose and he removed it then and replaced it. Did not "seem" pissed, but gave me a ****ty eval, though that was the ONLY half-day I had worked with him. Oh, and IUD's are about 150+ bucks or something.

-A few minor (3) lip lacerations in anesthesia. The attendings always tell you to be more aggressive to get the airway quicker.

-Maybe 1 or 2 esophageal intubations

-Classic venous blood gas instead of an ABG of course, that was last week!

-Accidentally/ignorantly locked a subcuticular stitch in ortho that was going to be pulled out in clinic

-Had an ICU patient in trauma surgery, who was breathing a little too fast and uncomfortably for my liking when prerounding. I told my team and senior, BUT I did not really express my true worry and should have been more aggressive to a resident to check it out ASAP (my senior had to present at grand-rounds in 5 minutes or so, but the 2nd year stayed). Then a code blue was called on the patient in about 30 minutes or so later... so yeah...

-Attending asked me to give a 10 min talk on diabetic foot ulcers specifically and gave a talk on diabetic foot "lesions", which are apparently different

Can you give us some hints as to how to avoid your mistakes. For example, what did you learn after placing esophageal intubations that you wish you could have known before in order to avoid it?
 
Can you give us some hints as to how to avoid your mistakes. For example, what did you learn after placing esophageal intubations that you wish you could have known before in order to avoid it?

The biggest thing is to just visualize the cords. If you see the cords, you can't miss it. If you don't see the cords, especially while learning and inexperienced, I would try to reposition and see if that works. When I couldn't see the cords after repositioning, the anesthesiologist did the tube.
 
Can you give us some hints as to how to avoid your mistakes. For example, what did you learn after placing esophageal intubations that you wish you could have known before in order to avoid it?

That one was a "difficult airway" with an obese, large 55+ yo man. I didn't get it, the resident didn't get it (got esophagus too), the ATTENDING couldn't get it and got esophagus too! Then they did two more advanced airway techniques to finally get it (I think they finally did with an LMA intubation where you intubate through a special LMA. But I had gotten about 15 in of 21/20 attempts in anesthesia, including missing first 3/4. Basically, you just see the cords and place it in while you see them to ensure the airway.

The problem was that I didn't see the cords, but had been told if you see the epiglottis, have the blade in the epiglottis and have been moving around, cricoid pressure, and everything, you can try to place the tube where the vocal cords "should" be somewhat blindly (the attending tried that too). Residents and attendings can try it, but med students probably should not 🙂 and it takes more experience to do it! But again, intubating the esophagus is not too bad, so long as you recognize it (which is easy by the way). Just look at end tidal CO2 and chest rising, etc.

For babies, just grab the neck and catch the feet! I remember someone taught us to grab the bottom shoulder instead of the neck, which is not a good hold at all.

Otherwise, listen to your attending, don't listen to your attending 🙂, speak up if you think something's fishy...
 
to the op jason, I totally understand the wanting to get something off your chest. Don't worry about it.

Just today during PALS, I asked, what I think now was a stupid question to an attending that I just met. I feel like he must think I'm a terrible intern and don't know anything, and my residency is ruined. In actuality, no harm done, better to ask now and look stupid in a classroom than screw up later with a real patient.
 
-A few minor (3) lip lacerations in anesthesia. The attendings always tell you to be more aggressive to get the airway quicker.

-Maybe 1 or 2 esophageal intubations

-Classic venous blood gas instead of an ABG of course, that was last week!

-Accidentally/ignorantly locked a subcuticular stitch in ortho that was going to be pulled out in clinic
that stuff is just going to happen. they're mistakes, not f-ups.
 
I scanned a laboring patient's belly and declared the fetus in the vertex position. turns out she was breech and i had scanned her bladder. lesson learned: always find the falx 😉
 
plainolerichie, it's not just that IUD's are $150...it's that even if they are a little bit out of alignment...it can be really, really painful. AND even more painful to have the thing put in again. I totally get why the attending would want it to be perfect. Doesn't sound like you have a uterus anyhow.
 
plainolerichie, it's not just that IUD's are $150...it's that even if they are a little bit out of alignment...it can be really, really painful. AND even more painful to have the thing put in again. I totally get why the attending would want it to be perfect. Doesn't sound like you have a uterus anyhow.

Don't get me wrong, I believe it would be very painful so I did not mean to offend by just mentioning the cost. I don't have a uterus 🙂.

But my whole point with regards to the attending is I did EXACTLY what he told me to do and he was using ultrasound to guide (which should ensure placement correct). I had been told that once in the uterus, it is usually a bit deeper than mine was and I told him how far it was in. I felt "funny" about it not being far enough in the uterus but the main thing you worry about is perforating the back of the uterus and I was coming across some resistance, which is a good sign not to push it in farther! So he said to go ahead and place it based on ultrasound. I did that, but then was able to see part of it through the cervix, told him, so he pulled it out and replaced it, etc... If you haven't placed one it's kinda hard to explain what all happened and proper placement and I forgot the whole protocol. Ideally, you should use a sound, but I think he said ultrasound guidance is even better.
 
Purely secondhand account of why a fellow student was no longer on rotation...but if it's true it is one major F-up. None of this SQ PPD nonsense.

This 3rd year student was scrubbed into a case and accidentally broke the sterile field. The attending told him he needed to scrub out, but the student insisted he didn't break sterility. The surgeon calmly explained it wasn't a big deal and he can scrub back in after resterilizing. The student was so adamant that he was still sterile he proved it by shoving his hands into the patient's open abdomen. You can imagine what happened next.
 
Surprise twins not seen on ultrasound the minute before (no prenatal care). Not as much an f-up as a funny story.
 
Purely secondhand account of why a fellow student was no longer on rotation...but if it's true it is one major F-up. None of this SQ PPD nonsense.

This 3rd year student was scrubbed into a case and accidentally broke the sterile field. The attending told him he needed to scrub out, but the student insisted he didn't break sterility. The surgeon calmly explained it wasn't a big deal and he can scrub back in after resterilizing. The student was so adamant that he was still sterile he proved it by shoving his hands into the patient's open abdomen. You can imagine what happened next.

:scared::scared::scared:
 
While helping with closing of a wound from excisional biopsy on the neck I kept saying 'oop's and 'i didn't mean to do that' and 'i haven't done this stitch since gen surg'...Chief resident says "don't forget your patient is awake"...
The patient was resting so quietly it didn't even cross my mind that she was awake and only slightly sedated with versed. I felt like a complete idiot. Thing is that I sutured it really well but my momentary stage fright from the resident watching me rocked my confidence and I instinctively felt like apologizing...
Never will I forget that one.
 
I want to start a thread on things 3rd year medical students commonly screw up on. Maybe the rest of us can learn from each others mistakes and try to not make the same one.

-So far, I have inadvertently place a ppd subcutaneously instead of intradermally. I had never done one before so I asked a 2nd year medical student who has and was told that it went subcutaneously. So when I stuck that needle in a bit too far and didn't see a dome swell up, I was ****ed. I told the attending and he told the patient it was fine, but I think we both knew that the test was not going to be accurate. I still feel really lousy about the whole situation.

Eh, I feel I ****ed up when you get told by a patient that you "sucked all the hope out of the room."

I had a patient in the ICU, intubated and sedated. The patient was 78 years old, had PD, fell and broke his hip. He came out of surgery, developed pneumonia and respiratory failure. They tried to take him off the vent for an hour and he de-sated.

Being a third year medical student, I try to avoid conversations about "end of life care." On this particular situation, the patient's wife asked me "he is going down hill, I don't think he will survive, what should I do." I tried to deflect the conversation asking her to talk to the attending but she just wouldn't let up. Finally I asked her (my mistake), "have you ever talked to him about...end of life care..advanced directives or what he would have wanted if he had been in this situation."

It was like an atomic bomb went off in the room. The daughter screamed at me from across the room ("WE AREN'T READY FOR THAT!) and the wife started crying uncontrollably. I tried to explain to them what "advanced directives were" but it was useless, they were completely ignoring me now. Long story short, the attending came in several hours later, and talked to the family about end of life care without using the words "end of life care." The family was more open to this and agreed on a plan. However, before we were leaving, the daughter, pointing at me, remarked "this guy sucked the hope out of the room by telling us there was no chance left. My father would want EVERYTHING done and he told us to give up."

I am not sure where I told them that but, I am assuming they took "end of life care, advanced directives or what would he want" as meaning, give up hes ****ed. Trust me, you never feel like you ****ed up more than when the patient is pretty much saying you are trying to kill their family member.
 
Eh, I feel I ****ed up when you get told by a patient that you "sucked all the hope out of the room."

I had a patient in the ICU, intubated and sedated. The patient was 78 years old, had PD, fell and broke his hip. He came out of surgery, developed pneumonia and respiratory failure. They tried to take him off the vent for an hour and he de-sated.

Being a third year medical student, I try to avoid conversations about "end of life care." On this particular situation, the patient's wife asked me "he is going down hill, I don't think he will survive, what should I do." I tried to deflect the conversation asking her to talk to the attending but she just wouldn't let up. Finally I asked her (my mistake), "have you ever talked to him about...end of life care..advanced directives or what he would have wanted if he had been in this situation."

It was like an atomic bomb went off in the room. The daughter screamed at me from across the room ("WE AREN'T READY FOR THAT!) and the wife started crying uncontrollably. I tried to explain to them what "advanced directives were" but it was useless, they were completely ignoring me now. Long story short, the attending came in several hours later, and talked to the family about end of life care without using the words "end of life care." The family was more open to this and agreed on a plan. However, before we were leaving, the daughter, pointing at me, remarked "this guy sucked the hope out of the room by telling us there was no chance left. My father would want EVERYTHING done and he told us to give up."

I am not sure where I told them that but, I am assuming they took "end of life care, advanced directives or what would he want" as meaning, give up hes ****ed. Trust me, you never feel like you ****ed up more than when the patient is pretty much saying you are trying to kill their family member.

Ouch! That really sucks. What did the attending say to you about it and was he/she upset?
 
Purely secondhand account of why a fellow student was no longer on rotation...but if it's true it is one major F-up. None of this SQ PPD nonsense.

This 3rd year student was scrubbed into a case and accidentally broke the sterile field. The attending told him he needed to scrub out, but the student insisted he didn't break sterility. The surgeon calmly explained it wasn't a big deal and he can scrub back in after resterilizing. The student was so adamant that he was still sterile he proved it by shoving his hands into the patient's open abdomen. You can imagine what happened next.

Reminds me of a story I heard secondhand. Apparently in the second week of his first rotation in 3rd year, some student paged the nurse manager to complain about one of the nurses. When the nurse manager got there, he started yelling at her.

Think he got pulled from the rotation and has to make it up this year. Assuming the story's true, I'm kind of shocked he's made it through the whole year.
 
Ouch! That really sucks. What did the attending say to you about it and was he/she upset?

The attending is really cool. He actually didn't say anything until I brought it up. He said that the family had grown up in the generation where "end of life care" meant to take everything away. He said that what I said and how I said it would have worked for 95% of people but I had been unlucky enough to catch the 5% who wouldn't get it. He kinda came to my rescue in the room too when the daughter started pointing at me. He reminded her of what "advanced directives and end of life care" was and that she had just set them up for her own father. Afterwords I apologized to the mother and daughter and they to me as well. It was just a miss communication and once they realized it everything was gravy. Safe to say I felt like a complete piece of crap during the finger pointing session though.

These things are bound to happen. If it didn't we wouldn't learn anything.
 
Dropping babies? Messing up procedures? Patients screaming at me that I'm trying to kill their family members? ...I'm officially terrified to start medical school.
 
Dropping babies? Messing up procedures? Patients screaming at me that I'm trying to kill their family members? ...I'm officially terrified to start medical school.

Part of the learning process. these are extreme cases. you will say things you wished you had phrased better to patients. not the baby dropping thats just terrible luck or someone who needed to learn to pay a bit more attention.

Don't be terrified, medical school can be good times.
 
not the baby dropping thats just terrible luck or someone who needed to learn to pay a bit more attention.

And also likely untrue given the source, who has been found to make up an occasional story or 12 to get a response.
 
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And also likely untrue given the source, who has been found to make up an occasional story or 12 to get a response.

I don't know though. I have heard it mentioned on OB/GYN about "such and such student dropped a baby once..." I don't know if it is just a tale told to scare students to pay more attention or not? Rest assured I made hella sure I had good grip on that baby before I handed it off after hearing that story.
 
I don't know though. I have heard it mentioned on OB/GYN about "such and such student dropped a baby once..." I don't know if it is just a tale told to scare students to pay more attention or not? Rest assured I made hella sure I had good grip on that baby before I handed it off after hearing that story.

Yeah it could be true. I've heard the same tale, but don't know anyone it's actually happened to. Those things are freakishly slippery.
 
We had someone here who apparently "almost" dropped a baby. This almost dropping was noticeable enough that the attending and residents commented on it to other students. Did I mention our ob attendings weren't very professional? Anyway, those things are slippery so I can see it happening to someone. Be sure to sit down, and I did like to do deliveries with the midwives because their patients didn't want their bed broken.
 
We had someone here who apparently "almost" dropped a baby. This almost dropping was noticeable enough that the attending and residents commented on it to other students. Did I mention our ob attendings weren't very professional? Anyway, those things are slippery so I can see it happening to someone. Be sure to sit down, and I did like to do deliveries with the midwives because their patients didn't want their bed broken.
Why would someone request a broken bed?? Isnt that against some sort of hospital regulation to have broken equiptment?
 
Why would someone request a broken bed?? Isnt that against some sort of hospital regulation to have broken equiptment?

I can't tell if this is sarcasm or not, so I'll just pretend it's a real question.

The beds on labor and delivery have removable ends with hidden stirrups. When a woman is about to deliver, they "break the bed" meaning removing the end and getting the woman into position. The OB then sits in a stool at the end of the bed, ready to catch.

A non-broken bed generally means a mess for everyone involved, but does reduce the chances of baby-dropping.
 
Purely secondhand account of why a fellow student was no longer on rotation...but if it's true it is one major F-up. None of this SQ PPD nonsense.

This 3rd year student was scrubbed into a case and accidentally broke the sterile field. The attending told him he needed to scrub out, but the student insisted he didn't break sterility. The surgeon calmly explained it wasn't a big deal and he can scrub back in after resterilizing. The student was so adamant that he was still sterile he proved it by shoving his hands into the patient's open abdomen. You can imagine what happened next.

Don't do that guys.
 
Don't do that guys.

There is a story our dean likes to tell of a case of an extensive surgery where they abdomen was apparently open (not sure what the surgery was). Anyways, there was a bunch of people standing around the body (residents, medical students, every one and their neighbor). The dean was giving a talk about the surgery when, to his horror, he noticed an un-gloved hand of a medical student reaching into to the body to "feel the liver." Now when he mentions the story he states that, "that student didn't last much longer here." haha
 
There is a story our dean likes to tell of a case of an extensive surgery where they abdomen was apparently open (not sure what the surgery was). Anyways, there was a bunch of people standing around the body (residents, medical students, every one and their neighbor). The dean was giving a talk about the surgery when, to his horror, he noticed an un-gloved hand of a medical student reaching into to the body to "feel the liver." Now when he mentions the story he states that, "that student didn't last much longer here." haha

I'd love to know how some people think.
 
There is a story our dean likes to tell of a case of an extensive surgery where they abdomen was apparently open (not sure what the surgery was). Anyways, there was a bunch of people standing around the body (residents, medical students, every one and their neighbor). The dean was giving a talk about the surgery when, to his horror, he noticed an un-gloved hand of a medical student reaching into to the body to "feel the liver." Now when he mentions the story he states that, "that student didn't last much longer here." haha

When you're learning sterile technique it's actually not that hard to make little screw ups. I think in the 20 central lines I've done I've probably made a little mistake 2 or 3 times. Usually just to where I had to change my gloves or get a new drape.

But in the OR... Just keep your hands on the field and if someone tells you to go re-scrub go do it.
 
The almost dropping a baby situations is a pretty common one.

Arguing with nurses or with surgeons is just a no-win situation. The OR is probably one of the few places where you must leave your ego at the door, and follow orders precisely.
 
One of my father's classmates at Jefferson, on his cardio-thoracic clerkship dropped his loupes into an open heart case and the attending said "Are you on my side or the disease's side?".
 
When you're learning sterile technique it's actually not that hard to make little screw ups. I think in the 20 central lines I've done I've probably made a little mistake 2 or 3 times. Usually just to where I had to change my gloves or get a new drape.

But in the OR... Just keep your hands on the field and if someone tells you to go re-scrub go do it.

Yeah, sterile technique can be pretty hard when you first start having to use it. I remember feeling like I was always going to do something to break technique when I was on my ob rotation last July. It takes a while for it to click and feel natural. So, MS3s, don't feel bad if you accidentally scrub yourself out. Just don't fight with the surgeon about it. 😱
 
One of my father's classmates at Jefferson, on his cardio-thoracic clerkship dropped his loupes into an open heart case and the attending said "Are you on my side or the disease's side?".

Med students were allowed to wear loupes back then? 😕

Dang. 🙁
 
Med students were allowed to wear loupes back then? 😕

Dang. 🙁

Yes, I'm in a BS/DO, in UG so I don't know if we do it where I go, but yes back in the day they did. FYI my dad was class of '78.
 
Yes, I'm in a BS/DO, in UG so I don't know if we do it where I go, but yes back in the day they did. FYI my dad was class of '78.

I have yet to see a med student wear loupes. Loupes are expensive, and heavy, and there's no real need for med students to wear them. (They're not doing the operation, after all!) I've always wanted to, just so I can see what the attending and resident see, but oh well.
 
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