Even as a med student though, you end up having serious responsibilities sprinkled through rotations. You just show up one day and are asked to do an LP, intubate, draw up deadly medications, retract/cut important structures, take a history on a critical patient, baby sit an unstable arrhythmic patient’s monitor. Even the simplest tasks can be deadly if you’re not aware of risks
I have one classmate whose first intubation led to a scary can’t intubate/can’t ventilate leading to a surgical airway during their first day on anesthesia a month into m3.
it’s pretty surreal and made me realize that depending on the field, eventually you will make a mistake/decision that contributes to someone dying. Whether it’s the decision to go to the OR, change a medication, risk of a procedure, failure to recognize a condition etc.
We all practice with our attendings licenses, until you’re not. That’s why training is so long, because it takes a long while until you understand you are ULTIMATELY responsible for a patients life.
When you’re a student, it’s the intern who forgets to tell you something. When you’re an intern, it’s the senior resident who fails to check the critical lab in the morning. The senior resident says the attending didn’t want the renal consult, now that the kidneys are shut.
When you’re the attending and the buck stops with you. You have no one to blame.... it’s your decision and yours alone. It’s a lonely place sometimes. That’s why learn as much and do as much when you’re a resident.
My first dead patient was during my intern year. Patient could not stay still, ED wanted to clean out ED. Patient came upstairs with some provisional orders, no proper exam, nor history. She cannot provide any history and there was some questionable psych history. My senior wanted a ct of her head. For days I could not convince her. For days, no family came to visit, couldn’t get any collateral information.
Tried multiple times to send her for the scan, was sent back multiple times without getting it done. One day I even stay after hour, and went downstairs with my senior resident to give some sedation in hope that she would get knocked out enough for the scan. She didn’t. We finally decided it just cannot get done and said forget it.
One morning, I didn’t see her on my census during the morning sign out. Night team transferred her to ICU for acute deterioration of her mental status. A day or two later she was pronounced for intracranial bleed.
For years, I tell myself, it’s the family’s problem, they didn’t come see her. It’s my attendings problem, she didn’t think it was important enough to get the scan. I told my senior resident what a challenging case she was, and he couldn’t provide enough medications for her.....
I am telling you a super long winded story to also demonstrate that when something goes wrong, that can be a systemic problem and/or no ones fault. **** sometime happens, I believe I did the best that I could. I think we all did, but still not a desirable outcome.
I will always remember her. And hope I will do better for my next patient.
