Wednesday, March 27, 2013

My overconfidence got busted ! - Doc confesses - 2

Not even 2 weeks into my internship, I was bubbling with confidence.
Overconfidence, actually.
I was posted in the dept. of Medicine and the residents were cool and they let me do many procedures. And I did them quite well for a first timer. I was already so much interested in medicine since my pre-final year and my confidence levels were sky-rocketing ! To help it all, I was free from migraine attacks.

I felt that Internal Medicine would be the area of my specialization. I actively involved myself in patient care. I tried to do more that what was required of me.

Now there was a 55 year old guy who had a 1.5 x 2 cm liver abscess. A diagnostic tap was required.
"I will get this one done", I declared. 
"This is not the first time I am doing one"

I took the patient to the procedure room and bored into his liver. I did everything correct. You can believe my word. I did do everything perfectly fine. Except for one little thing! The radiologist had surface-marked the abscess with the patient in the sitting position while I did the procedure in the lying position. I did read the radiologist's report but didn't notice this line ! And we know the liver moves significantly between the two positions and the abscess was small. My bad luck, I got 2 drops of thick pus in the aspirate and after that whatever came was dark red stuff.

Believe me, at the sight of blood, I was about to faint. My heart almost broke my rib cage. My useless double agent brain was frightening me more. "You've given your patient a hemoperitoneum, well done doc!", "I think you tore the IVC, your patient will be dead in minutes". Such thoughts came like a tornedo from nowhere and tossed my mind. 

Strangely, on the outside, I was calm. I abandoned the procedure and let the patient lie down. I kept checking his vitals every 5 minutes. The IV access was ready and fluids were all kept ready. I informed the residents.

Fortunately nothing happened to the patient. He was stable and fine. 
But me! I went through all the stages of shock and survived!

In a way, I was happy that this incident took place very early in my internship. My overconfidence got busted earlier and I maintained sanity.

The patient knew I had made a mistake. Being a terminally ill patient, he was already depressed and he didn't bother to make a big fuss out of this. Everyday I spent some time talking to him. We became friends. I came to know that he wasn't really afraid of dying. He and his wife lived alone after their children had left them long ago. His grief was in leaving his wife alone.