When you graduate medical school and you’re fresh faced, new, and excited. But in the back of your mind you know that one day, not too far in the future, you’ll make a mistake and it will hurt someone. Every order you enter, every parameter you set is a way that someone can get hurt. You’re careful, but you will make a mistake.
I’ve made plenty of mistakes this year, but nothing that hurt anyone until last week. It was simple, I just changed an order. I changed an antibiotic in a patient that was growing bacteria in their blood. In my mind I was changing the end date of that antibiotic, “coursing it out” to the full course I knew this patient needed. Instead, I changed the start date.
For a day and a half, no one caught my mistake, not the nurse, not the pharmacist, and not the patient. Then he spiked a fever. In the hospital, and especially in a patient I already knew was growing bacteria in their blood, a fever is not just a fever. It’s blood cultures, urine cultures, and x-rays. It’s “where is it coming from?” and “what bacteria have we missed?” It’s “let’s review their medications,” and in the case it’s “oh my…this patient hasn’t been getting antibiotics for a day and a half.”
It’s small, but it had a rippling effect in this case. Have a fever? Draw blood cultures. Do we need to pull out their central catheter? Well, now they can’t start chemotherapy.
We started antibiotics right away. I went in and told the patient and their family. I apologized. I explained the rippling effects. And they did not forgive me. After that day, they did not even like me. I don’t blame them. It’s a mistake anyone could make, but I made it and it affected them. My momentary lapse in attention affected them. I’m sorry means something, but it doesn’t make the extra days without chemotherapy come back.
I ran home from work last week and this was on my mind. Mistakes happen, they’ve happened over my entire year, but this felt…more somehow. It’s a mistake anyone could have made, and I learned from it, but it felt terrible.
It’s an interesting feeling being a doctor. You will do wonderful things, you will make bonds and relationships with people, but you will also make mistakes that have lasting impacts. Mistakes that will hurt people. This, on the grand scale of things, was small, but it caused me to take pause. I am happy I learned from it, but the intangible sensation of “you will hurt someone one day by accident or mistake,” became more real last week, and with it, near the end of my internship year, I felt the deep and profound weight of being a doctor.