‘The Patient I Failed — I’ll Never Forget Him’

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“DR CART … ICU. DR CART … ICU,” echoes overhead, alerting all those on call, scattered throughout the hospital, that there is a code or arrest. They are to stop what they are doing to come to assist when that hospital-wide alarm is sent out.

But when they enter the ICU, breathless from their sprint, they do not find a patient without a pulse, but instead, a senior resident who is failing in his responsibility to help his patient. I feel shame. Inadequate. An impostor. Worst of all, I am a danger to my patient.

There is now a larger group of residents, some more senior, others the same level of training as me. I quickly explain the situation. After a few questions, two of them look at each other with recognition of the pattern that has eluded me: acute right heart failure prompted by positive pressure from the ventilator. The right ventricle is struggling to pump blood to the lungs. Usually, our focus is on the left ventricle pumping blood to the body. It’s difficult to treat when recognized, impossible if not appreciated. One resident deftly places a line in his neck. The other goes to work on the ventilator, modifying the settings.

Thirty minutes later, my patient is stable at least for the next few hours, through no help of my own. The three of us debrief a bit and talk about a game plan moving forward, before I call and update the attending at home. They go back to their patients, leaving me alone with my team and my thoughts.

The patients in the ICU make it through the rest of the night unscathed, unlike my psyche. I am humbled by what I need to learn and shaken by how my deficiencies almost led to a death. My patient’s life now on a more stable course, I find my own career path in jeopardy.

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With a bit more time separating me from the event, I start to process the evening. My colleagues who came to my rescue did not judge me. They came to help a co-resident and patient in need. The shame or judgement I felt was my own, and my own to bear. Today, I appreciate even more the culture and learning environment at the University of Chicago, where cooperation trumps ego and pride. In an environment that encourages resident autonomy, asking for help is not a sign of weakness. What could have led to an abandonment of a life goal instead became a building block for future learning.

It has been 17 years since my first night as a senior resident in the ICU. Twelve of those have been as an adult pulmonary and critical care doctor working with a group of physicians that practice with the same philosophy. That recognizing one’s limits is an important part of being a doctor. There is no sin in having deficits.

But there is, in failing to acknowledge and learn from them. I learned more that night than the pattern of acute right heart failure.

I took a big step to being a lifelong learner.

Jeremy Topin, M.D., is a critical care physician in the Chicago area and a father of two who blogs at Balance. This article also appeared at KevinMD.com. [lz_pagination]