From Jan 2007
There is something that has been preying on my mind for going on thirteen years now, and I'd like to talk about it publicly and let it rest.
Back when I was in medical college (in picture), as a raw intern, I had to do a stint in the emergency department. One day in spring (and Lucknow in spring gets pretty hot) when the temperature was already touching 40 degrees, we had this young man come in with severe pain in his leg. he was a migrant worker and unaccompanied. Remember I was a raw intern, totally inexperienced. I had a kind of suspicion that he just might be suffering from deep vein thrombosis of the leg, which is a potentially fatal condition. I was also alone. There was supposed to be a medical officer supervisor (it was against regulations to leave all admissions in the hands of a solitary intern) but he had failed to show up. So it was my call. Now deep vein thrombosis is somewhat in the nature of a rara avis and I did not, obviously, want to make a fool of myself. So, I played safe and referred him to the Medicine department. There was supposed to be a wheelchair available to take him there but as usual under the administration we had in the college at the time (so incompetent it might've given Bush a lesson in incompetence) the wheelchair was inoperative and there was no one to bear a stretcher. Ultimately the guy walked off by himself to the Medicine department (1.5km in 40 degrees), reached there, collapsed (it was deep vein thrombosis) and died soon after. I've tried telling myself it was not fair to expect a junior intern to be able to handle this sort of thing unsupervised and alone, but still I remain morally convinced that I killed the man.
And that is not the worst of it, oh no.
You see, when the medical officer in the Medicine department came to ask just who had sent the man to walk all the way there and die on arrival, I kept my mouth shut. There was no signature on the referral form (it was the emergency medical officer's job), so "nobody" was to blame. Case closeed.
I am not just a killler. I am a coward as well.
Responses:
There is something that has been preying on my mind for going on thirteen years now, and I'd like to talk about it publicly and let it rest.Back when I was in medical college (in picture), as a raw intern, I had to do a stint in the emergency department. One day in spring (and Lucknow in spring gets pretty hot) when the temperature was already touching 40 degrees, we had this young man come in with severe pain in his leg. he was a migrant worker and unaccompanied. Remember I was a raw intern, totally inexperienced. I had a kind of suspicion that he just might be suffering from deep vein thrombosis of the leg, which is a potentially fatal condition. I was also alone. There was supposed to be a medical officer supervisor (it was against regulations to leave all admissions in the hands of a solitary intern) but he had failed to show up. So it was my call. Now deep vein thrombosis is somewhat in the nature of a rara avis and I did not, obviously, want to make a fool of myself. So, I played safe and referred him to the Medicine department. There was supposed to be a wheelchair available to take him there but as usual under the administration we had in the college at the time (so incompetent it might've given Bush a lesson in incompetence) the wheelchair was inoperative and there was no one to bear a stretcher. Ultimately the guy walked off by himself to the Medicine department (1.5km in 40 degrees), reached there, collapsed (it was deep vein thrombosis) and died soon after. I've tried telling myself it was not fair to expect a junior intern to be able to handle this sort of thing unsupervised and alone, but still I remain morally convinced that I killed the man.
And that is not the worst of it, oh no.
You see, when the medical officer in the Medicine department came to ask just who had sent the man to walk all the way there and die on arrival, I kept my mouth shut. There was no signature on the referral form (it was the emergency medical officer's job), so "nobody" was to blame. Case closeed.
I am not just a killler. I am a coward as well.
Responses:
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extrascentsory wrote on Jan 13, '07
Killer? Or victim of circumstance. It was the system that killed the man, not you.
People die needlessly in fancily equipped U.S. hospitals all the time and not a day goes by, it seems, without a story about pharmaceutical side effects killing people. That's why I gave up on allopathic medicine a long time ago and rely on alternative therapies. So don't be so hard on yourself, Bill. The fact that you have a conscience is your salvation. |
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You should read "The House of God," if you haven't already. One of the things that people don't understand is that doctors become the amazing godlike creatures we expect them to be by learning AFTER they leave medical school, when they're in internship and residency, and yes, they make mistakes, and yes, they kill people. Not deliberately, of course. And yes, a supervisor is supposed to try to make sure their bad judgment calls don't become fatal mistakes, but as you saw, that requires a level of competence that even the supervisors aren't held to.
The thing is, they redeem themselves later with the lives they save by using the knowledge gained. It doesn't bring back the dead, I grant you. But still it matters. If you had it to do differently what would you change? The wheelchair didn't work. You didn't have the ability or knowledge to treat him where you were, given that deep vein thrombosis isn't a common diagnosis in a strong young man and you would have been hung out to dry if you'd treated him for that and it turned out to be a muscle strain. You learned from it. You will never make that mistake again. And that's all you can do. |
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there is a somewhat relevant article in the decmber issue of national geographic regarding medical interns in iraq called 'iraq war medicine' (http://www7.nationalgeographic.com/ngm/0612/index.html) that might be of interest to you...
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dockbillin wrote on Jan 13, '07, edited on Jan 13, '07
Yes, the fact is that I was afraid I'd send him in for deep vein thrombosis and it would turn out to be cramps brought on by dehydration, which is what we'd expect in a navvy working in hot weather. I had no desire to hear jeers about young medical graduates who thought they knew everything.
Thanks, everyone, anyway. At least, yes, I will not make that mistake again. |
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wizengeeky wrote on Jan 13, '07
i agree with extrascentsory.... its the system that killed the man. and your blaming yourself even after all this years, is bit too harsh. i know conscience weighs heavily on anybody, and doctors usually see more cases of this than i suspect say engineers... and besides, it was a case that "could" have been prevented.
some things although not easy to let go, serve no purpose staying on as residue. perhaps its time to move on... because you have admitted something that means a lot to you, even though it doesn't seem like a very heroic thing in your eyes. it takes courage to admit to cowardice (i still think admitting itself is brave). i hope that now, you will leave this past behind and move on. |
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