I finally have had the most feared of all resident on-call experiences: an unexpected, life-threatening event happened to one of the patients I had been taking care of overnight. I had always joked—perhaps too glibly—that my only real goal on call nights was “not to dust off the code cart.” I had never really expected to need it. After all, I had faith in our excellent nursing staff, who would call me for any small irregularity or issue regarding their patients. And I was very careful on call, walk-rounding on patients at least once a night and always responding to any parent or nurse concerns promptly.
I trusted my nurse and other health professional colleagues, certainly, and I trusted myself, more or less, to know when I was in over my head and when to get someone more senior to come assess the patient.
This night, though, I watched in shock as the event unfolded, a flurry of my colleagues reacting to it and taking the necessary steps. There had been little or no warning before; he had been admitted for the mildest of illnesses, requiring minimal care during most of his first one to two days and was quite well mere hours before. Now I was watching him receive the best, most intensive care available, and my sleep-deprived brain kept repeating an old adage I had heard during my third-year surgery rotation: a code is your mistake announced overhead.
I couldn’t even begin, at that moment, to think about what my mistake might have been. I just watched helplessly as my more-expert colleagues took over.
Thankfully, the patient recovered well, without significant sequelae. After extensive discussion and review of patient results, it seems that he had had a rapidly progressing condition somewhat masked by his initial mild illness. The disorder is known to present in extremis since there are often few early warning signs. Because of this, I’ve been told, multiple times, to take off my hairshirt and to move on, not to blame myself, but instead to make sure that this was a “learning experience.”
What I have discovered, though, is that I don’t think I’ll ever get over it. Every day I feel the shock and horror I felt that night, that sense of utter impotence and loss of control. Although every day the feeling is not quite as strong as it was before, it is always there.
Since the event, I’ve been inundated with stories from colleagues—attendings, fellow housestaff, faculty—about the acute, life-threatening events that have happened to their patients. They tell me how they coped and what they learned, trying, I guess, to make me see that this happens to almost every physician.
Yet with each story I am told, I look past the words to what my colleagues are not saying, and I can see in their faces the same shock and insecurity I feel every day. Despite what they’ve learned from their experiences, the sense of distress and loss is still there, and I realize that they haven’t really moved on, either. Maybe it’s a blessing to be able to keep that feeling alive; maybe it keeps our patients safer, makes us better doctors, makes us as a profession stronger when we keep past complications actively in mind. Lying awake at night in my call room, again unable to sleep, I can only hope that this is true.
Tarayn Fairlie, HMS ’06, is an intern in pediatrics at Baystate Medical Center in Springfield, Mass.
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.
