Archive for January 1st, 2009

I let you down

I’m one of the slightly grumpy bitter ones who never enjoys new year – perhaps because I tend to have a difficult time actually enjoying myself at the inevitable social occasions that go with it, or maybe it’s the compulsive happiness that i object to. Or the reinforcement of the social ideal that is implied – get trolleyed and pull a random bird to go home with – do anything but don’t be alone…


Since starting work I’ve now got a wonderful excuse to avoid such revelry. I’ve managed to work 3 out of the past 4.

3 years ago – with dying nursing home patient in resus in A&E in craigavon, wondering where all the nurses had buggered off to and not looking at my watch

2 years ago – sticking tubes and lines in the lady in NZ who was too pissed to walk home and drove – into a tree

1 year ago – outside a cottage in Donegal with cigars and Bushmills, trying our best to ignore countdowns and the fact that the rest of the guys in the cottage had locked us out…

Last night – examining some woman’s manky infected toe. Poor dear.

I was not looking forward to last night’s shift – these days I’ve progressed to on-call from home overnight instead of being in on shifts but New Years Eve is normally chaos so we put extra staff on on purpose. Though i the end it was lovely and we were twiddling out thumbs at 3am wondering if maybe the credit crunch meant that people couldn’t afford to go out, get hammered and punch a window through.

I spent most of the night thinking through my latest medical mistake.

We all make mistakes, most of you reading this will know this. And mostly that’s not killing people, it’s more missing things that you could treat, and usually only missing them for a few hours till someone else notices them.

Medicine is not exactly an exact science and the luxury of time and observation usually gives you the diagnosis. unfortunately thanks to the wisdom of our government we don’t always have that in the emergency department.

None of this is excuse, none of this gets me off the fact that I missed something, but all of it put together makes all of us medics go “yeah, I’ve done that, I feel your pain…”

Yes it was busy, yes I looked at the x-rays for where i presumed the pathology would be and not looking at it as if it was a fresh slate – one of those situations where seeing the x-rays only and not the patient is actually a benefit cause it forces you to be thorough and not just look at the part of the x-ray where the swelling and bruising is… And yes it was a difficult patient who had absolutely no regard or responsibility for his own health. Yes he was hammered and that always makes everything more difficult. And yes alarm bells in my own head did go – that cautionary panic in your gut about a patient (which I have found bizarrely to be almost never wrong – i wonder how we could evidence base and audit that one…) – but still I did not listen. Still I got it wrong.

I’ll not mention what I got wrong -if you’re keen to know I can send you some interesting scans that even the non-medics could spot from across the room. The problem is not the scans, the problem was the decision to order them.

Now let it be clear that it made absolutely no difference to the patient. My gaff was picked up on the x-ray review within 2 hours of him leaving the department. We brought him back the next day and got him sorted having come to no harm whatsoever.

But still. You can’t help but take a little bit of a look at yourself. You can’t help but beat yourself up about it.

Mistakes are an inevitability of the job – this is probably my biggest in 5 years –  thankfully of no consequence, though that’s hardly the point. The point is that it happened, and it happened due to a mixture of busyness, pressure, timing, a difficult patient and most of all breaking almost all of my own rules.

Lesson learned? I hope so. Though I got away with it – and maybe one day I won’t and some poor patient will face the consequences.  Anyone have a better idea of how we do all this?



January 2009
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