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Low Risk Doesn't Mean No Risk

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Low Risk Doesn't Mean No Risk

"This one took me years to get over. When I was a medical student on my surgery rotation, I was in the OR with only the attending surgeon. The residents on service were otherwise busy, so the attending (somewhat impatiently) decides, 'Fine, I'll do it with just the med student.' It's a relatively straightforward case, placing a gastric tube for a patient who couldn't eat. The institution I now work at frequently does these under laparoscopic visualization, which is seen as overly cautious by some. Not me. The attending puts a scope down the patient's esophagus and I have a big needle to push toward the scope. He shines a light towards the skin when he's entered the stomach and I press on the skin and see it dent in on the screen, showing we're in the right place. I thought I took that exact same position and angle, and introduced the needle. Except it didn't show up on screen. So I pulled back. Pressed again and tried again and didn't see it. The attending grows frustrated and tells me to push the needle in deeper then. I had a twinge of concern, but eventually hubbed the needle, which was several inches long. Eventually, the resident shows up and tries as well, and tries introducing the needle but never can visualize it. Eventually, he switched places with the attending, and after another try, got the needle into the stomach and we finished placing the tube. I come back after my day off to find out that that patient died from internal bleeding. One of the multiple needle pokes - or possibly a cumulative effect - had injured arteries in the abdomen. Now, I know not to ignore that twinge, and I know that even 'low-risk' procedures have a risk of catastrophe and always take care to mention that when consenting patients for surgery. 'Low-risk' not 'no risk.' I harbored guilt over it throughout medical school and still had hesitation the first time I did that procedure as a resident" (Source)

The Worst False Alarm

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The Worst False Alarm

"I do HIV testing and once I showed up to work super tired because I couldn't sleep the night before. This guy comes in for a test, we go through the pre-counseling and then I tell him to step out for a few minutes while the results come up. Once he comes back to get his results, I tell him to take a sit and the first thing that came out of my mouth was 'Your results are positive' and then I saw the look on his face and that's when I realized I messed up. I then said 'Oh no no no, I meant to say negative.' I almost gave the guy a heart attack" (Source).

A Scary Realization

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A Scary Realization

"Not a medical professional but a patient who was almost victim to a simple, yet potentially fatal mistake. I have cardiac catheterizations and biopsies every year (transplant recipient) and up until a year or two ago was hospitalized the night before the procedure to receive IV fluids. During a catheterization they insert a catheter into my femoral artery and inject dye to look at my coronary arteries and biopsy a small piece of my heart. SO the night before my cath a few years back, my nurse came in and started hanging up a bag of what I figured was basic fluids but upon closer look was heparin, a blood thinner. The day before I was going to have my artery opened. I could have bled out. Luckily, my mom noticed, questioned the nurse who then talked to the physician. The physician ran in apologizing profusely and said she had been up for more than 24 hours and wrote herself up for the error. Crazy to think about how easy it is to make such a big mistake and how overworked physicians are" (Source).

Having An Uncomfortable Talk

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Having An Uncomfortable Talk

"I'm a Hospitalist - an internal medicine doctor that specializes in Hospital (inpatient) medicine. I had a lovely but truly unfortunate lady. She was in her late 40's and had metastatic breast cancer. It had spread to her brain and actually to her intestine causing persistent bleeding. She was in and out of the hospital for about 2 months. I knew she was dying. Her oncologist knew. I began talks about what to do if she got sicker and was nearing death. She wanted 'everything.' I was off and my partner took over. She eventually got sicker (which I 100% expected), was bleeding again from her tumor, essentially coded, was placed on a ventilator and sent to ICU. It should never have gone that far. I should have made her sign a DNR. She had no hope of survival. She should have had a peaceful death. Instead she was intubated and died in the ICU. Families and patients get mad at me when I try and discuss 'end of life goals' but this is the reason I do it. Despite patients getting ridiculously pissed at me for trying to address this important issue" (Source).

The Smallest Mistake Can Have Big Consequences

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The Smallest Mistake Can Have Big Consequences

"I'm a lab tech and used to work in Histology when I was new. I got a skin biopsy specimen and that day I was embedding, basically putting the fixed tissue into wax so it could be mounted on a cutting block to slice 3 micrometer sections for staining. It's very important what side you place 'down' based on how it was cut out of the body. Well I messed up and placed it sideways instead of down. The person cutting the tissue couldn't tell and ended up cutting through the tissue. This was a problem because the patient had skin cancer and they were looking at how far it had spread. Since it was cut too deep they couldn't see the edges anymore. This means the doctor had to cut a bigger piece of skin off to be sure they got it all. That's when I found out it was a skin biopsy from the patient's nose. This patient had to have a bigger, potentially unnecessary, piece of skin from his face cut off because of me. I was horrified and learned my lesson that day on how important it is to be certain of embedding technique" (Source).

You Have To Think Ahead

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You Have To Think Ahead

"I had a patient years ago for induction of labor. I knew her IV was good cause I'd put it in myself and it hadn't blown. I kept turning up the medicine per protocol but no contractions. Later that afternoon I moved the bed and discovered the IV had come apart and I had been giving the floor oxytocin for hours. I replaced the contaminated IV parts and plugged it back in, not thinking far enough ahead to realize I was essentially starting her meds at 10 times the starting dose. She immediately started having contractions, closer and closer together until it was one big tetanic constant contraction and we couldn't stop it. She was rushed to the OR and had an emergency C section under general anesthesia. This is completely what you don't want in a birth experience, which in addition it carries great risk of complications and/or death. I felt absolutely terrible and they wouldn't let me tell her and apologize. The family never knew what happened or whose fault it was. Fortunately there were no adverse incidents (besides a huge scar and having the shit scared out of you) and mother and baby were safe. The other thing I learned from this was how to criticize someone. The head doc took me out in the hall and quietly asked 'Do you understand what you did?' & 'You get how that happened, right?' and that was the end of it. I have used that technique with students' big mistakes and been successful. Students listen and don't get defensive or angry. They learn from it and never repeat it" (Source).

Not Focusing On The Task At Hand

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Not Focusing On The Task At Hand

"Pharmacy technician here. I once was much too stressed and I was rushing. Instead of Prednisone 5mg (a type of steroid), I used prednisone 50mg. The pharmacist checked it and didn't catch it, but I realized when I was putting my stock bottles away. Luckily it hadn't gone out yet so I fixed the mistake and vowed to be 100% dedicated to one task at a time. A few months later somebody made the exact same mistake but did not catch it, and the patient ended up in the hospital for a few months" (Source).

Even Doctors Have Plenty To Learn

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Even Doctors Have Plenty To Learn

"Once as a tired medical resident I was called to the ER to admit someone at like 3am. This bonehead had gall bladder removal a week ago and now had a surgical-site wound infection. I asked if they'd taken their post-op antibiotics they were prescribed, and they weren't sure. I was getting more and more frustrated with this dumb person preventing my sleep when I decided to use a 'pregnant pause' interview technique, and just shut up. This usually results in either awkward silence and the patient saying 'uhh WTF doc' or awkward silence followed by some useful deep revelation. In this case the guy hung his head low, looked at his feet through unfocused eyes, started to sniffle while his halting voice cracked 'I can't read. Never could. Didn't know the instructions they wrote down for me and didn't know I had medicine to buy. I didn't ask them because I was embarrassed.' Illiteracy haunts rural and urban places in most countries. Those folks aren't reading this, and they depend on our patience and understanding, and acceptance, to detect and bridge that vast communication gap. That's what stuck with me" (Source).

Doctor's Are Not Infallible

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Doctor's Are Not Infallible

"I'm an RN. Throughout school they drilled into us the importance of quality nursing 'you are the last line of defense to catch an error,' 'You, not the doctor, are the primary coordinator of patient care,' etc. But still, in my first months of work, I downplayed my role and maybe expected that the MD would always know what he was doing. What I learned later is that every day I have 4-5 patients to be concerned with, while my Doctors have many many times more than that. Where I work, in a small critical access hospital, the doctors have those they admitted to inpatient, while simultaneously managing their clinic patients, primary patients, OB patients, and some do 48 hour ER shifts as well. They simply can't be attentive to everything. We had one patient who stayed with us for weeks. Initially admitted for lower extremity pain and weakness, he had undergone physical therapy, been worked up for fibromyalgia, had be aggressively treated with painkillers and only seemed to be getting worse. I was concerned that he was beginning to show signs of delirium related to the medicine he was taking and I relayed that to his 'Doctor at the time being.' Doctor ordered around the clock ibuprofen to supplement his analgesics and increased the duration between his medicine doses. Later he was switched to a different medicine (longer acting NSAID that requires less frequent dosing). What the doctor never ordered was a GI prophylaxis. He was receiving daily doses of strong medicine that can cause GI bleeds and there are no medicines out there to counter that effect. Well then the patient changed hands to another doctor. The doctor did a thorough workup and finally found what may have been the most likely cause of his symptoms. The patient was experiencing spinal stenosis enough to pinch his lower spinal nerves. Doc #2 immediately ordered solu-medrol (very powerful IV steroid) twice a day for 5 days. Unfortunately he did not perform a thorough medication review. He did not realize 1. how long he had been on his original medication. 2. how frequently he had been taking Ibuprofen and for how low. 3. that his GI system was not protected with prilosec. Of course he didn't know all these details because (as I know now) it was the nurse's job to snoop out these problems and present them to him before harm could be done. The rest of the story is gritty detail and I am a bit tired so I'll just summarize. After a few days on another medicine, my patient developed a sever GI bleed. He was found ghost white and covered in sweat with a BP so low it was unreadable. We dumped him with fluids and shipped him out to a regional medical center but unfortunately he didn't make it" (Source).

Don't Be Afraid To Speak Up

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Don't Be Afraid To Speak Up

"Med student here. A few years ago, when I was working as a medical assistant in an interventional pain management clinic, I was asked by the doctor to place a grounding pad (a sticky pad like they use for EKGs) on the patient's leg during a radiofrequency (RF) nerve ablation procedure. The patient had some lotion or something on her leg that was keeping the pad from sticking properly, but it seemed to be mostly well attached and I didn't want to hold up the procedure to get another pad or clean off the patient's leg. The pad ended up partially coming off right as the high-voltage RF was being applied, causing a small burn on her leg. There was no lasting damage done and the patient was very understanding, but I still felt horrible. It was the first time I had caused harm to a patient, and it could easily have been avoided had I just spoken up. Now I never hesitate to say something if I have even a slight feeling that something is off. Nothing is more important than a patient's well-being" (Source).

A Mistake That Worked Out For The Best

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A Mistake That Worked Out For The Best

"I was a third year medical student on my surgery rotation at Cook County Hospital back in the mid-1990s. It was a chaotic mess. I was post-call and in clinic and saw a patient who had some type of intra-abdominal procedure and was in for follow-up. He lived in a trailer park on the far south side of the city, was poor as dirt, and clearly wasn't thriving post-op. He was dehydrated and we were concerned that he had a ileus (bowels weren't moving). I was told to admit him. I told the transporter to take him over to the surgical ward, but somehow forgot to write admission orders, so he went over with no paperwork. He ended up getting put in a bed, and stayed there. For 3 days. With no paperwork. He got IV fluids and bed rest for 3 days, but because no admission orders went over, he never got entered into the computer system. He never showed up on our list of patients. The nurses just kept changing his IV fluids. He had no vitals, no nothing. Well, 3 days later we were on rounds, and walked past his cube (it was an open wall with cubicles at the time) and my senior resident stopped and said, 'Who the hell is this guy?' The patient poked his head out, pointed at me and said, 'Hi Doc! When can I go home. I feel great.' He was completely better (probably because we did nothing to him). My junior resident whispered to me that I should just quickly (and quietly) write up admitting orders and discharge orders. Two lessons: 1.) always do your paperwork/orders right away; 2.) sometimes the less we do to/for patients the better" (Source).

Fifty Shades of Blush

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Fifty Shades of Blush

"Kind of humorous: I'm a nurse assistant (formerly worked in hospital with chemo patients). One day I was in with a client/patient getting the room back in order after his morning bed bath. I had already put all my supplies away and had an armload of soiled linen about to leave the room when I asked if he needed anything else. He said no, he was fine. Well, not skipping a beat, I say 'I'll just get out of your hair then.' FIFTY SHADES OF BLUSH. Let's just say, we were both shocked at what I had said, but he made a joke of it along the lines of 'I don't have any to hold you back' and I made sure I caught myself before it happened again" (Source).

Put Your Pride To The Side

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Put Your Pride To The Side

"I was removing sutures on this patient. Which I literally did every 30 minutes for years. Anyways I had distinct difficulty removing them which struck me as odd. The surgeon used a stitch I had never seen before. So I got them all out but I had a sneaking suspicion there was some left. However since I couldn't see anything and figured I'd waste the surgeon's time if I bothered them, I patched him up and sent him home. Usually, left over suture gets pushed out of a healing wound. 2 weeks later, guy comes back the incision site is healed up but it looks swollen as hell and the skin looked like it was breaking down. It was all textbook infection. Poor guy had to undergo an Incision and Drainage to clear out the infection and months of antibiotics. I told the doctor what happened and she said it happens like 1 in 100. That she also tried something different that surgery and that might be it as well. This was like 8 years ago. I check beyond thoroughly now and when in doubt get a second set of eyes. It's not worth putting someone through pain or discomfort because of your pride" (Source).

Bad Blood

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Bad Blood

"Before medical school I was working as a phlebotomist during undergrad to gain exposure to hospital. When I worked night shift, our daily list of blood draws would print off around 1 am and I would start getting blood on the floor around 4am. I got really good and i could sneak in, lights off, tell the patient what I was doing, quickly draw blood, and get out and they would barely wake up for it. Well one morning I went into a room, the patient had had a wash cloth over his eyes, and I told him who I was and what I was doing before tying the tourniquet around his arm and palpating a vein. About that time, his wife walked in and said 'WHAT ARE YOU DOING!' I said 'I'm so and so and here to draw his blood.' She said 'HE DIED OVER AN HOUR AGO!!!' Could you imagine the look on my face as I rip the tourniquet off and apologize I was running out of the room. Even after med school and residency, this is still my most embarrassing moment in healthcare" (Source).

Even When It's Not Your Fault, You Can Still Learn From It

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Even When It's Not Your Fault, You Can Still Learn From It

"I'm a Cardiac Cath Lab Tech at another hospital, I've been in the medical field for almost 6 years. I was being cross trained into Computed Tomography recently and was thrown into my first night shift by myself after a quick month of training. I had a script I spoke every time I would hook someone up to our power injector for a contrast study (the weird stuff that makes you feel like you pee all over yourself). The injector I used in Cath lab is a LOT bigger and scarier than this little thing, but they are still dangerous. I also don't worry about blowing IVs in Cath lab since we normally go through a much tougher femoral or radial artery. So we do two test injections of saline, one by hand and one my the injector to make sure the IV is patent and will tolerate the injection. 99% of the time this works and everyone is hunky dory; if it blows now the body will simply absorb the saline and you might get a bruise so no big deal. This time however the IV blew RIGHT at the beginning of the Contrast injection (Your body CAN'T absorb contrast in this fashion) and the little pressure waveform on the injector remained 'normal' looking. She didn't once cry out or scream as I injected 100cc of Iodinated contrast agent into her forearm and I only noticed something was off when I started my scan and saw ZERO contrast in her torso. I aborted the scan thinking the IV blew outside of the patient, walked into her quietly sobbing inside of the machine with an angry swollen arm about the diameter of a grapefruit. I pulled her out, wrapped a hot water soaked compress around her arm, held it over her head and rushed her back to the ER. I found out later she had to go to surgery for it and has long term nerve damage from the compartment syndrome she suffered. I've had people die on my table, I've been on a code team for my entire term in Cath Lab (I respond to Code Blue/ Cardiac Arrests) and see death and mutilation every day at my Level 1 Trauma hospital as the night tech. This one stuck with me since I felt I was directly responsible for it despite being cleared. It caused me to change my WHOLE approach when doing my contrast studies. I tell people to SCREAM bloody murder if their arm does more than burn now when I inject. Insult me, throw a shoe at my window, hit the big red EMERG button on the wall, anything so I don't disfigure someone again when my safeties fail and my machine lies to me" (Source).

Don't Lie

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Don't Lie

"True but not too serious. I was a medical student looking after a boy of about 8 years who had broken his arm. He needed an IV but was terrified of needles. I was trying to calm him when he asked 'Will it be like what they did in the movie Elf?' I had not seen Elf and I figured it must have been a pretty benign scene with that title. I said 'Yes' and the kid went into hysterics. I saw the movie later and understood why the poor kid got so upset. I became an expert in Barney, Dora, Bob and Blue to try and prevent future misunderstandings. I watched some Teletubbies too, but it kind of freaked me out" (Source).

Not Prepared For The Real Issue

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Not Prepared For The Real Issue

"I'm an EMT ending my first year working at a collegiate EMS squad in New Hampshire. Our dear college is known for drinking and going a little too hard in the party department (although we're smart cookies too I swear), so although we get a good amount of trauma/other medical from sports events and other stuff just responding to the town the college is in, we get a wholeeeeeeeee lotta intoxication calls. Once I got a call that seemed like a standard intox--our female patient was really embarrassed we had been called, as remorseful wasted people often are, and was really distraught and crying. She refused to talk to me or my two crew partners. We at least got a full suite of vitals that were all normal. I went to put her shoes on to get her ready for transport to sleep it off at the college's inpatient department and she refused to let me touch her, picked out the only female EMT and said she only wanted her to help her. So the males in the room stepped outside for a second because at that point we were a little suspicious. This girl was leaning against her own bed and didn't know where she was, how she got there or what time it was. She at least knew her name, but CAOx1 Is pretty low for intox with the severity she was presenting physically and physiologically. But when we had a straight line she walked it almost perfectly. Also strange. Then she told the female EMT she felt unsafe and didn't trust us, which we of course heard in the hall through the open door (thank god wasted people aren't good at whispering, it'd make my job a lot harder). Once we transferred care the only follow up we got on her was that it was a probable physical assault, which was on my mind after the call ran its course but didn't occur to me immediately. It was the first possible assault I'd been called to and it kind of disturbed me seeing this girl just messed up out of her mind, crying hysterically and saying she felt bad we were called, and then not trusting the people who were there to help. Assault can really destroy people's trust and make them anxious beyond rationality. After that call I go into every scene looking for signs of assault or abuse. Honestly, most college campuses have a problem with it and it's so often related to drinking. I should've probably been more prepared to deal with it, but I'm glad that call kinda woke me up so to speak. You never know what might've happened to your patient that they don't want to tell you, and that's a lesson that's generalizable to calls beyond college and partying" (Source).

Oops

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Oops

"When I was a new paramedic, we were called to a house for an unknown problem. We arrived and found our patient unresponsive but breathing on a bed. A friend of his found him after he hadn't returned his phone calls- they were going out to do something that day, and he found it weird that the guy hadn't called him yet, so he had gone to his house to investigate. The patient didn't have any medicine bottles laying around, and his friend didn't know anything about the patient's medical history. So, I loaded him up into the ambulance and started transporting to the hospital. Started an IV, did an ECG, drew blood work, the whole work up. Get him to the hospital, and the first thing the nurse asked was 'what was his blood sugar level?' Oops. Forgot to check it. Turns out, it was incredibly low- which is completely treatable, and probably wouldn't have required transporting him to the hospital if corrected on scene. Every patient gets a blood sugar check now" (Source).

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