Influential case #5

Just after I finished my first year of residency, I started a rotation in the emergency department. It was a high paced month.

On my last call night, a five month-old child with a history of a significant abdominal surgery presented with the chief complaint of “my child just is not acting the same”. I did a complete history and physical exam, and everything seemed fine. I could not identify a sign or symptom of disease.

I told the family that I would like to observe the child for a while. Over the next four hours, I observed a normal infant feeding and sleeping. At 2AM, I discharged him home with a plan for him to follow-up with his primary care doctor at 8AM.

In the morning, I handed over my pager, signed out to the oncoming resident and went home for sleep.

At 9:30AM, I was startled awake by my ringing phone. A surgeon was on the line and screamed, “What did you do to my patient! He is dead and you just saw him a few hours ago!”

It was the worst phone call of my life. I was speechless and entered a stage of uncontrolled stress. For 72 hours, I was completely nonfunctional. I could not eat, speak to my family or even step out of bed.

Over the following week, many pediatricians and surgeons stood by my side and helped me through my most difficult days. Despite a presumptive diagnosis of SIDS (there was no autopsy by family request) and all of the support, I still felt a feeling of tremendous guilt.

Moral of the story: No matter how hard I try, I am going to make mistakes. Despite knowing that mistakes are inevitable, they are never going to be easy to handle.


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