* * Anonymous Doc

Sunday, April 18, 2010

I'm starting this post at 5 AM, in the call room. I'm supposed to be asleep. This is the one stretch of night when maybe I could get some sleep, except I can't. I miss outpatient. Patients get better, or at least they leave. The level of responsibility on outpatient service, I feel like I can handle-- you can ask for help, things aren't happening with such urgency, you can stop and think, you can hand the patient off to a specialist, you can send them to the hospital, you're not alone.

In the ICU, you're alone. Especially on the weekend, and especially overnight. The attending comes in to do his morning rounds, and then he's gone and it's you and the resident. And the resident goes to sleep at 10, and then it's you. Just you.

We have a patient I've gotten to know over the past week. We talked about her grandchildren, we talked for about two hours the other day. I learned her whole life story. I got too close. We thought she was doing better, and this afternoon she started to slip. The attending said we suction her chest every hour, get the fluid out. I told the nurse. I told the nurse three times. I have 12 patients to deal with, we had two codes, we brought someone back to life and we took someone else off the life support equipment tonight. I've talked to seven different patient families. The woman who needs to be suctioned is maybe the 5th sickest patient out of the 12. There are 3 or 4 others who've needed me. I can't be in five places at once. So I told the nurse, suction her every hour, get me if anything changes. I checked in at 10. I checked in at midnight. And by 2 AM, I was falling off my feet. I told the nurse to page me if anything happens, but since nothing was going on-- nothing was urgent-- I needed to try and grab two hours of sleep. We're supposed to be able to. I paged the resident, told her I was going to sleep. She told me that's fine. She was sleeping too.

At 3:30, the phone rings. She's having trouble breathing. When was the last time she was suctioned? Two and a half hours ago.

I ask the nurse, what happened-- oh, I had other patients, I didn't realize, I forgot-- and so we just had to intubate the patient-- for like the third time in three days-- we're torturing her. We're torturing her and I feel like it's my fault. Because it is my fault. I should have made sure. I should have done it myself. I can't be everywhere at once, I can't be awake for 28 hours straight-- but what am I supposed to do? How can I not feel guilty about this? How can I not blame myself? This is my job-- it's my job to not make my patients sicker. And I failed. Because I didn't make 100% sure that this patient was being taken care of, we have to intubate her. Yes, I helped the four patients who were sicker, and yes, I told the nurse-- but can I really look this woman's grandson in the eye and say, oh, I could have suctioned her myself and prevented this, except I wanted to take a nap? If a doctor said that to me, about someone in my family, I'd want to punch them in the face. A nap is more important than this woman living or dying? No. Maybe. I don't know. I can't do this. I can't explain around it. No one would blame me-- no doctor would blame me-- I told the nurse, I told the nurse a million times. The nurse said she was doing it. But it's not like it's her fault either-- she was doing things, she's as overstretched as I am, she had patients to deal with who needed her right then. I don't know who needed her more, I'm not judging-- she wasn't trying to mess up, I feel guilty because I feel like this is on me, not on her. I'm the doctor. But I was also falling over, exhausted, and at 2AM, I wasn't of any use to anyone. We're supposed to be able to sneak in some rest if we can. Jobs we can have the nurses do are fair to have the nurses do-- we're supposed to be able to rely on their support. I didn't think I was failing her, I didn't think I was doing anything wrong.

And she'll be okay, I hope. We're causing discomfort but not damage, she's alive, she's stable-- but how am I supposed to ever go to sleep on an overnight again? I can't do this. The pressure-- the responsibility-- I don't want to be the doctor. I want to take orders and have someone else in position to feel guilty if something goes wrong. And starting in July, when I'm a second year, I'm the one in charge. It's absolutely my resident, right now, who would take the heat instead of me-- I might feel guilty, but she's the one who cleared everything, she told me it's fine to go to sleep, she went to sleep hours earlier, I kept her in the loop, she didn't think I was doing anything I wasn't doing-- I'm not blaming her, but she ought to feel just as guilty as I do. Whether she does or not, I have no idea.

And so now I sit in the call room, waiting for the attending to come in at 8 and yell at someone-- me, the resident, the nurse, I don't know-- or maybe not. Maybe this just happens, all the time, and I'm supposed to accept that we're not perfect and we can't do more than we can do, and I have nothing to feel guilty about. But that's not much comfort, not to me and certainly not to the patient.

This job sucks sometimes.


  1. i'm really sorry about your loss.....

    .it's not your fault
    ...you can't do everything.
    and you already do so much...
    ...i know nurses get overwhelmed, but you need to be able to rely on them. they're there to support you...and airway comes first.

    the work and responsibility of medical care are heavy burdens to bear...and no one person could stand to bear them alone...or take responsibility for every mistake made underneath them.

    you're doing more good than anything else.

  2. You're doing your best but I think you've realized inpatient (at least ICU) medicine isn't your favorite. Thats a big step and will hopefully help you see the light at the end of the tunnel (outpatient medicine as a career). Stick with it buddy!

  3. echo-ing others in that you're doing your best and you're only human. And think of the other consequences if you hadn't slept, you may have done the procedures improperly and do more damage than good.

    I'm not sure if that comforts you any, but at the very least-- what's done is done, you can't change the past, but now you and your team learned a lesson and hopefully can prevent it in the future.