Oopses, Gaffes, and Other Opportunities for Learning: A Guide for July

July 1 is upon us again: that New Year celebrated only by those in the medical field. When medical students begin as doctors, interns become residents, residents become fellows, and basically everyone in every position is one year less experienced at it than the person who held that position the day before.

This July 1 marks the end of my first year of pediatric hematology/oncology fellowship. Finally, after college, grad school, med school, residency, chief residency, fellowship #1, and now the beginning of fellowship #2, it is the end of my last first year of training. A time for gratefulness, sentiment, and exhaustion, as well as introspection.

As I watch the new interns at my hospital in the first hours and days of this step of training, I and those around me try our best to offer reassurances: We have all been there. This is hard. No one expects you to know it all. We made mistakes, too.  Recalling my own early training, I can only half-cringe, half-smile at some noteworthy mistakes I made along the way. Here, for your edification, reassurance, and amusement, are a few of the highlights:

The time I mistook an attending for a nurse. I was pre-rounding early one morning, checking in on patients and touching base with their nurses to learn of any overnight events. I approached a woman seated at a computer near a patient’s room, somehow ignoring the fact that she was in regular clothes instead of scrubs, and asked, “Do you have patient A?” She politely told me that she didn’t, and I moved on. Soon after I learned that she was actually a cardiology attending.

The time I screwed up a plan for sedation. On my first day of my first rotation in the pediatric emergency room, the first patient I saw was a little boy with a forehead laceration. I checked in on him and his family, did an exam, and prepared to go speak with my attending. As I exited the room, the family asked whether he could have something to eat. Sure, I replied, thinking, there’s nothing wrong with his belly!  In fact – as I learned as soon as I spoke with the attending – the answer should have been no. We sedate kids for sutures, and we want to do so on an empty stomach to prevent aspiration in the event of vomiting. “You should check with the attending before you ever tell someone they can eat,” she told me in response. Lesson learned.

The time I thought we could give oral medications to a crumping patient. One Sunday during my first rotation (as an intern) in the pediatric intensive care unit, a baby was transferred to the ICU from the general floors because he had decompensated overnight. The senior resident, who was managing the patient with the attending, called me to the room. “Becky, look at this baby,” she said. “This is what a sick baby looks like.” Indeed, he was dusky and minimally responsive, and a short time later would be intubated for respiratory failure. As I could do little of use to stabilize him (at that point I had been a doctor for all of four months), my job was to enter orders. The senior resident told me to order the two antibiotics that we commonly use for broad coverage in sick babies, and I set about researching the appropriate dosing, eager to be of assistance. But wait. The dosing was different if given by mouth vs. via IV. This baby didn’t have an IV. I made my way back to the patient’s room and pulled the senior resident aside. “Do you want PO [by mouth] or IV?” I asked. (Critically ill – and even moderately ill – patients should have at least one site of IV access.) Bless her, she took a deep breath with eyes closed and then calmly told me, “We are putting in an IV right now. They have to be IV.” I scurried back to the computer to enter the orders and only later realized how embarrassed I should probably be. But that’s why we have layers of supervision and teaching. The baby was ok and my lesson was learned.

The time I didn’t hear my pager… for hours. OK, these stories aren’t all from my earlier years. Near the start of my current fellowship, I awoke one night around 2am to my attending calling my cell phone. “The emergency room has been paging you for two hours, so they finally paged me,” my attending said. “Is everything ok?” Um, yes. Yes it was. It’s just that my pager was on vibrate and I was exhausted, so no matter how many times it reverberated against the wood surface of my bedside table, it had not yet permeated the depths of my sleep. A huge error? No. Embarrassing? Definitely.

I’m sure that won’t be the last of them. And if all goes well, two years from now will be the first of yet another step: life as an attending. May the learning never cease.

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