I remember being more confident that most of my peers. The look of dread on my fellow interns face pre-call, and the fatigue post-call always seemed unnatural to me. Maybe it was on account of my lifelong pursuit of medicine. I felt nothing but elation at the newly branded “M” and “D” that came after my name on the hospital badge. I was no longer a volunteer, no longer a student. I was a doctor. And part of that persona was walking into the unknown with a certain amount of confidence. This was exactly where I was meant to be.
A few months into internship, I admitted an obese lady with a skin infection on her thigh. I started the appropriate antibiotics and waited. My resident noting the appearance of the skin asked me to order an x-ray. I placed the order but secretly was befuddled. Why order an X-ray? What on earth was that going to show?
I was on call and busied myself with the drudgery of being the low man on the totem pole. I admitted five new patients. I drew blood. I did paperwork. I spent hours in front of the computer screen looking up labs and filling out charts. I forgot one thing though.
Maybe it was because I didn’t understand my resident’s clinical reasoning. Maybe somewhere in the recesses of my mind I had written the order off as something superfluous or unnecessary. To this day, I can’t explain why I failed to follow up on the x-ray of the thigh and retrieve the results. Some things may remain unexplained.
The next morning my resident and I breathlessly ran to the patient’s room at her nurses prompting. Her blood pressure was dangerously low, and her temperature was sky high. My resident looked at me in a panic and inquired about the x-ray. After we stabilized the patient, we ran down the stairs to radiology and glanced at the films. Our worst fears were confirmed upon staring up at the lightbox: subcutaneous gas.
The patient had necrotizing fasciitis ( a severe form of skin infection) and needed immediate surgery to remove as much of the infected tissue as possible. She would likely lose her limb and possibly more.
Years later, I can’t help but wonder how much better she would have done if I had seen the film the night before, and surgery had been called immediately. The patient survived either way, but by a hair.
And I learned an important lesson that night in humility. A lesson I would be taught over and over again as I journeyed through medical education and beyond.
Disease is tougher, more resilient, and far more cunning than the minds of the medical experts who struggle to tame it.
It is only to be rivaled by the human spirit of our brave patients, who battle day in and day out to survive.
Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion. Watch his talk at dotMED 2013, Caring 2.0: Social Media and the Rise Of The Empathic Physician. He is the author of I Am Your Doctor: and This Is My Humble Opinion.
