Alone with my shame

Every doctor has a case like this, where the guilt and shame burn on.

I was a new senior resident in anesthesia, rostered solo to anesthetize a patient for major vascular surgery. I’d worked in the hospital only a week and I didn’t know the surgeon or the operating room staff. I didn’t know where to find essential equipment and I was unfamiliar with local procedures and protocols. To make matters worse, all cases started late that day because the anesthesia department had a meeting.

My high-risk patient needed an arterial line, a central line and an epidural as part of the anesthetic management. I struggled with every procedure, wasting time. The waiting surgeon grew impatient, then angry, and stopped talking to me.

Both the surgery and the anesthetic went badly. The patient proved to have a sicker heart than pre-op tests predicted. I couldn’t control the blood pressure. The essential communication and coordination between surgeon and anesthesiologist was lost. The patient bled profusely. I struggled alone and didn’t call for help. Where I had trained in the UK, asking for help was not part of the culture.

In the middle of the day, one of the senior anesthesiologists stepped into my operating room. He said, ‘I noticed there was a new resident doing a major case alone so I thought I’d see if you needed help.’

He quickly realized I was in serious difficulty. He sent me out for a break and by the time I returned, he had greatly improved my patient’s condition. I was deeply grateful for his empathic support and practical help. While I was glad for my patient, I felt ashamed of my failings.

My patient went to intensive care and his condition gradually worsened. Every time I was on-call, this patient appeared on the list of acute cases for the operating room. I felt like he was haunting me. I took him two more times to the operating room for treatment of complications but his condition deteriorated. He died after a month in intensive care.

I’m sure it’s the worst anesthetic I have given. This patient’s death hangs on my conscience. I thought I was competent to do the case but have since come to understand that I was set up to fail on that day. No doctor could have performed well in those circumstances.

Experiences like this are traumatizing for the doctor, creating fear and vulnerability. Both my patient and I were abandoned by an unsafe system – save for my kindly rescuer. The patient’s relatives live with their loss, I with my shame.