“If I make a mistake, my patient could go home in a body bag.”
I don’t recall whom I first heard this from, but it stuck in my mind as terrifying thoughts do. And we wonder why burnout in medicine is a thing.
Mistakes in medicine can cause mortal consequences. They can harm another human being. We can’t escape this reality. We can’t undo it. We don’t get “three lives,” as in Ms. Pac-Man, if you turn the wrong way and run into a ghost. It’s done.
Consider the patient who comes in weekly for cannabinoid hyperemesis and presents with abdominal pain and vomiting … again. They swear it’s different this time. It’s not the marijuana. It never is. So you write for the anti-emetics and move on.
Two hours later, a code is called to her room. You assume it’s a false alarm. But when you arrive, CPR is in progress. Return of circulation is not achieved. The autopsy shows dead bowel.
She had two young girls that won’t grow up with a mother.
It’s hard to find grace in that.
Most medical errors don’t lead to the death of a patient. Harm may occur. Giving an antibiotic without dosing for renal function may necessitate short-term dialysis. That’s not inconsequential. But the patient gets to go home to their family.
And then, there are times when mistakes never reach the patient. In the above scenario, a pharmacist would call me to adjust the dose before the medication is given. If I write for an antibiotic a patient is allergic to, the medical record alerts me. A nurse may call and ask if I want to replace the potassium with the IV Lasix I just ordered before it drops further.
When we get home, the burden of our mistakes weighs heavy on our conscience. Most people enter the medical field because they want to help people. And we’re laden with perfectionism. Those aren’t bad things. They make great doctors. But without allowing ourselves to swim in the sea of grace – and absorb its healing nutrients – we’re left with malnourished spirits. And just as a body without nutrition cannot heal wounds, neither can we heal the trauma to our souls. That doesn’t just lead to “burnout,” as we often refer to the crisis plaguing our profession. It gives rise to despair.
Isolation: As the COVID pandemic progressed, I found myself less able to relate to those outside of medicine. Opening about how difficult it is to watch people die alone takes courage. And when the topic is met with blank stares from friends and family who prefer to change the topic, we’re unlikely to revisit it.
Midway through the third surge, I went out to dinner with a couple who told me about a terrible experience they had at a restaurant. Their table preference on the reservation hadn’t been communicated; it took half an hour to get their drinks. As I listened to them, I found myself feeling angry. Was that worth complaining about? Seriously? Didn’t they know people weren’t able to get beds in hospitals? Or that nurses were caring for patients in hallways at ratios they’d never experienced before?
The trials of everyday people no longer seemed valid to me. My ability to show grace to those not in the trenches with me plummeted. I started to feel like the only people who understood me worked within the hospital’s walls. Couple that with the isolation COVID already led to, and many of us succumbed to social and emotional isolation.
Grace starves in isolation.
The legal system: Sometimes, I wonder if I’m more afraid of attorneys than novel viruses invading our planet. I’ve experienced depositions and courtrooms on the defendant’s side. Regardless of its medical implications in the case, each tiny decision I made was scrutinized by non-medical people. I emerged “successful,” meaning I was dismissed, but the scars remain. I order more tests now – not because I think it will benefit the patient but because I’ll do almost anything to avoid going through that again.
Medical malpractice attorneys are not generally gifted in grace. Nor are family members who have lost loved ones or patients who have experienced complications. Those I have empathy for. I struggle to extend forgiveness to the former. That’s probably not just on my part. It’s certainly not gracious.
Maybe you’ve been through that, as well. Perhaps it’s gnawed away at your compassion, faith in yourself, or trust in your fellow humans. That’s fair. Living in a world without grace can do that.
Burnout and don’t have to triumph. Hope remains.
We can talk about the system-based approaches we have instituted to avoid burnout and the negative emotional consequences that arise from medical errors, miscommunication, or negative outcomes that occur outside our sphere of control: Just culture. Peer review. Physician health and wellness committees. Social events. CMEs about burnout. Burnout surveys. State-run physician health programs. These have positive impacts.
But what else? When we go home and collapse on the couch, wondering what happened to that pre-med we used to be, the one who rejoiced at the acceptance letter to medical school, thinking the hard part was over. Naive? Yes. But there is beauty in that innocence. How do we find that joy in the privilege we have to be health care professionals? How do we love medicine again?
And where does grace fit in? How do we mine it in our daily lives? In the small things? It’s a vital nutrient – and it doesn’t come in a pill. Or a drink. We need it daily to thrive.
As a medical community, let’s seek grace together. And let’s start with showing it to one another daily.
Marsha Hamner is a hospitalist.
Image credit: Shutterstock.com
