Shortly after beginning the practice of medicine I took evening shifts at a local hospital's emergency room to make some extra money. One shift was to be indelibly memorable.
There was pandemonium that night in the ER and, with all hands on deck, we struggled to help all the patients.
One patient somehow got lost in the shuffle and a nurse, suddenly aware that the patient had been waiting for a long time, asked me to see him pronto.
Pulling the curtain back I saw a man who was decidedly dead. The nurse said she would gather the family together so I could deliver the bad news.
This was a very large family. They took the news with disbelief, followed shortly by anger, then fury.
Though they did not know what role I might have played in the death (I never laid a glove on him), I was the messenger, and despite the conventional wisdom not to kill the messenger, they circled me, looking as though they were going to rethink the messenger advice. Indeed, one family member accused me outright of killing his relative.
Just then a short man in suit and tie appeared. He seemed in no hurry as he went into a desultory gait. Finally, he parted the circle and took up his position in the center.
What happened next was magical. He bent down, lifted his right foot and began dusting off his shoe with rhythmical swipes.
All eyes were on him. In just seconds murderous feelings gave way to deep grief. No one noticed that I was still there. The shoe dusting somehow broke the tension and incredibly became the focal point.
I never got to speak with the shoe swiper (he just disappeared) but i did learn that he was a psychiatry resident. If he didn't save my life, he, at least, saved me a long stay on the orthopedic ward.
I had occasion to use his technique over the years.
If you find yourself shoeless a tie suffices.
Thursday, August 11, 2016
A young woman sustains a major complication after receiving, from the nurse, ten times the ordered dose of an anticoagulant. Family and friends clamored for a lawsuit but the patient steadfastly declined to launch one.
Why? Perhaps it was because we came clean with her about the error. No jargon. No flinching. No rationalizations. “Honesty is the best policy” is indeed a cliche but it is nonetheless true. This contrasts sharply with those who think doctors bury their mistakes.
Though I did not encourage her to sue (we never discussed legal matters) I thought her family was correct about getting compensation. After all, the error was transparently clear and the complications great. Perhaps she was concerned lawyers would leave the nurse and hospital for road kill. She was that kind of person.
Over the years, when I inevitably made a significant error, I explained to patients, remembering that young woman who seemed to need nothing more than honesty, how I had been errant, and what I planned to do to set things right. To my amazement and gratitude they were almost always forgiving.
They didn't need me to be perfect; they needed me to be honest.