lessons learned

internship is sure to be full of learning. we'll learn how to appropriately manage a person coming in with diabetic ketoacidosis and how to change the ventilator settings in a patient in the ICU. in addition, interns learn how to maneuver a new medical system, full of its individual nuances. these are largely the lessons we are expected to master by the time we finish the first year. however, i'm unsure whether there is any expectation and certainly no standardized curriculum for the lessons that come from caring for flawed people in a crazy world. but these are the lessons that shape physicians for better or worse; these are the lessons that give character and preserve our fragile humanity in a more and more technical world.

i learned a few weeks ago that a patient i cared for in an urgent care clinic died suddenly a couple of days after i prescribed her narcotic pain medications. she was a young, depressed women who had recently been thrown to the ground by her abusive boyfriend, causing her to have significant back pain. she was found unresponsive in her home, taken to the ER by ambulance, and pronounced dead on arrival. in cases like these, overdose is highly suspected as otherwise healthy young people have little other reason for sudden death. her body was sent to the medical examiners for autopsy, and the cause of death at this time remains unknown.

whether she died of a sudden arrhythmia or indeed overdosed, this is a tragedy that i feel somewhat culpable about. no, i did not directly administer 40 tablets of narcotic pain medication to her, but i prescribed them to her as is commonly done and as my direct superiors signed off on. as young physicians, it is common to fear that you are going to kill one of your patients by either direct negligence or incorrect direct action, but i'm not sure we think much about the indirect ways we participate in the demise of those we care for by the small actions we take. it would be paralyzing to heavily measure each medication given but it only takes one experience such as mine to drive one to calling the seemingly innocuous acts of our profession to account. i have surely recovered from any since of overwhelming guilt, but i know hesitate momentarily and consider the consequences of supposedly safe and common decisions.