The delicate art of screwing up

Most people would say that there are two certainties in life – death and taxes. I would argue that there are at least three – death, taxes and the fact that at some point in your life, you’re going to screw up big. Now if your screw up is that you get done for drink driving or you have an affair and get caught – that’s pretty big and the fall out is immense but what if you almost kill someone.

In 1995 I was an intern at a busy regional hospital in Queensland. The hours were long but I loved the fact that I was eventually a doctor. One Saturday evening about 4 months into my job I was working the long day shift and was due to finish at 10pm. I had been doing ward rounds and paperwork all day and I was tired. A call came from the emergency department that a smoker with emphysema was being admitted for intravenous antibiotics and I needed to write him up for antibiotics.

Once he was comfortable in bed I took a brief history, inserted a cannula and wrote up the antibiotic he was going to have - Amoxil - the commonest antibiotic that we used for this situation. I retired to the nurses desk on the medical ward for a coffee and read the newspaper. Hotmail was a year away. Google was three years away. Yahoo had only just got off the ground but you couldn’t access it on the work computers anyway! So – I read.

I’m sure I was engrossed in something scintillating when the nurse assigned to Bill (let’s call her Ann) came running to the desk. She called me in to the room. Her face was grey. Her voice was hoarse as she told me that the patient was having a reaction to the antibiotic. I didn’t need to be a medical professional to tell that she was shitting her pants and I was about to join her.

As I rounded the corner of the door into the 6 bed ward I could see Bill sitting on the edge of his bed struggling to breathe. Almost his entire face was blue and a gurgling sound emanated from his chest. His eyes locked with mine and in a split second he communicated sheer desperation. I raced to his side and instantly knew he was about to collapse. The nurse and I heaved him up on to the bed. I expected his body to be limp but it was taut; wound up like a rubber band as if he was trying to fight whatever was happening to his body.

I needed the crash team to come help - NOW! The buzzer was by the door that I had just walked through. It was only metres away. I know I was racing to the buzzer but in my mind’s eye it was as if I was looking at myself doing these things from some parallel universe. It felt like I was trying to move through syrup in slow motion. Getting to that blue button seemed to take an eternity. Once I hit it – ALL HELL BROKE LOOSE. I turned towards Ann and said to her “I’ve just seen the medical registrar in ICU – I’ll go get her”, and ran down the corridor. In reality, I imagined that I had said that and simply ran down the corridor far, far away from this scene of horror. Talking to Ann after the events she recalled thinking I had lost my mind. She was very happy when I returned in less than a minute with one of the few people in the hospital that could deal with what was happening.

By the time I returned, Bill had arrested. One of the wardsmen was pumping his chest and a couple of the doctors from emergency were already working on him. A tube was going down his trachea into his lungs. He was receiving lots of high powered drugs into veins. He was still very blue. As the most junior doctor there, my job was to stand at the end of the bed and write down the times, interventions and drugs as they happened. By this time it was late in the evening. I was tired and hungry and my feeling of despair was about to get worse when another nurse came over to me and showed me the front of his drug chart on which was clearly stated that he was allergic to penicillin. What is Amoxil ? – a type of penicillin.

I felt sick. In fact if I hadn’t been concentrating so intently on the scene before me I probably would have fled to the toilet to vomit. But I couldn’t leave. I had to stand there for the next 45 minutes as Bill had every cardiac arrhythmia known to man. I had to stand there for the next 45 minutes while enough drugs to kill a horse were pumped into Bill’s veins. I had to stand there as my pathetically brief medical career flashed before my eyes. I felt like a drowning man. But the waves weren’t crashing over me, they were crashing over Bill. Thankfully – he was a fighter! After 45 long minutes a stable heart rhythm was achieved and he was transferred to ICU. He was in there for a week or more. I visited every day. Well, when I say I visited – I would sneak around the back door to ICU and with a whisper ask how he was doing. Every day the response was positive and I would be encouraged to come in and have a look, or say hello. But every day I would decline for fear that if I set foot in the place he would somehow summon the energy to punch me in the face. It was a long road to recovery. His kidneys packed it in for a while. He still had that infection to deal with, and we were yet to discover why he developed such a bad infection in the first place.

Bills initial chest x-rays were obscured by the infection. As the infection cleared a shadow became apparent and a suspicion of cancer became a possibility. In those days CT scans were difficult to get and one had to be transported to another facility to get one. Bill was still quite ill and he needed a nursing escort. I was surprised when Ann put her hand up. She told me later that as they drove to the CT facility he said to her that he knew that there had been a screw up for him to have such a bad reaction from the antibiotic but that he also knew that if the CT confirmed that he had lung cancer that he didn’t want to waste his remaining time trying to sue someone over the mistake.

Bill died less than a year later from the lung cancer that was diagnosed. He died peacefully at home with his wife by his side.

Ann and I had a “debrief” with the medical superintendent of the hospital about the events. Ann HAD asked Bill if he’d had Amoxil before and he said that he had without complications. However, I should have double checked his allergies and should have prescribed something else. The debrief was therapeutic and educational but I still spent the rest of my intern year terrified that I might somehow kill another patient. To this day I’m still just a little bit paranoid about allergic drug reactions.

Ann quit the medical ward within months and never went back to ward nursing again. The irony is that she ended up in a medical testing department and regularly performed exercise stress tests on patients with cardiac disease. We met again 5 years later when I was the obstetrics and gynaecology registrar in the same hospital and I delivered her first baby.

So, the next time you think you’ve royally screwed up. The next time you don’t think you can deal with the fall out. The next time that you wonder if anyone will ever talk to you again - ask yourself the question – did anyone die? I think that most of the time you will be able to give the same answer that I was able to – an unequivocal NO. You can then dust yourself off. Hang your head a little low and eat some humble pie for a while but then move on and do your best to not go there again. That’s what I did and still do although I can honestly say that I’ve never surpassed the magnitude of that first screw up since.