My second month of residency. My first solo thoracentesis–a procedure to remove fluid around the lung. The supervising physician I’d just met watches over my shoulder as I carefully count and percuss the rib, fasten the drape in place, gown, glove, and cleaned off the skin.
Infiltrate with lidocaine…good. Thread the catheter into the trochar…good. Attach the stopcock…good. Make sure it’s open in the right direction. Puncture the skin, pull back on the syringe, fill the syringe with fluid. A sigh of relief–it’s in the right place. Turn the stopcock, remove the syringe…. The supervising physician makes an inarticulate noise. I look at the stopcock and freeze. It’s turned the wrong way. I have just introduced air into the area around the lung–a major mistake.
And of course the patient needs a chest tube. And of course the surgeon who is called in to place the tube is irritated and impatient and doesn’t wait for the lidocaine to take effect before ramming the tube through the chest wall. The patient is not the only one crying.
At the time, I knew exactly what I’d done wrong, and I certainly never did it again. It’s also true that neither the surgeon nor the supervising physician ever talked to me at all about what I’d done wrong or how I felt about it. I don’t think any of my residency classmates ever knew it happened–I was on rotation at a satellite hospital. So I tried to put it out of my mind, chalk it up to a learning experience. I kept reminding myself that the patient was, in the end, just fine. I figured I’d get over it. I thought I’d get over it.
It was indeed a learning experience. I learned that shame settles deep and never goes away. I can feel it in my body as I type these words. I am short of breath; my chest is tight. I am both the patient and the young doctor, standing both in 2016 and in 1986.
I wish I could reach back across the years and offer us both comfort. But it it doesn’t work that way.