The toughest work emails always seem to come on days when I am post-call, feeling tired and pensive. This particular email came from Patient and Guest Relations at the urban hospital where I practice as a neonatologist.
“I received feedback from a patient who claims that she had a negative interaction with you…during her C-section surgery. She is requesting a visit from you….”
My heart sank. Although I have never knowingly been the subject of a patient complaint before, I knew that, in this case, I’d made a series of blunders in the course of which I’d practically ruined a mother’s birth experience.
Ms. Smith and her partner had come to the hospital so that she could have a cesarean delivery; her first child had also been delivered that way.
I’d arrived at the operating room after the surgery had started, and the obstetric nurse gave me a brief verbal report. Among other things, she said, “Ms. Smith has a history of prescribed opioid use after back surgery, but she hasn’t filled a prescription for the medication in more than a year.”
Ms. Smith’s newborn baby was vigorous at delivery. I congratulated the parents and completed my head-to-toe exam of the infant. Starting my documentation at the operating room computer, I skimmed Ms. Smith’s history and prenatal labs. She’d had a child born a year prior, who had died suddenly.
I clicked on Ms. Smith’s urine drug-screen result, which was obtained per our hospital policy because of her history of opioid use in the last three years. There I spotted the yellow flags indicating positive results for opioids and cannabis—and, at that point, I unknowingly committed my first mistake.
I approached Ms. Smith while she was still lying on the table (my second mistake) and asked my usual questions, which she answered, smiling.
“Do you plan to nurse?”
“Yes.”
“Do you have an office picked out for pediatric care after discharge?”
“Yes.”
“Did you take any medications during pregnancy?”
“No.”
And then I took a deep breath and said, “Are you aware that we will need to monitor your baby closely for withdrawal symptoms because you used opioids during pregnancy?”
Her smile disappeared.
“That’s a lie!” she exclaimed.
“Your urine drug screen was positive,” I said.
“I am telling you, that is not true!” she pleaded.
Returning to the computer, I scanned Ms. Smith’s test results again—and committed my third mistake: not catching my first one. The positive drug-test results were from her first pregnancy, and her current urine drug screen was completely negative. Skimming too quickly, I had mentally reversed her past and current test results—and I persisted in this mistaken impression.
I went back to Ms. Smith, who was still on the table.
“We can discuss this further after you’ve recovered,” I said skeptically, then left the room (my fourth mistake) to attend another delivery.
Not long after, I learned from the nurse that, after I’d left, Ms. Smith had started crying, had begun to vomit and had needed to be given supplemental oxygen.
I also learned that she’d discovered her latest pregnancy just two weeks after her first baby had died. She’d decided to make a change; she got off the prescribed opioid, stopped using marijuana, and was determined “to do everything right.” And she had.
Returning to my office to complete the delivery documentation, I finally realized my error. My heart sank, and a surge of adrenaline dread rushed through my body. I knew that I had messed up.
I went back to Ms. Smith, now recovering in a private post-anesthesia care unit.
“Ms. Smith, I am so sorry; I made a mistake,” I explained. “I was accidentally looking at an older test result and not the results from today.”
“Thank you,” she said, looking relieved. “I was freaking out.” She didn’t say much else.
I went on my way with a feeling of resolve, believing that my mistakes had been corrected, and that all was now well (my fifth mistake).
And now, the very next morning, here was this email asking me to see Ms. Smith in her room. So why did she want to speak with me again?
I entered the room. “Ms. Smith, again, I am so sorry. I feel embarrassed, ashamed and regretful about my mistake.”
“I accept your apology,” she said. “But I want you to know how you made me feel. I was panicked that you were going to take my baby away.”
She explained that her emotional reactions had come from the trauma of losing her first child: “That made me doubt whether I was fit to be a mother.”
She cried. I cried. I felt small.
Ms. Smith taught me valuable lessons. As a newborn intensivist, I take pride in my warm bedside manner and meticulous attention to detail—but I also need to remember that I’m human, and I have made and will continue to make mistakes.
In the future, I will not skim testing results; I will carefully scrutinize them. Whenever a newborn is not in any imminent danger, I will wait until well after the delivery is over to initiate a sensitive conversation with the mother.
The biggest lesson I learned is that, sometimes, simply apologizing for an error is not enough. If I’ve hurt a patient through my words or actions, they will want me to know exactly how I made them feel.
And taking the time and trouble to reach that mutual understanding is a vital part of my role in their healing.
9 thoughts on “How You Made Me Feel”
To say how heartbreaking this story is and unbelievably proud I am of Dr. Flannery is an understatement. Something lacking in the medical profession is the ability to recognize and apologize for what the patient is experiencing, be it in or out of our control. Although she may never know this I am most proud of the patient, many are unable to communicate feelings and this is how we learn.
Bravo Dr Flannery
Dr. Flannery, what you wrote about is one of the most difficult things we need to do as physicians. Owning such interactions and learning from them is the professional thing to do. Giving yourself permission to fail, however, is incredibly hard for many of us to reconcile with our most important mandate, “First, do no harm”. I am not suggesting a less rigorous attention to our work. Rather, what I have experienced myself is the humbling reality that mistakes I make as a doctor stay with me as a reminder of my fallibility, but not as a rationale for abandoning the work. During my 40 years of practice, I worked on that concept daily, some days more successfully than others, to be completely honest.
You are brave to share your story. I wish you continued success in your career, Dr. Flannery; what you do is important clinical work on which many of us generalists rely for the health and safety of our patients. Thank you for taking on that responsibility.
Thank you Dr Flannery. Your ability to even recognise these details shows that you are both compassionate and insightful.
In our now overly-litigious medical world, it’s easy to forget, or ignore, that almost universally patient want just two things: a simple apology, and genuine recognition and understanding of the emotional trauma it causes.
It is so simple, and yet so elusive, and I have no doubt your story will resonate with so very many people, on both sides of the bed rail.
Thank you for being vulnerable, it helps so many overcome when they were vulnerable.
Excellent story. Thank you!
You were so bravely vulnerable sharing this. From one doctor to another, thank you.
Love this story – thank you.
I think Maya Angelo said it best, ” I may not remember what you said, or how you said it, but I will never forget how you made me feel.”
I admire you for sharing this. As a retired neonatologist who has made her share of mistakes, I feel you. It’s SO hard to accept that we’re human, especially in this high pressure specialty. You handled it really well.
Such maturity. I am sure Dr Flannery is going to become a great blessing to his patients and colleagues.