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Saturday, April 17, 2010

The natural order of mistakes

When a patient goes into respiratory failure, or cardiac failure, or both, this presents a stressful moment for the medical workers taking care of the patient. Basically, if nothing was done the patient would die, and therefore without our intervention the patient would die.

This provides many of us with an adrenaline rush. During these stressful moments even the best trained mind can fail to work adequately. I've seen the best of the best RTs bag with the mask upside down. I saw a doctor forget to order Epinephrine. I've seen nurses who never miss IVs miss up and down the arm, with blood spattering everywhere. I've seen nurses and lab technicians get overanxious and forget to cap a contaminated needle, and poke someone with it. I've seen an RT set up a vent and yet forget to turn it on. I've seen the medical workers so focused on what to do next that I had to yell, "Um, someone better get on the chest and do CPR!"

Once I was bagging the same time I was holding the mask over a patients face, and the patient was getting good chest movement. The doctor decided to take the mask from me and she squeezed the mask so tight over the patient's face he wasn't able to get any air in. I tried to explain this to the doctor, but he said, "This is what they say to do in ACLS!" Well, ACLS also recommends common sense and constructive intervention. Thankfully that doctor who was obviously acting on adrenaline found something else to do.

You see, we prepare for this all the time, and yet when it comes you have to realize we are only humans. Some of the time our experience and education saves the life of the patient, and other times the patient does not make it. Still, there are many times that no matter what we did the patient would have died.

Yes, it is true, there are moments in the emergency room, especially when the patient is someone you know, or a kid, where the tension is so high you can feel it as something palpable in the air we breath in. You can smell it. You can even hear it. Yet, still, we are trained over and over again as to do what we do, so during these tense moments our bodies naturally do what is right.

Still, we are, after all, humans. And that is why after watching someone do something stupid, I usually take it with a grain of salt. Usually something stupid was something so minor it made no difference to the outcome of the patient whatsoever. For instance, recently I assisted with an intubation, and it took me 10 seconds instead of the two seconds the doctor expected to inflate the cuff on the ETT following the intubation. What I did had absolutely no impact whatsoever on the patient outcome. Yet, Instead of being understanding and appropriate, the doctor was condescending and inappropriate.

I was called stat to OB to be on standby for a 34 week gestation baby. As soon as I arrived in the delivery room the baby was delivered by the nurse. It appeared to me the nurse did everything appropriate, yet later, after the doctor arrived, the nurse was scolded. He said, referring to her delivering the baby, "That was a rookie mistake that will never be repeated again." I saw the whole thing. If she had not delivered the baby, it would have probably flopped on the floor.

One thing that I learned by the first RT to orientate me before I worked at Shoreline was that every other person at a code, or at the birth of a bad baby, will be stressed and the adrenaline will be flowing. She said that if any person is calm and level headed it should be you the RT. Make sure you know your stuff right side up and upside down, and know as much about what the nurse should be doing too so you can offer level headed advice and suggestions during the process. "As we are, in fact, a team. Our jobs are to help each other out. What you forget, it's my job to remember. What I forget, it's your job to remind me."

Yet, while most doctors, nurses and RTs are understanding of this rule, some continue to be inappropriate and condescending. They expect everything to be run as perfect. The truth is, I have never in my life left a code and said, "Well, that one went great." I am always saying to myself, "What could I have done better."

I had a discussion regarding this recently with four nurses. I said, "Do you think I think too much. Should I just assume I did my best, the nurse did her best, and so too did the doctor?"

We all came to the conclusion that we all second guess ourselves. It's natural. We also decided that the medical worker who doesn't second guess himself is the one we should be worrying about. The condescending doctor, the arrogant nurse, the omniscient RT are the one's who are the problem.

We must never forget we are a team. We work together for the benefit of the patient. We are all humans prone to doing stupid things, or making mistakes. It's our job to help the other members of the team do their jobs right when a natural brain infarct occurs.

Likewise, if a mistake is made, it should be addressed appropriately.

Here's a good analogy. Brandon Inge swiftly swoops up the ball and, instead of setting his feet and making a good throw, he tosses it over the head of the first baseman. Jim Leyland doesn't say anything, because he knows Brandon knows what he did wrong. Yet, Leyland decides, if he does it again, then he didn't learn and I'll have to address it.

That's the way things go in baseball. It's common sense. And it's also the way things go in life. Yet, some condescending people don't care about the natural order of things. Empathy lacking, you did wrong and therefore you need to be treated as a kid.

1 comment:

Unknown said...

I just wanted to say thank you for this blog. I am approaching the end of my 1st year of RT school & last week could have been the breaking point for me. Instead, this post helped to give perspective & grace where I thought none existed. And tomorrow will be one day closer to graduation. Thanks again