Abstract

One weekend day during my medical internship at Lincoln Hospital in the South Bronx, probably a Saturday, I received an admission. She was a woman in her mid thirties, well known to the medical service, with chronic renal failure. Every few weeks she would come into the emergency room with fluid retention and elevated potassium, and we would hustle around to get her to the ICU where we could initiate peritoneal dialysis. Our ICU had 7 beds for our indigent population of 350,000 and it was shared by all of the services: Medicine, Peds, Surgery, OB. There was never a free bed, so finding a bed for one patient always required a lot of negotiation and weight-throwing. To make it worse, she came at around shift change when it is always difficult to get anyone moved in or out of a bed. I have never been very good at weight-throwing and having started my career as an orderly and scrub nurse, I am very uncomfortable about “yelling” at the staff, which was what was required. Before I could get my patient into the ICU, place the catheter, and start the dialysis, she had a cardiac arrest and died. I took the full load of her death onto my shoulders. How had I let this woman die leaving her children (two, or three as I now remember) motherless? I had failed when my colleagues had succeeded and why couldn't I have been more forceful and aggressive? I went home the next day in a dark mood. I felt as if I was a harmful, dangerous person who had no business becoming a doctor. I thought about throwing myself under a bus or at least breaking my leg on a lamppost. It was all I could do to come in to rounds on Monday. I had to tell my team my story and how I had let them down. Our attending physician, who was also our nephrologist, listened patiently to my tale of failure then calmly told me that I had not killed the patient. The attending reassured me that the patient was killed by her kidney disease and a social system whose best solution was prolonged dialysis. She also reassured me that she would be happy to yell at the staff, if I ever needed help with that in the future.

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