One night at the end of my intern year working in the newborn nursery of Houston’s Ben Taub Hospital, I was called to see a young baby with rapid breathing. After an efficient exam, I ordered a chest X-ray. When I returned to the baby’s bedside to review the film, I arched back and held up the X-ray to the fluorescent light above me. After studying it for a few seconds, I called it normal and diagnosed transient tachypnea (passing rapid breathing) of the newborn, a benign condition. Then I went off in search of a couple hours of sleep.
Morning rounds began a couple of hours later in the neonatal intensive care unit. My team was gathered around an infant warmer, tending to a baby with rapid breathing that had become significantly worse overnight. His transfer to a higher level of care was the result of air leaking into the space between the lung and the chest wall (a condition known as pneumothorax) that had been missed by the intern on call — me.
As I elbowed my way to the baby warmer, I tried desperately to offer some kind of explanation, but immediately recognized that the story wasn’t about me but the baby previously under my care. My excuses and rationalization did nothing to improve his situation.
Beyond the immediate guilt of overlooking a diagnosis, I felt the shame that comes from the professional exposure of failure. I pulled aside my supervising resident physician, who was attending to the baby. We talked about my assessment of the baby and where I had fallen short. She discreetly but directly covered the consequences of moving too quickly and viewing an X-ray through the dingy overhead light of a county hospital. She recognized that I had learned from my failure the most important lesson it could have taught me.
Medical internship is a remarkable time. In the course of a year, a person moves from being a brand-new medical school graduate to an almost independently thinking physician. The transformation brings a level of confidence that has you believing you can see a sliver of air between the chest and lung through the glare of a fluorescent light.
Like me, all clinicians have that moment when they face their vulnerability. It’s that moment when one’s sense of self-importance and mastery is overshadowed by the reality of not really knowing all that much. This recognition of vulnerability is what separates the intern from the master clinician who recognizes his or her limitations and operates with a balanced kind of humility.
What one chooses to do at that moment of failure is vitally important.
Harming a patient by a misdiagnosis or an incorrect treatment is terrible for the patient. But it has tremendous value to the perpetrator when his or her heart is open to what the harm means. How it is processed not only reflects the individual’s character, but more importantly presages the kind of caregiver he or she is likely to become. The humility and grace that can come from making public mistakes are professional traits indispensable in a profession of uncertainty. The entitlement that too often holds young doctors from personal accountability can emerge as a dangerous habit.
The way that peers and supervisors respond to a learner’s failure also represents a critical point in the process of professional development. The growth that comes from facing one’s limitations can’t happen alone. It requires a community intentionally committed to cultivating the soft skills of introspection and humility. This kind of realization and public exposure of our own shortcomings can be jarring to a young professional mind. Training environments that breed disregard for the process of human adaption to failure do their part to help young doctors miss the opportunity of learning about vulnerability.
Humility is the personal trait of being other-focused. And it’s almost impossible to learn without the experience of full-frontal failure before those you trust and who trust you.
Bryan Vartabedian, MD, is an assistant professor of pediatrics at Baylor College of Medicine in Houston and an attending physician at Texas Children’s Hospital, both in Houston, and author of “Looking Out for Number Two.”
Your story reminds me of the many ways, beyond the clinical setting, that we all fail to engage with our fellow human beings, make quick judgments with no follow-up. Let’s thoughtfully engage over time rather than quickly leave our fellow human beings to move on to the next case/situation.
Very well written. Amazing how those episodes of human failing stay with us to forever remind us of our own vulnerability and need for humility as a protection for those we serve.
Thank you, Dr. Vartabedian, for sharing these kinds of insights. Over the years I’ve had clinicians who were arrogant jerks, never admitting they screwed up when I got infections from completely unnecessary procedures, as well as other doctors who had warm hearts and would discreetly admit at times that they didn’t always have the answer. As a cancer immunotherapy researcher, I will try to endeavor to always be honest with my future patients, even if there are times when I can’t do a damn thing to help them. They deserve no less.
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