Just about a year ago, as a bright-eyed intern, I made a medical error that caused patient harm. Thankfully, the patient was not permanently impacted, it was a small blip in his hospital course. But the lingering weight of that mistake has stayed with me.
On this particular day, I was on hour 25 of my shift on the general medicine floor. I had been dividing my time hammering our hospital’s off-brand Diet Coke, admitting multiple new patients, making frequent trips down to the harrowing ER, managing those who were becoming acutely ill, and fielding what felt like constant pages. Sleep was my husband off to war, and I was longingly sitting by the window unblinking, awaiting his return.
I received an admission for a patient who was altered and sedated for unclear reasons. I got the labs, reviewed the imaging, and worked through the differential for his mental status change. At some point, I ordered a protocol for alcohol withdrawal, with benzodiazepines as adjunct if needed. Sure enough, the patient received Ativan — and my sedated patient became somnolent.
The elaborate dance of morning rounds is a hyperbaric chamber of emotion. I presented my polished assessment and plan with self-congratulatory pride only to have the piece de resistance be a somnolent patient with barely normal O2 saturations. Within an hour, the patient was adorned with a nasal cannula and transferred to the intermediate care unit.
As a team, we reviewed the last administered medications to find the Ativan culpable. My heart dropped, and I looked around to see if anyone would be so kind as to place it back where it belonged. I peeped, “That’s on me. I ordered that. I didn’t realize this would happen.” The shame was crushing, enough that I considered what would happen if I didn’t say anything at all. Maybe my mistake could disappear. Maybe no one would ask. Maybe my mistake could be clandestine. But I had admitted fault, and my disappointment in myself was undeniable and deafening.
I left that morning after my 28-hour shift, unable to sleep. The guilt gnawed at me. I compulsively refreshed the chart, willing the vital signs to update. I read a triage note blaming the Ativan and texted my friends on service for updates. I wondered if I should quit. I was suddenly unmoored by the responsibility of this job. I braced for punishment, waiting for an email from my program director confirming what I already knew: that I was a bad doctor.
When I came to work the next day, my heart raced, certain that everyone was wondering how I could show my face. I checked my work two, three, four times, running it by my co-interns and my seniors. When my attending pulled me aside to debrief my block, I broke down, ready to accept that my medical career would be over.
But instead, she told me we were a team. That I was learning. In truth, the famed Swiss cheese model failed. I ordered the medication. My senior missed it. The pharmacist approved it. The nurse administered it. All the holes fell into a neat line.
This was my first mistake but not my last. Errors happen. They are accidental, incidental, unexpected, and accepted. Even when everything goes right, things go wrong. This mistake has made me more honest with myself, with medicine, and with my patients. As a second-year resident, I share this story with my interns not as a cautionary tale but as a promise: mistakes will happen, and we should talk about them in safe, vulnerable, and forgiving ways. With my patients, I speak about the unknown without hesitation, openly acknowledging my doubt while irrevocably standing beside them in the uncertainty.
I no longer think of medicine, or myself, as infallible, and I do so with pride. For the first time, I am wholly practicing medicine with the humility and compassion that my patients need, my team deserves, and that I aspire to carry forward.
Bhavya Ancha is a second-year internal medicine resident at the Johns Hopkins Hospital. She loves her job and is moved by the goal of making medicine better for everyone: patients and trainees.
Image by Nuthawut Somsuk / Getty
