One Saturday night early in my internship, I was called to the cardiology floor to evaluate a patient with a fast pulse. I walked into the room, today still able to remember what room and which bed he was in. The man’s heart rate was about 150, and while he was tolerating it, he needed to have something done. I hooked up an EKG, both confirming the rapid pulse rate and the diagnosis, atrial flutter, with 2:1 block, so the atrial rate was 300 contractions a minute and half of them were getting through to the ventricles. Back then, before the anti-arrhythmic drugs we have today, massaging the carotid artery was one way to stimulate vagal tone and slow the heart rate. Thinking I could see the EKG well, I started massaging the patient’s right carotid artery.
I can still see the patient as he had a seizure about twenty seconds later. I took my finger off the carotid and he quickly woke up. I looked more closely at what I thought I had been watching. The vagal tone I stimulated was so strong that I blocked all atrial conduction, no longer 2:1 but rather 300:0, so that not one beat passed through the atrioventricular node to the ventricle. I had put him into cardiac arrest. Great job, Doc. No pumping, no blood. No blood, no brain function. When the brain suddenly gets no blood, one of two things may happen: coma, which is the most common, or a sudden burst of electrical activity, a seizure. I once seized when I fainted. A lot of “near death” experiences may be due to excessive brain stimulation due to severe hypoxia.
The attending showed up an hour later, looked at the patient, then the EKG, and finally me. He held up the EKG, looked down his glasses, and quietly said, in a British accent, “Are you the author of this?” I was embarrassed beyond belief. The patient was moved to ICU and fortunately made an uneventful recovery.
My misadventure with a patient’s neck was the butt of many jokes for the rest of my internship. For days afterward, every one of my fellow interns, when they saw me, would rub the side of their neck. Even today, I would be willing to bet money if one of the interns I knew saw me, the first thing he would do is put his hand on the right side of his neck and act like he was rubbing it. He did that every time he saw me for the rest of the year.
The first few times it was tolerable. Then, it became annoying and finally hurtful. I admit it. I screwed up. Do I have to be reminded of it every time you see me? What do you want? Should I admit to being the worst doctor in existence? Would that help? Should I quit? Would that help? Why are you doing this to me? Have you never made a mistake?
Later, in practice, I saw a psych patient whom I was convinced didn’t have anything neurological going on. A nurse disagreed, and she was proven right; the CT scan I ordered showed a large, benign brain tumor, which had caused the person’s problems. I might add while this is always a consideration, I only saw twice a benign tumor causing psychosis in all the years I practiced. Oh, I diagnosed the other tumor. For years afterward, the nurse reminded me of my mistake. Stuff like that hurts. It starts to eat away at a person. OK, I missed a tumor. I am a bad person, a bad diagnostician, a bad doctor, and on and on up the ladder of inference. Do you continue to have to remind me? Does anybody remind me, I wondered back then, about the diagnoses I did make correctly, the patients I did help, the times I was right and others were wrong? What about the case of Wilson’s Disease that I diagnosed on the first visit in the office?
Teasing is toxic. Maybe in small doses, it is fine, but only in small doses. Let the individual poke fun at himself or herself. And perhaps that is why I behaved the way I did last February 2, when the hike leader gave me a stuffed toy of a groundhog and told me quietly to start hiking before everybody else and put the groundhog on the trail somewhere where it could be seen. About fifteen minutes up the trail, I stopped and placed the groundhog on the edge in the sun, because frankly I wanted six more weeks of winter. I like rain; I haven’t seen enough of it in decades.
I waited, and when the first group of hikers arrived, one looked at the groundhog and pulled out his camera. He was dead serious. “Wow, a groundhog is up here!”
I thought he was kidding. He had to be. But the furry thing did look kind of real. I quietly walked over and put my hand down on the stuffed animal.
“Oh my God,” the hiker said. “I fell for that. I can’t believe it!!” I didn’t say anything.
And I haven’t since. The individual has mentioned the groundhog event to several people, but I have stayed quiet. Sure, I could have teased him about it, but a long time ago, I learned what I should have known all along: a good deal of teasing is toxic. It hurts, and it isn’t appreciated, no matter what people say. “Can’t you take a little teasing?” I heard as a kid. I should have replied, “Can’t you take a little poison?”
Boreal B[l]og 
April 1, 2016 at 17:34 |
Hi Dear Mike,
I really enjoyed reading your story. Well written. I completely agree with you On ‘can’t you take a little poison?!’. You are number one writer as well. 😊🍀🍀🍀👍🏻