As a general rule, I tend to face challenges with over preparation, if possible. And over the years, I’ve come to recognize that this practice stems from an underlying fear of failure. But there have been occasions when I have taken on tasks with a relatively relaxed attitude. Such was the case during my final night on call as an intern.
Having endured the rigorous demands of other services that year, including transplant surgery, obstetrics, emergency and internal medicine, I presumed that my family practice rotation would be a cakewalk by comparison. But what ensued that night turned out to be both my most humbling and gratifying life experience as a physician.
That evening in late June, 1988 started as a fairly routine on-call experience. I had already confidently and effectively handled a few outside calls from patients for minor medical complaints, and then the proverbial hell broke loose.
Before I continue, a little background history is indicated…The family practice department at the teaching hospital where I completed my internship, enjoyed a national reputation for preparing its residents to work not only as ambulatory medical gatekeepers upon graduation, but also as competent hospital-based providers of trauma, labor and delivery, pediatric and adult medicine care. Such training equipped their physicians with the necessary skills to be medical “jacks of all trades” in underserved rural regions of the country.
To accomplish this formidable mission, these doctors received hands-on experience on multiple hospital services, while closely supervised by their respective specialists. And being the first accredited residency program established at this hospital, the family practice department had been accustomed to also admitting patients directly to their service. But as more specialty residency training programs came on board, some questioned whether continuing this tradition made good medical sense. Nonetheless, continue it did, with the idea that specialized consultation would be made readily available as needed. On that fateful night, however, I became intimately familiar with such expressions as “best laid plans” and “falling through the cracks”.
Without going into excessive detail of the nightmarish events that subsequently followed, suffice it to say that I was inadequately prepared, as was my back-up senior family practice resident, to competently meet the needs of several critically ill patients as first-line responders. As a result, 4 patients perished over the course of the next 12 hours, ranging in age from a feverish, floppy infant to an elderly lady with abdominal swelling. All of them had presented to the emergency room, and upon identification as family practice clinic patients, were quickly triaged to the on-call resident (yours truly), following cursory assessment. It was later determined in subsequent morbidity and mortality reviews (MMRs for short), that had these patients been seen first by the specialty services, the outcomes would most likely have been the same. Notwithstanding, in the immediate aftermath, I blamed myself for their deaths, attributing their demise to my casual orientation on the family practice service, which undoubtedly was related to my looking ahead to the start of my psychiatry residency in sunny Florida in mere days to come.
As the saying goes, man never stands taller than when on his knees. And having been in that position numerous times in the Catholic confessional during my formative years, I recall instinctively dropping alongside a bed in a resident’s call room, crying out to God to forgive me, not in a genuine way, but more as a cathartic reaction under the guise of sincere prayer.
The truth is that my ego had been severely injured. And though I was indeed distraught over the deaths of those helpless patients, I also remember worrying whether I would be granted a certificate of completion of my internship, which of course was a prerequisite for entry into residency. And it was at that very moment that I began to have serious reservations about the career path that I had chosen, as the latter thought should have never entered my mind. In fact, shortly before beginning morning rounds at sunrise with my attending physician, I had resolved that I was not morally deserving of the suffix title, “MD”, and impulsively prepared to submit my resignation later that day to the chief of staff.
Finally comes the story of “Mrs. Jones”…Just before daybreak, my self-loathing was interrupted by a page from a nurse on the family practice inpatient service floor. The call was about a patient, Mrs. Jones, who was requesting some medication for nausea. I had admitted her for a work-up of atypical chest pain in the preceding day’s afternoon clinic, which seemed like a lifetime ago.
Apparently, I had neglected to write prn or “as needed” routine orders for the typical and usually easily manageable patient complaints (e.g., nausea, headache, constipation, insomnia, etc) at the time of admission. So, reflexively I approved the order, as I had done a couple of hundred times previously and without incident, and hung up the phone. And then, something… SOMETHING struck me, That Which I’m convinced to this day, cannot not be ascribed to my education, experience, instinct, or just plain dumb luck. I had never experienced it before, so why was I then?...particularly while wallowing in the depths of narcissistic self-pity, wherein mental awareness of ongoing patient care responsibilities was nonexistent.
But the experience in the form of a strange, questioning premonition did occur, just the same…Mrs. Jones?
Mrs. Jones?? I remembered Mrs. Jones, the seventy-something, conservatively dressed and mannered woman from the clinic the day before. During a scheduled appointment, she casually reported having some “funny feelings” in her chest without other accompanying symptoms of classic angina, at least none that she volunteered. Just as a precaution, I admitted her for further tests, to which she reluctantly agreed, and had not given her another thought until that instant.
At first glance, my initial impression of Mrs. Jones had been that she was not somatically oriented nor one to worry or complain to others about her various ailments associated with the aging process. So, for what in God’s Name would she be calling the nurse at 5:30 in the morning to complain about…GOD’S NAME!
I promptly called the nurse back, and inquired as to Mrs. Jones room number, then hurried down to that location to discover her to be in some obvious physical distress as far as having difficulty breathing and exhibiting an ashen white complexion. She acknowledged at this point, that in addition to her nausea, she felt as if someone was standing on her chest. And that was all the information I needed to proceed further for emergency management of acute myocardial ischemia, which was subsequently confirmed and resolved in the ICU. Mrs. Jones had survived that night, not by my hand, but by God’s.
In the 30 plus years hence, I have thought often of how God intervened in my life then and many times since, when I have been on the verge of abandoning my faith in Him, not by direct rejection, but by lacking in constant awareness of Him. He has always been there for me when I chose to sense His presence, and there is no greater reassurance in life than that.
For those of you who, having read of my spiritual encounter with God, are perhaps asking yourselves, “Why haven’t I ever experienced a sign as powerful of God’s existence?”, I can only answer that your faith has probably been stronger than mine through similar struggles in your lives, and such intercession was not necessary. But if you doubt that explanation, then I have a responsibility to pass it on, with a faith and hope that my reality of His presence in my life becomes one for you. As John 20:29 reminds us, when Jesus spoke to Thomas, “…because thou hast seen me, thou hast believed: blessed are they that have not seen, and yet have believed."
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