Monday, October 28, 2013

Compassion is Caught, Not Taught

I read these words today and this is the story I remembered.

In the early morning at the end of a twenty-four hour shift I stood over a newborn boy in the cold, brightly lit newborn nursery. His heart rate was fine, he was breathing easily, and he was moving his arms and legs. But his nurse had called me because his blood oxygen saturation stayed stubbornly at seventy percent, instead of the normal ninety-nine. What could be wrong? We tried giving him some oxygen, which didn’t help. We tried rubbing his feet and back, which sometimes stimulates deeper breaths. That didn’t help. As a senior resident I hated to do it, but I turned to the nurse and asked her to please call the attending physician for help. While we waited for him we tried suctioning the baby’s mouth and nose. His heart rate was still fine, so I wasn’t panicking.

My attending stepped into the room and said, “Why haven’t you tried positive pressure ventilation?”

I immediately grabbed the mask and the pressure bag and started giving the baby breaths. Positive pressure ventilation! Why hadn’t I thought of that? Within 3 breaths the little boy’s oxygen saturation was back where it belonged. We stayed next to him, monitoring until we were reassured, then retreated back to the on-call room.

“Tell me what you were thinking.” my attending said.

Now I wanted to panic. Words tumbled out of my mouth. “His heart rate was fine, and he was breathing and moving, and usually I don’t go to positive pressure ventilation unless the heart rate is less than 100.” Inside my mind I thought “Oh my God. Obviously that was wrong. I could have killed that baby. I should have known better. Oh my God.” I started to cry. Not quiet tears rolling down my face that I could discreetly wipe away. Huge sobs, choking off my breath and constricting my chest and sending a knife through my throat. Tears that left me gasping, unable to hide my distress. Now I had “Stop crying you blubbering idiot.” crashing around in my mind in addition to “Oh my God.” All I could force out between the sobs was “I’m sorry, I’m sorry, I’m sorry.”

My attending, a reserved and distant man I didn’t know particularly well looked at me calmly. “You’re really hard on yourself, aren’t you?” he said quietly. “It’s okay. Nobody died. Just learn from it. You don’t have to be perfect.”

Doctors are perfectionists. Graduation from medical training is built on decades of relentless hard work, at times brutal self-denial in service of learning, achieving, perfecting, succeeding. Doctors are the best of the best of the best, and failure is not permitted because it could kill someone. It doesn’t matter how 
tired, hungry, sick or in pain you might be. Mistakes are not tolerated.

I wish I could say that my attending’s gentle words freed me instantly. Instead, I slowly calmed down, we talked a few more minutes analyzing the mistake in my thinking, and I went home at the end of my shift to rest. But those soft words have echoed and grown through my years as a doctor. Now mine is the voice that murmurs to my students, my colleagues, and my own face in the mirror. “It’s okay. Nobody died. Just learn from it. You don’t have to be perfect.”