What are you most afraid of after you leave here…

The second day of Telluride was possibly even more thoughtful and vulnerable than the first day. We started things off with a bang through the story of Bob Malizzo and the tragedy that faced his daughter Michelle. We had the unique and humbling experience of hearing from Dr. Tim McDonald who was directly involved in her care and in disclosing the events to her family.

The session then closed with a very challenging question posed to the group: What are you most afraid of after you leave here? My knee jerk reaction was probably one that most trainees would answer (beyond being worried broadly about patient harm which is, of course, also a major concern): I’m worried about the day when I kill someone’s child. Not if, but when… because inevitably a bad outcome will occur… because in medicine we are lifelong learners and therefore cannot know everything, cannot predict everything, and cannot protect everyone.

As a pediatrician the weight and pressure of caring for someone’s child is immense and unrelenting. It forever sits in the back of my mind as a constant reminder to be careful, to take my time, and to listen closely to every alarm or concern from my teammates. While I sometimes daydream about that glorious day when I’m finally an attending, I painfully acknowledge that the double edged sword of that autonomy and responsibility is the fact that I will be responsible when a bad outcome occurs. I worry that it will completely and unmistakably be my fault. And not necessarily in the legal sense (although there are worries about that as well), but in the eyes of the family, of my team, and of my own conscience.

I have had the unfortunate and painful experience of caring for a newborn infant whose death was potentially expedited or caused by medical mismanagement. While I absolutely felt the weigh of that truth I know it was nothing like what my attending (a caring, thoughtful, heart-on-her-sleeve ICU attending) was experiencing. And while we both learned from that patient and will carry them with us as we move on in our medical careers, as battle scars of our shortcomings or our dangerous optimism, I wonder… how many of those scars can I carry before it breaks me? How many times can I disappoint or devastate a family? How many times can I watch someone bury their child and know that I was helpless in saving them (or worse harmful)? I don’t have the answer to that question, but I worry that one day I will find out. I just hope if that time comes that I will be surrounded by supportive, caring, and understanding colleagues such as those around me today. I hope that in the end I did more good than bad, and that I did all that I could for the families faced with loss.

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