Moving forward when I reflect upon what scares me the most, its being responsible for the death of a mother or child.  It’s knowing that either due to my inability to act or my acting/operating in an inappropriate manner that led to the death of a patient.  My worst nightmare is having to confront a patient and or family to let them know that irreparable damage has been done on my watch… to my patient…. to someone they care about.  How do you/they  move forward from that devastating news?

A few months ago I was a part of a post mortem cesarean section.  The mother coded early one morning on the floor after being admitted the previous night for pneumonia.  Nursing and staff was alerted after family noted the patient seizing in her hospital room.  ACLS was initiated and the patient was briskly moved to the operating room.  After 12 minutes of ACLS, the decision was made to perform a cesarean delivery in hopes that at least one life could be saved.  The infant was delivered and transported to the NICU.  A heart beat was finally maintained on my patient, the mother, and she was briskly closed in the OR and sent to the ICU.  No neurologic function was ever regained.  Flash pulmonary edema was noted to the be initiating factor of cardiac arrest.  Two weeks after delivery, the decision was made to take the patient off of life support.  She had been a stay at home mother, leaving behind 5 young children and a completely overwhelmed spouse.

We all come into medicine wanting to do our best.  No medical student/resident/fellow/attending wakes up and shows up to work wanting to do a bad job.  No one presents to the wards thinking that they will do a mediocre job taking care of their patient’s that day.  Some things are beyond our control.  The fear I have is being able to compassionately, accurately, and professionally discuss these events with a family who is about to have their entire world turned upside down.