REFRESH
17/10/2019 1:16 PM AEDT

My Patient Almost Died From A Mistake I Made. I Apologised And It Changed My Life.

I learned that doing the right thing was probably best for everyone involved.

Courtesy of Jenny Recotta
Kate McLean in the operating room in April 2019.

Perfectionism is encouraged in the medical profession, and understandably so.  If a doctor prescribes the wrong medication or skips a crucial step in surgery, the effect can be catastrophic. The stakes are so high that being human can seem like nothing but a liability. We physicians don’t want to admit to our patients — or ourselves — that no matter how hard we try, there are no guarantees. Mistakes will inevitably happen.

One cold, gray morning, when I was a fellow in gynecologic oncology, I walked into the hospital not yet knowing that I was about to come face-to-face with my own fallibility. And that the outcome, which had significant professional and personal implications, hinged on one seemingly small thing: an apology.  

My patient was dwarfed by the hospital bed she sat in, but her eyes danced brightly under her gray curls. She had a strong handshake and perfect posture, and instantly reminded me of my grandmother. The sounds of the hospital awakening were all around us: nurses shuffling paperwork, EKG monitors beeping, laundry trollies clattering by.

She had a cyst on her ovary. It didn’t appear malignant, but having her surgery performed by our gynecologic oncology team meant that if cancer was found, any additional procedures needed to remove it could be performed at the same time.

“Nice to meet you, Dr. McLean. Now, when can we get this show on the road?” she asked.

Her husband patted her shoulder and chuckled quietly. “She just wants this over with so she can have a burger,” he said. “She’s been talking about a deluxe with cheese from Dick’s Drive-In all morning. We can’t understand why she isn’t allowed to eat before surgery — it just seems cruel!”

I couldn’t help but smile back at both of them. 

“General anaesthesia is safest on an empty stomach, but don’t worry ― after this type of procedure, most people are feeling well enough to eat later the same day,” I explained, briefly wondering if eating hamburgers for breakfast was the secret to a long, happy life. Many of my strongest elderly patients actually seemed to have some of the unhealthiest habits.

“And,” I went on, lowering my voice to a conspiratorial whisper, “I won’t tell anyone if you sneak something from Dick’s into the hospital. Just go slowly and don’t force it if you aren’t hungry.”

Her husband sought her hand, his knuckles whitening as he closed his fingers around hers. 

She might be focused on food,” he said, while she shot him an exasperated look, “but honestly I’m scared.”  

I could tell from her expression that her priority had been distracting him, rather than satisfying her hunger pangs, and he wasn’t exactly cooperating.

“We’ve been married for fifty-one years,” he went on, “and we haven’t been apart for more than a few minutes here or there since I retired. I wish I could stay with her now.”  

Tears were starting to glisten in her eyes. Impulsively, I put my own hand over both of theirs. “I promise to take really good care of her, sir.”  

She looked even smaller and more vulnerable asleep on the operating table.   While our attending supervisor put on his gown and gloves, the intern and I got started. I gave her an encouraging nod, and the intern inserted the Veres needle through our patient’s belly button and into her abdomen just the way I had taught her. This is the first step in robotic-assisted laparoscopic surgery, which allows us to operate by using a robot to control sophisticated instruments that fit through several tiny incisions.

Almost immediately, however, I heard the anaesthesiologist gasp from behind the drape.

“She’s crashing!”  

The next two minutes were complete chaos. I started chest compressions as our attending supervisor confirmed that the Veres hadn’t caused any internal bleeding. All I could think about was how much I wanted our patient to hold her husband’s hand again. When the anaesthesiologist finally called out that her heart had restarted, I sagged with relief, arms trembling.

All I could think about was how much I wanted our patient to hold her husband’s hand again. When the anesthesiologist finally called out that her heart had restarted, I sagged with relief, arms trembling.

We carefully inspected her abdomen and saw that her liver was enlarged, protruding lower than expected. At the very lowest edge, there was a tiny puncture, barely visible. We wondered aloud whether an air embolus could have flown passively through the Veres and into a blood vessel in her liver.

“That would explain why her heart restarted so quickly after you began CPR,” my boss theorized. “If there was an air bubble in her heart it wouldn’t pump properly, but the chest compressions likely pushed it out so it could dissipate.” 

We’d never heard of a complication like that before, but we all agreed it was possible.

Thankfully the rest of the surgery was uneventful, there were no signs of cancer, and she seemed to be stabilizing.

She spent the night in the ICU, but by morning, she was sitting up in bed, cheeks pink and hands steady as they smoothed the hem of her hospital-issue blanket. 

“You don’t know how happy I am to see you looking so good,” I said as I stepped into her room.

“I heard my surgery was pretty exciting! I feel a bit beat up, but otherwise OK,” she responded. 

My heart leaped into my throat, because while I had been anticipating this moment, I still wasn’t sure what to do. The previous evening I had reviewed her pre-operative CT scan and noted that her liver was visibly enlarged. The radiologist hadn’t caught it, and neither had anyone from our team.

It was the biggest mistake I had ever made, but I hadn’t been taught how to talk to patients about complications in medical school, and I’d never actually seen a supervisor apologize to a patient before. Was that because of a fear of being sued? Or because there’s this expectation that doctors are perfect? Either way, bringing it up felt like breaking some kind of unwritten rule.

“I’m so sorry I didn’t notice your liver was in the way before we started the procedure,” I said, going with my gut, my eyes starting to burn with tears. For a brief moment, it felt like the ground had opened up beneath me and I was free-falling. There was no taking it back now.

She looked at me searchingly, taking my hand in hers.

“Sweetie, the older I get, the more I’ve realized that nothing is certain,” she said. “I knew something might go wrong when I agreed to the surgery. What matters is that you all solved the problem. It matters that you care this much.”  

I pressed my lips together, willing my eyes to dry. 

“Not only are you tough, but you’re also clearly wise,” I said, when I finally trusted myself to speak.

“Now, when can I have some French fries?” she asked.  

This patient taught me that admitting a mistake didn’t mean that I was a terrible doctor; in fact, it allowed me to connect in a way that actually made me better at my job. She saw exactly how much her safety and well-being meant to me. 

Historically, research has shown that surgeons are unlikely to discuss errors with their patients, probably because they overestimate the risk of litigation. Although I only had my instincts to rely on at the time, more recent data suggests that when errors are disclosed and responsibility is taken, patients are less likely to sue. Better communication reduces liability costs, and apologies may actually be associated with more favorable legal outcomes. So, it seems that admitting to an error and doing the right thing is probably best for everyone involved.

When something goes wrong, it weighs heavily on me, but I’m able to own it and have an honest conversation about it with greater confidence. I don’t try to hide the regret and sadness I feel, either — when I’m sorry, my patients know it.

Since I broke the ice, apologies have come to me much more easily. I’m no longer in training, and I’m now solely responsible for my patients’ care. When something goes wrong, it weighs heavily on me, but I’m able to own it and have an honest conversation about it with greater confidence. I don’t try to hide the regret and sadness I feel, either — when I’m sorry, my patients know it.  

This lesson has also permeated far beyond the hospital. I’ve become a step-mom to a whip-smart teenager who lives with my husband and me full time.  When she first came into my life, I was terrified that I would fail her. What did I know about being a mother to such a mature kid, whom I’d only just met?

We’ve been feeling our way forward together for nearly three years now, and although I still make mistakes all the time, that hasn’t stopped us from growing close. Like so many parents before me, I get angry when I worry about her, as though yelling at her will somehow protect her from doing the silly, dangerous things that teenagers naturally gravitate toward doing. I have to check my own self-criticism too, because she never stops watching and listening. I want her to love herself the way she is ― the way I love her. So, when I’m not the role model I aspire to be, I’m open with her about wanting to change. I apologize.

Everyone ― even doctors ― makes mistakes, some small and some large, and the world won’t come to an end if we admit that. All of us — even robotic surgeons — are human, and our relationships are the better for it when we not only acknowledge that, but also embrace it.

Kate McLean is a board-certified obstetrician-gynecologist at the University of Washington Medicine in Seattle, and she’s working on a memoir about practicing medicine in the U.S. and abroad in Tanzania. You can follow her on Twitter at @DrKateMcLean.

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