I don’t always do the right thing. I don’t always figure it out. That’s the worst part of this job. The not being perfect part because not being perfect means I’m flawed and flawed people make mistakes and my mistakes can hurt people.
One time I almost missed a lung cancer. Oh God, the gut-wrenching weekend that I spent after that one. I must have lost 5 pounds just from the nausea that I felt. How could I eat? How could I breathe? My mind ground the details of the entire chart into a fine powder and then I sifted through that. Trying to account for every dust particle. How could I have failed so miserably? I could have just died. Truly. What a miserable wretch I was.
The crazy part is it couldn’t have been helped.
She had lung cancer a decade before. It came back. My angst came from –could I have caught it earlier? Should I have been doing more surveillance on her? It was back. It was bad and now she had blood clots. I took every ounce of blame onto myself.
How does one surveil someone after lung cancer? One can order CT scans periodically as a screen, but her insurance wouldn’t pay (it went to deductible). And it had been over 10 years. She did have the occasional chest X-ray. The last one just 6 months before and it was normal. She neglected to follow up with her oncologist or pulmonologist. She didn’t get mammograms or colonoscopies. She continued to smoke. Was it all totally my fault? I just didn’t find it early enough. Even if I did, lung cancer is so hard to treat…
This was such a lonely experience for me. Who do I talk to? I can not show anyone my weaknesses. I could not show that maybe I wasn’t diligent enough. Other better doctors would have done a better job. I couldn’t let them know. I just wanted so much to bounce the case off of someone else, like talking to a best friend. Confidentially. But I couldn’t. We just don’t do that.
It stayed with me. It churned in my gut. It gnawed at my mind. It stole my rest. It consumed me. And it wasn’t even that big of a deal. Except for her. It was a very big deal for her.
Photo Credit: Lorenzo Gonzalez
deconstructingdoctor.com 
Talk to me…the Gods know I have vented on you enough the last two weeks. 🙂
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Haha thanks sweetie! I might take you up on that!!😊❤️
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I can’t imagine how hard it can be.
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Mostly it’s good. Lots of saves. But you never forget the ones you didn’t. Like a beacon to your imperfections. Your humanity.
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I hear you. The saves must feel so good.
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Makes it worth all the turmoil😊
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It sure would help balance the heartache.
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well expressed!
many of the md’s i worked with
could have used generous doses
of time to thoroughly relax
and a regular support group. 🙂
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Truly. I wish the medical field and doctors would come to realize the health of the doctor -mental or otherwise, and all healthcare professionals, matters, too.
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Stop blaming yourself if you have not by now. The woman is to blame for not following up with up with the other MDs and the necessary tests. I can understand-I’m a retired RN and I think I can relate to some degree. We always think that we could have/should have, done more but in reality good people in the field of medicine have already done all they can do. I think it’s natural to be super caring when one is dedicated to the job.
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I have definitely “forgiven” myself. I think that’s the word I want to use. There’s only so much any healthcare professional can do, the patients sometimes get in their own way…
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That’s great and you are correct about folks getting in the way of their own care. 🙂
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As a former smoker who has tried to help people quit smoking, I wouldn’t be surprised if her denial was influenced by her addiction to tobacco – such an underestimated monster. And if I was a doctor, I think I’d need to go to therapy regularly.
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Hahah. Yeah the thought has crossed my mind!!! Tobacco use is one of the hardest battles I fight with patients. I tend to take an approach of education and support, and let me know when you are ready to quit, I’ll help you. Glad you were able to tackle that beast!
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You’re wise, brave and a sensitive woman to have shared this; all what you’ve mulled over, what’s burdened you, the self-doubt. It’s sobering to read your words, so thank you – dear doctor – for baring your stirred-up soul. We all have so much to learn…!
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Thank you. Being a doctor and being vulnerable don’t always go hand in hand. I just want to speak my truth even if it’s not comfortable for me or others. I think patients like that a doctor appears strong and perfect. Being flawed means someone isn’t perfect.
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You did everything you could, and the final result isn’t your fault. Angonizing over it now won’t change things and will only hurt you. People tend to forget that doctors are human, too. I can’t imagine how you doctors manage these types of things – in my field, the worst that can happen is that a house sale falls through.
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We get really good at compartmentalizing everything. Except like packing up and moving, putting things in boxes, you start running out of room, and the boxes need to be gone through and tossed. Time is our enemy. I don’t have the time so I start stacking the boxes on top of each. If I don’t get to them soon, they will topple over and crush me. Goodness such a morbid thought! My blog is my way of going through the boxes. I am sure you have agonized over a sale or two!!
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Ah, the difference is within this all is that you care!! And that my dear is the beauty of you. Someone (a doctor) who fails (and is flawed), but won’t admit it–now that is really the person who should be crawling under the rock and should be ashamed. Not you!! Because anyone in health care knows, the human body is a huge puzzle, mysterious and unpredictable. You can do something 100 times and get the same result and the do it again on another person and it won’t be the same. Plus the patient has a partial responsibility too…what was this person’s history that brought her to that point of lung cancer in the fist place? No blame, but we can only do so much. And you do more than most…..
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She didn’t follow up with her specialists and refused routine cancer screening. She was a tough personality.
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Well there you have it! Who then might be flawed too??
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Haha. Yes you are a wise woman! Love your perspective!!
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A good reminder for both patient and doctor – no one is infallible, and neither should they shoulder the whole responsibility of another’s life.
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I think most doctors feel responsible no matter what. We carry the weight of the world on our shoulders. Some do a better job of compartmentalizing than others. I’m learning.
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A therapist once suggested to me that caregivers need to remove the word “responsibility” from their vocabulary, as they are already burdened by too a great a sense of it, lol. Love your blog.
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Thank you that is great advise!
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The fact that you deeply care and want to help your patients will result in the best possible rate of success and drive you to keep learning and development of new skills and knowledge. No one wins gold every race.
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You are right. I have the best of intentions and sometimes a little patient cooperation helps😊
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I am a lung cancer survivor. I knew something was wrong,. I went to the doctor and told him the pain I had. He checked me out, and could not find anything. I insisted that something was not right I didn’t know what but there was something. He made me get a Ultra Sound, which turned into a Cat Scan which showed a small mass. The upper right lobe was removed. He said I was lucky it was very small.
My point is your patient had to know something was going on and if she ignored it that was not your fault. You are not a miracle worker. I am sure if she told you something was not right and she had cancer before you would have taken the necessary steps to find out what she was talking about. People don’t want to hear the word cancer but the earlier you find it the better your chances. I find that my body lets me know when something is not right. People need to pay attention to their bodies. What ever is wrong is not going to go away you need your doctors help.
So, from a patient who knows I can tell you, it’s wasn’t your fault.
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Thank you! She was definitely in denial about the potential for her cancer to return. She refused routine cancer screening and follow up with her specialists. You are right, she probably didn’t want to know…
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I’m a mom. I get it. I can well imagine how you feel and am terribly sorry.
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Reblogged this on Behind the White Coat and commented:
There are a surprising number of physicians who blog. I loved this post from Deconstructing Doctor about how it feels to potentially miss something, how it can eat you up, how isolating the medical profession can be. Check her out!
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Such a very good post. I have been there. Do you mind if I reblog this?
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Thanks😊. I don’t mind at all.
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I’ll do it at noonish today. 🙂
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I would be honored!
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