No one likes to get sick. When we do, we put our trust in the medical professionals who are tasked to help us. However, they are human, and mistakes can happen. Sometimes the errors are harmless, but other times, they can mean the end of the road for a patient. These medical professionals shared their stories of mistakes that will leave anyone praying they never need medical attention—ever!
I did HIV testing, and I once showed up to work super tired because I couldn't sleep the night before. This guy came in for a test. We went through the pre-counseling, and then I told him to step out for a few minutes while the results came up. When he returned to get his results, I told him to take a seat. The first thing that came out of my mouth was, "Your results are positive".
Then I saw the look on his face, and that's when I realized I had messed up. I said, “Oh, no, no, no, I meant to say negative". I almost gave the guy a coronary.
I worked in palliative care, and I sent a patient home to see if he could spend his final moments there instead of in the hospital. We weren't very hopeful but thought it would be worth a try. To no one's great surprise, he ended up coming back a couple of days later for whatever reason. Since I knew him, I re-admitted him.
I knew he wanted to be a DNR (do not resuscitate), so I wrote it on my notes. But there was one crucial thing that I forgot. However, I didn't re-fill out the hospital paperwork. The next day, I got to work to discover he had coded and was on a ventilator in the ICU. Instead of passing peacefully, his wife had to make the decision to turn off life support.
My entire job at the end of life is to ensure as good a death as possible. In one simple omission, I messed that up royally.
I was a hospice nurse for ten years. I admitted a patient with cancer who had intractable bone pain. Based on my assessment, I expected it to be a week or two before he passed. In his case, the only medication that gave him any relief was morphine. His wife did a great job taking care of him and giving him his meds as we planned.
It was very effective, and he was comfortable. As he came closer to losing his life, he slept more, which was normal and expected. One of his daughters flew in to be with him at the end. She went bananas that "daddy was on morphine" and raised so much trouble that his wife freaked out and caved to her demands. She revoked hospice and called the ambulance.
When he got to the hospital, the daughter told them that he had taken too much morphine, and the ER room doctor gave him Narcan. What happened next was absolutely horrific. He came out of it screaming in pain and didn’t stop. He stayed in the hospital until he passed, and he suffered. It's been years since this happened, and it's still the worst nightmare of my nursing career.
There wasn't anything I could have done, but I still feel bad about it.
I was a nuclear medicine technologist working in a PET department. I mainly dealt with cancer patients. Prior to exams, I would ask the patients why they are having the test done and for any other vital information. One day, a female patient told me she found a lump, had a mammogram and a biopsy, and it turned out to be stage four invasive ductal cancer.
Having confirmed the information I had on my sheet with the patient, I made the mistake of saying, "Sounds good". To which she replied, "No, it's actually pretty terrible", and she broke down in tears. I will never say “sounds good” again when a patient tells me his or her diagnosis.
When I was working as a medical assistant in an interventional pain management clinic, I was asked by the doctor to place a grounding pad—a sticky pad like they use for EKGs—on the patient's leg during a radiofrequency (RF) nerve ablation procedure. The patient had some lotion or something on her leg that kept the pad from sticking properly, but it seemed mostly well attached.
I didn't want to hold up the procedure to get another pad or clean off the patient's leg. The pad ended up partially coming off right as the high-voltage RF was being applied, causing a small burn on her leg. There was no lasting damage done, and the patient was very understanding, but I still felt horrible. It was the first time I had caused harm to a patient, and it could easily have been avoided had I just spoken up.
I was a medic in the Armed Forces. This one Marine who came in for physical therapy seemed overly depressed, more so than usual. He had bad nerve damage where he could touch his leg, and it felt like someone was touching him in the back. I was more focused on the therapy that day and was excited that he was making progress.
He didn't seem happy about the progress and made a comment about how it won't matter. I wish I’d seen the red flags. I also recalled when he left, I said I would see him next week, and he didn't say anything and just left. Over the weekend, he took his own life. I still wonder if I had paid attention to his comments and not dismissed them as him having a bad day, perhaps he would still be alive.
When I was a new paramedic, we were called to a house for an unknown problem. We arrived and found the patient unresponsive but breathing on a bed. A friend of his found him after he hadn't returned his phone calls and had gone to the house to investigate. The patient didn't have any pill bottles lying around, and his friend didn't know anything about the patient's medical history.
So, I loaded him up into the ambulance and transported him to the hospital. I started an IV, did an ECG, drew bloodwork—the whole work up. We got him to the hospital, and the first thing the nurse asked was, "What was his blood sugar level"? I forgot to check it. It turned out it was incredibly low, which is completely treatable.
He probably wouldn't have required going to the hospital if corrected on the scene. Every patient gets a blood sugar check now.
Once, as a tired medical resident, I was called to the ER to admit someone at around 3 AM. This person had gall bladder removal a week prior and now had a surgical-site wound infection. I asked if they had taken the post-op antibiotics they were prescribed, and they weren't sure. I was getting more and more frustrated with this person preventing my sleep when I decided to take a pause and just shut up.
This usually results in some type of awkward silence. In this case, the guy hung his head low, looked at his feet through unfocused eyes, and started to sniffle while his halting voice cracked. He said, "I can't read. Never could. Didn't know the instructions they wrote down for me and didn't know I had medicine to buy. I didn't ask them because I was embarrassed". I realized people count on us to bridge such communication gaps.
I was considering starting medication for a young woman and gave her the script. Four days later, she found out she was pregnant. My prescription had clear teratogenic effects. I was sweating bullets. Fortunately, she decided against taking the meds, and I found out from the pharmacist that she didn't fill it. I left a message saying, "Don't take it"!
She called me back, thanking me for being such a great doctor, but I think I just got lucky.
I was an EMT ending my first year working at a collegiate EMS squad. Our dear college was known for drinking and going a little too hard in the party department. Although we get a good amount of trauma and other medical emergencies from sports events and other stuff around town, we get a whole lot of intoxication calls. I once got a call that seemed like a standard one of those calls.
The female patient was embarrassed we had been called, was really distraught, and crying. She refused to talk to my two crew partners or me. At least we were able to get a full suite of vitals that were all normal. I went to put her shoes on to get her ready for transport to sleep it off at the college's inpatient department, and she refused to let me touch her.
She picked the only female EMT out of the three EMTs and the three college security officers there and said she only wanted her to help her. So, the males in the room stepped outside for a second because, at that point, we were a little suspicious. This girl also was leaning against her own bed and didn't know where she was, how she got there, or what time it was.
She knew her name, but some things seemed off. Then she told the female EMT she felt unsafe and didn't trust us. Once we transferred care, the only follow-up we got on her was that it was a probable assault, which was on my mind after the call ran its course but didn't occur to me immediately. After that call, I went into every scene looking for signs of victimization, which is often related to drinking and is a problem on many college campuses.
I CT scanned a guy who didn't speak great English. He had a metastatic tumor in his right leg and was in pain. I felt so bad getting him to lie down for the ten or so minutes it takes to prep for the scan. He was screaming, crying, and kept holding up his hands in a prayer position and saying, "PLEASE"! I kept saying, "Just another minute, just hold on, it'll only be another minute".
We saw the scan and realized that he also had a broken hip. Everyone assumed his pain came from the bone metastases, but he had also fallen and shattered his hip. I felt terrible.
I was still a new EMT and had a new paramedic as a partner. We got a call about a man with no pulse. We arrived and found a 350ish-pound man in the middle of a water bed with no pulse. So the new paramedic did a quick look with the paddles and decided to shock. He couldn’t have known what a horrible mistake he was making. The shock created a muscle spasm and set off a gruesome series of events.
This led to the patient being wedged between the water bed mattress and frame. It was impossible for the two of us to un-wedge him. Never shock someone you can't lift, especially if they’re on a water bed.
I was in a cancer clinic, doing follow-ups. I had just messed up a medication choice, but I was under supervision, so it was fine, and I wanted to try and ask something smart to the oncologist. We were in consultation with a woman who'd had a mastectomy. I asked about the probability of the cancer recurring, which was stupid.
Now the oncologist had to answer and be very conservative, which would scare the patient. That really destroyed me. I felt like a total idiot.
I was a new EMT and had a patient in the back of the ambulance who required oxygen via a cannula. Usually, the gurney oxygen tank is much smaller than the house tank on the ambulance, so we generally switch over the gurney to the ambulance tank. So, there would be a small hose attached to the ambulance wall that would feed the patient oxygen to his nose.
Being my first time, I forgot to switch back the hose to the gurney, and upon removing the gurney from the back, I essentially choked the patient when the hose tightened. The poor guy thought he had done something wrong. I explained what had happened, and then he laughed about it. However, I found out later he still tried to sue.
I was a pharmacist working alone on a Saturday. Before closing, a woman brought in 19 prescriptions for her husband, who had just been discharged from the hospital. Then a swarm of people came in after her, and I kept getting interrupted by people who refused to wait until the next day for their Xanax. One of the prescriptions was for isosorbide mononitrate, a heart/blood pressure pill.
It was written for half a tab daily, and I filled it with instructions for one and a half. It was an average dose that I saw often and was well within the dosing guidelines, but it was too much for him. Several days later, he was re-admitted for low blood pressure, and the prescribing physician caught my error. I called his wife to apologize as soon as I found out. She was understanding.
I offered to pay for the out-of-pocket costs of the additional hospitalization, but she would not accept. Unfortunately, he was a very sick man and passed two weeks later of issues not related to my error. It could have been much worse, but it really made me realize the lack of help that puts so much strain on pharmacists.
It haunted me for a while, but I was able to get over it.
As a paramedic intern, I had one call, in particular, that stuck with me. We were called out for an early 40s male with chest pain. We got there to see a healthy guy sitting in his car, breathing hard. I got a history from his wife and an initial assessment of the patient. He didn’t have any history except for having anxiety problems and was previously treated for overdoing his anxiety meds.
The patient described his symptoms as being just like when he had bouts of panic. I hooked him up to the monitor, and everything looked fine. He had a slightly elevated heart rate, but his other vitals seemed to be within normal limits. I got him loaded into the ambulance and began the 20-minute transport to the hospital. I started treating him with meds for the chest pain protocol, and I started an IV.
Then, he told me his chest didn’t hurt anymore, but he couldn’t breathe. His vitals didn't line up with respiratory issues, but I put him on high-flow oxygen just to be safe. As soon as I got the oxygen on him, he started losing it. He told me he needed to get out of the ambulance. He started standing up, ripping all the wires off of him, pulling the oxygen off, and even pulled his IV out.
I struggled with him to keep him on the gurney and calm him down. I started another IV, which he pulled out. I hooked him back up to the monitor, but he pulled it off. Same with the oxygen.
The situation turned into me having to physically hold him down to keep him from jumping out of the ambulance on the freeway. I ended up having to be pretty stern.
I was yelling at him to sit down and stop resisting. I gave what little report I could to the hospital, holding the radio in one hand and his shirt collar in the other. All I could tell them was we had an agitated patient initially complaining of chest pain which had resolved, and he was now seemingly having a panic bout.
I didn't use the words "panic attack" because it wasn’t my place to diagnose, but the description of the situation spoke for itself. I had no current vitals to give them, cardiac rhythm, nothing. I couldn't even get him to keep an IV in. When we finally got to the hospital, we wheeled him in, still holding him down. The moment we transferred him to the bed, things turned from bad to worse.
He went from an agitated guy to a full cardiac arrest instantaneously. We worked him up in the ER bed for over 30 minutes. After the doctor called the time of death, he came out of the room with us, looking confused. "I thought you were bringing in a panic attack". So did we. To this day, I have no idea why he died or what was wrong with him.
I couldn't stop thinking that there was so much more I could have done for him had I been able to manage his anxiety.
I was in nursing school, and several of our clinical rotations were done at a sub-acute long-term skilled nursing facility. There was one patient there who was in her 80s, and she had just had her second above-knee amputation. She had multiple bed sores, CHF, and horrible diabetes that she never controlled. A classmate and I changed her brief and did some simple wound care on her.
I held the patient over to my side of the bed while my classmate cleaned her up. The patient started frantically grabbing at me. She had a history of anxiety, so I soothed her as my classmate finished up. We laid her on her back and elevated her head so she could catch her breath before I did my side. She seemed more at ease and let us finish up, but as we were leaving the room, she coded.
This facility was so small that most of the doctors only came in once a week, and none of them answered their phones to give orders during the code. So, the nurses and a respiratory therapist ran it. Her intubation was harrowing, with blood coming out of her mouth. Her ribs were broken during CPR. That's how her daughter saw her.
She never came back to consciousness. It was my first time talking to a family about DNR and what they wanted us to do to keep her alive. The daughter signed a DNR about 36 hours later, and the patient was gone the next week when we were there for clinicals. After that, I became a lot more in tune with patients when they try to get me to do or not do something.
Even if they don't know the reason for it, there always is one.
I was a registered nurse. One night I had five patients, two of who were being treated for cancer. One was responding well; one was not. I had looked through the charts briefly beforehand, noting vitals, labs, meds, etc. It was extremely busy, though, so I didn't actually write anything down. I went in to do assessments, and my one cancer patient looked good.
She looked healthy, had a great appetite, and was on the phone making plans for her daughter's high school graduation. Surely this was the gal who was responding well to treatment and was probably near remission. She asked me what her CA-125 labs were. CA-125 is a cancer marker that is one test used to measure the body's response to certain cancer treatments in some cases.
I told her they were much better. I said, "Yeah, I think they're in the 30ish range". She immediately yelled, "Oh my god, what”?!?! She started to cry. That’s when I knew something was off. I got nervous and said, "Uh, here, wait a minute, I may be confused. Let's just look it up in your chart together". I logged into the computer in her room, pulled up her labs, and her CA-125 count was sky high and much worse than it was at her previous draw.
I told her the actual lab results, and she said, "I knew it was too good to be true", and started sobbing for real. This woman was 45 years old and losing her life. I apologized profusely, and she was so gracious about it, telling me that she knew the moment I said it that I couldn't possibly be correct. She told me, "You never give up hope, you know, and I just wanted to believe so much that I might live long enough to at least see my kids to adulthood".
I ended up bawling and puking in the bathroom several times that night. I have never before or since cried at work. Later, I found out the devastating truth. No one had gone over her test results yet because they were so horrible. The doctors were conferring about whether to withdraw care entirely or try to limp her along until graduation, knowing that further treatment was hopeless, expensive, and probably not going to buy her more than a couple of weeks.
She passed two weeks later and did not live to see her daughter's graduation from high school. I will never ever give results I'm not sure about again, and I will never ever make a statement that I can't verify to a patient. I am still horrified by the anguish I caused her with my careless comment, and it has stuck with me for years.
I was a pharmacy tech in a women's hospital. We had issues in the past with labor and delivery not returning the unused narcotics they signed out for a patient. We had strict guidelines that would be written up if meds were not returned properly. I was on break one day, and this young new nurse, who I had never met before, sat down beside me and started crying her eyes out.
She decided to unload and told me how she forgot to put aside the unused narcotics she used and threw them in the sharps container instead. I told her I worked in the pharmacy and it was OK, and mistakes happen. As long as she had her trainer vouch for her, we could just deal with it on our end; the pharmacist just needed to be called. She told me she wished she had known that an hour ago.
Her trainer made her go through the sharps container and bloody placenta-filled sheets to find this small 2ml bottle, which was put in for return to the pharmacy once found. I was floored that someone thought it was better to expose her to that instead of just calling the pharmacist to ask what to do. That poor girl had such a terrible and dangerous first week of being a nurse.
I sometimes wonder if she stayed in that career.
While in med school, I encountered one patient many times. Everyone knew him. He had spina bifida with lower-body paralysis that also led to many other problems. Despite his poor lot in life, he was always really optimistic and calm about it all. Even when cleaning out a rectal ulcer for him—one of the worst smells I've ever encountered in my life—he was still able to joke around and make the procedure no different than applying a Band-Aid.
Eventually, this patient had signed a DNR order and requested no further surgeries. He was in his mid-20s and just tired of all the procedures. I was on a 24-hour call when the nurse paged me to check on her patient, and sure enough, it was him. We knew each other by that point and greeted each other. Then I saw that one leg was purple and twice the size of the other. It was an obvious blood clot and occlusion.
I went to wake up the senior resident on call, called the surgery resident on call, and they started prepping for immediate surgery. We hurriedly talked the patient into consenting, which he reluctantly did. What we didn't do was call his primary doctor, slow down to actually talk to the patient, or notify any of his family. That fact haunts me years later. The patient did not wake up from the surgery.
His family and doctor arrived at the hospital that morning to find him not in his room but in the OR. He passed in precisely the way he had decided he did not want to go, and no one got the chance to say goodbye. Everything we did may have been medically correct, but that doesn't make it right. We were all new doctors so eager to save lives that we never stopped to wonder if we were saving the person.
I was an RN. Throughout school, they drilled into us the importance of quality nursing, stating, "You are the last line of defense to catch an error. You, not the doctor, are the primary coordinator of patient care", etc. Even so, in my first months of work, I downplayed my role and expected that the doctor would always know what he was doing.
What I learned later was that every day I had 4–5 patients to be concerned with, while my doctors often had many more than that. Where I worked—in a small critical access hospital—the doctors had those admitted in addition to simultaneously managing their clinic patients, primary patients, and OB patients, and some do 48-hour ER shifts. They simply couldn’t be attentive to everything.
We had one patient who stayed with us for weeks. Initially admitted for lower extremity pain and weakness, he had undergone physical therapy, been worked up for fibromyalgia, had been aggressively treated with painkillers, and only seemed to be getting worse. I was concerned that he was beginning to show signs of delirium related to his narcotics, and I relayed that to his doctor.
The doctor ordered around the clock ibuprofen to supplement his analgesics and increased the duration between narcotics doses. Later, he was switched to Mobic, a longer-acting NSAID that required less frequent dosing. What the doctor never ordered was a GI prophylaxis. He was receiving daily doses of potent meds that could cause GI bleeding and got no meds to counter that effect.
The patient changed hands to another doc. The doctor did a thorough workup and finally found what may have been the most likely cause of his symptoms. The patient was experiencing spinal stenosis enough to pinch his lower spinal nerves. The doctor immediately ordered a powerful IV steroid twice a day for five days. But there was still something crucial missing.
Unfortunately, he did not perform a thorough medication review. He did not realize how long he had been on Mobic, how frequently the patient took ibuprofen, or that his GI system was not protected with Prilosec. He didn't know all these details because it was the nurse's job to snoop out these problems and present them to the doctor before harm could be done.
The patient developed severe GI bleeding. He was found ghost white and covered in sweat with blood pressure so low it was unreadable. We pumped him with fluids and shipped him out to a regional medical center, but, unfortunately, he didn't make it.
I was an internal medicine doctor that specialized in hospital inpatient medicine, also known as a hospitalist. I had a lovely but truly unfortunate lady who was in her late 40s and had metastatic cancer. It had spread to her brain and her intestine, causing persistent bleeding. She was in an out of the hospital for about two months. I knew she wasn’t going to make it, and so did her oncologist.
I began talking about what to do if she got sicker and neared the end. She wanted "everything". I was off, and my partner took over. She eventually got sicker, was bleeding again from her tumor, coded, was placed on a ventilator, and sent to the ICU. It should never have gone that far. I should have made her DNR. She had no hope of survival.
She should have had a peaceful end. Instead, she was intubated and passed in the ICU.
I was a respiratory therapist and worked most of the time either in the ICU or emergency department. One time, we had to resuscitate a patient who went into cardiac arrest. Due to me doing CPR, I displaced a few ribs off the sternum—which is common—but also managed to nick an artery, which is terrible. It was a grave mistake that I still regret to this day. The code team was wondering why the patient couldn’t sustain his heartbeat.
The doctor got an ultrasound reading of the chest, and true enough, the patient was bleeding like gangbusters. The whole inside of their chest cavity was soaked with blood. CPR made it worse too. The doc stuck a chest tube in to drain the blood while we kept on resuscitating the patient. The bleeding didn’t look like it would stop anytime soon, so a cardiothoracic surgeon had to determine where it was coming from. He passed a day and a half later.
I was a tech in a busy inner-city ER. When the doc ordered blood work on a patient, a little printer would print out the stickers with the patient's name and info and what type of test should be performed on that particular blood tube. On one particularly busy day, several patients needed to have blood drawn for tests.
I gathered up all their labels, grabbed my blood draw kit, and went to work. I drew blood on a couple of patients and sent them off to the lab. One of the patient's results came back off the wall wacky for someone who was there for something that wasn't very serious. The doctor took one look at the results and immediately ordered the patient to get hemodialysis.
The procedure is pretty serious, especially if you don't need it, but renal failure patients need it fairly frequently. Fortunately, before they rushed him off to the dialysis lab, a smart nurse put two and two together and realized I had put the wrong labels on the tubes. Never again would I grab multiple lab slips for multiple patients. It was only one at a time from then on.
I was a medical student looking after an eight-year-old boy who had broken his arm. He needed an IV but was terrified of needles. I was trying to calm him when he asked, "Will it be like what they did in the movie Elf"? I had not seen Elf, and I figured it must have been a pretty benign scene with that title, so I said, "Yes".
The kid started freaking out. I saw the movie later and understood why the poor kid got so upset. I became an expert in Barney, Dora, Bob, and Blue to try and prevent future misunderstandings. I watched some Teletubbies too, but it kind of freaked me out.
I worked in pathology for several years as a histotech. Once, I had two biopsies for two different patients waiting to find out if they had cancer. The pathologist ordered additional testing in which I had to cut additional sections of the biopsy to stain for specific qualities in the tissue. I mixed up the two biopsies because the two patients had the same first name.
I put tissue sections from one patient onto a slide labeled for the other patient. The other histotechs missed it when they double-checked my work. Even the pathologist missed it when he diagnosed the patient. Amazingly, the two patients ended up having the same type of cancer, and the mistake wasn't even caught until a week later.
I never felt so sick to my stomach. If these two patients didn't have the same type of cancer, they would've received the wrong treatment or maybe even been told they had cancer when they actually didn't, and vice versa. All because I didn't pay close enough attention. I will never forget that moment as long as I live.
I was working as an intern in an ER. I was the doctor in charge of the "small OR", where we did stitches and treated smaller injuries. Our small rural hospital ER had only a few cubicles that were only closed off by a curtain, so you could hear pretty much everything that was going on. It was a busy night, and behind one of those curtains, my colleague had just examined an embarrassed patient with bleeding on his junk.
His frenulum had ruptured. This was something I would be treating in the "small OR" later, so my colleague told him that he would have to wait a short time until it was his turn. Meanwhile, I did not yet know that I would be stitching up a guy’s schlong later. The nurse had just told me that next up there was a three-year-old kid with a small head wound waiting.
So, I got into my Dr. Kidfriendly-mood, stepped out of the OR, and called out, "Okay, let's bring in the little fellow"! What happened next is so hilarious, it’s unforgettable. From behind the curtain came the angry voice of a man saying, "HEY MAN! He's not that little"!! I was, of course, puzzled, but my colleague and the nurses rolled with laughter.
I tried to explain to the patient what had happened, but I think he believed that we had played a joke on him and was quite grumpy.
I was a medic in Israel, and most of the time, I was on a special ambulance for extreme emergencies or dangerous runs. After an overnight shift, one of the morning shift medics didn't show up, so I offered to take his spot. I didn't realize that the driver and other medic were both orthodox, but when I did, I said whatever and went with them.
On the ambulance, there was a hierarchy, and in this one, I was on the bottom rung mostly because I was only young. We got a call for an unconscious woman at a bus stop. When we got there, a homeless woman wasn’t breathing, had a very weak pulse, and had a locked jaw. In such cases, you're supposed to break the jaw to open the airway.
However, the other two refused to because they were men and she was a woman. They physically stopped me from intervening beyond trying to tilt her head back. We watched her pass, called the coroner, and took off immediately after they arrived. I stopped working with them immediately after and went home. The next day I filed a complaint, but it wasn't taken seriously, and I wasn't allowed to be in their ambulance again. I'll never forget that call.
I was an ER doc. I had a colleague hand over a patient to me. He was a 50-year-old man who had been picked up off the street at 8 PM after he had been out drinking heavily all day. He was accompanied by his friend, who confirmed that he had been drinking heavily for several hours. He had further said that they had been staggering home when the patient had staggered off sideways and ended up in a bush.
My colleague had seen and examined this patient and handed over to me that he was heavily inebriated and that he had asked security to come and assist him to the front door. He told me there was nothing to worry about. I was busy with two patients who were in bad shape, so I figured if it was all sorted, that's fine by me.
A couple of hours later, I was writing up my notes when I saw the same patient wheeled back in by security. They said, "Doc, this guy isn't right". When I asked them to elaborate, they said, "Well, we took him out front and stood him up. He just keeled over and hit the deck. This guy can't walk, never mind go home safely". I told them to bring him back in so I could see him again.
They put this guy in the room he came out of, and I wandered over to take a look. The booze was coming out of his bones. I said hello and gave him a shake. He opened his eyes, nodded, but said nothing. After examining him for a few seconds, I realized that he was not moving his right arm. Then I noticed that actually, he was not moving his right leg either, nor was he answering any of my questions. I knew I had to act fast.
I did a full neuro exam, and the guy was having a stroke. After a CT and blood panel, he was taken to the stroke unit. I learned never to trust information that is handed over to you, no matter how skilled your colleague is, and never to assume anything. The patient was indeed hammered, but he was also having a stroke, and the clinician who saw him first let the booze cloud his judgment.
I was a third-year medical student on my surgery rotation. It was a chaotic mess. I was post-call and in clinic and saw a patient who had some type of intra-abdominal procedure and was in for a follow-up. He lived in a trailer park on the far south side of the city, was poor as dirt, and clearly wasn't thriving post-op. He was dehydrated, and we were concerned that his bowels weren't moving.
I was told to admit him. I told the transporter to take him over to the surgical ward but somehow forgot to write admission orders, so he went over with no paperwork. He ended up getting put in a bed and stayed there for three days with no paperwork. He got IV fluids and bed rest for three days, but because no admission orders went over, he never got entered into the computer system.
He never showed up on our list of patients. The nurses just kept changing his IV fluids. He had no vitals, nothing. We were on rounds three days later and walked past his cube. My senior resident stopped and said, "Who is this guy"? The patient poked his head out, pointed at me, and said, "Hi Doc! When can I go home? I feel great".
He was completely better, probably because we did nothing to him. My junior resident whispered that I should just quickly write up admitting and discharge orders.
I worked in end-of-life care and had a 21-year-old developmentally delayed patient with sarcoma. He never understood death and hated pain. His parents only wanted him pain-free. I was working the night shift. I had poured my heart into his care since his diagnosis. He was in pain. He was in patient hospice because he needed a continuous fentanyl pain pump.
It was at 500mcg an hour, which is like 50mg of morphine an hour. I went through the process of calling the hospice RN, then had to talk to the pharmacist, who refused to up the rate. I was irate. I asked her to come to his bedside and assess his pain herself. I remember the parents looking at me in shock when I told them I didn't get the order.
I could not see him in pain. I upped the pain pump without an order. I went up the chain of command to cover my behind, but there were six hours when I made the clinical decisions myself without any orders. At the end of the day, symptoms matter, not the numbers.
Years ago—as a 45-year-old female—I stopped being able to have a bowel movement. I had always been regular. After the first week, I went to my doctor, who, of course, told me to take stool softeners, etc., and sent me home. The following week I was back in with pain, and he gave me the same answer but added in an enema. It was of no help.
What bothered me was that the enema came out as clean as it went in. Over a period of a month, I saw the doctor five times. The last time, he ordered an X-ray, saw nothing, and sent me home. I hadn’t eaten more than a few rare bites of food for days, and I was losing weight. My husband started freaking out and demanded a CT scan. The doctor complied, and I went in.
The tech did the scan and pulled my husband aside. He told him he couldn't diagnose me, and he's not supposed to say anything, but he told him to take me around the corner to the ER and refuse to leave. By that time, I couldn’t walk. I was in too much pain and too weak. My savior of a hubby grabbed a gurney and took me over to the ER.
A nurse tried to tell him he couldn’t have the gurney, and he told her what was going on. Within minutes it was like I was the only patient in the ER. Those people were incredible. They doted on me, and I always had someone by my side. Within hours I was having emergency surgery for stage 4 colon cancer. My doctor checked in once while I was in the hospital.
The next time I saw him was two years later. I had been through chemo, had my bowels reattached, and was seeing him because I contracted ringworm on my back during my second stay in the hospital. He asked what all my scars were from. I was dumbfounded. He completely dismissed my symptoms, I lost 20 lbs in a month, was in pain, and had not pooped in weeks, and he couldn’t remember that he messed up.
That was my last time seeing him. You would think a lapse in care like that would have given him a wake-up call—guess not.
I had just started working as a nurse's aide in an emergency room. I hadn't been on the job for more than two or three weeks. The greeter had called back and asked for help getting someone out of a car so they could be taken into the hospital to be signed in. I went out there with the guy who was training me. The patient’s skin was ashen, and they were cold to the touch.
I was shocked but didn't say anything because my co-worker was extremely nonchalant about it as we picked them up and put them in a wheelchair. He calmly wheeled them up to the greeter desk and walked away. I remember turning back to ask if we should tell the charge nurse, but I didn't say anything because I didn't want to sound naive. What a horrible mistake.
I thought maybe he noticed something I didn't, which is why he wasn't worried, or perhaps I misinterpreted their well-being. I certainly hadn't been trained to assess anyone; I was just a tech. We returned back to work about 20 minutes later, and the triage nurse was sprinting while pushing the aforementioned patient into a room and shouting, "I need a doctor over here"!
They looked a lot worse. A CT scan revealed that they had a brain bleed. I don't know what happened after because my shift was over and I went home. However, after that day, I never had any reservations about voicing my concerns about anyone's well-being. Observing and reporting were indeed within my scope of practice when I was a CNA. I failed that day.
I worked as a nurse for ten years, and my biggest regret was not standing up for a patient who had a rare condition similar to one I had. The doctors eventually labeled the mom as drug-seeking and sent them to psych, PT, and even notified CPS. All of it was ultimately resolved, and the mom had the geneticists send packets for the doctors to read up on.
They even included a scathing letter explaining how they should pay the mom’s bills and apologize. What always stuck out for me was not to assume the worst just because someone comes across as a little crazed. They might be going crazy from people, and doctors, not believing them.
I worked for a horrible doctor. He was a psychiatrist and probably the meanest person I had ever met. He yelled at his employees all day for anything. If a patient walked in for their appointment and he didn't like them, he would yell at us for 20 minutes about it before finally treating them. My job was more administrative, but one of my jobs was to print off any lab work patients had done before they came in and have the doctor sign off on it.
One day, I printed the labs like normal, but he was in an especially bad mood, so instead of having him sign off on the lab work, I just kept stalling just to avoid speaking to him. It turned out that the patient had some dangerous readings in his lab work, and they needed to be read quickly so he could be treated. Luckily, nothing bad happened because of it.
At the same time, I regretted letting intimidation from my boss stop me from doing my job when it could seriously affect another person.
I worked in an EMS unit. We got called to a home for an unresponsive 18–20-year-old. We arrived, and the patient was on the couch with snoring respirations. The patient was a known user and had been shooting up all night. We loaded the patient up while bagging him to improve his oxygen levels. My partner started an IV in the left AC, and another partner began drawing up the rapid sequence intubation (RSI) medications.
The RSI meds were pushed, and it appeared that the patient was now paralyzed, which is what we wanted. We began intubation and placed the laryngoscope blade into the patient's throat, and my partner asked for cricoid pressure. I applied pressure, and almost immediately, I got the shock of a lifetime. The patient opened his eyes and screamed, "STOP CHOKING ME"! The patient then began to put up a fight.
We all stopped and looked at each other puzzled since the meds we just pushed should have rendered him unconscious and paralyzed. We immediately established another IV and repeated RSI since we couldn’t leave him with an unsecured airway after pushing those meds. After that was done, we checked the original IV and found that we had actually pushed all of the meds into the patient's bicep.
It was my first month practicing medicine at a rural clinic in the middle of nowhere. We had a considerable substance problem in the area. I had an ex-con homeless guy come in who was a frequent flier in our clinic. He had been tagged as a drug seeker on his chart. He complained of a really painful rash on his forehead. It was small and looked like an impetigo-like rash above his eyebrow.
He demanded oxycodone, and I told him no. He claimed to be allergic to all NSAIDs, tramadol, and codeine, and he had a history of drinking excessively and Hep C, which limited his pain med options. I prescribed some other stuff for him and sent him on his way. Three weeks later, I got a call from our risk management officer.
It wasn't impetigo, it was shingles, and it had spread to his eye. He was admitted to the hospital, and they couldn't save his eye. But then it got even worse. They also found that he had AIDS. He threatened to kill me and blind me and filed a lawsuit against me, which was settled out of court. The whole ordeal really changed how I felt about practicing.
I was a pharmacy technician. One day I was extremely stressed and was rushing. Instead of issuing 5mg of the steroid Prednisone, I gave Prednisone 50mg. The pharmacist checked it and didn't catch it. However, I realized it when I was putting my stock bottles away. Luckily, it hadn't gone out yet, so I fixed the mistake and vowed to be 100% dedicated to one task at a time.
A few months later, somebody made the same mistake but did not catch it, and the patient ended up in the hospital for a few months.
I was an ER tech. We accidentally CT scanned a lady's abdomen against the doctor's orders and found a HUGE post-op abscess the size of a baseball. The doctor thought she just had a bladder infection and planned to send her home. She would have come back very, very sick, or maybe even in a body bag if he had. Accidentally scanning her saved her a hospital admission measuring weeks in length.
IF she had survived, she would have faced a six-figure bill as her reward. Sometimes our mistakes can be to a patient's benefit rather than to their harm.
The biggest mistake I made happened when a patient was being treated for acute coronary syndrome. I didn't check the type of anti-coagulation my intern ordered, and it ended up working a bit too well. My patient was in renal failure, and the medication couldn’t be excreted through the kidney, so the patient ended up bleeding from all the IV sites and the throughout the bladder.
Luckily, they ended up living and did fine after dialysis.
I was an intern at a rehab facility, and in the mornings, we would see the bulk of our patients. We had two exercise bikes that you rolled the patients up to, and they would get locked in on their wheelchairs. They would exercise both arms and legs. Many patients had oxygen tanks, some that sat in the back of their chairs, others that you had to wheel behind them.
My patient was done with their time on the bike, so I unlocked her, and she started to roll backward. Then I heard a loud bang followed by the souls of compressed air rushing out of a nozzle. Her oxygen tank fell over and landed just so that the nozzle popped off, flew across the room, and stuck into the wall. Not only did I launch a projectile that could have seriously harmed someone in the full therapy room, but if there was one spark, there would have been an enormous fireball.
I was a cardiac cath lab tech and was thrown into my first night shift at a different facility by myself after a short month of training. I had a script I would go by every time I would hook someone up to our power injector for a contrast study. The injector I had used in the cath lab previously was a lot bigger and scarier than the one I was using that night, but they are still dangerous no matter what.
I also didn’t have to worry about blowing IVs in the cath lab since we usually go through a much tougher femoral or radial artery. We did two test injections of saline, one by hand and one by the injector, to make sure the IV was patent and would tolerate the injection. Usually, this works fine, and if it blows, the body will simply absorb the saline, and you might get a bruise, that’s all.
However, this time, the IV blew RIGHT at the beginning of the contrast injection. The body CAN'T absorb contrast in this fashion, and the little pressure waveform on the injector remained "normal" looking. She didn't once cry out or scream as I injected her. I only noticed something was off when I started my scan and saw ZERO contrast in her torso. I aborted the scan thinking the IV blew outside of the patient.
I walked in to find her quietly sobbing inside the machine with a swollen arm about the diameter of a grapefruit. I pulled her out, wrapped a hot water-soaked compress around her arm, held it over her head, and rushed her back to the ER. I found out later she had to go to surgery for it and has long-term nerve damage from the compartment syndrome she suffered.
I've had people lose their life on my table and have been on a code team for my entire term in the cath lab. However, this one stuck with me since I felt I was directly responsible for it despite being cleared. It caused me to change my WHOLE approach when doing my contrast studies. Now, I tell people to SCREAM if their arm does more than burn when I inject them so I don't disfigure someone again.
I was a lab tech and used to work in histology when I was new. I got a skin biopsy specimen, and that day I was embedding the fixed tissue into wax, so it could be mounted on a cutting block to slice three-micrometer sections for staining. It's very important what side you place "down", based on how it was cut out of the body.
I messed up and placed it sideways instead of down. The person cutting the tissue couldn't tell and ended up cutting through the tissue. This was a problem because the patient had skin cancer, and they were looking at how far it had spread. Since it was cut too deep, they couldn't see the edges anymore. This meant the doctor had to cut a bigger piece of skin off to be sure they got it all.
That's when I found out it was a skin biopsy from the patient's nose. This patient had to have a bigger, potentially unnecessary, piece of skin from his face cut off because of me. I was horrified and learned my lesson that day on how important it is to be certain of embedding technique.
As a doctor doing locums, I was on-call, tasked with looking after urology patients overnight. When I signed up for the shifts, I was told I would be covering ENT surgery and orthopedics, which I had experience in. When I got there, I had to cover all three. At 3 AM, I got a call to see a lady with kidney pain. She was admitted and loaded up with antibiotics and painkillers and assumed the job was done.
She was walking around feeling fine with minimal temperature. We kept giving her fluids, but her blood pressure wouldn’t rise. All else seemed fine, so I gave her even more fluids until her BP was level, then got on with the night shift. At 9 AM, I got a call from the urology consultant. This woman had a blocked ureteric stone and needed surgery ASAP.
Instead, I had just given her antibiotics. She ended up in ITU and almost didn’t make it. Luckily, she lived and was fine ten days later.
I needed to have my wisdom teeth removed. However, my dentist didn't put me under when he was pulling them. He just socked me with one Xanax and said, "Hereeeee we go"! I could feel the hammer cracking my teeth in half and the slurping suction sound when they popped out. Needless to say, I switched dentists after that.
I was badly bitten by an iguana on my thumb. They had assigned a resident to sew me back up. First, he shot me about six different times with lidocaine, and we just watched it pour out the wound. So I felt each suture perfectly. Then, he was trying to sew good tissue onto a flap of meat that was obviously no longer alive but still attached.
Twenty-four hours later, it started to turn necrotic. Even at 12 years old, I knew that he had messed up. I cleaned some clippers the next day, removed the sutures, and snipped off the necrotic meat. I can't imagine the infection I would have had if I had just left necrotic flesh sewn into a wound from an animal bite.
Before medical school, I worked as a phlebotomist to gain exposure to hospitals. When I worked the night shift, our daily list of blood draws would print off around 1 AM, and I would start getting blood on the floor around 4 AM. I got really good. I could sneak in, lights off, tell the patient what I was doing, quickly draw blood, and get out with them barely waking up for it.
One morning, I went into a room, and the patient had a washcloth over his eyes. I told him who I was and what I was doing before tying the tourniquet around his arm and palpating a vein. About that time, his wife walked in and said, "WHAT ARE YOU DOING"? I told her who I was and was there to draw his blood. She said, "HE PASSED OVER AN HOUR AGO"!
I ran out of the room, apologizing.
I had a patient years ago for induction of labor. I knew her IV was good because I had put it in myself, and it hadn't blown. I kept turning up the medicine per protocol but no contractions. Later that afternoon, I moved the bed and discovered the IV had come apart, and I had been giving the floor oxytocin for hours. I replaced the contaminated IV parts and plugged them back in.
However, I wasn’t thinking far enough ahead—and that’s when I made a serious mistake. I didn’t realize I was essentially starting her meds at ten times the starting dose. She immediately started having contractions, closer and closer together until it was one big tetanic constant contraction, and we couldn't stop it. She was rushed to the OR and had an emergency C-section under general anesthesia.
It was completely what you don't want in a birth experience, which also carries a significant risk of complications. I felt absolutely terrible, and they wouldn't let me tell her and apologize. The family never knew what happened or whose fault it was. Fortunately, there were no adverse incidents, and the mother and baby were safe.
I worked as an operating room porter for a number of years to help me through school. I was cleaning up after an operation on an inmate who was Hep C and HIV positive, and I was working quickly and recklessly. I stuffed the blue matting and used aprons into the garbage. As I pulled up from the trash, I made a gruesome discovery. Blood was pouring from my hand.
Unseen and unknown to me, a doctor or nurse had left a scalpel in the blue matting. It was so sharp that I didn't even feel it when it cut me, but I was bleeding profusely. The nurses and doctors jumped on it right away, cleaned and prepped my cut, and got me on special meds right away. I had to get shots and check-ups regularly for the next year. Luckily, I was okay.
When I was a medical student on my surgery rotation, I was with only the attending surgeon in the OR. The residents on service were otherwise busy, so the attending impatiently decided, "Fine, I'll do it with just the med student". It was a relatively straightforward case, placing a gastric tube in a patient who couldn't eat.
The attending put a scope down the patient's esophagus, and I had a big needle to push toward the scope. He shined a light towards the skin when he entered the stomach, and I pressed on the skin and saw it dent in on the screen, showing we were in the right place. I thought I took that same position and angle and introduced the needle, except it didn't appear on the screen.
I pulled back, pressed again, tried again, and didn't see it. The attending grew frustrated and told me to push the needle in deeper. I had a twinge of concern but eventually hubbed the needle, which was several inches long. Eventually, the resident showed up and tried as well. He tried introducing the needle but couldn’t visualize it.
Eventually, he switched places with the attending and, after another try, got the needle into the stomach, and we finished placing the tube. I came back after my day off, only to make a disturbing discovery. The patient had passed from internal bleeding. One of the multiple needle pokes—or possibly a cumulative effect—had injured arteries in the abdomen.
Now, I know not to ignore that twinge. I also know that even "low-risk" procedures have a risk of catastrophe and always take care to mention that when consenting patients for surgery. I harbored guilt over it throughout medical school and still had hesitation the first time I did that procedure as a resident.
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