The Catholic Medical Guild of Singapore

Am I to blame? Posted on 12th Jul 2012, 11:11pm by admin

Primum non nocere. An all-important code in medicine.

Perhaps all doctors carry with them haunted memories of patients whom they believe they may have unintentionally harmed.

He was three years old and he had acute leukaemia. He came in one night with neutropaenic fever. I
took a history from his parents, examined him and found nothing remarkable, and ordered the usual antibiotics. It was busy that night and I was called away to see other patients.

A telephone call from the nurse came some time later. “Doctor, I think you need to come and give the first dose of antibiotics now. He doesn’t look good.”

He was shivering when I got there, his hands and feet cold despite the blankets. His eyes, previously bright, were glazed. My heart went cold. How did he get worse so quickly? My hands shook as I drew up the diluent and reconstituted the antibiotic solution.

It was meningitis. He didn’t do well.

Was I too late?

She was three years old. She had come to the emergency department for gastroenteritis. I examined her, started intravenous rehydration and instructed her parents to feed her the standard paediatric oral rehydration solution. Two hours later, she had finished. No more vomiting.

I went back to see her. It was 2 a.m.. She looks tired.

“She can go home. Please bring her back if she keeps vomiting or doesn’t drink well at home.”

They brought her back three days later. She was dead on arrival.

I was not present at the resuscitation. The consultant on duty stormed into my cubicle.

“How could you discharge her??”

I was stunned into silence. I cannot remember what else she said. But she was better when I last saw her.

The medical inquiry ruled that there was no lapse in care.

Later, I found out that her parents had sought the aid of alternative medicine healers. By the time they turned back to Western medicine, it was too late.

The consultant’s words lingered in my memory, for years afterward. I would later resolve never to blame the junior doctors under my supervision for apparently irrational decisions. Judgement takes time and tears to mature.

~ by Dr Alison Snodgrass

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