Simple steps

I've started my second year of residency with a rotation where I don't really function that differently from an intern. Our job descriptions are almost exactly the same: arrive stupid early, gather data on several sick people, round with our moody attending, and run around following up on details for the remainder of the day. The care of most of the patients on our ward is pretty specialized; under the fellow's supervision, I play at subspecialist-style management, but my actual decision-making is limited to basic inpatient medical issues.

Most of the time, I feel just like an intern.

Yesterday, one of the patients on the ward needed a paracentesis--drainage of a fluid collection in his abdomen. During morning rounds, one of the very smart interns wrote for an ultrasound study to mark the largest fluid pocket for drainage, and later in the day, I did the procedure. Afterward, looking at the patient's abdominal CT scan, I realized we had drained only the largest pocket to the left of the abdomen, when really, there was a much larger pocket on the right that would have been a more productive target for drainage. Furthermore, the attending doctor's note had requested ultrasound marking of the right-sided pocket. The ultrasound order had been written incorrectly.

Two mistakes happened here: the very smart intern's--ordering marking of the wrong side--and my own--neglecting to review the patient's studies prior to putting a needle in him. When I mentioned the error to the intern, however, he immediately took all the blame onto himself. I explained that I, too, had played a role in the mistake, and talked about ways we could both prevent similar mistakes in the future. He wouldn't have any of it--it was all his fault, he said. Later in the evening, on our way off the ward, he let on that it was quite possible he was the worst intern ever.

"Whoa," I said. I reassured him that he was an excellent intern who had the good fortune to also be human, and then shared this choice nugget from my own intern year. He cringed appropriately. I said, "Every time you screw up without hurting someone, thank your lucky stars and figure out how to keep it from happening again."

I realized then that one of the biggest differences between me and my intern is that I am used to making mistakes. I don't enjoy making mistakes, but I've developed ways to cope with them that go easier on the self-flagellation and that maximize prevention.

These are not natural or simple steps for a highly self-critical person. Maybe that's why they feel more like growth than any other change I've experienced in the past year.