Medical school has lately made me think of a class I took in high school that changed my life. Not biology or chemistry. No, it was driver’s ed. I can still easily recall the feeling of behind the wheel, my overly aggressive (and possibly alcoholic) instructor urging me to drive faster, my timidity giving way to increasing confidence in my abilities, up to the point where I almost blast through a light into a subcompact and realize: “Holy #%@! – I could kill someone with this thing.”
Increasing stretches of confidence punctuated with bursts of panic is the rhythm of medical education. Partway through year two, I begin to understand how problems in one organ might impair another. I remember more drugs without having to consult my smart phone. I’m even growing semi-comfortable suggesting how to tweak the medicine mix for a patient I’ve only known for 20 minutes. Then, every few weeks, often following a four-hour lecture tour of the unexplored islands of my ignorance, the terror bubbles up: “I’m going to kill somebody.”
I don’t fear the truly bone-headed mistakes, like giving blood thinners to someone bleeding into their brain. I should, because these fatal flubs kill thousands of people every year. But I have the hubris to believe four years of graduate school will keep me from egregious accidents. I do worry about missing diagnoses, the heart attacks that look like heartburn. What really scare me, though, are the arcane bits of knowledge that can separate life from death, things that seem trivial, even absurd. Like humming.
In hospitals, it’s pretty common to stick a catheter in a big vein – called a “central line.” Hopefully, all those lines that go in some day come out. When you remove one, a teacher warned my small-group class one day, make sure to have the patient’s feet higher than their head, and tell them to hum. Otherwise, an air bubble might float into their vein and kill them.
My classmates must have looked as dumbfounded as I felt, because the teacher assured us this wasn’t that rare a problem. A friend of his during residency hadn’t asked his patient to hum head-down. The patient died; the resident never really recovered either.
That was the third sudden-death scenario our lecturers presented in one day. That morning, a teacher warned us that giving pure oxygen to an emphysema patient in respiratory distress could paradoxically erase their subconscious drive to get oxygen, stopping their breathing entirely. Next came the tale of a young woman with normal oxygen levels and a rapid heart beat who was sent home from the emergency room with a diagnosis of anxiety. She died the next day from a blood clot hiding in her lungs.
The fact that U.S. health care kills 98,000 people each year doesn’t ease my fears. The fact that I have five more years of training before I’ll practice unsupervised does ease my fears a little bit. And, hey, I’ve driven for decades and haven’t killed anyone yet. I can feel my confidence surge already.