Photo courtesy of Rachel

Alison, my resident at the Neonatal Intensive Care Unit (NICU) tonight, walks up to the counter, her eyes full of tears.

“What’s wrong?” I quickly ask, alarmed. Alison stays silent, too overwhelmed to say anything.

“Are you OK?” asks Grace, the NICU physician’s assistant, sitting next to me. Alison shakes her head.

“Do you want to go for a walk to talk about it?” I say. Having worked with Alison before on a different rotation, I knew she had trouble handling stress. Perhaps a NICU attending or patient’s parent had become upset with her?

Keeping her head down, Alison writes on her stack of notes, passing the top sheet over to Grace and me.

I messed up. I read the numbers wrong.

“What… numbers...?” I ask slowly, still confused.

Finally Alison answers out loud, “The pH numbers from this morning… I read baby boy Carson’s as minus 6, instead of plus 6!” Tears spill from her eyes. “It explains why his respiratory rate has been so low today…he’s more alkalotic than he should be!” More tears splash her papers.

A sick, nauseous feeling fills my insides, as I process Alison’s revelation. Baby boy Carson was receiving IV fluids that had been specially mixed based on Alison’s reporting of the pH. The wrong pH meant he was receiving the wrong fluids, a dangerous thing in a two-pound premature baby delivered at 25 weeks.

“OK, calm down,” advises Grace. “You can fix this by adjusting his IV fluids. Go talk to the overnight NICU attending and sort it out.” Alison rushes back to the NICU workroom, returning a few minutes later, looking slightly less frazzled. A few frantic phone calls later, the baby’s fluids are stopped, and new correct ones are on the way. The attending wasn’t happy, but thankfully, no damage had been done.

“I am such an idiot.” Alison says to me dejectedly. “Use tonight as an example of what not to do.” There wasn’t much comfort I could offer her—we both knew she’d made a mistake. This one hadn’t killed her patient, but it was a reminder that our actions had the potential to seriously harm patients, instead of help.

Usually as a 3rd year med student, I’m eager to get as involved in patient care as possible. This is one of the few instances where I’m glad to be just a student, insulated from real responsibility. The only consequence I face when “mismanaging” my patients is looking unprepared or stupid in front of the attending.

Why I want a job involving such high stakes and stress, I still don’t know. I’m probably crazy. Knowing that I’m far from perfect, a distant part of me has already accepted that, someday, a mistake of mine will hurt someone. After coming as close as possible to experiencing that with Alison, though, I’ll be working my hardest to ensure those times will be few and far between.

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