To this day, I have never killed another human being. But I can tell you about a time when I was convinced I had.
Let me begin with a sobering fact: no matter how much you study in medical school, your earliest experience working with real patients will boil down to a mix of clumsiness, half-remembered science, and a bit of luck. You will recall, in a moment of hesitation, how you never balked at any of medicine’s complexities on your written exams. You will look down at your trusting, wide-eyed patient and realize your bravado has escaped you. And you will wonder why it couldn’t have been kind enough to take you along with it.
With a queasiness deep in my stomach, I gazed back and forth between the needle in my hand and a gentle woman I’ll call Claudia. It was a quiet afternoon in the emergency room during a sticky New York City summer. I was only a first-year student on a research fellowship, but my project was going slow and I was itching to try something clinical. After I nagged her for a whole morning, my favorite resident Supriya told me that a patient was complaining of abdominal pain and needed an IV in her arm for some fluid. People place IVs all the time, and it is not considered a risky procedure. Since I had never done one myself, Supriya agreed to let me do it with supervision.
Claudia was a dark-skinned and heavyset woman, about twenty years old, with a friendly round face. She had been sitting alone in a dim examination room, dressed in a loose blue hospital gown and fidgeting with her fingers when Supriya and I entered. We had spent some time reviewing the procedure, but as I looked down at the tangle of tubes, packages, vials, and needles in my hands, I realized that nothing in my twelve months of study had prepared me for the simple task of inserting a plastic tube into someone’s vein. My palms started to sweat. The room grew colder. My mouth became bone-dry. But then a small voice in the back of my head (perhaps my estranged bravado, watching from afar) reminded me that I had askedto do this, and that the longer I waited the stupider I would seem. So I took the patient’s arm, gently stretched her skin to expose a vein, and whispered “just a pinch” as I plunged in my needle.
Would it surprise you to hear that it was a flawless stick? It certainly surprised me to see rich, purple blood flood into the tubing as I advanced my catheter. Feeling like a prospector striking gold, I began filling vials to send to the lab. Everything was going as planned, and I was attaching the last vial when I allowed myself a small smile and a peek at Claudia’s face to see how she was doing.
My smile vanished. What had been a warm face with full lips and inquisitive eyes was now as pale as cream. Her lips were drawn, her brow knotted, and her eyes were squeezed shut. All of a sudden the going didn’t seem so smooth.
“Supriya,” I croaked, still holding onto the IV in Claudia’s arm. I caught her attention, and as we both looked up Claudia’s eyes opened and stared blankly at the wall. It already seemed that something was terribly wrong, but then Claudia began to shake violently and slumped toward the edge of her bed. My breath caught in my throat. I realized, in that moment, that I was worse than a medical novice. I was an audacious child who had duped the system into letting him play doctor. I had my first patient in front of me, I thought she was dying, and there was absolutely nothing I knew how to do to save her.
Supriya was far more useful. She managed to catch the still-shaking Claudia and shift her onto the bed, cautioning me to “save the line” (make sure the IV stayed functional, so we could give medication) and calling down the hallway for the nurses and other doctors. I was clinging to Claudia’s arm like my own life depended on it as a sea of green scrubs and white coats filled the room. Everyone was talking at once, passing around equipment and giving each other orders. Rather than try to understand what was happening, I decided to do what I deemed safest for my patient: walk out.
The rest of the ER was silent as the commotion surged behind Claudia’s door. I sat in a chair near the nurse’s station fiddling with my cell phone and wondering about my impending investigation for medical malpractice. Hoping Supriya wouldn’t get in trouble. Trying to remember the last name of the patient I had just killed so I could argue that she had been more than just a pincushion to me.
It took about ten minutes for everyone to file out of the room, going back to work without a glance in my direction. When Supriya came out, the first thing she did was walk over and demand to see my hands.“Did you get jabbed with the needle as she was falling?” she asked, watching expectantly as I peeled off the purple gloves I had forgotten I was wearing. My hands were pale, clammy, and still shaking a little, but I couldn’t see any injuries on them. I checked twice, because I didn’t think I would have been able to feel any if there were.
“I don’t think so,” I replied. Why was she doing this? Surely there were more important issues to discuss. I took a deep breath, stood up from my chair, and asked, “What happened to Claudia? Is everything okay?”
As it turned out, Claudia had experienced something called vasovagal syncope in response to seeing her own blood. Occasionally these reactions involve twitching movements that mimic seizures, but they resolve on their own and patients feel better with a little hydration. Put differently, Claudia passed out from being just as anxious about getting an IV placed as I was performing the procedure.
Claudia’s story ended well, but my story as a burgeoning physician was just beginning. I spent a long time that day talking to Supriya about Claudia, her other conditions, and what we could have done differently (as it turned out, not much). It’s a case that I won’t be able to forget, and one that will guide the way I treat patients moving forward.
I’ll be back in the ER next year as part of my clerkship. I’ll be sure to bear in mind the last thing Supriya said to me before we left that day: “Don’t be discouraged; it could have happened to anyone. Just keep practicing.” For the sake of all my future patients, I most certainly will.
Benjamin Wadowski earned his M.D. at New York University, and has remained at NYU Langone Medical Center to continue his postgraduate training in General Surgery.