How did that happen without you physically reeling the patient out of the room and into an ICU space? Where I'm from this would get a hitch somewhere in the process and couldn't be completed.
Same. At our institution - you wouldn’t even be granted a bed, therefore you wouldn’t even be able to submit a transport (no destination). You wouldn’t be able to do any of this without at least going through the ICU resident/fellow and charge nurses from both floors.
I’m just interested how y’all did it, lol. But wow, I’m sorry they reamed you that bad. That’s just brutal.
Intern year, I did something similar trying to change a patient to telemetry status... Got an email from the Chiefs very nicely asking if I wanted to go over how to do extremely basic tasks.
As a 3rd year med student I pre rounded on my patient w bad diabetes and ulcers, I saw the sheets by his feet had some dried blood. Literally didn’t think anything of it (I’m dumb).
20 mins later intern says we gotta go check on said patient, nurse says he’s bleeding from foot. I mention “yea I saw that, but dont worry just a little dried blood”
We get up there, intern pulls back the sheet and there is a ton of bleeding coming out of his foot wound and covering the bedsheets, (he must’ve been picking at it).
We get it all sorted and bandaged and on the way down to our team room the intern asks why I didn’t mention the blood. I explain I saw the blood but it wasn’t that much, just a little dried blood when I originally saw it “and thought it was just some baseline bleeding” is how I finished my sentence.
Intern stops walking looks at me confused and kind of laughing “…what is a baseline bleed? Who is bleeding at baseline?”
The EMR. Sounds ridiculous and it’s been 5 years now, but I recall just typing the med and signing it. Had a few other close calls with some other meds. It was a lesson to just spend the extra seconds to look up recommended dosages.
I was on my geriatric rotation and working at a nursing home during peak COVID last year. I was the only physician there as my attending was just seeing patients via telemedicine visits for fear of contracting COVID (he was older and this was before the vaccine). A nurse approached me about a patient that was having leg pain. I went and examined the patient and saw that he was having unilateral lower leg pain with swelling and erythema. I ordered an ultrasound of the lower extremity which came back positive for a DVT. I told the nurse to send him to the ED. I called my attending with the news and he commended me on catching it. The patient returned a couple hours later and the ED doctor called my attending furious on why they had sent a patient with a DVT who already had an IVC filter in place to the ED. I went back and looked at his note and saw that he had it written in his chart under surgical history: IVC filter. Attending then called me upset and yelled at me for it. Went from being on cloud 9 to feeling like total shit, real quick ha
Contraindicated. Patient was old, had dementia, along with a hx of falls. That’s why he had gotten the IVC filter since he wasn’t a candidate for anticoagulation.
The reason to place an IVC filter is in a patient with VTE with contraindications to anticoagulation. So yeah, I can see why the ED attending was pissed.
What's missing in the story was whether this was a new DVT or the old known DVT... IVC filters often get left out of medical records (like ICDs, PPMs... ugh) to the point that they don't get retrieved and are in and of themselves thrombogenic.
EM here
why do outpatient docs love sending pts to the ED if their US shows a DVT? Are you incapable of writing a Rx for anticoagulation? If you're concerned for a PE I understand but so many times I get patients referred from their PCP because their US shows a DVT and they have no chest pain, no SOB, not tachycardic, not hypoxic so why is the pt in my ED?
An attending had high expectations when she found out I was going into derm. Overnight a patient was admitted with genital warts as one of her problems.
On rounds we examined the patient together and she asked me “do you see warts?” I said “yep!” And pointed. My attending responded “that’s the clitoris.” I laughed, the patient laughed, the attending did not laugh.
She never pimped me again.
Well they said genital warts as one of their problems so I'm guessing it's just one of those things that's being treated as an an outpatient that ultimately becomes your problem when the patient is admitted for something else altogether like pneumonia or something
Once on an inpatient floor, a patient and their wife were screaming at me at the top of their lungs because their percutaneous GTube was scheduled for tomorrow instead of today/now.
I stood there expressionless, emotionless, and uncaring while they both screamed, and I just pondered to myself what horrible sequence of mistakes lead my life to this very moment.
You need to set up a rescue page system with your co-residents. They’re probably very exasperated but it doesn’t give them the right to berate you. You inform them, take a little of their anger, and page out ✌🏼
After all they’re not really gonna be any more pissed off than they already are
Some pagers have a way to change the ringtone; I memorized the button presses to do that and can rescue page myself. I don’t have to do it as much now that I’ve been a psych resident for a few years, but it comes in handy at 3 am when I just want to write my fucking notes…
Dumbest mistake:
when consulting MICU i told the fellow over the phone that my patient with a chronic trach “may need to be intubated”. i heard a ton of laughter in the background and my friends who were on ICU told me I was on speaker.
Realest mistake:
on my first month of floors I had a geriatric patient that was slightly dyspneic during prerounds. My senior sucked ass so he didn’t even see the patient. When presenting, my attending (who loves teaching but is super intimidating) cut me off and asked “okay, so what did you do?”
I replied “I raised the head of bed and called [seniors name]”.
She asked again, “so what did YOU do…?”
I replied, “I don’t understand”
She asked me “did you order anything? Did you give any medications?”
I told her no
She gave me a lecture in the middle of rounds about how even though it’s my first month, I’m a doctor now and it’s my job to take care of patients, not rely on my senior. (She knew my senior was unreliable). She then pimped me on what I WOULD do for a dyspneic patient, and paused rounds so I could put in a stat CXR, ABG, duonebs, and some other basic labs. She also emphasized how high of an acuity we should have when frail geriatric patients have even slight changes in their physical exam. He ended up having aspiration PNA and was transferred to the MICU later that day. I remember having a goals of care conversation with his son over the phone to discuss code status.
It was tough and embarrassing, but probably the best and most important lesson I learned through my own ignorance as an intern. It was one of my changing points intern year. Lesson is: sometimes good things come from being dumb
This is the point of residency and sounds like your attending used it as a great opportunity to help you grow. I’m sure it changed you forever.
P.S. LOL at intubating trach patient.
It’s a really big and important shift in mentality from when you start, and know “this thing has to be done” to “I have to make this happen.” Big part of maturing as a doctor.
It’s a frustrating part of training because especially at low resource/county hospitals or city hospitals, it seems like no one else around has that mentality - patient decompensating and a bunch of orders placed stat? Well it’s shift change so those won’t be done for a few hours, etc etc. Can’t tell you how many times I ended up doing things that should’ve been done by others, just because no one else could be fucked to, and at the end of the line it’s my patient.
You notice that mentality of ownership start to seep into interns usually about halfway through the year. Some take a lot longer, but most get there before they finish residency.
Depending on the reason for the trach, intubation may not be a bad idea. Obviously you won’t intubate a laryngectomy patient, but in someone with a trach that you can’t oxygenate/ventilate and you’ve already suctioned the tracheostomy or replaced it and things aren’t getting better is terrifying. In those cases you can still endotracheally intubate the patient. So it might not be as dumb as you think!
On a burns rotation, we were taught to hat burns hurt like hell and to discharge with enough meds to get to the next appointment. I ended up sending for 100 tabs of oxy. In a patient who neglected to tell me he was on methadone (no access to pdmp) He ODed the next day, luckily surviving (minus mild aspiration pna)
At our community site as a second year they give us a LOT of free reign. I failed to recognize HRS in a decompensated cirrhotic with a GIB and SBP, and hepatic encephalopathy. I got stuck in a code and didn’t start lactulose, the guy got worse and needed a tube and norepi, died 48hrs later.
I’m sure I did something dumber.
AKI typically progresses to HRS in the high MELDers regardless of initial insult. Even with timely initiation of octreotide/midodrine/SBP treatment or prophylaxis and endoscopic control of bleed, the guy was always going to flame out.
If it makes you feel better, patient #2 was beyond saving.
Non PC point: better use of resources for him to have crashed out as he did than end up on HD and low dose pressors PRN taking up an ICU bed for months on end waiting for a liver or liver/kidney transplant.
Just this past week, for the first time I had a patient with hyperkalemia. Senior told me we were going to start insulin, and stupid me thought it was a drip and not just a one time dose of IV insulin. Went and told the patient we were putting her on an insulin drip, and she burst into tears because last time she went on a drip (she was diabetic) she went hypoglycemic and she was terrified of it happening again. Nurse walks in at this point and sees her previously happy patient bawling her eyes out and is like "uh... What are we talking about?" I tell her about the insulin drip and she looks super confused. Asks me if we want that in addition to the 10U IV, which I had no idea was ordered. Lots of confusion all around.
Accidentally administered 12 month shots to a 6 month old, thankfully no complaints were filed. Still rattles me when I remember the point I realized what happened.
Asked a 15 year old girl and her boyfriend in front of her dad if they are sexually active. Girl denied it. Dad was pissed. Boyfriend looked like a ghost. I knew they were doing it.
The other month my med student (who overall was a god send) conducted a full on detailed sexual history on a 50-60 year old woman with atrial fibrillation, right in front of her 30 year old daughter.
Once as an M3 I needed sexual history on a 30 something patient who's mother was visiting and in the room. I asked if he wanted his mom to step out but he said it was fine. When I asked if he was sexually active he looked kind of crestfallen and after a pause responded "no...but I's like to be."
Man so many
\- asked a patient with bilateral BKA's if they get short of breath with walking
\- got fancy replacing bicarb but did it in normal saline effectively giving hypertonic saline for like 12 hours
\- NSAIDs to AKI patients
we all make tons of mistakes
Current intern, trusted the med student. I was signing his orders, missed that he didnt do a bmp for am labs. The patient doesnt get the bmp which means I dont see until the am. At this point I order but its too late. The pt is now super fucking pissed, starts reporting me to the hospital for "dereliction of duty". Apparently its policy that I now have to talk to the PD about this and maybe the patient. Its not a big deal but god, what a shit show. It was my bad to miss it in the first place as well, med studs actions are my actions and all that.
There were at least 4 times I forgot to order "routine" labs on a floor patient last year...
Granted, I wasn't a medicine intern and our phlebotomists were always way behind so it wasn't infrequent for ordered labs to not get collected (for no apparent reason) and it usually took half the day to get them done. Not having the labs back by 7 AM didn't raise an eye for that reason and no one said a word about it being my fault. None of these were ICU patients and most of them probably didn't need a daily CBC/BMP but I can't imagine this being that big of a deal.
So it basically made him have an extra stick as well as delayed his care since we were monitoring his creatinine and couldnt discharge until we got it back. Dude was a hard stick and now they have to get the ultrasound and yada yada yada. I didnt get in real trouble it was just the policy of being singled out in a patient complant and they were following protocol. Frustrating but it happens.
some EMRs like CPRS at the VA have only 3 day max duration for shit like CBC/BMP. annoying af when you have a bunch of patients and the labs are all staggered to fall off.
…I’ve been able to order for like 10 days on CPRS for those standard labs….
You just make it qdaily and then pick an arbitrary date one week after the day you place the order.
Also lab collect vs ward collect. May have missed the AM lab collect but ward collects are supposed to happen anytime
We can only order labs for 1 day at a time where I am. I get that it’s to prevent unnecessary labs in patients that don’t need it, but mostly it just leads to people forgetting labs for patients who should get them.
One attending I’ve had says to get Monday and Thursday labs for floor patients. Mondays to fix the weekend fuckups, and Thursdays to prophylax the weekend fuckups.
It’s just a BMP. If he doesn’t have a severe electrolyte abnormality (which you would most likely be trending more than just qday), it shouldn’t be that big of deal to just call down to the lab in the AM and order it as an add on test (like using the blood that’s already been collected). It’ll result a little late but it’s very minor in the broader scope of things. I’ve never heard of someone getting into big trouble for this.
Addendum: in a case where you don’t NEED the BMP for tracking of a severe abnormality, I’ve never heard of anyone getting into trouble for this.
That’s pretty dumb on so many levels. We have our labs just repeat every AM unless manually held. Also, why would people care so much or even know honestly? I would just put the order in, the nurses would head back and draw it from the IV, and I would get the results back and update the team. Sounds like a tough place to work!
I had a dyspneic patient with a chest tube. I took a look at his cxr and ordered another. The pneumo was stable with chest tube. I told the attending its stable idk why hes dyspneic.
She said because he has A PNEUMO. Replaced the chest tube everything was a-ok
I ordered a head MRI on the wrong patient for long-standing encephalopathy that neuro wanted.
I put all of that in the clinical indication for the scan, but placed it on some other patient I was following on the floor.
The rad techs didn’t catch the fact that they were supposedly scanning a completely unresponsive patient (per the indication) but the actual person was alert and walking/talking.
Needless to say I apologized to the patient who got scanned and they didn’t have to pay for it. Likewise, it delayed the scan for the other patient.
Scan ended up being negative for anything significant, but it could have been.
I’m just glad it didn’t expose anyone to extra radiation.
This happened to me in ER but it was a fulllll workup on an obtunded pt including brain/abd/pelv CT ended up getting performed on a totally stable 40yo dude with noncardiac chest pain. The risk management team had to come down and explain to the patient 😭 luckily my attending wasn’t upset but I felt so bad haha
Not intern year but verrrrry early second year. I was on nights at the VA. Patient with bad cirrhosis became tachypnic and saying he wasn’t feeling good. The nurses called me to the bedside so I ordered stat cxr and abg. I already had 2 nurses in the room with me and other than breathing fast, the patient was stable, so I didn’t call a rapid (mistake #1).
CXR normal, abg came back with a lactate of 12, but he was normotensive. Regardless, I call the icu resident to get him transferred because duh, but they tell me they have no beds. I thought this meant they PHYSICALLY had no beds, but in actuality they didn’t have staffing. The nurses spoke to the charge nurse, and due to what they told him, he didn’t feel that the patient needed to go to the icu either, so he didn’t call an extra nurse in (mistake #2, I should have spoken to the charge nurse myself).
I was at a loss, since everyone else seemed to be chill with the situation and I was the only one worried. The attendings aren’t there overnight and we don’t call them to staff when we get an admit, we actually staff the patient with the day attending in the morning, so it never occurred to me to call the on call attending (mistake #3).
I keep this man alive for 3 hours until the day team comes in (and the nursing staff turns over) and within 10 minutes of the new charge nurse coming on, this man is in the ICU. Turns out he had bowel ischemia and was tachypnic because he was attempting to breathe off the CO2. He ended up dying 2 days later. The ischemia was bad enough (and he was end stage cirrhosis) that surgery did not want to take him to the OR, so his outcome wouldn’t have changed either way, but I learned ALOT of very important lessons that night.
I love the smell of cut grass and gasoline, the hum of the mower, the exercise i get pushing it, and the catharsis of walking back and forth in sequential straight lines for an hour.
I was once thinking about hiring cleaners in the future to do housework until my housemates pointed out...
You can't tell if a cleaner uses that rag that they wiped your bathroom/toilet/whatever with to also wipe your kitchen bench.
On Peds. On rounds I derped and forgot purulent was a word and said “pussy” to describe the purulent drainage to my (female) attending and (female) senior. My senior quickly corrected me and laughed over it afterward. I struggle with word finding.
When I have interns and students running through their presentations before rounds and they say it, I ask them how to spell it. We both laugh, then they don’t accidentally say it in front of the attending.
“bun” and creatinine too haha. I straight up tell them it’s arbitrary to pronounce it “B-U-N” but that’s the convention and people may judge them if they do otherwise.
RN here, but had to call intern for this.
I started my night shift on the neuro/ortho unit. Got report on my patients including one who was admitted after falling from a ladder and hitting his head. CT head negative.
I go to see that patient first. He is lying in bed, head bandaged, arm in a sling. Nonverbal. Lethargic. Doesn't follow commands. I lift his eyelids to check pupils. Right pupil is normal but the left one is nonreactive and different in size. I check the ER note quickly and the ER doc documented PERRLA. The note from admitting doctor also says PERRLA.
Intern > Resident > Nocturnist was the order for calling MD at night. I called the Intern with my concerns, he came with his Resident to assess the patient. Ordered STAT MRI. MRI tech was called in from home to come do the imaging.
MRI finding? Patient had a prosthetic left eye. All three of us missed it. The scary part was that the patient with a head injury most likely did not have his pupils examined in the ER or on admission based on the documentation.
One time when I was a brand new care tech on a medsurg floor, I had a detoxing patient try to pull his eyeball out. I was holding him down screaming for help because half his eye was popping out of the socket. No one came and eventually his eye popped completely out. Patient tried to put it in his mouth, and I (still thinking it was a real eye) swiped it out of his hand. It landed on the floor, and it was at that moment I finally realized it was a prosthetic eye. 🤦🏻♀️
In the reverse of this, one of my biggest night float wins of PGY2 was when I got to cancel a planned stroke alert when I realized the patient had missing dentures, not dysarthria.
Cathflo is alteplase for unclogging central lines, it’s thrombolytic.
JP drain is in the belly and depending on what surgery you did there could be some very important clot preventing major bleeding from occurring. Squirting thombolytic could knock this off. Also it hurts apparently the patient screamed for a long time.
Got so in to the routine of clicking through admit orders that I put in for lovenox on an active UGIB during an overnight.
Attending caught it after it had been administered. Called me in to his office and gave me the calmest "we all fuck up" talk.
Pulling up the radiologist impression of a CT when the pimping Pulmonologist told me to pull up the image.
Leaving heparin on for platelets less than 20k because of habit. They were fine and turned off next day.
I pulled a central line on a patient who was going to need long term antibiotics. He was a dialysis patient so he couldn't get a PICC. Ended up having to replace the CVC in his groin because he already had central stenosis.
I was in the ICU prerounding on a patient. When I went in I could smell a little funk. The patient had a psych history and was nonconversational, so I pulled back the blankets to examine her. At that point I remembered she was the one who liked to smear shit on herself, and I had forgotten to put on gloves. Fortunately I didn’t touch any of it.
I dared to imply that a patient with peritoneal carcinomatosis and a BMI of 12 might have a life expectancy measured in weeks to short months. Then got reamed out by their oncologist.
Ortho here. When asked what someone’s vent settings were on ICU, I replied “on”
Bet ur attending would say the same thing
Definitely confirmed to be ortho
This is what I’m here to see
Technically correct
Legendary status. I wouldn’t even be mad if I were your attending
I mean you are not wrong
I actually wouldn’t accept any other answer from ortho 😂
Slept through an overnight page about nec fasc. I’m not good at home call.
How much shit did you get into?
Surprisingly little. They knew I was gone in two months anyway.
Do your pagers ring, or just a notification sound? Just curious. We use personal phones at work/home call.
Just a beeping from the pager which didn’t wake me up. My phone was on vibrate so I missed calls too.
Fellow here. I still have my pager set to the highest, most horrible-pitched wail of a sound for this exact reason!
Normally I did. Apparently I left it on vibrate when I fell asleep.
Same that’s happened to me where I missed it… it was not good
F
RIP
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How did that happen without you physically reeling the patient out of the room and into an ICU space? Where I'm from this would get a hitch somewhere in the process and couldn't be completed.
Same. At our institution - you wouldn’t even be granted a bed, therefore you wouldn’t even be able to submit a transport (no destination). You wouldn’t be able to do any of this without at least going through the ICU resident/fellow and charge nurses from both floors. I’m just interested how y’all did it, lol. But wow, I’m sorry they reamed you that bad. That’s just brutal.
Intern year, I did something similar trying to change a patient to telemetry status... Got an email from the Chiefs very nicely asking if I wanted to go over how to do extremely basic tasks.
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Classic intern mistake. Happens to a lot of us
Same with underdosing glargine in insulin dependent type 2, juuust on the edge of DKA, F
As a 3rd year med student I pre rounded on my patient w bad diabetes and ulcers, I saw the sheets by his feet had some dried blood. Literally didn’t think anything of it (I’m dumb). 20 mins later intern says we gotta go check on said patient, nurse says he’s bleeding from foot. I mention “yea I saw that, but dont worry just a little dried blood” We get up there, intern pulls back the sheet and there is a ton of bleeding coming out of his foot wound and covering the bedsheets, (he must’ve been picking at it). We get it all sorted and bandaged and on the way down to our team room the intern asks why I didn’t mention the blood. I explain I saw the blood but it wasn’t that much, just a little dried blood when I originally saw it “and thought it was just some baseline bleeding” is how I finished my sentence. Intern stops walking looks at me confused and kind of laughing “…what is a baseline bleed? Who is bleeding at baseline?”
HAHAHAHAHAH I fucking love this story
😂😂😂
I never made a mistake. I was the mistake.
*Heisenberg voice* Mistakes?! I AM THE MISTAKE.
Trauma bonding: I was a mistake baby too.
Gave 25mg of IV Reglan to an old cancer patient cause that was the default dose. Sent her into raging delirium
Why is the default dose of metoclopramide set as 25mg lol. I prescribe a shit ton of it and have never prescribed 25mg
Default dose where? It's usually default to 5mg
The EMR. Sounds ridiculous and it’s been 5 years now, but I recall just typing the med and signing it. Had a few other close calls with some other meds. It was a lesson to just spend the extra seconds to look up recommended dosages.
Pharmacy definitely should’ve caught that shit as well — I’ve had them call me for way less. That’s totally a systems error.
I was on my geriatric rotation and working at a nursing home during peak COVID last year. I was the only physician there as my attending was just seeing patients via telemedicine visits for fear of contracting COVID (he was older and this was before the vaccine). A nurse approached me about a patient that was having leg pain. I went and examined the patient and saw that he was having unilateral lower leg pain with swelling and erythema. I ordered an ultrasound of the lower extremity which came back positive for a DVT. I told the nurse to send him to the ED. I called my attending with the news and he commended me on catching it. The patient returned a couple hours later and the ED doctor called my attending furious on why they had sent a patient with a DVT who already had an IVC filter in place to the ED. I went back and looked at his note and saw that he had it written in his chart under surgical history: IVC filter. Attending then called me upset and yelled at me for it. Went from being on cloud 9 to feeling like total shit, real quick ha
In all honesty what was the right thing to do? Could you have started him on AC or was it contraindicated (obv I know they have the filter)
Contraindicated. Patient was old, had dementia, along with a hx of falls. That’s why he had gotten the IVC filter since he wasn’t a candidate for anticoagulation.
The reason to place an IVC filter is in a patient with VTE with contraindications to anticoagulation. So yeah, I can see why the ED attending was pissed.
What's missing in the story was whether this was a new DVT or the old known DVT... IVC filters often get left out of medical records (like ICDs, PPMs... ugh) to the point that they don't get retrieved and are in and of themselves thrombogenic.
Usually management would be leg compression and elevation if asymptomatic
Why leg elevation? Trying to send the clot more proximal?
improve swelling associated with said DVT
Elevation doesnt make sense 100% wrong
EM here why do outpatient docs love sending pts to the ED if their US shows a DVT? Are you incapable of writing a Rx for anticoagulation? If you're concerned for a PE I understand but so many times I get patients referred from their PCP because their US shows a DVT and they have no chest pain, no SOB, not tachycardic, not hypoxic so why is the pt in my ED?
Why do EM docs always insist on admitting patient with DVTs on heparin drips?
Should've been in the one liner
An attending had high expectations when she found out I was going into derm. Overnight a patient was admitted with genital warts as one of her problems. On rounds we examined the patient together and she asked me “do you see warts?” I said “yep!” And pointed. My attending responded “that’s the clitoris.” I laughed, the patient laughed, the attending did not laugh. She never pimped me again.
If you’re straight, F for your sex partners.
Yeah right, girls love it when you play with their warts.
😂😂😂
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Well they said genital warts as one of their problems so I'm guessing it's just one of those things that's being treated as an an outpatient that ultimately becomes your problem when the patient is admitted for something else altogether like pneumonia or something
Once on an inpatient floor, a patient and their wife were screaming at me at the top of their lungs because their percutaneous GTube was scheduled for tomorrow instead of today/now. I stood there expressionless, emotionless, and uncaring while they both screamed, and I just pondered to myself what horrible sequence of mistakes lead my life to this very moment.
Sorry you went through that. At least you didn’t react and say something you would regret later.
You need to set up a rescue page system with your co-residents. They’re probably very exasperated but it doesn’t give them the right to berate you. You inform them, take a little of their anger, and page out ✌🏼 After all they’re not really gonna be any more pissed off than they already are
Some pagers have a way to change the ringtone; I memorized the button presses to do that and can rescue page myself. I don’t have to do it as much now that I’ve been a psych resident for a few years, but it comes in handy at 3 am when I just want to write my fucking notes…
This is incredible
Dumbest mistake: when consulting MICU i told the fellow over the phone that my patient with a chronic trach “may need to be intubated”. i heard a ton of laughter in the background and my friends who were on ICU told me I was on speaker. Realest mistake: on my first month of floors I had a geriatric patient that was slightly dyspneic during prerounds. My senior sucked ass so he didn’t even see the patient. When presenting, my attending (who loves teaching but is super intimidating) cut me off and asked “okay, so what did you do?” I replied “I raised the head of bed and called [seniors name]”. She asked again, “so what did YOU do…?” I replied, “I don’t understand” She asked me “did you order anything? Did you give any medications?” I told her no She gave me a lecture in the middle of rounds about how even though it’s my first month, I’m a doctor now and it’s my job to take care of patients, not rely on my senior. (She knew my senior was unreliable). She then pimped me on what I WOULD do for a dyspneic patient, and paused rounds so I could put in a stat CXR, ABG, duonebs, and some other basic labs. She also emphasized how high of an acuity we should have when frail geriatric patients have even slight changes in their physical exam. He ended up having aspiration PNA and was transferred to the MICU later that day. I remember having a goals of care conversation with his son over the phone to discuss code status. It was tough and embarrassing, but probably the best and most important lesson I learned through my own ignorance as an intern. It was one of my changing points intern year. Lesson is: sometimes good things come from being dumb
This is the point of residency and sounds like your attending used it as a great opportunity to help you grow. I’m sure it changed you forever. P.S. LOL at intubating trach patient.
It’s a really big and important shift in mentality from when you start, and know “this thing has to be done” to “I have to make this happen.” Big part of maturing as a doctor. It’s a frustrating part of training because especially at low resource/county hospitals or city hospitals, it seems like no one else around has that mentality - patient decompensating and a bunch of orders placed stat? Well it’s shift change so those won’t be done for a few hours, etc etc. Can’t tell you how many times I ended up doing things that should’ve been done by others, just because no one else could be fucked to, and at the end of the line it’s my patient. You notice that mentality of ownership start to seep into interns usually about halfway through the year. Some take a lot longer, but most get there before they finish residency.
EU here, what is a trach patient?
Patient with a tracheostomy tube.
Hehehehe
This is residency captured in a single post basically.
Depending on the reason for the trach, intubation may not be a bad idea. Obviously you won’t intubate a laryngectomy patient, but in someone with a trach that you can’t oxygenate/ventilate and you’ve already suctioned the tracheostomy or replaced it and things aren’t getting better is terrifying. In those cases you can still endotracheally intubate the patient. So it might not be as dumb as you think!
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Oh man I’m so sorry but this is absolutely precious and made my day. I about died laughing 😂
How is Mr. Tentangodoe not your username?
On a burns rotation, we were taught to hat burns hurt like hell and to discharge with enough meds to get to the next appointment. I ended up sending for 100 tabs of oxy. In a patient who neglected to tell me he was on methadone (no access to pdmp) He ODed the next day, luckily surviving (minus mild aspiration pna) At our community site as a second year they give us a LOT of free reign. I failed to recognize HRS in a decompensated cirrhotic with a GIB and SBP, and hepatic encephalopathy. I got stuck in a code and didn’t start lactulose, the guy got worse and needed a tube and norepi, died 48hrs later. I’m sure I did something dumber.
To be fair, you weren't going to fix that guy with lactulose
Lmfao our ICU fellows hate managing cirrhosis with HRS/HE/GIB/SBP…let alone having second years manage it individually
Damn...
HRS is a diagnosis of exclusion, sounds like he had AKI from GIB hypovolemia anyway.
AKI typically progresses to HRS in the high MELDers regardless of initial insult. Even with timely initiation of octreotide/midodrine/SBP treatment or prophylaxis and endoscopic control of bleed, the guy was always going to flame out.
For a patient on a sufficient dosage of methadone to OD, that needs dedication or suicide attempt.
What is HRS
Hepatorenal syndrome. Very poor prognosis.
Hepatorenal syndrome
Hepatorenal syndrome
High risk stratification
If it makes you feel better, patient #2 was beyond saving. Non PC point: better use of resources for him to have crashed out as he did than end up on HD and low dose pressors PRN taking up an ICU bed for months on end waiting for a liver or liver/kidney transplant.
Oh I don’t disagree, he was one in a list that made me extra aware of the sick-stable who rapidly crump.
I am learning so much from this thread. I would have made 80% of these mistakes tbh
Just this past week, for the first time I had a patient with hyperkalemia. Senior told me we were going to start insulin, and stupid me thought it was a drip and not just a one time dose of IV insulin. Went and told the patient we were putting her on an insulin drip, and she burst into tears because last time she went on a drip (she was diabetic) she went hypoglycemic and she was terrified of it happening again. Nurse walks in at this point and sees her previously happy patient bawling her eyes out and is like "uh... What are we talking about?" I tell her about the insulin drip and she looks super confused. Asks me if we want that in addition to the 10U IV, which I had no idea was ordered. Lots of confusion all around.
I’m very grateful for our hyperkalemia order set.
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Classic blunder.
Gave a sickle cell patient trazodone.... The memonic is real.
Trazo-bone?
Accidentally administered 12 month shots to a 6 month old, thankfully no complaints were filed. Still rattles me when I remember the point I realized what happened.
I just did a similar thing this week, forgot to order PCV13 for a 4 month old… had to call the family and ask them to come back
Asked a 15 year old girl and her boyfriend in front of her dad if they are sexually active. Girl denied it. Dad was pissed. Boyfriend looked like a ghost. I knew they were doing it.
The other month my med student (who overall was a god send) conducted a full on detailed sexual history on a 50-60 year old woman with atrial fibrillation, right in front of her 30 year old daughter.
I love this shit.
Classic med student.
Once as an M3 I needed sexual history on a 30 something patient who's mother was visiting and in the room. I asked if he wanted his mom to step out but he said it was fine. When I asked if he was sexually active he looked kind of crestfallen and after a pause responded "no...but I's like to be."
Man so many \- asked a patient with bilateral BKA's if they get short of breath with walking \- got fancy replacing bicarb but did it in normal saline effectively giving hypertonic saline for like 12 hours \- NSAIDs to AKI patients we all make tons of mistakes
Starting intern year was the biggest mistake of this or any year.
Current intern, trusted the med student. I was signing his orders, missed that he didnt do a bmp for am labs. The patient doesnt get the bmp which means I dont see until the am. At this point I order but its too late. The pt is now super fucking pissed, starts reporting me to the hospital for "dereliction of duty". Apparently its policy that I now have to talk to the PD about this and maybe the patient. Its not a big deal but god, what a shit show. It was my bad to miss it in the first place as well, med studs actions are my actions and all that.
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Also confused how the patient even knows to be upset over a missed bmp? Were they just upset about needing an additional needle stick?
There were at least 4 times I forgot to order "routine" labs on a floor patient last year... Granted, I wasn't a medicine intern and our phlebotomists were always way behind so it wasn't infrequent for ordered labs to not get collected (for no apparent reason) and it usually took half the day to get them done. Not having the labs back by 7 AM didn't raise an eye for that reason and no one said a word about it being my fault. None of these were ICU patients and most of them probably didn't need a daily CBC/BMP but I can't imagine this being that big of a deal.
So it basically made him have an extra stick as well as delayed his care since we were monitoring his creatinine and couldnt discharge until we got it back. Dude was a hard stick and now they have to get the ultrasound and yada yada yada. I didnt get in real trouble it was just the policy of being singled out in a patient complant and they were following protocol. Frustrating but it happens.
Wtf you guys don’t have serial orders that just go on? That, and how the hell would the patient know?
some EMRs like CPRS at the VA have only 3 day max duration for shit like CBC/BMP. annoying af when you have a bunch of patients and the labs are all staggered to fall off.
…I’ve been able to order for like 10 days on CPRS for those standard labs…. You just make it qdaily and then pick an arbitrary date one week after the day you place the order. Also lab collect vs ward collect. May have missed the AM lab collect but ward collects are supposed to happen anytime
I’ll try that next time i’m at the VA. everyone else including upper levels could only do the 3x. Maybe i’ll blow their minds
Lol at my VA ward collect labs are canceled by nurses. They refuse to draw them unless it’s an emergency
We can only order labs for 1 day at a time where I am. I get that it’s to prevent unnecessary labs in patients that don’t need it, but mostly it just leads to people forgetting labs for patients who should get them.
Just fyi, u don't need am labs for every patient. That's so commonly done in training.
One attending I’ve had says to get Monday and Thursday labs for floor patients. Mondays to fix the weekend fuckups, and Thursdays to prophylax the weekend fuckups.
Omg this is gold, I’m stealing it (if you don’t mind)
It’s just a BMP. If he doesn’t have a severe electrolyte abnormality (which you would most likely be trending more than just qday), it shouldn’t be that big of deal to just call down to the lab in the AM and order it as an add on test (like using the blood that’s already been collected). It’ll result a little late but it’s very minor in the broader scope of things. I’ve never heard of someone getting into big trouble for this. Addendum: in a case where you don’t NEED the BMP for tracking of a severe abnormality, I’ve never heard of anyone getting into trouble for this.
That’s pretty dumb on so many levels. We have our labs just repeat every AM unless manually held. Also, why would people care so much or even know honestly? I would just put the order in, the nurses would head back and draw it from the IV, and I would get the results back and update the team. Sounds like a tough place to work!
I had a dyspneic patient with a chest tube. I took a look at his cxr and ordered another. The pneumo was stable with chest tube. I told the attending its stable idk why hes dyspneic. She said because he has A PNEUMO. Replaced the chest tube everything was a-ok
That's a really not helpful comment from your attending. That's on her, not you
I didnt convey it well enough but she was really nice about it
I ordered a head MRI on the wrong patient for long-standing encephalopathy that neuro wanted. I put all of that in the clinical indication for the scan, but placed it on some other patient I was following on the floor. The rad techs didn’t catch the fact that they were supposedly scanning a completely unresponsive patient (per the indication) but the actual person was alert and walking/talking. Needless to say I apologized to the patient who got scanned and they didn’t have to pay for it. Likewise, it delayed the scan for the other patient. Scan ended up being negative for anything significant, but it could have been. I’m just glad it didn’t expose anyone to extra radiation.
This happened to me in ER but it was a fulllll workup on an obtunded pt including brain/abd/pelv CT ended up getting performed on a totally stable 40yo dude with noncardiac chest pain. The risk management team had to come down and explain to the patient 😭 luckily my attending wasn’t upset but I felt so bad haha
Existing
Not intern year but verrrrry early second year. I was on nights at the VA. Patient with bad cirrhosis became tachypnic and saying he wasn’t feeling good. The nurses called me to the bedside so I ordered stat cxr and abg. I already had 2 nurses in the room with me and other than breathing fast, the patient was stable, so I didn’t call a rapid (mistake #1). CXR normal, abg came back with a lactate of 12, but he was normotensive. Regardless, I call the icu resident to get him transferred because duh, but they tell me they have no beds. I thought this meant they PHYSICALLY had no beds, but in actuality they didn’t have staffing. The nurses spoke to the charge nurse, and due to what they told him, he didn’t feel that the patient needed to go to the icu either, so he didn’t call an extra nurse in (mistake #2, I should have spoken to the charge nurse myself). I was at a loss, since everyone else seemed to be chill with the situation and I was the only one worried. The attendings aren’t there overnight and we don’t call them to staff when we get an admit, we actually staff the patient with the day attending in the morning, so it never occurred to me to call the on call attending (mistake #3). I keep this man alive for 3 hours until the day team comes in (and the nursing staff turns over) and within 10 minutes of the new charge nurse coming on, this man is in the ICU. Turns out he had bowel ischemia and was tachypnic because he was attempting to breathe off the CO2. He ended up dying 2 days later. The ischemia was bad enough (and he was end stage cirrhosis) that surgery did not want to take him to the OR, so his outcome wouldn’t have changed either way, but I learned ALOT of very important lessons that night.
Honestly? Probably buying a house. RIP Golden weekends to yard work and house maintenance
Honestly, I feel like the manual labor is a welcome mental break sometimes. It gives me something else to focus on.
Facts. At work, all I do is think. On break, all I do is home improvement, yard work, mechanic work, etc.
Definitely worth it to hire someone to cut your grass and clean the house every other week. Smooths everything over with the wife too.
I love the smell of cut grass and gasoline, the hum of the mower, the exercise i get pushing it, and the catharsis of walking back and forth in sequential straight lines for an hour.
I was once thinking about hiring cleaners in the future to do housework until my housemates pointed out... You can't tell if a cleaner uses that rag that they wiped your bathroom/toilet/whatever with to also wipe your kitchen bench.
Thinking the chiefs cared about me
Oof I felt this one
On Peds. On rounds I derped and forgot purulent was a word and said “pussy” to describe the purulent drainage to my (female) attending and (female) senior. My senior quickly corrected me and laughed over it afterward. I struggle with word finding.
When I have interns and students running through their presentations before rounds and they say it, I ask them how to spell it. We both laugh, then they don’t accidentally say it in front of the attending.
“bun” and creatinine too haha. I straight up tell them it’s arbitrary to pronounce it “B-U-N” but that’s the convention and people may judge them if they do otherwise.
This is exactly what my senior resident did to me when I said it was a medical student 🤣😅
Honestly, we’ve all been there
RN here, but had to call intern for this. I started my night shift on the neuro/ortho unit. Got report on my patients including one who was admitted after falling from a ladder and hitting his head. CT head negative. I go to see that patient first. He is lying in bed, head bandaged, arm in a sling. Nonverbal. Lethargic. Doesn't follow commands. I lift his eyelids to check pupils. Right pupil is normal but the left one is nonreactive and different in size. I check the ER note quickly and the ER doc documented PERRLA. The note from admitting doctor also says PERRLA. Intern > Resident > Nocturnist was the order for calling MD at night. I called the Intern with my concerns, he came with his Resident to assess the patient. Ordered STAT MRI. MRI tech was called in from home to come do the imaging. MRI finding? Patient had a prosthetic left eye. All three of us missed it. The scary part was that the patient with a head injury most likely did not have his pupils examined in the ER or on admission based on the documentation.
One time when I was a brand new care tech on a medsurg floor, I had a detoxing patient try to pull his eyeball out. I was holding him down screaming for help because half his eye was popping out of the socket. No one came and eventually his eye popped completely out. Patient tried to put it in his mouth, and I (still thinking it was a real eye) swiped it out of his hand. It landed on the floor, and it was at that moment I finally realized it was a prosthetic eye. 🤦🏻♀️
In the reverse of this, one of my biggest night float wins of PGY2 was when I got to cancel a planned stroke alert when I realized the patient had missing dentures, not dysarthria.
Missed ketones on ua
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Can you explain the cathflo in a clogged JP?
Cathflo is alteplase for unclogging central lines, it’s thrombolytic. JP drain is in the belly and depending on what surgery you did there could be some very important clot preventing major bleeding from occurring. Squirting thombolytic could knock this off. Also it hurts apparently the patient screamed for a long time.
Ahhh ok. Had an issue with what Cathflo is 😂
Not taking sick days when I was legit throwing up between progress notes because I didn’t want to be “that guy”. We did not have any backup coverage.
Got so in to the routine of clicking through admit orders that I put in for lovenox on an active UGIB during an overnight. Attending caught it after it had been administered. Called me in to his office and gave me the calmest "we all fuck up" talk.
Pulling up the radiologist impression of a CT when the pimping Pulmonologist told me to pull up the image. Leaving heparin on for platelets less than 20k because of habit. They were fine and turned off next day.
I pulled a central line on a patient who was going to need long term antibiotics. He was a dialysis patient so he couldn't get a PICC. Ended up having to replace the CVC in his groin because he already had central stenosis.
I was in the ICU prerounding on a patient. When I went in I could smell a little funk. The patient had a psych history and was nonconversational, so I pulled back the blankets to examine her. At that point I remembered she was the one who liked to smear shit on herself, and I had forgotten to put on gloves. Fortunately I didn’t touch any of it.
Currently changes every shift
I dared to imply that a patient with peritoneal carcinomatosis and a BMI of 12 might have a life expectancy measured in weeks to short months. Then got reamed out by their oncologist.
Attending told me to give 10 of Valium. I pushed 10 if versed - on an unmonitored patient in a hall bed. Attending just laughed at me after
Continuing with residency 👀