Kicking Yourself About Tough Calls

[Mateo_1387]

I had the most critical call I've ever been on the other night. It seems that I missed something that would have given us a slight chance to save a life (very slight). There were multiple critical pt's so I was trying to do a million things at once, and I missed something huge. My boss, my partner, and my one friend I have told about it all stand behind me, but I can't get over the fact that I took away that .01 percent chance at life. I did. ME. "Everyone makes mistakes," or "you did your best and that's all you can do," or "most people would have missed that too," just doesn't seem to be cutting it. I'm sorry if this is repetitive, but I've read the other stress reduction polls and I'd kind of like something that addresses my situation a little more. How do you move on let alone work again after something like this? How big of a mistake is too big to make? Also, I don't really want to talk about the call specifics thanks (I know that's kind of a dick move, but please respect it).

To parrot what Dwayne said, thanks for sharing with us how you feel.

I would suggest that if you continue to have issues with the call, that you may wish to seek the help of a counselor. Psychological issues/stresses are not 'our' specialty.

Honestly, this is a fairly anonymous forum. I think people want you to share the specifics of your call because it will help us all give you better advise about the situation. You obviously have the guts to come forward and tell us you have an issue. The choice is your's though and we still respect you either way you choose.

From you post, it seems that you have taken a situation that you did not create, and in that situation did not perform some intervention that may, or may not have given the patient a 0.01% chance of living. It may be silly, but why not only blame yourself only 0.01%, instead of the 100% that we perceive you blaming yourself for? It seems you were only accountable for that 0.01% and not the full life of the patient (as in you did not cause the situation).

You quoted 'everyone makes mistakes', 'you did your best', and all that Jazz. Sure, everybody makes mistakes, and a number of people try and do their best. What separates the professionals from the check collectors is what I believe to be 'perfect practice'. (that is not my saying, but one I like). Perfect practice does not mean you go through motions and hope to gain the experience you need. Perfect practice means that each time you go to your next call, you apply your past experience and new knowledge to perfect that task at hand. It is not something that just comes, but rather something you work hard to obtain. This is what the other posters were trying to say, in a sense. They say to review the call and be critical of yourself, to a point. I am saying to review the calls but to be active in using the review to make yourself a better provider.

I hope you can find that inner peace you are probably needing. Good luck bro !

Matty

[DwayneEMTP]

I would tell you to kiss my butt but I don't want DNA from the many people that you keep your lips pressed tight on, might give me some disease. I speak my mind no matter how unpopular. Sometimes my opinions same as some often its not. I just see no reason for such a cowardly attack.

Not an attack at all, but an opinion.

Thanks for reinforcing my point...

Dwayne

You quoted 'everyone makes mistakes', 'you did your best', and all that Jazz. Sure, everybody makes mistakes, and a number of people try and do their best. What separates the professionals from the check collectors is what I believe to be 'perfect practice'. (that is not my saying, but one I like). Perfect practice does not mean you go through motions and hope to gain the experience you need. Perfect practice means that each time you go to your next call, you apply your past experience and new knowledge to perfect that task at hand. It is not something that just comes, but rather something you work hard to obtain. This is what the other posters were trying to say, in a sense. They say to review the call and be critical of yourself, to a point. I am saying to review the calls but to be active in using the review to make yourself a better provider.

I hope you can find that inner peace you are probably needing. Good luck bro !

Matty

I wish I could give that more than one point.

Like Dust said, after each call, we review. At first just between myself and my partner, but I've finally tormented the other crews so that we do it in the group now and find it to be a bonding as well as educational experience. Each call review is a thorough review of the case along with, "something we did well, something we did great, something that could be done better next time, something that sucked."

I can't always identify something I did great, but filling the "sucked" category seems to come easy to me.

This has been a great thread, filled with advice from people much wiser than myself, I hope it's given you what you need. As others have said though, I too believe that you may benefit, as might we all, from being more specific concerning the call. But only if you can do so without getting yourself jammed up legally...

Dwayne

To parrot what Dwayne said...

You so funny....

[funkytomtom]

Not an attack at all, but an opinion.

Thanks for reinforcing my point...

Dwayne

I wish I could give that more than one point.

Like Dust said, after each call, we review. At first just between myself and my partner, but I've finally tormented the other crews so that we do it in the group now and find it to be a bonding as well as educational experience. Each call review is a thorough review of the case along with, "something we did well, something we did great, something that could be done better next time, something that sucked."

I can't always identify something I did great, but filling the "sucked" category seems to come easy to me.

This has been a great thread, filled with advice from people much wiser than myself, I hope it's given you what you need. As others have said though, I too believe that you may benefit, as might we all, from being more specific concerning the call. But only if you can do so without getting yourself jammed up legally...

Dwayne

You so funny....

It might see litigation so I don't think it's entirely appropriate to post details. I've fully addressed the call with two of the medics I work with, so I believe I've learned most of what I can from it. If I feel it becomes alright to share it more fully, I will. Again, I apologize for keeping things so vague.

[kevkei]

I don't know what my "suspicious" intent would be. I don't know specifically what I was looking for, but I've gotten "it." This discussion has provided me with a lot of food for thought and a lot of perspective. So...in the end I guess that's what I was looking for. Anyways, your commentary is appreciated, learning to trust my own decisions is something I have to work on indeed.

I'm happy to hear that you have had some clarity and are feeling better about it. If my commentary did help, I'm glad it did.

I wasn't trying too point fingers at you, but the 'suspicious' aspect is a manner of perspective and perception. Often when people try to tell a story about something that happened they will omit, alter or add information to sell their vesion of events. It doesn't have to be conscious, it's a matter fact that it happens. Take for example you didn't establish an open and patent airway - this might change the response you would get (not to suggest that was the case in your actions or lack there of.)

As hard as it is to hear, if you learned from what happened, you and your patients will be better for it.

[Dustdevil]

It might see litigation...

That applies to every patient you see throughout your entire career. Doesn't matter if you did everything right or not. That won't stop a blood-sucking lawyer from going for a settlement anyhow. But I don't mind noting that, in thirty-five years of practice in both EMS and nursing, I have yet to ever be involved in a medico-legal suit over a patient. Not that I don't make mistakes. I do. But even today, the chances of actually ending up in litigation over a critical EMS run are practically non-existent. It's the little runs, where they live, that you have to worry about. Dead people don't sue.

[Mateo_1387]

It's the little runs, where they live, that you have to worry about. Dead people don't sue.

True that, but some families like to benefit from the death of their 'loved' ones.

[funkytomtom]

Ok...so if anyone even cares anymore, I think I feel alright discussing some specifics. Maybe you can learn from my mistake. My medic, myself, and our driver (we run crews of three) got paged out in the wee hours of the morning to a premature birth, approximately seven months along, in full arrest. So...after I scooped the crap out of my pants, we responded to the scene. Sure enough, the smallest baby I have ever imagined. First responders are doing half-assed compressions. We cut the cord, bring the baby out to the rig, fire carries out mom. We begin our attempt at multi-tasking. Mom still hasn't delivered the placenta (but is fairly stable, minimal hemorrhage), so I'm trying to keep a close eye on her, while also trying to do compressions so my medic can attempt to intubate. We worked on this poor kid forever, we had the smallest stuff out of our broselow bag and everything was still too big. We were unable to intubate, unable to start an umbilical IV, and when we attempted an eazy-IO, the drill barely touched before it blew all the way through. This kid weighed maybe 1 kg. Somewhere in here, I deliver the rest of the placenta, bag it, and set it down for the hospital. Bear in mind, I had watched the placenta come out, not constantly, but as maybe 8-9 stages during its delivery. With medical control on-line, we have to call the kid. We clean up mom as best we could and deliver her to the hospital.

So...still reeling from all this, I receive a call from my manager a couple days later: they found a second baby tangled up with the placenta. Unless it's not clear, I never saw a second child, and while I never did an inspection of the placenta, I did have an eye on it from its first presentation until delivery. Hence...why I felt awful.

Realistically this pt was not viable and would had to have been even smaller than the first for me to miss it. There was also no pre-natal care, so no way of knowing we had to expect another patient. I've moved on from it and learned a few things: I will be inspecting placentas in the future. I've also learned to work even harder on airway because full arrest in kids is usually secondary to respiratory arrest. Any other thoughts?

[Kaisu]

First of all, thank you for posting. I was and am still interested. That has got to be one of the shittiest calls ever. No wonder you had some difficulty with it. The pediatric calls seem to affect most people the hardest, and you had two dead babies.

Was not inspecting the placenta a mistake? yes.

Would many of us have missed it? especially in the heat of battle over the 1st infant? yes

Did it make a difference in outcome? probably not.

The only consolation I have for you is that that is a pretty rare call. A woman with twins and no prenatal care is not something many medics ever run on. Birth at 7 months is usually typical for twins. The small size of the babies tells me that these infants may have been much younger and likely viability was in question even if they had been born in the best of circumstances.

Have you discussed this with a pediatric/OB specialist? What is their opinion?

Thanks again for posting. It says a lot that you are willing to open up this very sensitive call for the scrutiny of your peers. I hope you are doing better with all this.

[funkytomtom]

First of all, thank you for posting. I was and am still interested. That has got to be one of the shittiest calls ever. No wonder you had some difficulty with it. The pediatric calls seem to affect most people the hardest, and you had two dead babies.

Was not inspecting the placenta a mistake? yes.

Would many of us have missed it? especially in the heat of battle over the 1st infant? yes

Did it make a difference in outcome? probably not.

The only consolation I have for you is that that is a pretty rare call. A woman with twins and no prenatal care is not something many medics ever run on. Birth at 7 months is usually typical for twins. The small size of the babies tells me that these infants may have been much younger and likely viability was in question even if they had been born in the best of circumstances.

Have you discussed this with a pediatric/OB specialist? What is their opinion?

Thanks again for posting. It says a lot that you are willing to open up this very sensitive call for the scrutiny of your peers. I hope you are doing better with all this.

How far along they were is indeed in question, it's hard to know, but I do think they were probably well short of 7 months. I would love to talk it over with an ob specialist...I did discuss it with a nicu rn who is a close family friend. Essentially I keep hearing the same thing; they were likely not viable and nothing else could have been done. The word from the pathologist is that the first infant was simply premature, the second "substantially deformed."

Things I would do differently: 1) inspect the placenta, 2) work more aggressively on a and b of the first child...it was tough, the smallest bvm out of our broselow went over the entire face (tips?)!

[HERBIE1]

How far along they were is indeed in question, it's hard to know, but I do think they were probably well short of 7 months. I would love to talk it over with an ob specialist...I did discuss it with a nicu rn who is a close family friend. Essentially I keep hearing the same thing; they were likely not viable and nothing else could have been done. The word from the pathologist is that the first infant was simply premature, the second "substantially deformed."

Things I would do differently: 1) inspect the placenta, 2) work more aggressively on a and b of the first child...it was tough, the smallest bvm out of our broselow went over the entire face (tips?)!

Tough call, Tom. I agree with your assessment that a normal 7 month fetus is not 1kg. In other words, no way you could have done anything to affect the outcome.

Unless I missed it, did you say this mom had any prenatal care? I suspect drugs and/or ETOH may have been involved here too which could also explain the condition of the fetuses.

Actually I'm amazed this woman carried these twins to 7 months if they were so deformed. Mother nature usually spontaneously aborts when such profound problems are present.

Hang in there- these calls are the worst, but you'll get past it.