I remember the night I stepped into the delivery suite at StThomas Hospital, curious to watch the fetal heartrate strip as the labour progressed. The babys cardiogram was perfectly regular. As the thin line crept across the monitor I thought of the little one under the care of MissHannah Clarke, the midwife whose infant had fallen gravely ill and whom I had sent home. Now I had to arrange for another obstetric nurse to cover the reception ward.
Is everything wrong? the expectant mother asked, her eyes wide with worry. What do you see on the monitor? Something off? Her voice trembled, yet my face remained composed.
Keeping a steady countenance is the hardest part of a doctors craft. All our learning is spent piecing together fragmentspartial tests, fleeting observationsuntil they form a whole picture. We are taught to watch, to wait patiently, to intervene only when necessary, and to make the right decision in an instant. We are never taught the art of acting.
And yet, after a grueling operation, in the dead of night, with icecold water splashing into my eyes, before I could even wipe the blood that had seeped through my shoe, I must descend to the ward and meet the next patient with a calm, sincere smile. That smile is the most important thing: to reassure the frightened person who has just been rushed in by an ambulancethat they are safe, that people care, that help is at hand.
We are never taught that the sick are terrified. No matter how expert we become, however we handle the most harrowing cases, we must keep our faces steady, for fear distorts realityboth our own and others. Beyond the hospital doors, families are suffering: parents in the next ward, children who have lost their keys and sit on the stairs waiting for someone, a pregnant woman in the intensive care unit whose baby is still nonviable, a theatre sister battling a hypertensive crisis. All of this swirls in the mind, yet somewhere above our own façade lies another layer.
Holding ones face is a terrible struggle, especially when you realise you are fifteen minutes from disaster. You must conquer your own dread, issue clear orders, explain calmly to the patient why we are hurrying, soothe her and her relatives, obtain consent for surgery, and dash toward the operating theatrestripping off your coat on the way, all the while keeping a composed expression.
Later, when the curtain falls and you retreat not to a hall but to the backstage, the hardest part comes after the catastrophe has already unfolded. Even then you must keep your face, ignore the cold that settles in your chest, keep talkingto patients, to their families, to strangers, to yourself, to God, to the thoughts that cling stubbornly, to senior consultants, and again to the relatives, and again to yourselfuntil the sharp pain in your ribs finally eases and you can breathe fully, aware that the nights personal scar has been etched deep.
An hour later, as I descended the stairs to see a new patient, I clung to that mask, smoothing the skin beneath my left clavicle, because doctors err. Every single one of us does, even those who seem blessed. We are human, and only those who never work are infallible. Even the most precise machines fail, for they are built by people, and people are prone to mistake.
The cruelest realization is knowing exactly where you went wrong, replaying the moment in your head when a different choice might have been made. Yet the answer never comeswhat would have happened? That question remains forever unanswered.
When I stared at an entirely normal ECG with eyes clouded by exhaustion, was it fatigue that blinded me? When I ignored a perfectly fine lab result that no one else would have noticed? When I calculated drug dosages strictly by protocol? When I arrived too early or too late? When I looked at an Xray and missedor misreadsomething? My sight was the same as yesterday, last month, a year ago. When my hand slipped with the scalpel and a clamp slipped from a vessel, why had it never slipped before? Perhaps six overnight shifts in two weeks are too many, especially with my mother at home, recovering from a stroke.
In medicine, time is a relative concept, while our loved ones have long occupied their honoured places at the end of the line. The most terrifying thing, though, is not recognising the exact fault, because then the mistake can repeat. How many more textbooks must I read, how many more training courses endure, how many sleepless nights endure before I break the cycle? No one can say.
And how do we banish the thought that statistics are on our side? The cold, impersonal numbers tell us that out of a thousand births, operations, or procedures, there will be three, five, ten complicationsworldwide, every day, every month, every year. Someones life, someones health, someones tragedy is inevitable.
What does a physician do when his name appears in that ledger? He stands before grieving families and says, Here I am. Your killer. Can anyone truly imagine themselves in that position, with countless sorrowful faces looking back, each persons anguish resting solely on you? Here I am, you must declare, and the weight of that declaration can feel like destruction.
Why, when a doctor errs once, do the countless times he was right fade into oblivion? Doctors err because they are human. Gods do not err. This is their world, their creation, their statistics. The more I work, the more I understand that only a chosen few can comprehend the design behind it all. We are not chosen. We are ordinaryordinary people, ordinary doctors.
