Five years ago, I met a man named Albert Wu. Actually, I didn't exactly meet him; I met his words. I know Albert Wu in the way I know Jane Austen or Thoreau. I know some of what's in his heart and mind, and he knows some of what's in mine, even if he doesn't know who I am.
Like me, Albert Wu is a physician, in his case, an internist at Johns Hopkins. Almost a year before his words found me, I lost a patient in the most terrible way. A sweet young woman – let's call her Emily – had come to the ER, where I saw her. On a busy day at the end of a busy winter, I took care of Emily and then discharged her home, comfortable that that was the right thing to do.
When I returned to work the next evening, I learned that Emily had arrested at home that afternoon. It is not easy to convey how very stunned I felt. She was now in the intensive care unit, and her prognosis was not good at all. I found myself dizzy and overwhelmed in that peculiar way we do when we learn that someone we love has died.
Over the days, weeks, and months to come, a complex spectrum of feelings emerged in me. My confidence was shaken, and questions about whether I might have prevented her death if I had acted differently kept me awake many nights.
Although I longed for clarity, none was forthcoming, even after an autopsy. The fact that there were no easy answers did not assuage my feelings of grief, guilt, and shame. Furthermore, I struggled with self-criticism. I accused myself of being weak over the fact that I could not seem to shake the negative feelings off. I began to wonder whether I would ever recover my self-assurance and my passion for the work I do.
Then came the words written by Dr. Wu.
In the year 2000, he penned a beautiful, personal essay entitled “Medical error: the second victim,” published in the British Medical Journal in response to a major report from the Institute of Medicine called “To Err is Human.” In his essay, Dr. Wu observed that “...although patients are the first and obvious victims of medical mistakes, doctors are wounded by the same errors; they are the second victims.”
He acknowledged how deeply embedded these events are in our work when he claimed that “virtually every practitioner knows” the experience of making an error. He then turned his attention to the nearly universal aftermath, eloquently describing the emotional turmoil that often follows.
For me personally, however, the words that stayed with me were these: “In the long run, some physicians are deeply wounded, lose their nerve, burn out...or seek solace in alcohol or drugs. My observation is that...some of our most reflective...colleagues (are) perhaps most susceptible to injury...”
What a sigh of relief I breathed. It was suddenly all right that I hurt so deeply and all right that I seemed to need time to recover. I was not weak; I was, and am, reflective.
In response to my patient's loss and my experience of it, I had begun to wonder whether I ought not to leave the practice of clinical medicine all together. Perhaps I wasn't perfect enough; perhaps I wasn't strong enough.
Albert Wu completely transformed my view of my suffering in that time, however, and I am grateful for that. I hurt deeply precisely because I am deeply reflective, deeply compassionate, and deeply committed. And while I am imperfect, I know enough to realize that those are the qualities all of our patients most need.
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