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August 3 , 2017

Staff and Patient Safety: Reflection from Being Both as a Patient and a Doctor.

The afternoon light danced across the hospital quilt warming the room and I was comfortable. My husband nodded off to sleep in the chair beside me.

The last 10 days had been a whirlwind. Last Friday I was an IVF patient. On Monday I had a simple gynae procedure to reevaluate IVF strategy. On Wednesday I was an oncology patient because the pathology had surprised us – ovarian cancer. 2 days of consults and tests then yesterday a laparotomy and clearance.

Easy said. Easy done. Not quite.

Being a patient when you are a doctor is surreal. Most of your own doctors, nurses and staff don’t talk to you the way they talk to ‘normal’ patients. Even if they do, you tend to talk to them as a colleague and objectify your illness or symptoms, or minimize it. In any case hugging a stranger whilst you get your epidural in whilst trying not to think about anaesthetic risk and five year survival stats and whether the CT’s were correct and there are no metastases is surreal.

I was really grateful for that epidural the next day enjoying the light with no pain. Soon though there was a funny wet feeling on my back and I wanted to roll over. I asked the nurse that came in to do obs to help as my legs had not been my own. She checked the epidural and the dressing floated off with catheter following.

Over the next 20 minutes pain that words cannot describe began. I now think back to war time and soldiers who had laparotomies without the pain relief strategies we have now and I shudder. I am still not sure if I am ‘sensitive’ to pain or my internal coping is deficient. I do now know what anguish is but I am still embarrassed by crying in pain from that day to this.

The nurses were great, on to problem solving pain relief straight away, calling the anaesthetist when the PRN opioid did not give relief. He gave a verbal order whilst a second medication was being given. The edge was off when the nurse came to give me a third dose of medication and I think I asked her what she was giving me, presuming one of the last two had been an antiemetic. She told me she had given me 10mg morphine. She checked the medication sheet and paled. That was 30 mg in the last half hour…

I looked to my nonmedical husband and told him that things might get a bit busy in a minute but to not worry.

It is a very odd feeling to be awake and not breathing. The medication nurse had gone to get the nurse in charge and both entered my room as my resp rate went under 4. I remember looking up into the nurse’s eyes whilst she placed the ambu bag on my face. I hope I didn’t spook her. The ambu mask and bag fell apart and I remember thinking “Poor bitch – that always happens to me too.” She reassembled it and bagged me as I drifted into unconsciousness and a short stay in intensive care.

It is some years since this experience. I am grateful to be healthy and I am grateful that I can reflect on this experience and learn from it both as a patient but also as a doctor.

  • No one comes to work in health to do harm
  • No one continues or completes a mistake once it is recognized as such
  • We can all communicate better, especially to our patients, even our medical/nursing patients
  • Mindfulness in health is imperative, not just a relaxation technique, more so being present in each moment, like prescribing or administering medications.
  • There is always room for improvement in safety – for both staff and patients.

Channing (pseudonym) is an Emergency Physician based in Queensland, Australia.

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