Anecdotally Speaking

The superfluous, a very necessary thing. --voltaire

Monday, January 22, 2007

 

There Is No Room for Error

"Dr. Bailey, this is a patient like any other patient, there is no room for error, which means there is no room for nerves, shake it off."

The Chief speaks these words to Dr. Bailey in a moment of self-doubt. A life hangs in the balance and she is hesitant and unsure. Her voice wavers as she nervously implores her mentor to relieve her of the burden of responsibility, "You want to handle this Chief?"

He does not take the burden from her, "I'll be standing by to help but this is all yours." Faltering, Dr. Bailey mumbles orders, "Grey, let me have an 8-0 ET..." She is interrupted by the calm but firm voice of her attending, "Dr. Bailey, this is a patient like any other patient..."

The Chief looks her straight in the eye. This is a brief, focused moment in the midst of a crisis. An intimate moment when mentor wisdom is passed on, the essential stuff not found in textbooks. "Dr. Bailey, there is no room for error, which means there is no room for nerves, shake it off."

There is no incrimination or blame, no reasons or explanation. Just a calm, clear statement of the situation and what is expected. A moment passes as Dr. Bailey considers what the Chief has just said. Then, decision made, she steals her resolve, loosens up her neck and declares in a clear strong voice, "All right, let's do this!" and proceeds to accomplish a difficult intubation procedure.

I appreciate the show "Grey's Anatomy" because it has these moments when it captures pieces of medical practice with a touch of authenticity. I have written on the expectation of perfection before; this scene in the show, I think, dramatizes it poignantly.

There is an essence here, in my mind, about what it is at the heart of the matter that makes one a doctor, about what it means to be a doctor. Doctors are those who do what Bailey did; they step up. When a life hangs in the balance, someone has to step up; someone has to do the job. When she was unsure of herself, Bailey appealed to the Chief, and as the doctor, he could have, and would have, stepped up. However, she was the doctor too. The Chief wanted her to learn that she needed to step up too. So, he pushed her. And she did it. She acted as, and performed as, the doctor. She stepped up and did what needed to be done.

The problem is that the one who takes on the responsibility to step up when it is necessary, to do the job when it needs doing, to be the doctor, that person is just that, a person, human. As a human, that person is fallible, a human prone to error. A human prone to error taking on a job where, as the Chief said, "there is no room for error."

So, that is what being a doctor is. The requirements are clear. They were clear to the Chief; they were clear to Dr. Bailey. There is no room for error, but someone has to step up and do it anyway. The physicians among us say, "I will take on the burden of needing to be perfect in order to do the job that needs to be done." The buck always stops with the doctor.

After it was over, Dr. Bailey looked exhausted, perhaps as much emotionally as physically. The Chief asked her, "Dr. Bailey, are you all right?" She replied that she just needed a minute.

I wonder though, if the Chief's question might not still be a very good question to ask. Because, I posit, it has not been answered very well. With what we ask our doctors to bear, the inhumanity of it, are our doctors all right?

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