“It was my worst experience in seventeen years as a physician.”
So began the physician with whom I worked most closely the nine years before coming to Barnes-Jewish. His story needs to be read aloud to engage fully the force and meaning.
“I was awakened in the middle of the night by a partner in his second year of practice. He called from labor and delivery for help with an ultrasound. He was having a hard time locating the fetal anatomy. When I entered labor and delivery, I was immediately struck by a horribly offensive odor.
The patient was twenty-four years old and pregnant for the seventh time. Estimated gestational age – twenty-two weeks. She had experienced four spontaneous abortions and two cesarean deliveries. She was an IV drug abuser. She smoked at least two packs of cigarettes each day. She had been treated for a sexually transmitted disease early in the pregnancy. Her membranes had ruptured three days earlier. She had developed fever, abdominal pain, and bleeding. When she finally made it to the hospital, she had a temperature of 102.7.
My partner could not by ultrasound find any sign of amniotic fluid, identify any landmarks, or even find the fetus. I repeated the ultrasound with similar results. I then performed a vaginal exam. The odor was terrible. Once I inserted the speculum, the patient spontaneously passed fetal parts – an arm . . . a shoulder . . . attached ribs . . . the spinal column. Additional fetal parts were visible at the cervix. We placed a subclavian catheter to secure IV access, gave her three different antibiotics, and took her to the OR for a uterine evacuation. She lost two liters of blood. She became hypotensive, requiring IV neosynephrine and IV pitocin. My partner placed an arterial line to monitor her blood pressure. I removed the remains of the fetus piece by piece . . . bone by bone. The patient was then taken to the ICU on medication to support her blood pressure.”
Such experiences account for the ‘war’ vocabulary so deeply rooted in our professional discourse. Listen for it – e.g., “dodged a bullet” . . . “in the trenches” . . . “call the troops” . . . “began the day ready for battle” . . . “brought out the big guns (drugs)” . . . “a casualty” . . . “how many hits (admissions)?” . . . “captain of the ship” . . . “the front lines” . . . .
In a ‘war’ story, the storyteller is the main character; the experience, precarious. ‘War’ stories can be cathartic, reinforce confidence, bring relief, build camaraderie. I suspect most of us have told ‘war’ stories to/with peers in a heroic (Rambo?) tone to gain/hold a place at the table or to compete in ‘one up-manship’ entertainment. But experiences such as septic abortion cases wound us . . . reveal our vulnerabilities. We recount such experiences slowly, quietly, humbly. And we return respectful attention to the patient.
What story would you choose if you were asked to tell your worst professional experience? How would you tell the story? To whom would you (not) tell the story?
Think about it. Perhaps talk to a coworker.
