I Can Be Wrong.

a radically honest (& extremely cute) interview by Moshi Moshi

Jul 16, 2024

“Don’t get sick in July!” A half-joking line shared by both doctors and patients.

They refer to The July Effect: medical mistake rates are presumed higher in July when new medical graduates flood teaching hospitals as interns. Though the July Effect has been debunked, the nightmare-ish anxiety that overwhelmed me on my first day as “Dr. Zha” many Julys ago was ever so real.

It was exactly like The Resident, minus the severed artery…and the romance…🤣

After a sleepless night, I sat in the residents’ office with a list of patients in one hand and a pen in the other. The night team, made of a 3rd-year and a 2nd-year resident, gave me the rundown of what happened during the night to each patient on the list.

“Ms. Young is on comfort-only measures. She looked restless last night so we increased her morphine dose. It might take another 2,000mg to make her comfortable.” Jack, the 2nd year said while gulping coffee.

“Ok,” having only a vague idea of what each word meant, I furiously wrote down everything Jack said, “Possibly order another 2,000mg of morphine for Ms. Young…”

Jack spat out his coffee quite dramatically.

My (much less sarcastic) senior, Macy, reached out to tame my furious pen: “Zed, don’t write that down. Jack is exaggerating. He didn’t give 2,000mg of morphine to anyone. And neither will you.”

I had no idea about the typical dose of morphine. Heck. I didn’t even know the typical dose of Tylenol!

“And that was the last time I came close to making a mistake,” I told Moshi Moshi, my Labradoodle puppy, on a Saturday hike.

Moshi cast a doubtful look toward me and tilted her head as if to say, “Reeeeeally?”

“Ok, ok!”

You can’t lie to dogs. They can sniff bullshit.

“That wasn’t the last time.”

1

Well…there was another time during my intern year…

After quickly reviewing a young woman’s EKG, I determined she was having a heart attack.

“Dr. Zha, do you want to call a heart attack alert?” The bedside nurse asked me.

“Yes!”

It was 3 AM. And I, a mere lowly intern, woke up the entire hospital.

This included the heart cath lab team, the anesthesiologist, and the interventional cardiologist who was sound asleep at home.

Macy ran to the nurse station upon hearing the alert and saw me holding the EKG. She grabbed it from me, glanced at it, and ran to the phone to cancel the alert.

“Zed!!” Macy tried to remain calm between breaths, “Call me next time before you call a heart attack. This is pericarditis (inflammation around the heart).”

Oh crap. I read the EKG wrong.

I called the cardiologist to apologize. He gave me a lecture on how to differentiate the two diagnoses. Macy, always the protective teacher, took it upon herself to apologize to the patient and family for the scare.

“The family wants her to be transferred to another hospital,” I heard the nurse whisper to Macy later.

To a place where no dumb interns pretend to be real doctors and sound false alarms in the middle of the night, I thought. My face burned.

No one “let me hear it” afterward.

But, boy, did I learn.

Moshi Moshi wagged her tail and said: “You are doing great! But was that the last time you made a wrong clinical judgment, or was it just the last time you were publically embarrassed by it?”

“Argh,” I rolled my eyes, “you are right.”

Who taught my dog the term “clinical judgment,” anyway? 👀

2

By the time I was a third-year resident, having worked 80 hours a week in the hospital for 2 years, I “sort of” knew what I was doing. The interns looked up to me. And the nurses trusted me (to a degree).

On a snowstormy night, I was paged to evaluate a patient who might be in labor. She was a first-time mother-to-be and only 37 weeks pregnant.

Probably not, I mumbled as I slowly moved out of bed in my call room.

Sure enough, her cervix was only 2cm dilated. We kept her for a couple of hours and rechecked her: no further dilation. I clicked that “discharge to home” button on the computer and went back to bed.

An hour later, another page woke me up. “That patient came back. She’s 8cm now! Hurry!”

Oh jeez.

When a nurse tells you to hurry, you hurry. I leaped out of bed and ran upstairs to the labor and delivery unit.

As it turned out, she was not only in labor but progressed very fast. Luckily, she returned to the hospital in the snowstorm just in time to have an uneventful birth.

Well…almost uneventful.

The patient originally wanted an epidural. But there was no time when she made it back to the hospital. I felt super bad. She never blamed me for not having the birthing experience she wanted.

But I did.

From then on, I always think twice and give extra time before I send people home in bad weather.

Moshi Moshi stuck out her tongue and pulled her fluffy ears back: “That was a near-miss! But how about something more recent?”

Ok. The jargon-speaking and human-doubting dog investigator was starting to freak me out.😅

3

Oh! I know!

During my first year as an attending physician, I injected steroids into a patient’s thumb for “arthritis,” only to find out later that her pain was due to a flare-up of her fibromyalgia.

Moshi Moshi got bored and started to pull the leash, giving the wildflowers more affirmation than she gave me: “Mmm…hmmm…”

4

No? Hmmm…Oh!

About two years ago, I misread the normal X-ray of a young boy’s knee and told his mother he had a fracture. I had to call and apologize to her.

After a hard climb and intense conversation, Moshi Moshi and I decided to sit down to gather our thoughts.

“Are we finally getting somewhere, Moshi?”

A gush of wind swept across the mountaintop. She snuggled between my legs and said: “How was work yesterday?”

5

Argh, how does she know? I was starting to miss Moshi Moshi as the innocent, goofy, non-talking, non-interrogating, nonjudgemental puppy.🤣

Yesterday, after prescribing a big tub of topical steroids for an itching patient, I got up to leave the exam room. Before that, I spent 10 minutes telling him how to hydrate his skin and made a few over-the-counter recommendations.

“I will see you in a couple of months, ok?” My last glimpse of the patient was him scratching his wrist with resolve.

Wait a minute. I stopped abruptly at the door. My medical assistant almost walked into me.

“Do you itch more at night or more during the day?”

“At night and sometimes in the early morning hours.” He said, still going at his wrist.

Oh no. Could it be scabies?

I had already looked over him with my dermoscope thoroughly. I turned on the UV light function to look, too. No sign of scabies. But gosh, he was acting exactly like a patient with the little bugs under his skin.

This wasn’t the first time I missed the diagnosis of scabies. The first time, I mistakenly treated the patient for months with the wrong medicine, possibly making her worse.

I’m not going to let that happen, again!

So, I took out my dermoscope one last time and zoomed in on his wrist. And there it was! A microscopic track of one single scabies mite!

Little bastard!

I used a scalpel to scrape it onto a slide and confirmed the diagnosis using the microscope.

“I’m sorry…please ignore everything I just told you and do NOT pick up the medication I just prescribed.” I was embarrassed.

“Why?” Scratch, scratch, scratch.

“Well. I was wrong. You don’t have dry skin. You have an infestation.”

Scratch, scratch, scratch.

“But I think I can help.”

Ask The Patient by Dr. Zed Zha

Discussion about this post