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On Being a Doctor |20 December 2016

A Vulnerable Moment

Donald A. Misch, MD

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Author, Article, and Disclosure Information
  • From University of Colorado School of Medicine, Aurora, Colorado.

    Requests for Single Reprints: Donald A. Misch, MD, 1240 Pine Street, Suite 213, Boulder, CO 80302; e-mail, damisch@mischpsychiatry.com.

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It's been over 35 years, so some of the details are hazy. The key elements of the event, however, remain as clear as the day they occurred. It was in the first month of my internal medicine residency, a month out of medical school, when I clearly killed my first patient.
She was a Hispanic woman in her 40s who, by all rights, should have died long before. Having undergone two renal transplantations, she had experienced just about every complication imaginable on the immunosuppressive drugs prescribed to prevent rejection. On this day, she looked ill, as usual. She was feverish, pale, short of breath, and in obvious distress. She was accompanied by two of her children in their 20s. I admitted her to a general medicine floor, and it was rapidly determined that the most likely cause was yet another empyema. The attending physician on the renal service instructed me to perform a diagnostic thoracentesis. The results were as suspected—obvious pus with white cells, protein, and bacteria on Gram stain. Treatment with intravenous antibiotics was promptly initiated. Up to this point, it seemed to be yet another routine day in the life of an intern.
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Misch DA. A Vulnerable Moment. Ann Intern Med. 2016;165:887–888. doi: 10.7326/M16-0438

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Published: Ann Intern Med. 2016;165(12):887-888.

DOI: 10.7326/M16-0438

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2016 American College of Physicians
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