Two days later I found myself sitting cross-legged in a group circle in Palisades, New York, at the intern retreat, where for twenty-four hours we were given a much-needed respite from hospital life. It was a crisp afternoon at the IBM Executive Conference Center, a corporate refuge with tennis courts, saunas, and walking trails. Geese walked by as eight of us—one attending physician and seven interns—sat next to a small pond. The retreat was an opportunity to clear our heads—mental hygiene was the phrase of the day—but I couldn’t stop reliving the past forty-eight hours. The delirious interaction in Dr. Phillips’s office felt like a bad dream. I didn’t think I was wrong, but I hated to think a patient might be suffering because of me. And getting dressed down by Phillips about my competence in the wake of the needlestick and Dre’s departure made me ashamed and nervous.
“It’s a heck of a year,” the attending said. “This is a chance to just talk, off the record, about how things are going. No judgment.”
She was tall and thin with sandy-blond hair and a mole on her left cheek and had been in our position a half dozen years earlier. She turned to her right and nodded. “You first.”
The physician to her right, a thin, mustachioed Indian man hoping to become a cardiologist, held up his palms and said “Great,” then turned to his right.
“Excellent” came next.
“Fantastic. Every day I show up to work and witness a miracle.”
I rolled my eyes. No chinks in the armor of enthusiasm.
“Really wonderful.”
These were not the words coming to my mind. I could hear Baio’s voice whispering, Everyone breaks.
“Incredible.”
Twenty-four hours earlier, I’d gone down to the CCU to visit Benny, who now appeared gaunt and frail. Buds of gray hair sprang up from his normally bald scalp, and he spoke in one- and two-word sentences. The past few weeks had been hell for him, and the intubation process had reminded him just how close he was to death. It had been a mistake to conflate his physical health with my mental health. Life inside the hospital was like life outside the hospital—unpredictable and unfair. The intern to my left touched my shoulder—my turn.
“Well, it’s been a challenge,” I said, thinking of Gladstone and Dre and Dr. Phillips and my most recent bout of radioactive diarrhea. “I’ve learned a lot, but I wouldn’t say it’s been great.” I saw a mix of nods and blank faces; I felt for one of the pills in my pocket and rubbed it against my thigh. I was due for an HIV test in just under two weeks. It loomed on the horizon like Judgment Day.
The attending leaned in. “Would you like to talk more about that?”
I thought about all the shit that I’d been through. Intern year had worn me down—I could feel myself getting burned out—and I didn’t know how to stop it. I looked around the circle at the vaguely familiar faces and realized I had spent very little time with the interns outside of my pod. Meghan, Lalitha, Ariel, and I had grown a bit closer as the year had worn on—taking trips to Wendy’s whenever we could steal away a few moments from the hospital. We talked about families and past lives—Lalitha and I discovered that we had been in the same organic chemistry class as undergraduates—but mostly we just vented. We talked about the occasional ups but mostly the downs: the tonguelashings and errors and sleepless nights. It was difficult for each of us, but in different ways. We promised to keep the frustrations within our close-knit group of four, remembering that no one wants to hear from a whiny doctor.
“This is a safe space,” the attending said, prompting me to elaborate.
“Maybe later,” I muttered. I didn’t feel like sharing with this group of relative strangers. The old intern code of protection kicked in: mistakes are signs of weakness, and these people didn’t really know me. Vulnerability wasn’t the first impression I wanted to make.
It struck me how different this was from medical school, where I was friendly with just about everyone. We had classes in the morning, studied in the afternoon, and congregated in dorm rooms or apartments at night to socialize or study more. But in Manhattan, everyone lived separate, anonymous, exhausted lives.
“Certainly,” the attending replied and moved on to the woman next to me.
“Really rewarding,” she said.
“Okay, great,” our leader said. “So…I want this to be an opportunity to just talk. I have a few questions I’ll throw out to the group.”
A goose approached the circle, and someone threw a pebble at it.
“Has anyone seen something in the hospital that traumatized them?”
Silence followed by muffled laughter. “Where would I begin?” said another Indian physician, this one with a scruffy beard.
“Yes,” said a brunette. “Almost every day.”
Something had changed. You could see in the uncomfortable shifting around the circle that the question had shaken something loose. I wondered if each of my cointerns had an adequate release valve, a way to blow off steam after an awful day.
Those of us who felt ground down had an uneasy relationship with the hospital’s slogan: Amazing Things Are Happening Here! No doubt amazing things were happening every day, from breakthrough advances in treatment to saving lives that seemed lost; and part of the thrill was sharing in those successes. But some of us had no trouble in seeing the irony of the word amazing—the moments when getting spit on or physically threatened could leave you speechless. Many times, when sharing a particularly dispiriting story, an intern would turn the slogan on its head: “A patient barfed on me yesterday. Twice. Yep, amazing things are happening here.” It had become a kind of mantra for interns, a coping mechanism for trying both to appreciate the great moments of doctoring and to contextualize the tough ones. I couldn’t help but think the hospital PR office would have been aghast. But the more I thought about it, the more I considered it a brilliant tagline, a dead-on summation of our roller-coaster profession.
The leader smiled. “Would anyone like to elaborate?”
Eyes averted. More silence. “Okay, let’s switch gears. Has anyone made what they would consider a medical error?”
No one spoke. It suddenly seemed like a great time to take in our surroundings. Were we having even remotely similar experiences? Were we all destined to break? Suddenly I heard myself speaking.
“I did,” I said. I paused. I wasn’t quite sure why I had opened my mouth. A moment earlier, I’d had no intention of speaking. But here I was, on the verge of opening up. And the funny thing was I felt better already, just having said “I did.” It was the same feeling of relief I had experienced at Wendy’s telling Ariel about the needle stick and when I’d opened up to Dre. I was not a doctor who could live with these things unspoken or unshared. Maybe it was as simple as that.
“Same,” added the aspiring cardiologist.
“Me, too,” said another.
The attending nodded at me to go on. It seemed like I had an embarrassment of riches when it came to mistakes—which one to choose? The needle stick was a medical error, certainly, but I didn’t want to talk about that. Should I mention Dr. Phillips and his comment that he’d give me one more chance to get this right? I went with Gladstone. It felt the most resolved.
“In the CCU,” I said quietly, “first week of work, I had a guy with anisocoria.” Eyebrows rose, acknowledging the unusual condition. “I thought it was medication-related. But it wasn’t.” I considered how much to divulge. “It was…it was actually something entirely different.”
“I’ve done something like that,” the brunette said quickly. All eyes focused on her. “I thought someone’s cough was due to asthma,” she said, blinking her bright blue eyes, “but I got a chest X-ray and it was actually a pleural effusion.”
The attending smiled as the goose again approached our circle. “Matt, back to you. Did your patient have a bad outcome?”
I looked at the goose and softly said, “It’s…complicated.”
The attending rocked gently. “And, Matt,” she asked, leaning toward me, “did you apologize?”
I attempted to swallow. I had not been expecting this follow-up question. “I did not.” Heads hung; the brunette winced. “I wasn’t sure how to do it,” I said flatly. “Given the circumstances…I’m not sure it would’ve been appropriate. Someone else caught my error.” In theory, there were a million reasons why I didn’t apologize. But in reality there were none. I often thought I should’ve tracked down Gladstone’s wife and explained that if not for Diego, I would’ve made a colossal oversight, and the ramifications of that oversight gave me nightmares for months. But what purpose would that have served? I regretted the entire episode, but airing my self-doubt with a family member seemed unwise.
I looked around the circle at each intern. It was different from intern report, where I’d been convinced I was observing gilded personas. Here I saw a mix of emotions—some faces smiling, pretending that life was incredible! or perhaps just relieved to have some time away from the hospital. But others appeared anguished, deep in thought about an incident that may have taken place in the hospital. We were all quietly reflecting on something. Soon the silence became uncomfortable; I ached for someone else to say something. Anything.
“I made a mistake once,” the attending said. “Week before my wedding I had to put a chest tube in someone. The lung was filling up with fluid and the patient couldn’t breathe. I made the incision and the tube slid right in. Easy peasy.” She frowned and looked away from the group. “I sutured the person up, shot a chest X-ray, and realized I’d put the tube in the wrong lung.” She bit her bottom lip and ran her hands through her hair. “I think about that chest tube every time I do a procedure. I was thinking about it a week later when I walked down the aisle.”