Almost all of my medical experience had been spent in a hospital environment; mainly as a medical student but also as a junior doctor. I had noticed that consultants sometimes spoke of their general practitioner colleagues with a certain disdain. They seemed to regard themselves as superior beings and were prone to comment adversely on GPs diagnostic skills and the quality of their referral letters. As a result, I embarked on my locum GP post eager to set a high standard. How the mighty are fallen for within a few days my eyes were opened to the entirely different world that is general practice and the range of skills and experience required of the general practitioner.
I had been asked to see a lady on a home visit who was breathless. She was a wiry 75 year old and the moment I walked through the door, I realised that I had a medical emergency on my hands. She was collapsed in a chair, cold, pale, clammy and acutely dyspnoeic.
She had experienced some chest pain earlier in the day and was in acute heart failure. It was a situation I had dealt with many times in the past but always in a hospital setting. I quickly realised I had no ECG machine, no oxygen and no one to turn to should I need assistance.
I did however have a medical bag in which I had put a variety of items that I thought might be useful. These included the standard drugs used at this time to treat heart failure; frusemide, digoxin and aminophylline.
With a fair amount of confidence, I opened the three glass vials and placed them on a small adjacent table. Then I delved into my bag for needles and syringes. There were plenty of needles but only one 20ml syringe. No matter, I thought, I’ll draw up the 10mls of aminophylline and then mix in the digoxin and frusemide; after all I reasoned, it’s all going to be injected intravenously.
But disaster struck. When I added the digoxin and frusemide, the clear solution of aminophylline turned cloudy which then set with the consistency of thick yoghurt. I placed the needle in the patient’s vein but no matter how hard I pushed on the plunger, the mixture was far too thick to inject through the needle.
By this time, the patient was getting increasingly breathless, her husband increasingly concerned and I was getting increasingly red-faced, embarrassed and fearful I should have a death on my hands.
‘Dial 999 for an ambulance, I instructed the husband, trying to hide the panic in my voice, ‘and stress to them it’s very urgent.’
I sat with the patient until the paramedics came. They gave her oxygen and whisked her off to hospital.
A greater embarrassment occurred a fortnight later when I visited her after she had been discharged having survived her heart attack.
Her husband forced a bottle of whisky on me, whilst she gave me a hug and a kiss with tears in her eyes and thanked me for saving her life.
Comment
To make a mistake is human. No one goes through a career in healthcare without making mistakes. Anyone who claims they have done is a liar. What is important is to learn from mistakes and to avoid repeating them. Some mistakes have severe consequences – fortunately the outcome in the story related here was merely embarrassing.