Fatigue Makes Cowards of Us All. –Vince Lombardi

I thought of this quote yesterday as I sat at my computer, in my office, at my hospital, quietly crying. I could not stop crying. I was hoping no one would walk in and see me. It wasn’t that bad of a morning, just very, very busy; and, I had made a prescribing error.  An error that was caught early with no harm done, but an error nonetheless, and I knew I had made that error because I was exhausted.

Ever since Babyboy was born, this is one of my husband’s favorite quotes. I’m not sure Lombardi intended his line as consolation to sleep-deprived new parents… And we may not necessarily have qualified for its use as such, seeing as Babyboy was sleeping through the night at age 3 months. As a matter of fact, until last month at age 13 months, we were able to tell everyone who asked (and they do ask!) that Babyboy was a GREAT sleeper.

For reasons that are not quite clear, that has changed. For the past 4 weeks or so, Babyboy has gone from being a 7pm- 7 am solid sleeper with 2 predictable long daytime naps, to a 9pm- 6 am sleeper with one nighttime wakeup and maybe one lousy daytime nap. This change was, and is, alarming to us, as well as pretty darned disruptive to our (luxurious) schedule…

And other parents haven’t had too much sympathy. Oh, people are nice enough, but when I have turned to other moms and dads for advice on this issue, I usually hear about how much worse their kid was, and how we have had it easy, and how ONLY ONE nighttime wakeup “is actually pretty good”.

At any rate, we’re working on it- he’s so much more physically active now, cruising and crawling and scurrying up the stairs, we think maybe he’s burning all his calories and he’s waking up hungry. Or maybe he’s overtired. Or maybe he’s teething. We’re treating all of these.

Meantime, even with my 4-day-a-week clinic schedule, I am getting progressively sleep-deprived. As much as my husband tries to protect me on days that I have to work, as he gets up with a screaming Babyboy at 3 am, I wake up too. I can’t sleep through it… Babyboy gets frantic, like he’s in pain. A warm bottle will usually soothe him back to an uneasy sleep… but not me. I’ll then be up for hours. Usually as soon as I start drifting off, I realize I have to pee (I’m 24 weeks pregnant) or that the alarm clock is going to go off soon anyways. Might as well get up.

And then I’m up for work. It hasn’t been going well. Every morning I feel nauseated with exhaustion. I can’t drink too much coffee because I’m pregnant. I can’t jump up and down to wake up because I’m pregnant. I’m also tired because I’m pregnant. So I just slog through the days…

Yesterday was a particular low. Most of our docs are away on vacation, and there are precious few of us holding office hours this week.  I had a pretty solidly booked clinic, plus I was covering patient messages, our nurse practitioners and any urgent issues. At about 10 am, there was a flurry of activity: a patient in the office with chest pain, a call from the emergency room regarding another patient with a GI bleed, and several urgent messages from nursing that had to be attended to. And I had people waiting.

I felt stressed. I took my usual approach of triage: deal with the sickest person and the most urgent issues first. I made it a point not to multi-task. I saw the chest pain patient. I called the ER back and talked with them about the GI bleed patient. I checked the urgent messages. One was a positive urine culture from a medically complicated patient I did not know. I opened their chart and quickly scanned the notes, then opened the microbiology results and scanned several recent positive cultures. I prescribed an antibiotic based on the culture I saw and closed out the message.

And I went on to see the rest of the clinic patients, running behind but not terribly behind. When I had finished, I got a call from a physician in another specialty of our hospital, who happened to be related to the medically complicated patient with the positive urine culture. They informed me that I had prescribed the wrong antibiotic. I thought, that’s ridiculous, but I checked the culture again. And again.

I must have been looking at the wrong culture when I made my choice, because I had indeed picked the wrong antibiotic. If the patient’s relative had not caught the mistake, the patient may have had complications from an untreated UTI. I felt sick.

I admitted my error, explained that I had apparently looked at the wrong date urine culture, and set about correcting the problem. I called the pharmacy and cancelled out the previous prescription, and prescribed the correct one; we informed the patient of the error; I documented the error and correction in the chart. I was a bit in shock, but I wanted to fix the problem completely, and be completely transparent about it.

When that was taken care of, and all the other urgent issues had been taken care of, I sat down at my desk, and suddenly started crying. I just couldn’t stop. I felt like such a failure as a doctor, trying to hold it together and do good work, but screwing up anyways. I went and found the nurse who had sent me the urgent message in the first place, and we talked it out. She’s been with this practice for decades. She told me she’d been doing this for a long, long, time; that every single doctor in the practice had made mistakes, some worse; and not to worry about it. She told me to go home and get some rest. To take care of myself.

So I did. I went home, and on the car ride I felt better. I picked up Babyboy at my mom’s and I felt better. I got home and broke down again in front of my husband, who was great and watched Babyboy so I could take it easy for awhile.

And, last night, Babyboy slept through the night.

Today I feel more normal. I still can’t understand how I managed to look at the wrong urine culture for that patient, but will certainly make it a point to double-check dates next time. I also am embarrassed that I cried in front of our nurse, but hey, probably everyone else has too.

And I am comforted still by Lombardi’s wisdom.