One day, I am going to kill.

Excuse the overly dramatic title, but before you click away I have to stress this isn’t just for clickbait reasons. It may sound a bit crude, but as part of my future career as a doctor, I expect people under my care to die. Some will die of natural causes, others will die of a medical condition. And some will die because of me.

People expect that when they go to the hospital, they will leave in a better state than when they entered. It is a place of recovery, healing and a place of refuge for those who are suffering. People expect hospitals to give them the care and medications needed to help them overcome their physical and mental ailments. And for the most part, it is true. Every employee of a hospital, from the administrative staff to doctors and nurses, work with the intention of making someone feel better. Whether it is prescribing medication or providing physiotherapy, the goal is to improve someone’s physical and mental state so that they can be discharged safely. Let’s be real, I’m not here to insult the very community I am about to enter myself. But let’s also not forget that the medical industry can do just as much harm as it can do good.

A previous Australian study found that 2 to 4% of hospital admissions are medication-related, with up to 75% of those preventable. Adverse effects as a result of medication and decisions made by doctors only increase once you are admitted. But they are never intentional (apart from a few horror stories of criminals taking advantage of the system). Sometimes we don’t know what effect the medication will have on the body even if we know all the theoretical knowledge behind it. Different people will have different physiological responses, and sometimes we simply cannot know until we try. It is especially difficult if there is already a cocktail of other medications in the system, which makes it hard to predict what interactions could occur. We cannot calculate how helpful a certain procedure or surgery is and what the exact benefit to harm ratio is. Or even whether an already fragile patient can endure such a trial. Sometimes in complicated cases there is a huge grey area where decisions resemble educated guesses more than anything else.

Being a doctor does not mean we can cure everything, sometimes it doesn’t even mean we can cure something in someone we normally would have no trouble doing so. It doesn’t generate a cape of invincibility against wrong decisions and human fallibility.

What it does mean is that unfortunately, some will die from the wrong decision, some will die from a mistake and some will die from our ignorance. Regardless of how good our intentions are and how knowledgeable a doctor might be, it does not exclude them from the possibility of killing someone. It is one of those careers where the stakes are extremely high, and those who suffer are not ourselves. It is familiar to anyone who works in the medical field and should be common knowledge before we sign up for a lifetime of responsibility, but no one actually warns you about it. No one teaches you what to do, how to emotionally cope with it and how to not let it ruin your psychological well-being. It seems like it is no one’s business and concern until it finally happens and you are thrown into the deep end. Then, and only then, will you discover what happens after.

I do sometimes wonder who my first victim will be and under what circumstances will it happen. Maybe it is a little too pessimistic and weird to be actively thinking about, but I am scared. Of how it will affect me. Emotionally, mentally and professionally. It’s a selfish thought, to be thinking about myself when I have just caused a family to lose someone they deeply love. But the reality is, as much as I sympathise with their grief and loss, I will likely never see them again. The guilt I carry within myself has the potential to remain there all my life.

Of course I know it won’t be a common occurrence, it will be exceedingly rare. Every hospital has safeguards to prevent such tragedies, where everything is triple checked by several staff before being implemented. Where every minute detail is read aloud and recorded to make sure it is correct. It is why the hierarchy exists, so that junior doctors who are the most likely to make mistakes or not know what to do have the least amount of responsibility in the team. And as things work up the ladder before the consultant finally signs off on a decision, we hope that any misconceptions or errors have been corrected. It is called the Swiss cheese model, where all the holes have to align perfectly together in every layer for something to fall through the cracks. If enough people are vigilantly checking each decision and there are validated tools to reduce mistakes, then technically the risk should be minimised. The only problem is that ‘minimisation,’ does not mean impossibility. Overworked doctors, a busy and understaffed rural hospital, or even just one honest mistake that is overlooked can carve a gaping hole into that crumbly cheese.

And it only takes one. One person to die under your hands for you to feel the wrath of grief, responsibility and self-doubt. The shame and remorse to look someone in the eye and tell them you could have done better. The pain of knowing you failed someone who was completely at your mercy and trusted you to help them. The resignation that the family may never forgive you and certainly have no obligation to give you that closure. Even trying to describe it now, it feels contrived and disingenuous. It is not something I can truly fathom until it happens, and to say I am not looking forward to it is an understatement. And even if it isn’t due to a mistake or a bad decision, even if it is because of something no one could have predicted, you still feel like shit. Perhaps even more so, as you recount every step and detail to look for the missing piece that was never there. Hoping to learn from a mistake that never existed. And regardless of what anyone tells you, that it wasn’t your fault and anyone in your shoes would have done the same thing, it doesn’t lessen the pain that the world is one soul short because of you.

But I suppose it is no use dwelling on such depressing thoughts when I have no idea where, when, who and what is going to happen. I can only do my best and hope that I will never have to face such an ordeal (whilst knowing its probable inevitability). And when the time comes, to seek forgiveness from not only those I have affected but importantly, myself.