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.


45 thoughts on “One day, I am going to kill.

  1. No, doctors aren’t gods, even with a little g. That’s why I ask many questions and am not afraid to say no. That’s also why medical malpractice insurance is so expensive as well as necessary. I have no doubt you will be a most conscientious doctor.

    Liked by 1 person

    1. Oh definitely, always ask as many questions and never be afraid to question the advice you have been given if it does not feel right. Insurance is an absolute necessity for any health worker, let’s just hope it doesn’t get used too regularly.

      Liked by 1 person

    1. It is not, but also a very practical thought to have. Let’s just hope it doesn’t happen for a long time and that when it does I will have the knowledge and wisdom to handle it in the best manner possible

      Liked by 1 person

  2. Good luck with the career, you seem to be doing plenty of thinking about it and this can only be a good thing. You are going to help a lot more people than you kill.

    From a patient’s view can I point out that we don’t always want to be prodded and poked and dosed and cured. I’m already getting to a point where I don’t always appreciate medical intervention – I don’t feel too bad at the moment and I don’t want to be messed about.

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  3. When I go to the hospital, my own objective is to leave. But, sure, I want to feel better. So I can leave. I don’t expect anyone to be perfect, though I guess that it is the expectation at large of the medical community. I see a cycle here or circle: doctors appear too confident, because we expect them to know everything; because we expect everything, doctors appear too confident. The reality is we’re all part of the same humanity. And humanity ain’t perfect. It would take such great change in the ethos, however, before we let medical folk off the hook for being human. Which is unfair and unjust.

    Liked by 1 person

    1. Medicine has come a long way since its origins, but it is continually changing and improving. Confidence is important, who doesn’t feel safer with a confident practitioner? But humility and the honesty to acknowledge faults and uncertainty are also extremely important, which is something I’d like to hope most people have.

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  4. If I recall it correctly, the term for this is iatrogenesis. Some researchers even https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/ that the iatrogenic effects of modern medicine are among the biggest threats to global health in general.
    I think, much would already be achieved, if the question whether some form invasive treatment is really necessary or
    are other options with similar effects might be available too. This is by no means a case against modern medicine. But the issue of multi-resistent bacteria is a very real one and so for we struggle to find useful solutions.

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    1. I think the question is, do certain things need treatment at all. Multi-resistant bacteria has been facilitated by an unnecessary over-prescription of antibiotics, which is a result of people wanting tangible treatments for a common viral infection and doctors failing to care enough to say no. There will be a day where we find a deadly bacteria we have no way of treating, and I can only hope I’m not the one to meet it.

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  5. Reading this, and knowing that you have such a deep compassion and understanding of the worst case scenario for yourself and the patient, seems to me it would be the exact reason a patient would choose you to be their doctor. It’s clear that you care, and I think that will come through in your work. It is that caring nature that will have patients trusting you and that very thing which will allow them to forgive you for the worst case scenario. Just remember to forgive yourself. Just my opinion – as a patient.

    Liked by 1 person

  6. As someone who previously worked with addiction in counseling, I can so completely relate to this. No one ever died while under my counseling, but just hearing about relapses and overdoses sometimes shortly, sometimes a good while after leaving my care, I couldn’t help but wonder what I could have done more. But the truth is, there wasn’t anything more I could have done. I appreciate the your raw and authentic blog.

    Liked by 1 person

    1. Mental health is such an incredibly tough field to work in, and I admire you immensely for the work that you do. I think one may even be able to argue it is one of the hardest because often it is difficult to see progress or feel like you have helped in any way. You did your best and I am sure everyone was greatly appreciative of all of your efforts. Thank you so much for reading and responding 🙂

      Liked by 1 person

  7. Some doctors lose their empathy or have never had any at all… sometimes as a patient of many, you just become a number….

    All you can do is do your best and learn. Never lose your empathy.

    And on a side note – you might become desensitized somewhat? But I do love that you care and are entering the profession with that caring and empathy ❤️✌️

    I have experienced drs with no empathy or care – and also ones who were extremely caring and helpful…

    The ones I treasure are the ones who do care… I am very thankful for the ones who care. I trust them no matter what happens.

    I don’t trust the ones who have no empathy.

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    1. Empathy is such an important quality to have, and should be present in everyone. I agree desensitization is something that is common and expected, but I do hope that it does not happen at the expense of compassion and care. Thank you for the support 🙂

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  8. Thanks for your honest and compassionate article. I am a person who has been seriously damaged by doctors, most of whom refuse to take responsibility for their mistakes. It’s true doctors are only human and therefore imperfect but in my experience many of them are more concerned with their egos and avoiding litigation than the welfare of their patients. Doctors who try to cover up their mistakes only add to the hurt they have already caused. I hope you will not become jaded and immune to human suffering as you progress through your medical career, I wish you all the best.

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    1. Thank you very much, I am sorry you have had some bad experiences and I definitely never want to become an egotistical and selfish doctor bent on protecting myself at the cost of patients. I wish you the very best and hope that you have not completely lost faith in the medical field because I am sure there are plenty of doctors out there who will do the role justice.

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  9. Hi Helen,
    I enjoyed this. From observing people in similar situations, I think the hardest thing will be balancing admitting fault with apology. It appears survivors are most angry, and in hindsight would have settled for, a simple, “I made a mistake.” and, “I’m sorry.”.

    Liked by 1 person

  10. A very forward-thinking post. Unfortunately I had a terrible experience where I had a bad reaction to medication and haven’t been the same since, almost four years now. Like you said: the “intention” is always geared toward a benefit but the outcome doesn’t always link up with that. Good luck on the rest of your journey!

    Liked by 1 person

    1. I am sorry you had a bad reaction to something and that it’s had a significant impact on your life. I hope you continue to recover and that you can get back to where you want to be. Thank you so much for being understanding and encouraging, I appreciate it!

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