Musings on M&M's

Death is a humbling thing.
Because it levels us all I suppose.
Those who succumb quickly and those who fade slowly. Those who die with fluffy pillows and those who die on a casualty stretcher. The brand new baby. The tired old lady.
We all suffer the same fate.

Sometimes it encroaches on life…in the last week it has hovered around the corners of mine.
It was there while I was getting the presentations ready for our obstetrics morbidity and mortality meeting. The series of unfortunate events which eventually led to the death of post-dates baby because we didn’t realise just how much he was struggling inside…but we should have.
There was the 21 year old whose mother gave her some herbal tonic to induce labour, which it did but overzealously so that the contractions were too strong and so the baby was hypoxic and we realised it too late. How terrible to tell a mother that her baby is dead, how much worse because she unknowingly caused it. How terrible to know that I should have picked up the problem sooner.
There was the mommy who’s uterus gave us the impression that her baby was about 2kg’s, her membranes ruptured and we took her for a Caesarean Section but this is government and not everyone gets a scan so in actual fact her baby was only 900g and well, we couldn’t really put him back.
In the next room was Nombulelo; pregnant for the fourth time. Her first 3 babies were all pre-term and they all died. The same thing happened again. 1.6kg…big enough to survive but the placenta pulled away before the baby was born and again salvation came too late. She cried for 2 days.
And Aletta, who was discharged from ICU too soon (aren’t they all) and spent 2 days in my ward getting too much fluid while her kidney’s were shutting down so that when I walked into her room on Tuesday she said ‘Dr, I feel like I’m dying’…and she was literally drowning in her own body.
And then there was Tshidi who I saw about 12 hours into a 32 hour shift. She was 38 and diabetic and she arrived complaining of being tired and weak. I thought she had a chest infection and that was what was making her sugar’s all crazy. I stabilised her in casualty and sent her to the ward for observation. She wasn’t even in the ward for 10 minutes when they called us to certify her…and she was dead just like that. She was so well in casualty, no one could believe it.

What I’ve realised through all of this, and my consultant said it today as well: there will always be adverse events. Sometimes even when you do everything right you still miss things and they turn out to be important things.
Morbidity and mortality meetings are no ones favourite. They are generally protracted and boring if you are not involved and they dissect your faults under theatre lights if you are. But they have their place in therapy. They force humility, which is an underrated quality of a good doctor I think. They are an opportunity to step back and recognise that you are human like your patients and capable of error. Once you acknowledge the error you can learn from it and hopefully avoid it in the future.

It’s a tough pill to swallow – a real penicillin injection.
That being said: I will never forget now to not just write off severe pain in labour as just a low pain threshold, I will be less trusting of the size of a uterus and more insistent on a sonar. I will be more attentive to my instincts because they turn out to be surprisingly accurate.
And I will acknowledge my imperfections and be willing to learn from my mistakes and hopefully cultivate humility.