I stepped into the delivery suite at StThomas Hospital to watch the fetal heartrate strip during a labour. The babys cardiogram was perfectly normal. As the line of the monitor snaked across the screen, I thought of the little one wed discharged earlier because the midwifes baby had become seriously ill. Now I needed to arrange cover with another midwife from obstetrics to backfill the reception area.
Is everything alright? Please, tell me, the worried expectant mother whispered, her eyes fixed on me. Anything wrong on the monitor? You look so focused.
The hardest part of being a doctor is learning to keep a steady face. All our conscious life is spent learninglearning to make diagnoses, to piece together fragments until we see the whole picture. We learn to observe, to wait patiently, to intervene only when necessary, and to make the right call in an instant. We were never taught the art of acting.
After a tough operation, in the dead of night, eyes stung with icy water, blood splashing onto my shoes, I would have to descend to the ward, greet the next patient with a calm, sincere smile. Thats the point: to show a frightened, bewildered person brought in by the ambulance that they are safe, that were glad theyre here, and that help, relief and treatment await them.
No one ever taught us that a sick person is terrified. No matter how professional we become, no matter how we handle the most harrowing situations, we must still keep a steady face. Fear distorts realityboth yours and theirs. Outside the hospital doors your parents are ill, children have lost their keys and sit on the stairwell waiting for someone, in the ICU a pregnant woman with a nonviable fetus wont stabilise, and in the operating theatre the scrub nurse suffers a hypertensive crisis. All this churns in your head, yet somewhere above your own mask
Keeping your face together is incredibly hard, especially when you realise youre only fifteen minutes from disaster. You must conquer your own fear, issue clear orders, explain calmly to the patient why were rushing, soothe her and her relatives, obtain consent for surgery, and sprint to the operating theatre, stripping off your coat on the waystill keeping that calm façade. Then, after the drama, you slip off the stage and disappear backstage.
The hardest moment comes when the catastrophe has already unfolded. Even then you must keep your composure, ignore the chill in your chest, keep talkingtalking to patients, to families, to strangers, to yourself, to God, to the thoughts that have frozen inside you, to the senior consultants, back to the families, back to yourselfuntil the painful weight in your lungs eases and you finally draw a full breath, knowing that another personal scar has been etched on your heart.
An hour later, walking down the corridor to see a new patient, you still hold that mask, rubbing gently just under the left clavicle, because doctors make mistakes. Every single one of us. Even those who claim theyre from God. Theyre human. Only those who never work never err. Even the most precise equipment fails, because it was built by people. Humans are prone to error.
The most frightening thing is recognising that youve slipped up. Your mind keeps replaying the moment you could have acted differently, but theres no answer to what the result would have beenbecause that future never arrives. You remember staring at a perfectly normal cardiogram through bleary, exhausted eyes; your eyes have grown accustomed to fatigue after years of night shifts. You recall overlooking an entirely normal lab result that no one else would have noticed. You recall dosing medication exactly as the protocol dictates, running late to an emergency, or arriving too early. You recall looking at an Xray and missingor misreadingsomething, even though your vision was the same as yesterday, a month ago. You recall a sudden jerk of the hand with the scalpel that sent a clamp flying off a vesselwhy didnt that happen yesterday, the day before, a year ago? Six shifts in two weeks is a lot, and at home your mother is recovering from a stroke.
In medicine, time is a relative concept, and your loved ones have been on the honorary final bench for years. The real horror is not just the mistake itself but not understanding what went wrong, because then it can happen again. How many more textbooks must you read, how many more training courses endure, how many sleepless nights must you survive to prevent a repeat?
Who can say? And how do you push away the thought that statistics are on your side? The grim medical statistics, spoken in cold numbers, tell us that out of a thousand births, surgeries, procedures, there will be three, five, ten complicationseverywhere, every day, every month, every year. Someones life, health, tragedy. Someones.
What does a doctor do when he finds himself in that statistic? He stands before grieving families and says, Here I am. Your murderer. Can anyone picture themselves in that spot? When countless, countless people suffer and youre the one face they see, you become the sole source of their immeasurable sorrow. Here I am. Destroyer.
And why, when a doctor errs once, are the countless times he was right erased? Doctors err because theyre human. Gods do not err. Thats their world, their creation, their statistics. The more I work, the more I realise only the chosen can grasp their design. We are not chosen. Were ordinary. Ordinary people. Ordinary doctors.
