Decisions that kill

It was stressful. The second day of cardiology attachment started with ward round in Coronary Care Unit with 2 doctors and 1 nurse. I reached before the specialist and introduced myself to the doctor-in-charge.
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“Good morning, I’m Ching Mun from IMU. May I join your ward round, doctor?”
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So the first patient was seen without the specialist. Half way talking to the patient, the doctor turned to me and asked again for my name. He looked at my name tag and scribbled on the bed ticket:
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“S/W Dr. Ng Ching Mun” (S/W: Seen with)
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Oh my… Perhaps I didn’t introduce myself as Medical student from IMU. Felt so uneasy and didn’t know how to correct him that I’m not a doctor yet! The specialist came there after and his name was written in the subsequent patients’ bed tickets instead of mine *allayed*.
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This was not the major stressors. Being the only Medical student there (Deva started with cardiothoracic surgery first) means I have to answer all questions directed to me. There were only 2 questions for me today and I answered 1 wrongly and couldn’t answer the other one at all. It simply means I need to read and practice more.
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Going into the main point, many think doctor is a noble occupation. Well maybe it is. A quote from the Spiderman remains vividly in my mind:
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“The greater the power, the greater the responsibility.”
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I testified that verse again.
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Patient A, a known case of heart disease on warfarin with INR of 4+ who was last seen well and active. A doctor tried to correct his INR by giving Vitamin K to prevent bleeding tendencies. However, a thrombus formed as a result of the attempt. He complained of sudden abdominal pain. Laparotomy showed bowel infarction due to blockage of vessel by the thrombus and resection was done. He passed away of sepsis lastly.

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Patient B, a dentist who complained of pain and numbness on her left upper limb. She was diagnosed with subclavian artery stenosis and had a stent done. A rare complication of broken stent occured. The vessel leaked to develope aneurysm which compressed her laryngeal nerve affecting her voice quality and ability to speak. She was treated with antibiotic for 2 weeks due to infection. To prevent the aneurysm from getting bigger, another stent was inserted to block the blood flow from aorta and thus the blood flow to her left upper limb was impaired further. The pain progressed from bad to worst. She was depressed.

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There is no absolute right or wrong in Medicine. Patient A might be at risk of massive bleeding if INR was not corrected. And nobody expected patient B would get worst after treatment. One can suggest a treatment plan with his points going for while the other can say no with valid reasons.

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Patient C, an elderly in her 80s with a previous coronary artery bypass graft presented with chest pain. She was subjected to either bypass again or treated medically. The doctor chose the latter, and secretly told me that the chances of her dying of heart attack is high based on his experience. She might leave anytime. It is still better than to die in an operation theater.

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It striked me the most when one patient submissively said:

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"Doctor, it's all up to you. You decide what is best for me."

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Medical students can make mistakes and fail exam, but medical doctors can't afford to decide wrongly and loss life.

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Greater power comes greater responsibility.