Medicine from the heart . . . Kathryn Wilson

On Thursdays, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.

Kathy Wilson, MD, a third-year resident at the Barre Health Center, talks about going through "mistakes" with patients, and has a pretty surprising outcome.—Hugh Silk, MD

Learning from mistakes . . . 

I remember that the first time I met “Rick,” he was an older gentleman with a huge smile on his face. His previous doctor had removed a mole prior to her graduation, and my first encounter with him was to remove the sutures. He promised me that day that he would find a mole for me to remove in the next two years and, sure enough, there has been a mole or two. But most of all, he said to me, “I can’t wait to grow with you, doctor. I promise you, you will learn a lot from me. All of the residents have.” I did not know how true that statement was going to be . . .

Throughout the past year, I have been taking care of his multiple medical problems, from his hip pain, to his depression to his diabetes. I have met his longstanding girlfriend and his closest son. Every visit starts with, “Doc, do you want to laugh first or last?” and I of course say first, and he hands me a paper with a joke on it.
The toughest part has been taking care of his diabetes. We ended up after long discussions putting him on Lantus and soon adding Novolog to his regimen. He was finally controlled for the first time in years and I was finally spreading out the visits. He would occasionally give me updates on his sugars with email to make sure he was still doing well. That is why, when I received the text late one evening when I was on call, my heart dropped.

The text had the wrong spelling, but I knew it was my patient. It said “wrong insulin.” I called immediately. “Doc, I accidently grabbed the Novolog instead of the Lantus and took 86 units.” I was shocked. I was sad. A million feelings jumped in my head at that moment. I still don’t know how I was able to speak with all that going on. But I found myself asking if he ate his candy bar that is in his pocket and if he grabbed the juice. I hung up to call my attending to let him know while Rick grabbed the OJ and realized I forgot to ask Rick if he called 911. After quickly talking to my attending, I called Rick back and he hadn’t called 911. I hung up again as he called and then called him back immediately. We talked over the phone until the ambulance came.

I remember when I saw him a few days later in the office, I felt responsible since I had started him on Novolog and Lantus. Was that the right choice? Did I make a mistake? Could I have stopped this from happening? When I opened the door to that visit, I did not know what to expect. I did not know whether he might have lost faith in me, or if he might be mad. What I got was a huge hug and a big thanks. “Doc, they said because of the candy bar and the juice my sugars never dropped below 70. Thanks doc. And thanks for staying on the phone with me. That meant a lot.” We had a long discussion about what had happened. What I learned most that day was how much he blamed himself. He felt he was a failure. He did not understand how he made that mistake. It has taken many sessions to help him realize that we all make mistakes, but he finally forgave himself and I forgave myself.

I learned a lot in that one call, but I have learned even more throughout the whole year with him and can’t wait for what he can teach me the rest of this year. Some of the knowledge has been medical, but most has been on how to become a passionate, caring doctor and how to work with your patient to best take care of them.