Dis the season to be crying.

What is it about me and bad outcomes right before christmas time?

Three years ago, as a 4th year medical student in Toronto, I was part of a vascular surgery team that lost a patient on the operating table right before the joyous holiday season. The family was devastated. The surgeon, who looked so unflappable just hours before, looked so distraught I wondered if he could get over it dispite all his experience. I, naturally, wondered perpetually whether my involvement had any intricate ties to the bad outcome.

Last year, I was again on a medial team that had to deal with the tragic passing of a 1-day old newborn. It took me probably months to stop questioning every involvement I had with that case and I tried to learn from what lessons I developed from that experience to this day. That family, however, I'm sure, would be devastated for years to come.

Then yesterday, again as we stepped into the month of December, I was again intimately involved with the sudden passing of who would have been a "previously healthy female" patient. She crashed right in our emerg, and a 30-minute code couldn't bring her back. The exact cause was still uncertain, but could well have been an aortic dissection which has the potential to kill rapidly. I was the resident on the case. I don't know if I couldn't have done anything differently to prevent her death. I will probably never know. The family may even refuse an autopsy. Nothing will bring her back, however.

I don't think I am a bad doctor. I try my best with every patient and try not to ever miss anything, although that is becoming increasingly difficult as I find myself struggling with being thorough, being thoughtful, and being time-efficient. I know I did not rush yesterday. I felt I mentally covered all angles. I could always have done better on my assessment and management. That always ring true with every single bad outcome you evaluate. There was always something more I should have, could have, would have done.

Nothing could ease how terrible I felt when I had to walk into the room full of shocked family and relatives and reharsh the events that led to their loved one's surprised passing. Most of them were too shocked for questions. I would have been too shocked to answer them.

Yet another family is ruined this christmas. I don't know if other trainees are involved with bad outcomes as much as I seem to have been. Or maybe I just talk about them more. I didn't cry this time around. I felt empty inside. The sad thing was this had happened quite early on my shift. I still had hours of emerg medicine to do. I took a washroom break, shooked off my nerves, and picked up the next chart. Thank goodness it wasn't another chest pain case. I couldn't handle two in a row.

After I came home, I logged on facebook, and saw postings from my friends about their otherwise "normal" days. I thought to myself. It would be nice if having a 'bad day at work' doesn't mean someone had just died on your watch. It would be nice to not have to worry about whether your next day could be 'another bad day'. It would be nice to just go, do your thing, and come home, and that any potential imperfections do not cost lives.

But then that's all about being a doctor, I guess.

With great power comes great responsibilities. Yeah I quote from Spiderman. But it's simple enough and it's true.