6 - Shame in Medicine: The Mistake
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What does the episode introduce about shame and medical errors?
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Thanks for listening to The Nocturnist's Shame in Medicine, The Lost Forest. If this is your first time tuning in, welcome, and I actually recommend you rewind and start at episode one. This is a series that builds on itself over time, so starting at the beginning will definitely lead to the richest listening experience. Enjoy the show.
Thank you.
So a few months ago, I was texting with a friend of mine who's a surgeon, and we were joking about how when we were kids, we were such perfectionists. I mean, we had color-coded notes, A-plus on every homework, and we were utterly devastated when we got our SAT scores back, and they were only in the 90th percentile. And then my friend asked... And we were actually laughing about this over text because even though it sounds like an exaggeration, it's also kind of true. The stakes in the profession of medicine are so high that it sometimes feels like perfection is the only acceptable way. Of course, we know that nobody's perfect. So how do we embrace that truth and still do our job? How do we even know when we've made a mistake?
What's the difference between a mistake, an adverse event, and a bad outcome? When we do make mistakes, how do we navigate the tension between individual responsibility and this broken healthcare system that makes these mistakes so common? How do we even begin to wrap our minds around the devastating consequences of our mistakes on our patients? And how do we take care of ourselves in the aftermath? In this episode, you'll hear stories from healthcare workers grappling with medical errors. Not all of the stories end in a tragic outcome like a patient death, but all of the stories resulted in profound experiences of shame. We're listening to Shame in Medicine, The Lost Forest. I'm Emily Silverman, and this is The Mistake.
So I'm going to admit that I absolutely love disco music. I love 70s disco. I love early 80s disco. I just love disco music. And one of my favorite songs is called There But For The Grace Of God Go I. And it is stuck in my head right now. And it makes sense given the story I'm about to tell you. Friday afternoon, I'm finishing up shift huddle, you know, shift huddle, the one where you're either in a hallway or a back room or some space where someone comes in and announces all the changes and sometimes even gives kudos. And there are nurses and they're waiting around for their assignments and they're talking and there's so much excitement and emotion around this conversation. And I want to hear what's going on.
And I go over and they're talking about the recent case, this case about the nurse at Vanderbilt, Redonda Vaught, the one who made a mad error, the one who was fired and criminally prosecuted, which is pretty rare. And one of my favorite nurses, a really good nurse, tells me this story. She tells me about a med error that she made and caused a patient to become over sedated. And she told me that she reported right away. And the response she got from that caused her to feel such deep shame. And she's walked around with the shame for the last 20 some odd years, she tells me. And she tells me that she always feels less than she never feels like a good nurse. And she says, what if that were me? What if I went to jail?
And then she kind of grins and looks at me and she says, you know, no one's ever self-report again after this case. And, you know, immediately I can go into this long story about the studies of how when we don't self-report, we cause more harm and how that's bad for healthcare systems and it's bad for any system in general. I give her a hug and it's actually not for her. I hold on a little bit longer because of me because I'm feeling such immense shame and guilt. I feel so guilty.
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Chapters
4 chapters
1
What does the episode introduce about shame and medical errors?
0:00–6:53
2
How does a hospital administrator describe the pressure of investigating a nurse’s medication error?
6:53–14:39
3
What lessons emerge from the nurse’s 20‑year shame and the system’s response?
14:39–26:23
4
How did an interventional radiologist handle accidentally puncturing a patient’s heart?
26:23–34:43