Tuesday, February 19, 2013

My Favorite M&M

For those of you who don't know, in the medical world, M&M stands for Morbidity & Mortality conference. Basically, this is a conference where we go over Bad Things that happened to patients and why it was all the fault of the damn resident.

When I was a resident, there was an M&M discussing a patient who I will call Mr. Smith. Mr. Smith was a patient of a resident named Herbert, who was the one presenting the case. It was a bit of a mess, but in summary, Mr. Smith kept having massive GI bleeds on the rehab service, he'd get transferred to Medicine and they'd get him to stop bleeding for just long enough to force us to take him back, then the next day we'd transfer him back again for massive bleeding.

I was on call during a Saturday when Mr. Smith got sick of bleeding and instead decided to have chest pain and tachycardia. I spent practically the whole day dealing with him in addition to the other 70 patients I was covering. My call was officially over at 7AM the next day, and I got a page (at home) at 6:30AM saying that Mr. Smith was bleeding again.

I got dressed and started to go to the hospital, then before I could leave, I got a second page, saying that Mr. Smith had become unresponsive and a code blue was called.

I called the attending on call, Dr. Sneak, and she told me she was on her way in. I arrived at the hospital about ten minutes later, and the patient had already been whisked away to the ICU. I made a halfhearted attempt to see the patient, but the Medicine service kind of shooed me away. They knew the patient much better than I did, and I was sort of in the way. Apparently, when a patient is coding, rehab getting the chart to write a note is not high priority.

Since my call was officially over at that point, I phoned Dr. Sneak again. I told her Mr. Smith was safely in the ICU and that I hadn't been able to see him. Dr. Sneak was on call Sunday as well, so she told me she'd see the patient later that day.

Truth be told, I didn't write a note. I probably should have, but I couldn't get near the chart, and my note would have just been something along the lines of: "Patient coded. Medicine took him." I did mean to maybe go back and write the note later, but since Dr. Sneak said she'd see the patient, I figured there was no need.

Fast forward to the M&M:

Herbert is talking about what happened that weekend to the patient. I realize I know some details he doesn't have so I do the stupidest thing imaginable, which was to volunteer that I was on call when it happened.

I got skewered. Mostly for not having written a note on Sunday morning, but also for not seeing the patient on Sunday, even though I wasn't on call that day. It's not like me seeing the patient on my day off would have made any difference to anything whatsoever.

And all the while, Dr. Sneak sat there, not saying a word. I didn't mention that she had told me she was going to see the patient herself on Sunday, but failed to do it. It just seemed like a bad idea to say that right in front of her.

In all honesty, if you are the attending, the buck stops with you. If your patient codes, you better see that patient, whether the resident sees him or not. I was pretty pissed off that nobody seemed at all curious who the on-call attending was that day. But that seems to be the way these things go.

Anyway, I did learn one valuable lesson in that M&M....

Herbert: "I was trying not to mention your name. Why didn't you just keep your mouth shut, you idiot?"

Yeah, good point.


  1. One of your best stories :)

  2. Reminds me of the advice I got before my first deposition (which went back to a case I was a resident on): "There are only three possible answers to a question - yes, no, and I don't recall at this time." Offer nothing. It never, ever shows how smart you are. Just the opposite.

  3. What does Grumpy say? KMS = Keep Mouth Shut = the most important thing you will ever learn during your medical training.

    I'm going to go practice that right now.

    (Sorry you got skewered, but I agree Dr. Sneak totally dropped the ball.)

  4. Yeah, Herbert nailed it.

  5. Yeah -- it would have been a really bad idea to mention that Dr. Sneak was on-call. Should she have just mentioned it herself? yes. Would you have been right 'in theory' in mentioning that you had spoken to Dr. Sneak, and she said she would go to see the patient? yes, in theory. Did you do anything wrong? No. But the fact is that in medical training, s**t rolls downhill. There was a reason that no one seemed curious as to who the on-call attending was...

    It's stories like this that make me glad I'm not in residency anymore. Thanks for sharing.

    ER MD

  6. Could your inability to acquire a taste for both have something to do with the age at which you started trying to drink them? In my family, even very small children are given milk and coffee as a breakfast drink. (And I've never "grown" enough to really like coffee without milk as a result.) And even small children are given a few sips of wine with dinner. (Although since it was homemade wine, it could peel paint, so it's a wonder anyone develops a taste for it.) There are wines that I think are so good that I could easily kill the bottle. (Fortunately, I can't afford them so it isn't an issue.) Others, meh. Same with beer except for beers gotten in Germany. They truly do have wonderful beer. American beers deserve the epithets.

    1. sorry. posted this in wrong place accidentally.

  7. Unfortunately the very point of an M&M is to find fault, to skewer someone.
    I remember how we hated M&Ms when we were residents... glad those days are gone