Are doctors allowed to make mistakes?

The crowd had left, and I was picking up the projector and the rest of my stuff in the conference room. To say that I had messed up was to make an understatement.  A last-minute biopsy slide, which turned out to be that of a different organ, was probably the worst that could happen to a pathologist in training. Oh, my God, I thought, there is no recovering from this one. I had failed to adequately establish the cause of the patient’s death.

Many people view doctors as infallible. That was my perception, too — until I began the journey of becoming a doctor myself. It’s more of a burden for pathologists because clinicians depend on us for diagnosing malignancies, classifying or staging tumors, or confirming infections that would have serious implications on the treatment approach. Meaning: A misdiagnosis might result in the surgeon removing a benign breast or kidney, or the oncologist administering the wrong chemotherapy protocol, or clinicians undergoing the nightmare of over- or undertreating their patients.

I have tremendous respect for my fellow residents and consultants. More often than not, after a less than desirable score on the monthly exam where we are ranked, or missed lesions on microscopy, I doubt whether I should continue. Being in this specialty requires one to be objective, methodical and precise — three adjectives seldom used to describe me. While my colleagues were completing secondary education in science high schools, I was a college student during the day and a call center agent at night.  Almost every move on their part was geared toward the goal of becoming the specialist they intended to be. In my case, I started late in medical school in the province, with the intention of becoming a general practitioner.

Almost a year into training, I am still adjusting in a major way. Distinguishing benign lymphocytic proliferation from lymphoma and further subclassifying require years of study, and up to now, doling out a diagnosis of cancer makes my heart beat faster. Of course, the fact that I’m alone in this journey — my brothers, my only family left, live abroad — does little to help. Homesickness presents a constant struggle, but I have been in frequent touch with pathologists in my native Leyte for encouragement and direction. Training in Manila comes at a high price, and I hope that when I go home to practice in the province one day, it would all be worth it.

I had felt this overwhelming longing to be with family and something familiar and comforting, but I needed to again head to the morgue to get additional tissue sections, to correct my mistakes in the diagnosis. I needed to prove in this case that mucosal and submucosal erosions and profuse bleeding from enteropathy had killed the patient.

I laid out the organs on the steel table, and began unraveling the colon. An image flashed in my mind: the patient’s face, not when his body was undergoing my autopsy, but the way he looked in his ID card as a fresh graduate. He was young, and his siblings were at a loss as to what had really happened to their brother.

I thought I owed it to the patient to find the truth about his demise.

For a moment, I forgot about my own problems and focused on the task. But there was a lump in my throat and tears began to blur my eyes. Maybe it was the formalin, or maybe it was just me.

* * *

Thaddeus C. Hinunangan is a resident pathologist at the Philippine General Hospital.