The Doctor Will See You Now [Non-Fiction]

Chapter 16: Oncology

One time I thought I'd screwed up big time.

On night shift a while back, I admitted a patient who is on chemotherapy for cancer. Didn't think much of it. The chemoradiotherapy they received made them really sick and dehydrated, so I completed their admission documents, hooked them up to fluids, and saw the next patient after that.

A few weeks later, someone from adverse events investigations asked to speak to me. They asked if I remember this patient's name. I said no -- I had seen at least a hundred patients since then and my memory is hazy at best on night shift. They relayed the story and it became somewhat familiar. They told me the patient received an antibiotic called Gentamicin, which interacted with the chemotherapy they had received, giving them an acute kidney injury (an attack on the kidneys, dropping their function) and damaging them enough so that the patient can now no longer receive that chemotherapy. They told me it was me who had prescribed that Gentamicin. Gentamicin is commonly used in severe urine infections and it's a great antibiotic, but its drug interactions are wide and adverse effects severe, and it was not a drug I would easily give without good consideration and even senior advice.

I was horrified. Effectively, this clinical mistake had robbed the patient of the chance of continuing with their first-line therapy. It could mean they lose their curative chance. It could mean they die earlier. It was my fault.

I had a meeting with this adverse events investigator a few weeks later so they could get my side of the story. Their job was to interview every single doctor and nurse who had looked after the patient to get a thorough story of what was going on, where the mistake was, and they would then draw up a plan to prevent similar events from happening again. Lessons had to be learnt and we had to learn them. They had the patient's notes with them and showed me what I wrote.

It turns out I hadn't prescribed the Gentamicin. The patient did not become sick with an infection when I first saw them. They were just dry. The plan I made was if they became sick with an infection, they were to start on piperacillin-tazobactam ("Tazocin"), a broad-spectrum antibiotic often used in haematology and oncology patients as it covers most common infections and is pretty hardcore. I did not suggest Gentamicin at all, nor did I prescribe it.

Ultimately, the mistake was further down the line and I was not at fault, but I was part of the team who looked after the patient and so I was interviewed for it. The way the initial conversation with the investigator -- that *I* had given the Gentamicin -- had shaken me. The outcome for the patient was devastating to know. Would the patient have died at the same time and the same way anyway, given (as it turned out) it was not curative chemotherapy they were getting? Perhaps. But this was a major clinical mistake and it taught me a lesson: chemotherapy medications are nothing to be messed with and it's so easy to just give strong routine antibiotics for a routine infection on reflex, and make a mistake because one did not consider their interactions.