A Strangely Common Occurrence

You feel like you have assessed and managed a patient properly, treated them well enough to see remarkable improvement. You feel the patient is safe to be admitted into your wards without referral to a tertiary hospital.

So you happily send the patient on his merry way to the ward.

Barely an hour later, the patient has apparently deteriorated and needs to be sent to the tertiary hospital- intubated.

So...

Is your assessment really good?

Did you miss out obvious signs of deterioration?

Did you even manage the patient properly?

The vital signs chart, does it lie? 

Was the entire department complicit in pretending the patient has improved clinically just so the doctor in charge doesn't have to pick up the phone, discuss the case with her superior and refer the poor, unfortunate patient to the nearest specialist hospital?

Did some supernatural process weave its way through to plant its horrendous, cursed lips on the patient while he was in transfer, leading to a rapid decline in his well-being?

Weird stuff happens.

You could be the first doctor, or the second one.

Your level of knowledge or competency tend not to matter much in these strange aberrations.

The second doctor, kudos for catching a deteriorating patient and doing the needful before proverbial feces hits the proverbial fan.

The first doctor... Well, let's hope your documentation is sound and you have a good track record.

Let's be real, I've been in both situations. 

And only recently was I in the situation of the first doctor.

I kept rewinding through my memories, thinking where did everything go wrong... 

I was by the patient's side for most of his time in the emergency room.

I assessed the patient myself instead of relying on the nurses for vital signs.

I managed the patient as thoroughly as I could.

I gave the final word that the patient was stable enough to be sent to the ward without requiring specialist input.

And much, much later, when my colleagues told me the patient's condition in ward on arrival, I was utterly shocked, because from what I hear the patient was in a worse condition than upon his arrival to the emergency department.

The irate second doctor who had to manage the patient was understandably cross with me, assuming I was dumping proverbial feces into her ward so she could clean it up.

Honestly... 

I think we are all in this field not to dump feces, but clean it up.

Plus the specialist in question that day was actually quite pleasant, so what would really deter me from speaking to her?

So what happened to the patient??

Sigh.

I keep beating myself up for things that are out of my control.

Vital signs that do not tally.

Magical changes in condition.

Troublesome people.

Miscommunication.

Feeling like James Blunt on a moody day...