Honestly, I'm not sure I deserve to be a resident. I admitted a patient with pneumonia complicated by pleural effusion. I performed a thoracentesis (drained fluid in the space between the two linings of the lung) and since the fluid was purulent, foul-smelling, and turbid, I labeled it as empyema. (Which it was -- see the beautiful Gram's stain below!)
As is protocol when performing a thoracentesis, I ordered a STAT chest roentgenogram to evaluate for iatrogenic pneumothorax.
But did I check the roentgenogram? No! I am pretty sure I didn't or perhaps I glanced at it far too quickly. I assumed my senior was following it. (Shame on me!) I also shouldn't have assumed Surgery was reviewing it. (We consulted their service for chest tube placement to drain empyema.) While I tried to push for a chest tube overnight to drain the empyema, I didn't realize that I had caused a pneumothorax. If I had, I would have gotten that chest tube in immediately. Instead, my poor patient didn't get his chest tube placed until the morning after admission, a good sixteen hours after I created a pneumothorax. He's lucky he did okay. He was never symptomatic from his pneumothorax but his pneumonia was so bad that he was already requiring supplemental oxygen at that time.
There must be a special guardian angel looking after my poor patients. And from now on I will make ABSOLUTELY sure I review post-procedural studies on my patients.
Thank you, God, for getting my patient through a serious medical mistake! Let's hope he and all the other patients have a speedy recovery.