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“Complication” FREE TO VIEW

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Editor’s Note: The poet writes, “Despite my intentions, I still make the M&M list. Based on a recent case, I used this creative expression as an opportunity to explore the tension I feel in these outcomes. I cannot decide if guilt is a proper response to these situations.” He is an anesthesiologist, focusing his clinical and academic efforts on airway management and resident education.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2013;144(1):355. doi:10.1378/chest.12-1492
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The ultrasound in my glove
Shows a plump right IJ,
Punctured, and professing blood,
A hue of dark red.
I thumb the wire in the hub
And it is partway fed.
It will not follow the course,
And starts to bend and twist.
So I increase the force.
The surgeon waits with impatient stance.
Belly prep continues and I sigh,
Trying again to advance.
This obstinate wire.
I remove it and verify return,
And wonder what forces conspire
To thwart this man’s line.
I regroup and feel the resistance
Of scar and pressure of time.
Then I feel it slide
And the wire feeds.
The needle is cast aside.
I nick the skin and dilate.
The line pauses at the fascia,
Then is placed. I aspirate
Nothing. I try a second port,
But receive no blood, just air.
My line has come up short.
Silence ensues,
Interrupted by my request
For a chest tube.
Later, charting the events,
I feel the guilt swirl inside
And I try to make sense
Of that man on the table:
Am I right to feel wrong,
Or was I just unable?




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