"There's nothing more daring that showing up, putting ourselves out there, and letting ourselves be seen." - Brene Brown

That feeling...The realization of what just happened, or what could have happened.  You get a little dizzy.  Your vision closes in on that lab result, the wrong dose, that piece of history you missed, that procedure gone wrong.  It's a little hard to breathe.  People keep talking and joking around you and you try to act like everything's fine. It happens so fast.  You're the one who screwed up.  You see it as clear as day.  You did that. How the hell did that happen?

Now there are some choices.  Forget about it! Stuff happens.  Nobody got hurt. Just move along. You can change the note a little.  Just fudge the history or the timing of events, just a little.  Or you can blame the lab, the tech, the nurse, the secretary.  Anybody and everybody else is at fault.  The better choice is to own it.  Somehow you can swallow that giant lump in your throat, breathe deep, and own it.

The medical community is not great at this.  In fact, I'm pretty sure I'm writing to an audience of one - me.  None of you have ever experienced this, I'm sure.  It feels this way.  Nobody ever talks about the errors.  I thought I was the only one until I shared it.  And then - the stories I heard made me humble, they made me cry, they made me incredibly proud to work with these people.

It made me proud of my coworkers because, to show up the day after an error,  takes some serious courage. Word travels fast, albeit, quietly in an ER. It feels like people can look straight through you.  You instantly feel vulnerable, weak, and fragile. Your confidence if rocked.  I find most people either put on an extra layer of armor and become even bigger assholes or they ignore it and act like nothing happened, hiding behind humor, grand standing, and false confidence.

What about honesty? They say it's the best policy. But man, that's tough. Unfortunately, I think it's the only healthy way through the anxiety.  The sleeplessness, worry, and burnout that comes from shoving these situations into the deep dark corners of our hearts is worse.

"Here's what I think integrity is: It's choosing courage over comfort. Choosing what's right over what's fun, fast, or easy.  And practicing your values" - Brene Brown

So, that's it.  No easy answers.  No plans, policies, or get out of jail free cards.  Own your shit! The reality is, we're all humans with a whole lot of junk, faults, shortcomings, and knowledge gaps. The more honest we can be about this, the safer our patients will be.  When our medical culture changes from a bunch of islands that look perfect from a distance to a bunch of humans who communicate, ask questions, connect, and learn, our patients will benefit.  If we as clinicians can take the armor off and be more real and more honest, we will also be more free.

 For more advice on this topic read or listen to ANYTHING by Brene Brown - seriously, ANYTHING!