About a year ago, I made a mistake at work. As a result, there was harm done to my patient.
This was the first time in my medical career that I’d ever made a significant mistake before.
It was purely human error.
My mistake was amenable to treatment and it was corrected rapidly. And at the end of it all, my patient was okay. They left the hospital with only a tale to tell and not a scar or disability to live with for the rest of their life.
I was fortunate.
But the dread I felt in that moment was indescribable and will live on as a less than ideal memory. Because after I realised what I’d done, my heart raced and my hands trembled. And the cold pit of doom that I felt in my stomach was the hard slap of reality that my work as a doctor has direct, significant and sometimes devastating consequences if it goes wrong.
It wasn’t that I had forgotten but that despite my healthy compulsions and obsessive routine — I had still made a mistake.
I was human after all.
Who would have thought otherwise?
Me, of course.
I was capable of being distracted.
Susceptible to being overwhelmed by emotion.
And always one mistake away from disaster, or a career-defining error.
But what happened too, was also an unexpected test of integrity.
Because despite what occurred, no one actually knew what I had done. This is because I’d managed it well.
See after I discovered my mistake, in my sheer panic and in the midst of everything happening around me, I decided against disclosing my error, in fact, I vowed at that moment never to tell a soul.
How could I?
What would people think of me?
“Shut your mouth and get on with it,” my mind yelled at me.
My mind vs my conscience
As I left work that day and everything around me quieted down, my mind was not kind to me. It sensed a crisis and activated its cold and harsh protective mode. My thoughts and actions were driven by my head and certainly not my heart — where the truth and my conscience lay.
Unsurprisingly, I could not sleep.
I tossed and turned as my stomach churned and my thoughts found no safe place to rest. The secret that I had tried to bury and hide, lit up my subconscious and would not be silenced.
It screamed in defiance — Tell the truth, Jonathan!
I had no peace.
The next morning I opened my bible and started my quiet time like I always did — my standing appointment with God.
However, before I began, I did something that I hadn’t ever done before. I wrote a list of reasons why I needed to remain quiet about what had happened. I rationalised my silence. I made excuses for my lie.
What would people think of me?
What would be the consequences of disclosing what actually happened?
Why didn’t you say something at that moment?
If you keep your mouth shut, this will all eventually go away.
You aren’t a very good doctor, are you?
My hand raced to keep up with the flood of confusing and self-deprecating thoughts that peppered my mind with worry. It didn’t seem impossible — covering the truth with the only proposed viable action, silence.
It was little surprise that opting for silence did not bring me peace.
And then as I closed my eyes and opened my mouth to pray, God spoke to me in a still, small and clear voice.
“Be still and know that I am God”
I knew in an instant what I needed to do next.
I heard God’s whisper in my heart and I felt his presence in the room.
I was both terrified and at peace. Awe-filled and trembling. Joyful and untroubled at the same time.
At that moment, I had clarity and overwhelming peace about my next step.
And in an instant, my fear evaporated. My worry dissipated. My rational thought of keeping silent was replaced with the godly action of telling the truth about what had happened.
I had to make the call.
God had given me the direction that I needed. But more than that I sensed his wrap-around presence and confidence in my heart to face the storm that I knew lay ahead.
I knew that I needed to disclose my mistake. It all had to be recounted, recorded and reported. Only then would I have peace but more than that, I would restore life, honesty and purpose to my practice of medicine again.
Medicine is impossible to practice without honesty. For without it, our practice is shifty and insecure. It’s a palpable uneasiness to our patients. And it’s living two lives parallel lives that will eventually implode.
See I hadn’t said anything at the time because I was overwhelmed with emotion, guilt-ridden and shame-filled for the situation that I found myself in and the consequences of what would happen next.
I was afraid of what came next. So I hid what I had done.
Hiding guilt — what human beings have been doing since the creation of time.
But God declared to me that he was God and I was not in this and all situations.
I was relieved. I could drop the charade and tear up my pages of rational reasons to hide what I had done.
I needn’t have worried or been afraid about what would happen next because God was with me.
He was God and I was not.
When I said, “my foot is slipping,”
your love, O Lord, supported me.
When anxiety was great within me,
your consolation brought joy to my soul.
See, in hiding my mistake and rationalising why I needn’t disclose anything, I had tried to be “god” over my life.
I’d tried to fix my mistake rather than putting my faith in my Heavenly Father to help me walk through what came next.
Nothing was going to be too difficult for him and it convicted me that I was more afraid of people’s opinions than trusting in my all-powerful God.
And if God was for me then who could be against me?
I had nothing to fear.
What happened next
Each person I called was surprised at first, but their warmth and concern were palpable as they heard the solemness in my voice. Their reaction helped me grasp the gravity of what had happened and the effect that mistakes can have on the careers, personal lives and mental state of health professionals.
It was painful at the time, but God’s supernatural presence never left my side then and through everything that followed. To my readers who aren’t Christians, I describe God’s presence as peace in the middle of a storm. Seeing light at the end of a dark tunnel. A surety of protection in the midst of chaos. Reassuring fearlessness in the midst of trouble.
My mistake was investigated and the case was dissected in every possible way. It was presented to several audiences about the perils, dangers and ways of preventing the mistake that I had made. Everyone seemed to have an opinion about what I should have done, which I appreciated but couldn’t help but feel daft and a little depressed each time a new suggestion was made.
But despite this, I was flooded with concern and compassion for my well-being. I also found unexpected reassurance in several senior doctors who had made similar mistakes. My vulnerability was seen, appreciated and cared for.
The medical literature too was peppered with case reports and solutions to the mistake that I had made which led me to see how close I came to making a career-defining and tragic error.
We all make mistakes.
Not one of us is without fault and we all have imperfections — smudges, creases, dents, cracks and chips.
“It’s okay to be the teacup with a chip in it.
That’s the one with a story.”
Matt Haig — The comfort book
I am that teacup with several chips in it. And I dare say you my friend are one too.
And gosh, do we all have stories!
But this story is more than about making mistakes.
It is also about integrity.
Integrity in the face of challenge
The most significant part about disclosing my mistake was that it reinforced the value and meaning of integrity in my life.
It showed me how close I came to losing everything that I had worked for when I decided to withhold the truth of what had happened.
It is only by God’s grace and his work in my life that I made the call the next morning.
My honesty worked in this circumstance to strengthen my reputation as a man of integrity and a doctor that you could trust.
Because every person who heard the story knew that I could have kept my mouth shut, as my “rational” pages had told me to do.
But in doing this, I would have broken rapport with myself, in that my outer world would have been out of line with the values and beliefs of my inner world.
And more than that I saw that my reputation would have been irreparably damaged should the truth have been uncovered or my life imploded under the weight of my dishonesty.
Integrity in the face of difficulty is the value that counts.
Who we are when we are tested, tried and terrified is the person underneath all the layers we wear — our true self.
Our integrity is everything.
Integrity is who you are when no one is looking. It is living with transparency and accountability, truth and justice. Integrity is built with one honest decision at a time. It takes time to build but is destroyed in an instant with dishonesty.
The massive certainty of living with integrity
Perhaps the greatest benefit of integrity is that it brings massive certainty to our lives (Kidner 2009).
Think about that for a moment.
In an uncertain world where accidents and disease, evil and misfortune lurk, having a sense of certainty is valuable, if not priceless.
And as doctors, we love certainty because of the great uncertainty that medicine brings. We develop certain routines, we practice certain techniques, we drill and commit to memory certain pathways and knowledge and use certain cognitive aids to help us in an emergency. Certainty is the most prized but fragile goal of clinical practice.
That is why integrity matters.
Integrity brings massive certainty to our journey through life. There are no secrets and lies or hidden facts and unpleasant surprises that we ever have to contend with.
To live with massive certainty means that we live with no fear of being found out or the worry that what we’ve painstakingly built (in our marriage, business, career and reputation) will be destroyed by duplicity.
To live with massive certainty means to walk with boldness and fearless confidence in life.
The book of Proverbs has several useful insights on integrity.
The one who walks in integrity will experience a fearless confidence in life.
But the one who is devious will eventually be exposed
And the best news of all is that living a life of integrity brings massive certainty to your legacy and the blessing that your family, especially your children, will experience.
Lovers of God will walk in integrity, their children are fortunate to have godly parents as their examples
The value of mistakes
I look at this mistake now as a gift and certainly not a difficult period that I needed to get through.
This is because what happened hasn’t simply lifted and sharpened my clinical practice, it has drawn me closer to God in building my faith.
Mistakes and difficulties are what God uses to shape us and mould our character.
Who I was when no one was looking was put to the test and I am glad that I listened to God’s direction.
And just like that, one of the worst days of my clinical career became a defining moment for me as Dr Jonathan Ramachenderan.
Everyone makes mistakes and imperfection is part of who we are as human beings. We all have stories and we all have chips in our armour and dents in our souls. I love what Eugene Petersen has to say about our faith in the midst of challenges in his commentary Conversations.
“For our faith develops out of the most difficult and challenging aspects of our existence, never the easiest.
It is God who defines our lives, not culture. It is the help we experience, not the hazards we risk, that shape our days” (Petersen — Conversations 2007)
We never pray for misfortune, but challenges and suffering are what God uses to shape us, grow our faith, widen our compassion and deepen our love for him.
In the midst of my pain and misfortune, I experienced joy and peace — the joy of doing the right thing and the peace of knowing that God was by my side.
Challenges and suffering can be moments of great clarity and bring tremendous change in our lives. These can be inflexion points of growth and serve to deepen our compassion for others.
Never miss the opportunity to grow through and learn from a mistake with integrity.
Enjoy your health!
Dr. Jonathan Ramachenderan
8 comments on “Making mistakes in medicine — Why my faith and integrity mattered”
This a powerful sharing of vulnerability! Thank you.
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Thank you, Jean. The medicine for me is in sharing and writing through my emotions.
I can relate!
Jonathan, my cup has cracks in it, more than just chips. Love your writing as usual. you know I’m a fan of your writing.
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thank you Janet! Yep, I loved that quote when I read it because I was reminded of myself too!
I hope you said sorry to the person you could have hurt with the mistake. I hope you owned it to the person, not just your colleagues.
All the best, your honesty is appreciated, as well as refreshing.
Most certainly I did. Thank you for reading and taking the time comment.
I don’t doubt it for a second. You’re a brave human. And raw. Your words make it okay to struggle but also to find that strength to not give up.
You are a sunshine behind the rain.
And thanks for being honest. And not dismissive in matters of the human condition.
(You haven’t changed a drop☺️)