I just got off one of those hellacious emergency room shifts. And now I am torturing myself. Did I miss a subtle stroke? Send away a 19 year old who fainted who will later go into cardiac arrest?

I am not sure how much of this is me and how much is the drug and how much is the general ambiguity of medicine.

The stroke – an elderly patient with multiple comorbidities, fell down. Seemed to be an inocuous story, but in the morning the patient was still dizzy, so I had to think of a vertebrobasilar stroke. Did I miss it before? Can you have a vertebrobasilar stroke without nystagmus? Should I have called neurology sooner? I don’t think he would have been a candidate for any kind of reopening anyhow. Worst of all, is the lithium slowing me down cognitively and causing me to think less clearly?

And the 19 year old with the simple faint. Most probably nothing, but you never know. Lots of “malingering” hints in the story, but that’s an easy way to make an error. The fact that this case bothers me, however, makes me wonder if I am not medicated enough – this should be open-and-shut; the fact that I doubt what I did makes me think that the problem is my doubting.

I hate being so responsible, so young, without much backup. I hate being unable to separate how much is the job, how much is me, how much is the meds. I really shouldn’t have started this new job. The contract is up in April. I definitely will not renew.



  1. Sara, this is you being new in the job and taking small steps to gain your confidence. STOP WORRYING! gonna get better I promise. no, you are NOT cognitively impaired. every one new has the same worries but they are good at not showing it! the problem is since probably you do not share your bipolar concerns with other people, you feel isolated and think that you are the only one who has doubts. so stop it! now!

  2. What Milo said. We all worry. We all have doubts. When there’s anything else stressing us personally, those doubts get worse and wake us up at 4:00 AM. Or at least that’s true for me, and I chose my practice setting in large part because it’s the setting in which i can most effectively deal with my own anxieties. 19-year-olds faint and elderly people feel dizzy (the latter is far more likely to be a side effect of meds than anything else, but you knew that). It happens. If you think it was benign, it was.

  3. You are doubting yourself too much and blaming your disorder and your medication, creating more doubt and second guessing in your mind until you are on a merry go round. Better get off right now and stop blaming these things for what is just ordinary caution and care and newness at the job. You are good at what you do, remember that. You are smart and can do this. Give yourself a fair chance.

  4. Hi Sara,
    I get the worrying and the second guessing. I did feel slowed down on Lithium. At the time I was volunteering for our city’s Shakespeare festival and was a bartender. I was having a difficult time adding and subtracting and counting change…(I was a banker before so I should be able to do that stuff in my sleep)

    I can’t imagine having as much responsibility as you do, but I’m sure other Dr’s have the same thoughts and fears too. Do you ever consult with your co-workers if you are worried about a particular circumstance/patient/diagnosis, etc? I know for me that would help relieve some of my anxiety. Worrying like that can also be a residual symptom of your depression, or an OCD thing. I have OCD like worries.

    I like that you are writing more. I find your writing very interesting and it speaks to me.

  5. At least you’re thinking and trying to make yourself a better doctor. We should all work on self-improvement. You can’t be perfect, and doctors shouldn’t be expected to be perfect either, but often they are. Be thorough, and question. And allow yourself to make mistakes occasionally.

  6. Thanks everyone, especially Jay. I soooo want out of this setting and into a clinic where there aren’t a million people second-guessing me, where I know my patients and know who gets dizzy and who doesn’t. I hate hate hate the emergency room. I hate hate hate hospitals where there are too many specialists available and you have to consult them for legal reasons.

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