I’ve noticed that these experts range from the appropriately modest to the ludicrously arrogant
Ican do this. I think.
The patient, an unconscious 87-year-old man suffering from septic shock, is oblivious to my indecision. My attending instructs me to place a central line in the man’s jugular vein, running through his neck. I know the theory cold, but actually doing it to a living, breathing person is another matter.
“Insert the needle into the jugular…” drones my attending, and ignoring my clammy palms, I slowly follow her instructions. Trying to thread the wire through the needle, into the vein, I sense resistance. Breathe. Rotate the wire carefully. Ease it in. Breathe. The patient’s still alive. Breathe. I’m sweating by the time I’ve finished. It’s time for the routine X-ray to ensure the catheter is properly placed, something we always do when central lines involve the neck.
Scanning the black-and-white image, I suddenly notice that the attending is stifling an unprofessional chuckle.
“We don’t see that every day,” she informs me, pointing to the scan. I can see the length of the central line. Somehow, instead of reaching my patient’s heart, I’ve inserted the wire Into. His. Brain.
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