Jerome Groopman

In many ways a doctor keeps stories behind their back – stories he's a part of, stories that happen to patients he take care of, stories that he has to live with after sleepless nights, stories nagging at him in the dark places of his mind. So I was not surprised to learn that Jerome Groopman, one of my favourite medical doctor writers for The New Yorker, has been haunted by his own tale.

Having finished his book How Doctors Think, I've learned his story of looking after a middle-aged woman with a litany of complaints. After listening to a new complaint of discomfort in her upper chest, Dr. Groopman made a diagnosis of acid regurgitation from the stomach, and couldn't think in a different way. Several weeks later, his patient died of aortic dissection, a life-threatening condition when a tear happens to the giant artery that carries oxygenated blood from the heart to the smaller blood vessels throughout the body.

Simple as the case may seem to us in hindsight, many of us – certainly I include myself – could have been fooled and regret afterward. I do not wish to compete for a trophy in making wrong diagnosis. I'm simply trying to understand the corrosive mixture of shame and guilt that I learned to feel after hearing the story of Dr. Groopman.

Not long ago, I met an extremely fit man who attended the emergency room after a growing weakness in his legs. He didn't recall injury but he mentioned numbness. The admission team arranged an x-ray and an MRI scan of his spine. That's the way to find out if the large bundle of nerves (that run from the brain to the bottom of the back) is being compressed. I'd already had the MRI reports in the patient file when I first met him. I asked myself what was wrong with this patient. "Ugh. I really don't know, if they can't see evidence of acute spinal cord compression." I then pondered the possibility of a neurological condition in which spinal cord inflammation leads to the disruption of its communication to the legs, and thus problem with moving and feeling his legs. After putting a needle into his lower back to get a sample of fluid surrounding the spinal cord, I found nothing abnormal.

Two days later, a young doctor, who had bothered to take a good look at the MRI films instead of the radiologist's report, discovered an all-too-obvious tear at the large blood vessel, alas, shutting off the blood supply to the patient’s spinal cord.

I kicked myself for missing another case of aortic dissection, but it's too late.