Primum non nocere.

The attending surgeon, still dressed in his tuxedo, was clearly drunk; the patient, dressed in a revealing party gown, had also had a few drinks. I was the junior resident on surgical call. I never dared to ask how the diagnosis was made but, somehow, during the party, the surgeon learned that she had an inflamed superficial varicosity of her upper thigh. He told her that she needed to have this excised immediately or she could have a pulmonary embolus. I was told to admit her, to bring her to the OR, to inject the raised, thickened lump with local anesthetic, and to incise the vein. I followed the orders. To my surprise, I soon withdrew a long clot, about the length of my finger, that extended into her iliac vein. A few stitches completed the procedure and the two, surgeon and patient, drove off in his car. I never spoke to him about the incident again, but it was clear to me that we had breached some very basic standards. Even today, 48 years later, I am still distressed by my participation. I have had other troublesome incidents with impaired physicians. In the Air Force, I worked for two years for an alcoholic, bipolar individual who, fortunately, never saw patients and spent two to three days at a time in his office, binge drinking, without going home. Again, as junior officers we tolerated his behavior and never reported him. I have assisted surgeons when you could smell that sour odor of alcohol seeping around their masks; I listened to whispers about nurses sequestering narcotics; and, like my colleagues, I worried, waffled, gosComplaints: Handling Them and Learning from Them