At the beginning of every clerkship you get a lecture where you're told that as a third year student, you have the most time to spend with the fewest number of patients and therefore you can truly make an impact on their care. You catch things other people miss, know more about the patient than anyone else and so on and so on.

Anyway, I guess we should take that message to heart because it's true. Within the last two weeks I've caught two of these mistakes. Yay. But both times I acted very "I'm-just-an-M3-and-I'm-not-sure-about-anything" about it. How irritating.

Last week we were in the OR doing a wide local excision for squamous cell on the upper auricle and finishing up with a full thickness skin graft. E, my pgy4, was responsible for thinning out the clavicular skin flap and along with S, the pgy3, they were about to stitch it onto the ear. It didn't take a genius to realize that the graft was upside down. It was pearly white and the person's skin was brown for heaven's sake, but both residents just kept going and the chief stood by and looked on. So I asked timidly, "Is that upside down?" And no one answered.

Five minutes pass. Finally, it's all in place and they're about the throw the first stitch and something makes me ask again, so I cleared my throat and this time I said, "Are we supposed to flip the graft upside down before we sew it in? Does that help it heal.....?" All of the sudden the resident realizes I'm talking and voila, the stupid piece of skin was indeed upside down. All's well ends well.

Today, I pulled a very stupid M3 act, the opposite of my somewhat helpful observation last week. This morning we were in the OR doing a total thyroid and modified neck dissection, and I'm retracting at the head of the bed when Dr. P goes to the phone to curbside an ID attending about another one of our inpatients. I'm eavesdropping because there wasn't anything too exciting going on and I hear him say, "Minocycline? Oh great! I didn't even think of that." And in my head I'm thinking, "Hmm...I could've sworn she was allergic to minocycline......" but I didn't say anything because 1) this was a patient I had seen a few weeks ago and I don't know why I would remember, 2) maybe I was confusing her allergies with someone else's, 3) I was eavesdropping - maybe this wasn't even the patient I was thinking of, 4) Dr. P/ID/residents would probably know better. So, I didn't even double check, and I figured I'd just check when the case was over. After the case, we did a trach and it wasn't until afternoon rounds that I realized that I should remember to check. Turns out the patient was the one I was thinking of and she DID have an allergy to minocycline! To make things worse, she had already been discharged with a script. And to make things even worse, she had already filled the script at the pharmacy. The pharmacy didn't even catch it! So, I mentioned it to the residents and we're tracking the patient down, and I don't think anything terrible's going to happen, but....I could have prevented all of this if I just spoke up when I was supposed to. So, my friends, don't be like me. If you have a gut feeling or a hunch, be a good M3 and just say something. What's the worst that could have happend? I could've been yelled at for being totally wrong, but if I was right (which I was), I could have done some good today.