Whenever anything on my ward goes wrong, particularly when someone dies unexpectedly, I go through the case over and over again in my mind, searching for the thing that I could've done differently to change the outcome. Clearly there's value in this from a learning perspective, but there's a fine line between self improvement and torturing oneself with unnecessary guilt. Look hard enough at any chart, and you'll always find something that could've been done better.
Which is why I'm awake in the wee hours of the morning, despite being exhausted to almost my breaking point, reflecting and self berating and wondering whether I'm competent to do the work that I set out to do. I try not to do this to myself, try to be forgiving of my own imperfections, but my brain is filled with well-established neural pathways of self doubt and blame that will fire in response to the slightest of stimuli. So instead of sleep, I come here and try to purge myself of the false belief that if I were only better, smarter, more capable that I could somehow prevent anything bad from happening to one of my patients. That somehow it's only my weaknesses that prevent me from reassembling the broken people who are entrusted to my care.