M&M

Seriously, how can a light-hearted and tasty chocolate candy that melts in your mouth and not in your hand share the same name with morbidity and mortality conference, the most malignant thing a set of residents and attendings can do to each other?

For those of you not in the medical field, M&M is when serious complications and deaths are reviewed in order to see if there was something missed or errors made, and if we can learn from these situations. There are several varieties of M&M conferences, but may be generally broken down into two categories: medicine and surgery.

Surgery M&M, bring some popcorn. I think it'd best be done in an urban movie theatre with a large black audience. I don't mean this in a racist way. My God, I love the black folk, and whenever I want to see a movie the way it should be watched, I wanna see it in the ghetto theatre. Because it's so damned entertaining that you really need a running commentary.

Surgery M&M is vicious. It's a witch hunt initially, trying to find the right person to blame. Once that person is found, he is grilled on why he was so incompetent, because regardless of the cause, it boils down to incompetence. Cause of death was MI due to stress of surgery? Why didn't you crack his chest and do intrathoracic cardiac massage? Invariably, one attending will question the skill or acumen or technique of the attending of record, and that's when the sparks start flying. Only an inane jackass would dare try to do an end to end anastomosis in a case like this. Stuff like that. It really would go better if someone in the back row yelled out, "Oh no he didn't!"

Medicine M&M, that's not nearly as fun. Medicine M&M is when every senior resident and attending chooses to second guess the responsible party. Even though your D-Dimer was negative, you still should have scanned the chest. Weren't you suspicious of the heart rate of 110? The patient's reports of a recent episode of rhinorrhea should have tipped you off to acute bacterial meningitis. The premise of Medicine M&M is that if you did some extra test, used a better medicine, paid a little more attention, the outcome would've been different.

Medicine M&M is so hell bent on teaching people something, but in the end, the only lesson you walk away with is that you're glad it wasn't you. I'm practically a veteran of M&M's at this point. I've done more than my fair share. I didn't really do anything wrong per se, but everyone feels better when they can find my flaws.

Because there's something very reassuring when you can walk out of a conference talking about the untimely death of a person and say to yourself, if it was me, I would've done this, and the patient would still be alive. That's fucking comforting. Better than a warm glass of milk.

I don't mind doing Medicine M&M's, because I know that the learning value is not for me. It's not the scolding of a Surgery M&M. There's no veiled insult. It's like a morality play. The story has a message at the end, like always remember to consider pulmonary embolism as a cause for mild elevation of troponin in a patient with chest pain. But the part of M&M I enjoy most is when my attendings ask questions, and I agree. Like one time, one of my attendings asked, "So, why did it take so long to change the code status in this patient?" Why indeed.