M&M-not just candy anymore

I got my first M&M case, and it wasn't even my fault. For those of you who don't know, M&M is not a tasty candy...it's Morbidity and Mortality conference. Basically, if you screw up a case and there is a bad outcome, you get to present it in front of all your colleagues as a "learning" experience...but if you've watched Grey's Anatomy, you learned that it can be a pretty traumatic event for the presenter. Lots of accusations and arguing. Fortunately, I've never seen one like that in my program.

OK anyway, back to the screw up. This lady had renal failure and was paralyzed at the beginning of the case by my attending with a drug (rocuronium) that is metabolized by the kidneys. Well, since she has kidney failure, they don't work too well and can't get rid of that particular drug too well, so it will have a lasting effect. About 30 minutes after the case began, I was sent into the room to replace the CRNA who was running the case, as it was time for him to go home. The lady was sick as Hell. Her blood pressure was horrible and I kept having to give her phenylephrine. All through the case, I was checking her "twitch reaction" to see if she was still paralyzed. She stayed paralyzed way longer than she was supposed to and because of the extent to which she was still paralyzed, I could not give her any of the normal medications to reverse the paralyzation (neostigmine and glycopyrrolate). So, at the end of the case I'm worried. I called my attending and told him the case was over and she had no twitches so I couldn't reverse her. He sounded annoyed and came in the room. He checked her twitches, fully expecting me to be wrong. I was right. He gave her reversal drugs anyway, even though she wasn't supposed to have any yet. She sort of started breathing on her own so we took her off the ventilator. Her effort was pretty minimal and she was only marginally following commands, but my attending told me to pull out her breathing tube. Guess what happened when she got to the recovery room? She quit breathing! Big surprise. She had to be re-intubated emergently and placed on a ventilator. When I left, she still wasn't breathing on her own and had earned a stay in the ICU. I was pissed. For one, this wasn't my case to begin with. 2. The lady was already a train wreck 3. I didn't think she was ready to breathe on her own, but Hell, I'm just a first year...I do what my attending says 4. because I did what my attending said to do, now I get to present this mess at M&M. Blah!