Saturday, February 11, 2012


When he looked down at the floor I couldn't help but feel my heart drop. The words stung to the core.

What happened to the docs who used to take care of everything.

Although I knew that the abscess was best handled by a surgeon, I too felt a a strange sense of longing. How many times did I have to hand off care to another more specialized doctor?

My patient sat quietly in his chair and stared past me at the eye chart on the wall. He labored to breath through the oxygen prongs affixed to his face. His legs were swollen and oozing edematous fluid into the kerlex wrapped around his monstrous ankles.

I was managing so many of his medical problems.

But there was a time when I handled everything.


The residents work room had a large window that looked onto a poorly lit street with various anonymous figures lurking in an out of the shadows. The VA hospital sat on the border of two equally poor neighborhoods. The residents and medical students dared not leave the safety of the parking lot or the medical complex.

It was midnight, and as a second year resident I was the most senior physician in the hospital excluding the ER attending. I sat with my feet on the desk and a stale pastry in my hand. My interns were dispersed amongst the medical floors, catching up on work from the previous day.

The buzz of the pager almost knocked me off my chair. A moment later, I was talking on the phone with the emergency room attending a few flights below the residents work room. He was almost hyperventilating.

Come quick, I need your help.

I alerted my interns, and we bounded down the steps. I burst into the the three room exam area that VA administrators called an emergency room. The patient was a middle aged man in extremis holding his sternum. His chest and stomach were pumping back and forth at a respiratory rate that was too high to count. The attending was fidgeting beside him adjusting the nonrebreather mask.

As the ER physician hurriedly presented the patient to me, I looked at the vitals monitor. The systolic blood pressure read 250 and the heart rate was peaking at well over 100. I barked a series of orders at the nurse.

Start a nitro drip, give a 80 of lasix and 5 of morphine stat.

I knew immediately what was wrong. The patient was in flash pulmonary edema from a hypertensive crisis. I had seen it before. Over the next ten minutes, I threw just about everything I had at him. Eventually his respiratory rate slowed. He unclenched his hands and sat comfortably in bed.

I handled it because I had no choice.

There was no else to.


Over the years my medical knowledge and experience have expanded exponentially. Yet, the most difficult lesson has been to know when you need help.

I am no longer a resident stuck in a VA hospital. There's ample backup available.

And I have no problem asking for help when I need it.


drerhumu said...

Advantage of working in a teaching hospital, there's always someone or some other specialty to cry out to.

tracy said...

i remember hearing a saying that if a Physican does not believe in asking another Physican for help if that physician is more expertise, the fomer is not a Doctor to be trusted. Umm, does that make any sense?

My own Physican sent me to someone else for a wound that needed made me trust his jugement and admire him even more.

"....I shall not cut for stone...."