Post something good or GTFO.

[RustedFox]

Title says it all. Trying to bring some positivity to this place during the holiday season.

Here's my "something good":

Took care of a guy for chest pain two months or so back.
I threw the book out the window when it comes to talking to him about chest pain and such. HEART score = admit!
Talked man-to-man. Gritty to gritty. The admins would have freaked if they recorded the conversation.
Admitted.
Didn't hear from him for awhile.
Two days ago, charge nurse says to me: "Hey, /b/ - there's a guy up front that says he wants to thank you. I dunno. Looks kinda rough. You want security?"
"Nah."

It's chest pain guy.
"Doc. You saved my life. You gave it to me straight; not like some dickhead in a white coat who dun know nothin' about life. I wuldn'a listened to nobody, but I listened to you."

Guy hands me a package.

"You mentioned you was [sic] a Pittsburgh Pirates fan. Here you go. Merry Christmas. C'mere and give me a hug."

Guy gives me a giant hug. I'm 5'6'', 155 pounds. This gorilla crushed me with love, then leaves me with a box in my hand in the lobby. I wasn't upset.

I walked back into the triage. Both nurses look at me confusedly.
I opened the box.

There were three replica Pittsburgh Pirates World Series Rings. One for each series win. Very handsome settings. Very handsome box. Wow.

Wow.

I read the patient care notes.

"Patient taken to cath lab. Stents deployed all over the place. No way should this 48 year old male have this much coronary disease."

Merry. Christmas.

---

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[Arcan57]

Title says it all. Trying to bring some positivity to this place during the holiday season.

Here's my "something good":

Took care of a guy for chest pain two months or so back.
I threw the book out the window when it comes to talking to him about chest pain and such. HEART score = admit!
Talked man-to-man. Gritty to gritty. The admins would have freaked if they recorded the conversation.
Admitted.
Didn't hear from him for awhile.
Two days ago, charge nurse says to me: "Hey, /b/ - there's a guy up front that says he wants to thank you. I dunno. Looks kinda rough. You want security?"
"Nah."

It's chest pain guy.
"Doc. You saved my life. You gave it to me straight; not like some dickhead in a white coat who dun know nothin' about life. I wuldn'a listened to nobody, but I listened to you."

Guy hands me a package.

"You mentioned you was [sic] a Pittsburgh Pirates fan. Here you go. Merry Christmas. C'mere and give me a hug."

Guy gives me a giant hug. I'm 5'6'', 155 pounds. This gorilla crushed me with love, then leaves me with a box in my hand in the lobby. I wasn't upset.

I walked back into the triage. Both nurses look at me confusedly.
I opened the box.

There were three replica Pittsburgh Pirates World Series Rings. One for each series win. Very handsome settings. Very handsome box. Wow.

Wow.

I read the patient care notes.

"Patient taken to cath lab. Stents deployed all over the place. No way should this 48 year old male have this much coronary disease."

Merry. Christmas.

While back coded a early 60’-ish guy 3 separate times in the unit (we covered “floor” codes) being out of the ED for a couple of hours on a brisk Saturday morning shift. Central line, intubation, a-line, kitchen sink, no ICU doc willing to come in to assume care. Maybe 75 total minutes of chest compressions. Had to walk away to keep from throwing down on the cardiologist that managed his septic shock induced tachycardia by calcium channel blocking him into asystole (code 3) after said cards doc starting yelling at me for not consulting him on a UTI pt that he followed for BP issues when I went to talk to him about the code. That’s not the awesome part of the story.

I’m seeing a pt sent from rehab for some minor MSK issue about 3 months later. I’m getting a weird vibe from the guy’s wife, but guy’s with it and basically just complaining of some muscle spasms as they’ve been working him hard at PT. Finally, wife blurts our “He doesn’t remember you, but I do”. It clicks why his name seemed familiar and I realize this is the guy I spent that Saturday morning coding. Neuro intact, all his limbs moving. Wife hugs me and tells me I’m the reason her husband’s alive.

See the wife accompanying a niece to another ED I was working at a year after that and she says he’s back home and living life, back to his job, etc. It’s not WS rings but it’s a clear, unambiguous win that’s memory will stay with me forever.

 

[DrMcCoyDO]

In one of my first weeks doing emergency medicine as a resident, I was taking care of a Spanish-speaking woman who’d had an incomplete abortion (diagnosed prior to arrival at the ED) and was dealing with heavy bleeding due to the medications she’d been given to expel the remaining POC. She and her husband were obviously pretty scared by the whole situation. Well, after making sure she wasn’t severely anemic or in any immediate danger, I had to explain to her that the heavy bleeding was unfortunately going to continue for awhile longer, and there was nothing we could do about it. Sat in the room with her and her husband (and the translator on the phone) for about 15 minutes or so answering any questions they had until they ran out of them. Apparently I did a decent job of calming them and allaying their fears; because, the husband told me that if I ever visited their country, I could stay at his house instead of a hotel. InternMcCoyDO went home feeling pretty good about himself that day.

 

[RustedFox]

While back coded a early 60’-ish guy 3 separate times in the unit (we covered “floor” codes) being out of the ED for a couple of hours on a brisk Saturday morning shift. Central line, intubation, a-line, kitchen sink, no ICU doc willing to come in to assume care. Maybe 75 total minutes of chest compressions. Had to walk away to keep from throwing down on the cardiologist that managed his septic shock induced tachycardia by calcium channel blocking him into asystole (code 3) after said cards doc starting yelling at me for not consulting him on a UTI pt that he followed for BP issues when I went to talk to him about the code. That’s not the awesome part of the story.

I’m seeing a pt sent from rehab for some minor MSK issue about 3 months later. I’m getting a weird vibe from the guy’s wife, but guy’s with it and basically just complaining of some muscle spasms as they’ve been working him hard at PT. Finally, wife blurts our “He doesn’t remember you, but I do”. It clicks why his name seemed familiar and I realize this is the guy I spent that Saturday morning coding. Neuro intact, all his limbs moving. Wife hugs me and tells me I’m the reason her husband’s alive.

See the wife accompanying a niece to another ED I was working at a year after that and she says he’s back home and living life, back to his job, etc. It’s not WS rings but it’s a clear, unambiguous win that’s memory will stay with me forever.

That's way better than WS rings, amigo.
Had a similar thing happen to me. Went to local pub for club sandwich, french fries, and a beer (this would be my last meal, if I were on death row for my heinous crimes) EDIT: I need tacos, too... when a monster of a man taps me on my shoulder. Big red-haired whiteboy immistakably from Bahhhstan. Probably Southie, given what I can figure.

"You're Doctor Fox!"
"Well, maybe. Can I help you?"
"You saved my dad's life cuz you wouldn't stop doing compressions and that. He's over there at that booth. He'd love to say thank you. Would you? Please?"
"Sure."

I recognize him immediately. I must have coded this guy for an hour into and out of ROSC. Cooled. Went to ICU. Thought he was toast.
Walking, talking, drinking a Guinness.

 

[RustedFox]

In one of my first weeks doing emergency medicine as a resident, I was taking care of a Spanish-speaking woman who’d had an incomplete abortion (diagnosed prior to arrival at the ED) and was dealing with heavy bleeding due to the medications she’d been given to expel the remaining POC. She and her husband were obviously pretty scared by the whole situation. Well, after making sure she wasn’t severely anemic or in any immediate danger, I had to explain to her that the heavy bleeding was unfortunately going to continue for awhile longer, and there was nothing we could do about it. Sat in the room with her and her husband (and the translator on the phone) for about 15 minutes or so answering any questions they had until they ran out of them. Apparently I did a decent job of calming them and allaying their fears; because, the husband told me that if I ever visited their country, I could stay at his house instead of a hotel. InternMcCoyDO went home feeling pretty good about himself that day.

Good on you, son.

 

[Alvarez13]

 

[Birdstrike]

I ran into a lady not too long ago, who's daughter I had seen in the ED, one brief time. The site of her face stopped me in my tracks. Her eyes immediately locked on in. I immediately remembered her daughter, her appearance, her diagnosis, her hair color, even the number of the room she was in. I'll probably never forget her as long as I live with a functioning brain, simply because of the unforgettable scene that I saw and became a part of for such a brief time. For the purposes of the thread and "keeping it positive," I won't dwell on those details. But what blows me away about what she said when we ran into each other, was not so much the words, or how she said them, but that she had held on to them, remembered me and delivered the words a full TEN YEARS later.

What she said was, "Thank you so much for helping my daughter that day. I'll never forget how nice you were. And that you cared. Thank you."

 

[RustedFox]

I ran into a lady not too long ago, who's daughter I had seen in the ED, one brief time. The site of her face stopped me in my tracks. Her eyes immediately locked on in. I immediately remembered her daughter, her appearance, her diagnosis, her hair color, even the number of the room she was in. I'll probably never forget her as long as I live with a functioning brain, simply because of the unforgettable scene that I saw and became a part of for such a brief time. For the purposes of the thread and "keeping it positive," I won't dwell on those details. But what blows me away about what she said when we ran into each other, was not so much the words, or how she said them, but that she had held on to them, remembered me and delivered the words a full TEN YEARS later.

What she said was, "Thank you so much for helping my daughter that day. I'll never forget how nice you were. And that you cared. Thank you."

Hey, man.

Whyncha come out of retirement and post all the details behind this?

C'mon, man.

 

[dchristismi]

Probably because it's a terribly heartbreaking story and there was nothing Bird could do to save her. You wanted happy and Bird's posts tend to make people cry.

You know, like I make people cry... when I walk into a patient room, at the grocery store... hell, I was at a local wine bar one day when a lady walked over and announced she was buying my drink because I'd saved her father. First (and only) aortoenteric fistula I'd ever seen - or recognized as such. He had an INR of 7 and a rocky course, but "you gave me back my father for another 2 years." And yeah, I cried too.

 

[TXEMC344]

Despite all the BS we deal with everyday, this is why we come back each and every shift.

 

[Birdstrike]

Hey, man.

Whyncha come out of retirement and post all the details behind this?

C'mon, man.

"Just when I thought I was out, they pull me back in!"- Michael Corleone

You seemed pretty clear about starting a thread that was "good" and followed it up with a pretty uplifting post, so my point was to keep in line with that by focusing on an unexpected "thank you." So the details I think, are secondary to that central point. But since you asked, I'll tell you. This is where it gets sad. So, if that's not what you want, move on to the next post.

It was a 14-year-old girl. She was dying of bone cancer and was in tremendous pain. It was quite a devastating scene from the hopelessness and futility of it. Clearly a patient that was hopelessly dying, at the end of life. A mother in the depths of devastating sadness, no human being should ever have to suffer. And an overhanging cloud of futility under which I never would have thought myself capable of bringing about something meaningfully positive. You know, in EM, you want to think of yourself as someone highly trained who "saves lives," restarts hearts and bring people back from the cliffs of a crisis. We're not trained, or necessarily naturally attuned to how to deal with hopelessness and futility. And when I ran into this lady unexpectedly, saw her face and all of a sudden flashed back to the heartbreaking sight of her daughter in the back hallway room 19, pale, skin as gaunt and thin as crumbling paper, curly near-black brown hair, feeling nothing but pain and whatever a 14-year-old feels about the inexplicable cruelty of dying far too young by no fault of their own, I had no expectation that anything positive could come out of having been reminded of the scene. After all, these are the moments you bury and try to forget. You walk away in shame, feeling you failed, unable to make a difference or do anything positive, and somehow in the process generated a bill for some disconnected, soulless healthcare businessman to cash. But somehow, somehow, inexplicably this hurried, exhausted, crispy shell of a formerly bright-eyed bushy-tailed, idealistic EM hopeful, managed to make enough of a difference, on a human level, for this woman to thank me, ten ****ing years later. So frankly, it blew me away.

And how does that happen?

I've restarted hearts, decompressed tension pneumothoraces, made diagnoses that I thought were unfreakingbelievably awesome and clearly live saving that most people would miss, and not even gotten a hint of 2% of a thank you. But somehow, on this one, I did. Maybe I stopped and listened longer than she expected. Maybe it's the morphine I gave her daughter and the pain relief it brought. Maybe I was the only person that had the guts to stand there in the pain and listen, rather than run away, because they couldn't bear the sadness of it all. I don't know. But whatever "difference" I made, which sure as heck was far from life saving, was good enough for her to hold to, for ten years.

After she have her thanks, we stood there and talked for a few minutes. She told me about her life since her daughter was gone. Her divorce. How she dealt with it all and managed to come through the other side of it. And how she still remembered me and how much she felt I helped, that day. I hadn't felt I helped much at all. But she did. And it all came from one little ED visit, that seemed like a total loss by me, at the time.

What it reminded me of, is how much of a massive difference we sometimes make, even when we least expect it, and maybe when we don't even think we're trying to. Is it our mission, what we were put here for, is it "God's work" as some would say? I don't know. But it restored my faith a just a little bit, actually more than a little bit, in what we do, as physicians.

Keep up the amazing work, folks. The world needs you and appreciates you, even when they don't, or aren't able, to tell you.

 

[RustedFox]

Birdstrike's post falls under "good".
Therefore, he posted something "good", and does not need to GTFO.
Carry on.

And good on you, Bird.

 

[GonnaBeADoc2222]

Back when I was an intern, was working a pedi shift at one of the community sites with this hard core, tattooed, motorcycle riding attending.

We went into see this 10 yo with "something hanging from butt."

Took a look and basically there was this dingleberry looking thing that literally fell off the anal area when we examined it.

Attending threw it in the trash.

I said "Wanna just send it to path just in case?"

"Sure, whatever."

Fishes it out of trash.

Path comes back as squamous cell carcinoma.

Kid did well.

Attending took me to the bar after our next shift.

 

[DrMcCoyDO]

Back when I was an intern, was working a pedi shift at one of the community sites with this hard core, tattooed, motorcycle riding attending.

We went into see this 10 yo with "something hanging from butt."

Took a look and basically there was this dingleberry looking thing that literally fell off the anal area when we examined it.

Attending threw it in the trash.

I said "Wanna just send it to path just in case?"

"Sure, whatever."

Fishes it out of trash.

Path comes back as squamous cell carcinoma.

Kid did well.

Attending took me to the bar after our next shift.

 

[Perrin]

Years ago, I was out to dinner for my mom's birthday. We had just sat down and the manager comes out yelling if anyone here is a doctor. I turned around and in my head was thinking someone in the kitchen cut or burned themself. He yelled out that, "She's having a baby in the bathroom." I asked the manager to get me some gloves and towels and call 911. I got to the bathroom and she has already delivered, but is standing there screaming with the newborn in her underwear at her ankles. I assessed mom and baby while drying and warming the little baby girl. EMS arrived within minutes and I clamped and cut the cord. Got everyone situated and off to the hospital. Damn were my hands shaking when I sat back down at the table.

Fast forward a year and I get a text asking if I would like to attend her daughter's first birthday. My parents had gone back to the restaurant recently and the waitress remembered my dad. She asked if she could have my number to text me and invite me to her daughter's first birthday. I bought and wrapped a few toddler gifts and came to the same restaurant where she worked and the party was held. She gave me a big hug, thanked me, and introduced me to her daughter and family. It definitely warmed my heart.

 

[Groove]

I don't really have any cool cases where the pt or their family sought me out years later to personally thank me. I'm kind of envious. Many times, even on the cases where I know I made a difference, I feel as if nobody remembers us in the ER. If patients are on the brink of death and I somehow pull them away from that in the ED, chances are they are intubated, sedated, and probably have no recollection of those events whatsoever. I think patients usually wake up down the road and associate their medicine or ICU doc as the "doctor who took care of me in the hospital" and are the docs usually getting the Christmas hams and cards.

That being said, I was moonlighting years ago in residency as a PGY 3 in an ~18K single coverage ED in a nearby state for extra cash and a mother comes through the ambulance bay doors screaming "save my baby!". Kid was an unresponsive 2yo female with blood all over her head. They quickly lay her down in my resus bay and as I'm doing a primary survey, I notice her breathing becoming irregular and she starts to posture (full on decerebrate out of a textbook). It's then I notice that the blood on her head is coming from a large occipital skull fracture. The story per the mother (per the boyfriend) was that the child had "fallen off her bunk bed" at which point I'm wondering how many stories up was the bunk bed located and what was the floor made out of...concrete? Regardless, I fly into motion and kid gets intubated, aggressively resuscitated, hyperventilated, manitol, scanned....turns out to be one of the largest SDH I've ever seen in a child and most adults for that matter. After aggressive efforts, kid starts to neurologically improve. Deep sedation, deep paralysis. I'm frantically calling to our local tertiary care facility and ended up in a screaming/cursing match with the pediatric neurosurgeon who declined transfer because "Man...I haven't operated on a kid under 5 in 15 years!" I pleaded with him to make an exception in this case as if she didn't get decompressed, she was going to die immediately. He declined.... I called around to all the tertiary care facilities in the area and most were full. I finally found one 3.5 hours away by ground who accepted but the weather was bad the entire way and I couldn't fly her there. There was a family practice resident rotating through the ER (community site for them) that I grabbed by the scrubs and as he stares at me with big eyes I'm shoving all sorts of meds into his hands, paralytics, sedatives, mannitol, ACLS drugs, and going "DO YOU KNOW HOW TO RESUSCITATE A CHILD?!" He stammers...."uh....uhhhh...I..ahhh...had PALS a week ago!" I go "GREAT!, LISTEN TO ME....you're going to jump in this ambulance with this child and help them transport her 3.5 hours to the PICU where NSGY is standing by to take her emergently to the OR. You're going to keep her deeply sedated and paralyzed and this is how you're going to handle any other issues that arise...." At which point we briefly go over some different scenarios. He nods that he's got it...with terror in his eyes and off they go in the ambulance with my cell number and strict instructions to call me with any issues en route.

Kid amazingly makes it alive to the facility without herniating and the FM resident was a rock star en route following all the instructions to a T. The child underwent surgery, has a long recovery in the ICU and very few reported neurological sequelae. The last I heard, she was doing great. The family practice resident kept in touch periodically with the mother and would frequently update me if he happened to be in the ER over the next year. Turns out, the boyfriend was abusive and had grabbed the child by the ankles and slammed her up against a brick wall. I was subpoena'd to expert testify on this case during residency and they kept cancelling until finally the boyfriend confessed and was put in prison.

I still remember that case like it was yesterday. I never got any pats on the back or Christmas cards but I felt really good about making a difference in at least one child's life. I've since forgotten her name or the family's and doubt they would ever look me up or are even aware of what a difference we made that night in the ER but that's ok and something that I consider to be part of the job.

 

[bravotwozero]

That’s pretty badass man. Strong work!


Sent from my iPhone using Tapatalk

 

[Birdstrike]

I don't really have any cool cases where the pt or their family sought me out years later to personally thank me. I'm kind of envious. Many times, even on the cases where I know I made a difference, I feel as if nobody remembers us in the ER. If patients are on the brink of death and I somehow pull them away from that in the ED, chances are they are intubated, sedated, and probably have no recollection of those events whatsoever. I think patients usually wake up down the road and associate their medicine or ICU doc as the "doctor who took care of me in the hospital" and are the docs usually getting the Christmas hams and cards.

That being said, I was moonlighting years ago in residency as a PGY 3 in an ~18K single coverage ED in a nearby state for extra cash and a mother comes through the ambulance bay doors screaming "save my baby!". Kid was an unresponsive 2yo female with blood all over her head. They quickly lay her down in my resus bay and as I'm doing a primary survey, I notice her breathing becoming irregular and she starts to posture (full on decerebrate out of a textbook). It's then I notice that the blood on her head is coming from a large occipital skull fracture. The story per the mother (per the boyfriend) was that the child had "fallen off her bunk bed" at which point I'm wondering how many stories up was the bunk bed located and what was the floor made out of...concrete? Regardless, I fly into motion and kid gets intubated, aggressively resuscitated, hyperventilated, manitol, scanned....turns out to be one of the largest SDH I've ever seen in a child and most adults for that matter. After aggressive efforts, kid starts to neurologically improve. Deep sedation, deep paralysis. I'm frantically calling to our local tertiary care facility and ended up in a screaming/cursing match with the pediatric neurosurgeon who declined transfer because "Man...I haven't operated on a kid under 5 in 15 years!" I pleaded with him to make an exception in this case as if she didn't get decompressed, she was going to die immediately. He declined.... I called around to all the tertiary care facilities in the area and most were full. I finally found one 3.5 hours away by ground who accepted but the weather was bad the entire way and I couldn't fly her there. There was a family practice resident rotating through the ER (community site for them) that I grabbed by the scrubs and as he stares at me with big eyes I'm shoving all sorts of meds into his hands, paralytics, sedatives, mannitol, ACLS drugs, and going "DO YOU KNOW HOW TO RESUSCITATE A CHILD?!" He stammers...."uh....uhhhh...I..ahhh...had PALS a week ago!" I go "GREAT!, LISTEN TO ME....you're going to jump in this ambulance with this child and help them transport her 3.5 hours to the PICU where NSGY is standing by to take her emergently to the OR. You're going to keep her deeply sedated and paralyzed and this is how you're going to handle any other issues that arise...." At which point we briefly go over some different scenarios. He nods that he's got it...with terror in his eyes and off they go in the ambulance with my cell number and strict instructions to call me with any issues en route.

Kid amazingly makes it alive to the facility without herniating and the FM resident was a rock star en route following all the instructions to a T. The child underwent surgery, has a long recovery in the ICU and very few reported neurological sequelae. The last I heard, she was doing great. The family practice resident kept in touch periodically with the mother and would frequently update me if he happened to be in the ER over the next year. Turns out, the boyfriend was abusive and had grabbed the child by the ankles and slammed her up against a brick wall. I was subpoena'd to expert testify on this case during residency and they kept cancelling until finally the boyfriend confessed and was put in prison.

I still remember that case like it was yesterday. I never got any pats on the back or Christmas cards but I felt really good about making a difference in at least one child's life. I've since forgotten her name or the family's and doubt they would ever look me up or are even aware of what a difference we made that night in the ER but that's ok and something that I consider to be part of the job.

Dude, that's frickin' awesome. You may have not been given a pat on the back or a Christmas card by the family, but great job! They may be too buried in guilt and self blame to show their face in the ED, although they might want to; who knows. But as far as your "pat on the back and Christmas card," consider it given right here and now, by us. Great job. And by the way, did you at least buy that FM resident a new, clean set of underwear?

 

[thegenius]

I had a 48 yo man, healthy, come in with his wife for vomiting and just "not feeling right". He was walking around the room complaining of something kind of like pain....very hard for him to describe. Vomited a few times in front of me. His vitals were OK. He was obviously hurting...but his exam was OK. He talked about how "there is pain in my scrotum that went away." At one point he talked about pain "between my shoulder blades." He was generally pointing to the middle of his body, not the flanks. But overall a very weird symptomology. He was walking around the room, vomited a few times. Couldn't sit still.

I walked out of there thinking to myself this might be a kidney stone, but it was an odd presentation. I ordered an IV, standard abd labs, UA, zofran, morphine, and I knew he needed some sort of imaging but didn't quite know what to order. So I started writing my note, and I found myself writing things like "scrotal pain", "mid back pain", and "pain between the shoulders" and I told myself

"how can I justify not ruling out a dissection if I write these phrases in the chart?"

So I ordered a CTA and the CT tech called me the moment it was done...he said on the phone "doc he has a dissection". I quickly looked at the images and saw it myself (from aortic root down to the iliacs) and then immediately called Radiology to confirm, and indeed it was.


What was so memorable about this case is the pts symptoms got better on his own within about 10 minutes. He was now without symptoms. All he got was zofran. Didn't even get morphine. And at the end of the day he really just a workup of "abdominal pain with vomiting in a 48 yo guy", very normal guy and with a normal wife and has a normal, good job, all around good guy. Those workups are, 99% of the time, abdominal labs and CT. Maybe they get RUQ ultrasound too. But I happened to protocol it with angiography and picked up a life-threatening medical condition.


I called the CT surgeon and presented the case. The pt and wife were in the room just outside my desk and overheard my entire conversation. CT surgeon accepted transfer and then I went into the patients room. As I walk in the wife had a very scared look on her face.


"we overheard your conversation with another doctor............what....is....going on?"

I pulled up a chair and sat down. "We need to talk." I proceeded to tell them about Type A dissection, the treatment, need for surgery now, etc.
And I told them "I feel very fortunate, almost lucky....that I caught this. ER docs see patients with vague abdominal pain and vomiting all the time. We perform a thorough and routine evaluation on a regular basis. Had I ordered the CT a different way, I would have never caught your dissection, you would have gone home would have probably died several days later."

"I'm thinking about all the other times I have seen patients just like you, ordered labs and a CT and sent them home without a definitive diagnosis. I feel humbled, almost lucky, that I made a diagnosis that will result in me saving your life."

The pt and wife looked at each other and held each other's hands. Then the wife looked at me and said "We thank you so much."

I choked up a little bit in front of them. I shook their hand and said we are transferring you to San Francisco where you'll meet the CT surgeon.




In subsequent weeks and months I got little notes from them and other doctors.
- Their PMD sent me a note saying much the pt appreciated my dedication and workup
- I received a card at the ED a few weeks later thanking me, addressed to me and the staff
- I got another Christmas card with a picture of their family on it. And chocolates. It read "Thank you Dr. ***** you saved my husbands life, and as a result you saved our family. Our children have a healthy father. We thank you so much."
- Acknowledgement from our chief of EM at the hospital.


In retrospect I give 100% credit to my training. I realize that I wasn't lucky. All 4 years of training, about pattern recognition, and seeing thousands of patients helped me get to where I am now. How I write notes and force myself to come up with 5 potential diagnoses for every single complaint. No matter how trivial. I've diagnosed 3 dissections in my life, and two of them didn't count as a "good catch". This one was.

This is a top 5 most significant EM catch for me!

 

[WilcoWorld]

Ooooh, here's a good one: On my last swing shift, I got out right on time. Like, to the minute. It was glorious.

 

[Dane07MD]

About 6 months ago, I met some ER buddies for golf at an equidistant meeting area (~60 minutes). I had recently started at a new gig so this was our new solution to playing together. We're on the first tee, just the three of us, when a single player zooms up in a cart as a last second addition to the group. Mullet, trucker hat, scruffy, I think already smoking a cigarette at 8am. Introductions are exchanged. He looks at me funny for a second and says I look familiar and he thinks he knows me. I have plenty of dirtbag friends and friends of friends, but I am pretty sure I have not interacted with this guy socially before.

We're approaching the first green and he says, "Wait a second. Do you work at the hospital in XXXXX?" Surely enough yes. He had recognized me from diagnosing his 62 year old mother with pancreatic cancer several weeks earlier. Was a sad case nonetheless as she had been brushed off with GERD/dyspepsia for months by her doc and other ER doctors. That day, the diagnosis and the whole day was difficult. Devastating for family, devastating for me. My best friend's father died from pancreatic ca just after retiring after a long career as a very successful colorectal surgeon, so these cases are hands down my most challenging. As soon as he mentioned "mother with pancreatic cancer" i knew right away.

At any rate, we played a great round of golf, the four of us. He could not stop thanking me for what I had done, taking the time and thought to look further into her problems and make the diagnosis. She had already passed, but he said getting answers and being able to alleviate the suffering toward the end meant more than anything. He bought me some beers after the round and hoped he would never see me at work again, but the golf course would be just fine.


Also had a young guy with syncope on take off last christmas two rows behind me. Flight attendant rushed by me about 2 seconds after leaving the ground and I turned and saw him slumped over and unresponsive. He woke up several seconds later as I carefully arrived seat-side as the plane was sharply ascending (there's good reason they don't want you standing during take off...). Many passengers thanked me as they deplaned (I was in row 1 (no, not first class) of a small regional jet). Even more thanks came from the other docs on the plane who were glad they didn't have to respond. Airline tried to offer money/airline credit but I politely declined. Got an email several days later with a nice airline credit and a thank you; the flight attendant must have gone out of her way to make sure they showed their appreciation. I will admit I always joke about putting on noise canceling headphones on flights mainly so I don't hear the call for medical needs, but I appreciate that both patients and other passengers get VERY scared and we can offer quite a substantial amount of anxiolytic comfort even if sometimes the medical stuff is minimal. Plus, what's worse? An EP not responding in flight to a medical issue, or having an ophthalmologist or orthopedist try to evaluate and treat someone instead??

 

[Backpack234]

Not really patient care but:

When I started pursuing medicine, I loved what I was doing but I put off a lot of my other goals. I remember back then that I wanted to write webcomics, make films, be a photographer (you know, feed the artsy side of my brain). Once I got into medical school though, I put all of that on the back burner. Lots of studying. Days off became more about decompressing, being stupid, netflix, etc.. Still, I always had that thought in the back of my mind to spend an hour a day doing x y or z, build something, etc. Thankfully I made it into EM, I work at a place that doesn't stress me out too much and I get to work 10-12 days per month. Now that boards are over (I hope. Scores not posted yet) and I'm a little bit older, not only do I have the free time to feed that part of my brain, but I also have the money to support it. I think that's pretty cool and all in all I'd say I'm pretty happy

 

[deleted836128]

Great thread, and some of these cases are making me emotional!

I am a fairly new PA and haven’t felt like I DIRECTLY saved someone’s life yet but a few stories come to mind.

There was a grungy looking kid who came in to the emergency department with complaints of heroin withdrawal. Long story short, he was a normal kid who was on narcotic pain medications after a knee surgery way too long, found out that he felt like crap without taking them, so he started buying them off the street, which turned into a heroin addiction. He had tried to quit for years unsuccessfully. I talked for him a long time which I think was surprising to him as usually in the ER these people are brushed off as pains in the ass. He said he wanted to be done with it but declined transfer to a rehab, so I sent him home with some medications to manage his symptoms - clonidine, Benadryl, Zofran. Didn’t really think he would quit. Moved on with my day. Nearly a year later I am walking in a parking lot and I hear a shout and a scruffy guy coming towards me. I immediately recognize this guy. He started crying and told me that he finally kicked heroin after that ER visit that day - he had been clean ever since. He told me I was the first medical provider who had ever actually helped him. We hugged in the parking lot, crying together. I even saw him in a store a month ago and he looked well - color in his face, gained weight... he looked happy. That was so rewarding.

Another time I had this 30-year-old guy who came in with low back pain after straining his back. Lifting a giant window. Totally healthy guy, without any concerning symptoms. He had reproducible tenderness along the lumbar paraspinal muscles, normal range of motion, strength and reflexes, and sensation of the extremities. No red flags like fevers or bladder/bowel issues. X-ray was negative and I sent him home on meds. Two days later he comes back and asks to see me. Pain is not better. Still no other symptoms developed but I felt something wasn’t right. I ordered a work up including an MRI of the lumbar spine which I rarely do for back pain unless emergently indicated. I realized my attending was going to rip me a new one for it. Long story short - this guy had lymphoma. He was so upset when I fold him about the suspicious adenopathy on his scan that he demanded to leave the ER and smoke. Nurses said no and he said he was leaving. So I went outside with him and just stood with him while he smoked and processed everything. Came back in, arranged follow up. Months later his mom runs into me in the hospital and grabs me and starts crying, telling me how grateful she was that I caught the lymphoma (Hodgkin’s), and that they expected a good prognosis as it was caught early. Literally this guy had a back strain for all intents and purposes and it gives me shivers to think I could have so easily missed what lied beneath the obvious.

Not as breathtaking as the stories posted but these little things meant a lot to me and I hope to have as many good stories as you all have one day.

 

[Birdstrike]

... it gives me shivers to think I could have so easily missed what lied beneath the obvious.

Not as breathtaking as the stories posted but these little things meant a lot to me and I hope to have as many good stories as you all have one day.

Plenty breathtaking. Keep up the great work.

 

[deleted109597]

apropos

 

[WilcoWorld]

Just today most of my neighborhood was outside doing yardwork when one of my neighbors comes across the street looking miserable.

"My shoulder came out" he said in between winces.

So, I pushed 2 chairs together, sat him down in one as I took a seat in the other and got him reduced using the Cunningham method...then I laid him down to manage his vagal response

The whole thing took less time than it would've taken him to get to the nearest ED. It's been a long time since I felt that cool. Not many outside of EM ever get the chance.

 

[e30ftw]

Paid off my loans yesterday!

 

[thegenius]

Paid off my loans yesterday!

Me too! 301k in less than 5 years!!! Just finished this month.