Abdominal pain case rant. 0130 hours. 19ym with abdominal pain. 2 days. RLQ, but also RUQ. Really not well localized (yet) but ttp more in RLQ. Very soft abdomen. No guarding. Not a great story for other causes but really lack luster exam. Not an exam I'd wake the surgeon for to come see kid. I have sent countless folks to surgery based on exam, but this wasn't the kid. Labs also norm as they often are. Really no worsening exam. Talk with him and mom who was with him. Basically the return 12-24 hours talk. Not really jiving with this. Smiling comfortable and not surgical abdomen. In the community you just can't have a surgeon come exam a clinical soft call like this. I cannot remember what my exact thinking was. But just a little voice that said he's got something. So we talked over and talked about risks as well as possibility that even with radiation of a CT, this could be benign. Eventually did CT begrudgingly. So CT showed an appy. of course. Impressive stranding, no rupture. I honestly send these folks home most of the time. I don't know why not this time. The part that pissed me off was the griping from the surgeon of why the CT? Pretty much just being a [email protected] thistle. They have no idea the thought process that goes in and the back and fourth about diagnostics in such cases. So I told him that I would simply call him at 0200 for every RLQ pain in a young male regardless of exam and he can figure it out. Does he come to the ER to confront me? Of course not. Lesson for young EM folks. Often, there are just no win situations. Nurses were like, "great catch!" I said, "not really."