It was another weekday night shift; pushing my workstation on wheels slowly through the ambulatory care unit (ACU) at 1:00AM as I dispensed paperwork on URIs, otitis media, and a sprained ankle. Slow nights in the ACU meant that I would be able to enter rooms and listen to wheezes, palpate edematous limbs, and gaze into fluorescein stained eyes. The physician with whom I was scribing for and I stepped outside of a room, groggy with the beginning of the night shift, when one of the triage nurses started howling for help. We raced around the corner from the ACU only to come face-to-face with a man bleeding heavily from a gash in his abdomen with a clear partial amputation of his left arm. All the triage nurse yelled was “he made a homemade bomb.” In that moment we were thrust into my favorite aspect of medicine; there were clues to be investigated, missing puzzle pieces to be dug through, turned over and placed correctly.
The patient was a walk-in trauma in our trauma level two hospital, unequipped to handle this emergency. A nurse raced the patient back to the largest room, my workstation wheels dragging through and kicking up the blood from the ground that had spurted from his arm. Thirty nurses responded to the code call and were cutting off the patient’s clothes, calling out exam findings, and screaming for anything to construct a makeshift tourniquet. It was at this time that the patient’s wife arrived to the room. Shaking and tearful, she was barely able to tell me anything other than the patient’s name. She was soaked in deep red blood over her light pink sweatshirt. It was then that I noticed something was wrong with the way she was breathing. Her abdomen fluttered up and down, quickly quivering in and out in shallow motions. It looked exactly like the presentation of a pneumothorax I had seen the day before.
Behind every patient door was the potential for a new mystery, a new differential, equation of lab results, and exotic diagnoses. I would chart as quickly as possible and pray for any extra time at the end of my shift that I could learn more about EKGs, MRIs, or a new medication from the provider with whom I was working. Behind the scenes, I bought a stethoscope, poured over EKG books, and watched videos on procedures at my desk at home. I practically glowed when I presented a differential on a complex pediatric patient and got patted on my back as my mentor laughed and announced that I was an astute scribe.
Looking back, there were challenges to overcome, yet through it all I have been able to maintain my focus. I grew up in a rural, medically underserved city and am a first generation student. My freshman year of college, a week before spring midterms, my older brother unexpectedly took his own life. I was horrified, depressed, and withdrawn. I returned to school the day of my first midterms, only to bomb all of them, with no time left to drop the courses after midterms. I feared that my perfect ideal of becoming a physician may have been over. I resolved to tap deep into my sense of mental resilience. I vowed to work harder and became the class senator, health center representative, and committed to volunteering more of my time. Losing my brother taught me a sense of empathy, humanity and strength that can only be learned through great loss.
While working as an emergency medical scribe, I craved a continual source of creative energy and a way to break away from my desk while studying. The decision to pursue medicine is a long-term goal that requires constant devotion and persistence, which makes a day or weekend hike refreshing and exhilarating. Overcoming the short-term goal of climbing a mountain while battling uneven terrain is a renewal of creative energy. Physical fitness is important as a successful physician must be able to care for themselves in order to care for others.
That night, in the chaos of the gaping abdominal wound and the partial amputation, I sadly resolved that this woman may likely experience her husband’s death. Although her light pink sweatshirt was soaked in blood, I tried to support her as well as furiously maintain my scribing duties. In the moment of watching this woman leaning onto me and my computer, struggling to breathe, I began to question if the blood on her sweatshirt was her husband’s, if not potentially her own. If I was going to speak up as the lowest member of the clinical team in a full-blown crisis, I had to be confident she was actually wounded. Terrified that I might jeopardize my job if I were wrong, I yelled out for the physician over the crowd, disrupting the synchronized dance around her husband. Arms around her shoulder, trying to support her and calm her, I guided her to a chair near my computer. Another physician was called over to examine this woman, and he announced that she was medically clear. Thirty minutes later, she drove herself to the trauma hospital twenty minutes away, to meet her husband who had been transferred. Upon arrival it was reported that she collapsed in their lobby and emergent imaging showed metal shrapnel in her chest. She was suffering from a pneumothorax. The patient and his wife ended up making a great recovery and, as it turns out, the “bomb” was actually a historical replica cannon accident gone wrong. The patient’s wife had reportedly been standing ten feet behind her husband as the cannon jammed and backfired.
To have the honor of shadowing close to eighty physicians and getting to be a first-hand witness to hundreds of these fascinating mysteries has made my desire to become a physician even more deeply rooted. I hope to take my wide breadth of experiences, struggles and triumphs into medical school.