How to lift the blackest mood: a case report
Introduction
We had a run of the mill day yesterday.
Case Description
One sort of exciting thing that happened was an urgent consult called in by the cardiac care unit: a young man, only 38, had been admitted with what looked like a STEMI (bona fide heart attack). There was a tear in his coronary artery which had clotted off the entire vessel. The cardiologists found it unsafe to stent this area, and opted to treat medically, with 4 different blood thinners.
The patient came to the ICU, and immediately started to have what we call "massive hematemesis." He was basically exsanguinating from somewhere within his GI tract and vomiting the blood up. What the source of the bleeding is was not clear.
I showed up there, and saw about 15 people around this room: the ICU attending, the ICU fellow, the ICU resident, the ER intern rotating in the ICU, the medical student, the interventional cardiologist, the interventional cardiology fellow, the surgical chief and his mid level resident, and about 4 or 5 nurses.
I called my attending, and we activated the endoscopy people, who promptly came up and set up the procedure. We started - but the patient continued to vomit, so we stopped to put him on a breathing machine so his airway could be protected.
We started again, and not unexpectedly, saw a stomach and intestine full of fresh red blood. It was difficult to clean because it had clotted, but we used a really big scope with a lot of suction power, and finally, could get a good look. The intestine and the stomach were clean, but the esophagus had a tiny tear in it, with a little piece of a vessel sticking out. We put two clips on it to prevent further bleeding, and came out.
All proper and appropriate, no high fives or anything.
Discussion
But the point is, today we came to check on the patient, and he's completely awake, totally stable, looking happy and asking for food. Joking around with us about the color of his jello. He turned out to be a cop, with a young wife, who, I think, was pregnant.
When we were leaving the room, the wife came out after us. She wanted to thank us for what we did. She choked up. She said, she couldn't believe how quickly we all knew what to do and what to look for, and how if it wasn't for us, she wouldn't have him anymore. She gave my attending a teary hug! At this point, I choked up too!
The best part is, for me, at least, it was totally enough to just see this man, who was gonna die, actually get better, like 100% better! That NEVER happens in medicine. They show up sick, dehumanized, ugly, and we never get any sort of idea of what they're like as people on the outside. Who's got the PhD, who loves makeup, or who likes fishing... And here's this guy! Joking around about the good quality of the drugs we gave him for sedation....
Conclusion
I don't know how not to be such a cheeseball... but...
We had a run of the mill day yesterday.
Case Description
One sort of exciting thing that happened was an urgent consult called in by the cardiac care unit: a young man, only 38, had been admitted with what looked like a STEMI (bona fide heart attack). There was a tear in his coronary artery which had clotted off the entire vessel. The cardiologists found it unsafe to stent this area, and opted to treat medically, with 4 different blood thinners.
The patient came to the ICU, and immediately started to have what we call "massive hematemesis." He was basically exsanguinating from somewhere within his GI tract and vomiting the blood up. What the source of the bleeding is was not clear.
I showed up there, and saw about 15 people around this room: the ICU attending, the ICU fellow, the ICU resident, the ER intern rotating in the ICU, the medical student, the interventional cardiologist, the interventional cardiology fellow, the surgical chief and his mid level resident, and about 4 or 5 nurses.
I called my attending, and we activated the endoscopy people, who promptly came up and set up the procedure. We started - but the patient continued to vomit, so we stopped to put him on a breathing machine so his airway could be protected.
We started again, and not unexpectedly, saw a stomach and intestine full of fresh red blood. It was difficult to clean because it had clotted, but we used a really big scope with a lot of suction power, and finally, could get a good look. The intestine and the stomach were clean, but the esophagus had a tiny tear in it, with a little piece of a vessel sticking out. We put two clips on it to prevent further bleeding, and came out.
All proper and appropriate, no high fives or anything.
Discussion
But the point is, today we came to check on the patient, and he's completely awake, totally stable, looking happy and asking for food. Joking around with us about the color of his jello. He turned out to be a cop, with a young wife, who, I think, was pregnant.
When we were leaving the room, the wife came out after us. She wanted to thank us for what we did. She choked up. She said, she couldn't believe how quickly we all knew what to do and what to look for, and how if it wasn't for us, she wouldn't have him anymore. She gave my attending a teary hug! At this point, I choked up too!
The best part is, for me, at least, it was totally enough to just see this man, who was gonna die, actually get better, like 100% better! That NEVER happens in medicine. They show up sick, dehumanized, ugly, and we never get any sort of idea of what they're like as people on the outside. Who's got the PhD, who loves makeup, or who likes fishing... And here's this guy! Joking around about the good quality of the drugs we gave him for sedation....
Conclusion
I don't know how not to be such a cheeseball... but...
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