It was 8:57am on a Thursday morning in the ED.
“Sir, are you awake?” yelled a nurse in the room closest to the physician workstation.
Silence.
She repeated the question, much louder this time.
Silence.
My resident and I jumped up and ran into room 64. We saw a yellow-colored man taking deep sporadic breaths, his eyes closed as if he were sleeping. Two baseball-sized hernias protruded out of his abdomen as he inspired. His GCS was 6.
There was no doubt this patient was sick. He was immediately transported to the resuscitation bay, intubated, and put on a ventilator as labs were drawn, fluids started, and his head was scanned.
The most bizarre thing was that no one knew how Mr. A had arrived in room 64 in the first place. There was no hand-off note, no paramedic, and no record that he had checked into the ED. “This isn’t the first time a dying patient has shown up in this ED without notice”, the resident remarked later that day
Although this is one example of a strange moment in medicine, it is not just an isolated incident. Think about it – whether it’s dealing with a patient who chose to smoke a pack of Marlboro Lights in his hospital room, a psychotic individual who attacks the attending on rounds, or a post-surgical patient whose wound gushes arterial blood upon inspection of the site – medicine is full of peculiar encounters. And for health care professionals, it is just another day in the hospital.
We take the situation for what it is, deal with the challenges, and move on aiming to do what is best for our patients. After all, we signed up for this exhilarating experience. Nevertheless, even the most creative person would be hard-pressed to predict the complex scenarios that arise on a daily basis.
And to me, this complexity and uncertainty is what makes medicine fascinating. If every surgical case had the same outcome or every patient responded similarly to a therapeutic drug, then life would become mundane. There would be fewer reasons to pay attention to detail and more feelings of déjà vu. Sure, at some point, once you have experienced a variety of outlandish encounters over years of training, you may become less fazed by the chaos around you.
These days, it seems like we are taught to reduce complexity and to treat patients using a standard algorithm of options. This streamlines the process of delivering health care, allowing us to see more patients in a fixed amount of time. However, I challenge you to avoid this temptation. Instead, approach each patient with a curious mind because each encounter has the potential to become an intriguing case with underlying concerns that can only be addressed with an open, unbiased mind.
This is much easier said than done. If we become unfazed by the nuances in medicine, then we will be less effective as health care providers. And that is unacceptable. We have engineered machines to process and accurately diagnose patients based on their history, but only a human can detect subtle cues and variations in behavior. This is why doctors have not become obsolete. Regardless, it is impossible for us to heal if we are closed off to the possibility to begin with.
Hussain Lalani is a MS2 interested in population-based health outcomes and mortality, global health, and innovation.
