Just when I start to feel comfortable..

For the last couple of months I've really gotten in to the groove of things. Gone are the days when I would interview a patient and then immediately discuss it with the attending to make sure I was on the right track with my treatment plan. Now, it is not uncommon for me to see two or three patients, start the orders on them, and then sit down with the attending to discuss what I've done. I feel much more like a actual doctor now.

However, every now and then I still get humbled. Case in point, yesterday I was walking by a room the EMS guys had just dropped a patient in. I noticed he was screaming in pain and grabbing his abdomen.

"I got this," I said. He was then placed on a monitor and his vitals where: Pulse: 158, BP 65/40, Resp 34.

"Shit, I don't got this." I thought. The patient subsequently leaned over the bed and vomited at least 250ccs of bright red blood. His wife looked at me and said he's been doing that all day. The guy continued to scream aloud in pain. I was relieved to see that his screams had gotten the attention of my attending. He took one look at his vitals and the blood on the floor and then called for emergency release blood. The guy leaned over again and vomited another 250 ccs of blood.




I remember standing at the bedside frozen while multiple nurses were trying to place two IVs to start rapid fluid resuscitation. The attending came back in and asked me if I minded transferring this guy to the trauma bay (a very polite way of telling me that is what was going to happen.) I ended up putting in a central line along with intubating him as it was deemed he could not control his airway. Long story short, Gi was called in and he ended up getting a scope right there in the bay. The guy turned out just fine.

That's the problem with being an intern. The common things come in so frequently we get complacent and or cocky only to swiftly brought back down to earth when something new comes along. This guy was a great case, and now one less emergency medicine topic that will freeze me in the future.