A Good Call

Having gone home recently for two weeks to spend some time with my family, I was informed that my blog has of late become rather depressing. While it is true that the last few entries (scarce as they have been) have been somewhat macabre and morbid, it is also true that I simply haven't been writing as often and when I do write, it is usually because I need to get something off my chest. And typically that something is not something happy. Today, though, was a good day.

When I was training to become an emergency medicine physician, there was something I occasionally saw written on my evaluations. "Has good gestalt for the field," it said. Though I never did look up the meaning, it apparently referred to the "gut feeling" which, it is said, is important in the field of emergency medicine. Trust your gut, I was always told. But this is easier said than done. After all, medicine should be less about gut and more about science. Evidence, bloodwork, lab results, CT scans, Xrays - don't all of these trump this "gut"?

Eight months into practice, I've learned that they don't. I've learned the hard way. Just about every single time I've ignored my gut and proceeded to send a patient home based on their normal bloodwork/labs/CT scans/Xrays/physical exams - I've been wrong. It's hard to trust your gut. It's especially hard to trust your gut when you are a fledgeling newbie in the field. It's even harder to trust your gut when you have to consult an irate specialist and say, "I have a patient complaining of X. All the workup is negative but something just isn't right and I'd like your opinion." You feel like a schmuck. You absorb abuse sometimes. You know that the specialist thinks you're an idiot. In fact, some of the more grizzled ones will tell you so too. But I've learned to trust my gut a little more than I did when I first started. Sometimes my gut is wrong and there really is nothing wrong with the patient. But it's better for my gut to be wrong than to be right. Because some really bad things have happened when I've ignored my gut. If something doesn't feel right, I've learned to look harder.

Today I saw a young patient. Something didn't feel right. I could have sent this patient home, written it off as an asthma attack. It looked like asthma. Sounded like asthma. Wheezed like asthma. Coughed like asthma. But something didn't fit. My gut said it wasn't asthma. So I started looking closer. And it turned out in the end that it wasn't asthma. In fact, it was a pulmonary embolism. Something potentially fatal. People get sent home with PEs not all that infrequently and some of those patients drop stone cold dead shortly after.

So today I made a good call. And I learned again to put faith in my gut. And today making that good call makes me feel good about what I do. And it's the things like this, I guess, that make me love what I do even when there are many times when I question whether what I do makes a difference. Because I know that I made a difference in my patient's life today - about as big a difference as the difference between life and death. And it doesn't really get much bigger than that. I get to be a hero today even if it's just in my own eyes. It sounds grandiose, it sounds stupid and egotistic - but it's important to me to be that once in a while, because it's what makes the rest of the work tolerable. It's knowing that despite all the other crap that we have to absorb and face, despite the gruelling and often disheartening parts of the job, for all the people that we lose, sometimes we also win. And even if nobody else is watching, if nobody else sees it, if no cards come in the mail nor letters of thanks appear in the paper - I know that I made a difference in this young patient's life. And that's enough for me.