Page 16 of Dr. Fellow

“Did you see what we just got in bay two?” I ask the brunette doctor sitting at the desk in the middle of the ER. She’s focused on her computer screen, but I know she’s listening, so I continue, “Fourty-eight-year-old male with crushing chest pain radiating to the lower back. Came in with stable vitals. History of smoking and hypertension. I got two sixteen gauges in him, drew labs, and started tele. Couldn’t hear shit on physical abdominal exam though.”

Her brown eyes go wide at my summary before she looks back down at the screen to open the patient’s chart. Technically, I’m supposed to go to the resident first with updates or requests, but I don’t bother in this situation. I need someone who isn’t fresh out of medical school to put their eyes on this case.

“When did it start?” she asks, quickly scrolling through the patient’s information.

She just got back from maternity leave last month, and I’m happy to see her back. I’m sure it’s hard for her to work in a male-dominated specialty, but she’s a badass and one of the only physicians that I genuinely like. Most ER doctors are weirdos who like to rock climb and use words like chill and dope. While there’s nothing wrong with that, sometimes I just want to shake them and tell them to shut the fuck up.

I lean over the desk to peek at her screen.

“According to the wife, around noon. They were out to lunch when the chest pain started, and he ignored it. But I guess it got worse, and she made him come since they live around the corner.”

“Thank God she did.” Dr. Averill’s concerned eyes flick up to mine momentarily. “Get him to CT. I’ll make some calls.”

She must be thinking the same thing—a ruptured abdominal aortic aneurysm. Depending on the size and stability of the clot, you can sometimes use a “watch and wait” approach. However, since our patient is already symptomatic, the chance of rupture is pretty high.

I might not believe in marriage, but in cases like this, I can see the benefits—his wife might have saved his life by making him come in today.

“You don’t want the lab results first?” I ask, thinking through my next steps. “They should be back soon because I had them run down.”

“His ability to tolerate contrast doesn’t really matter if he’s actively bleeding into his abdomen.”

Valid point.

She picks up a phone, presumably to call CT and inform them that I’m on the way. Normally you don’t need to go with a patient to imaging—it’s a task that can be delegated to a medical assistant—but in situations where a patient is unstable, you have to be physically present in case you have to run a code.

“Alright, Mr. Morningside, let’s get you hooked back up to that IV,” I say when we make it back to the room after the CT.

Once the scan results come back and confirm the rupture, we’ll likely get this guy into surgery to remove the aneurysm and stabilize the bleed. Fortunately, everything has gone smoothly so far, and my nurse radar is starting to calm down. He’s not out of the woods yet, but at least we have a plan in motion to save his life.

My patient sways slightly as he stands from the wheelchair. I hold him steady while he takes two heavy steps to the bed. His face has substantially paled in the short time it took me to wheel him back from the scan, and a thin sheen of sweat is now covering his brow despite the ever-present chill of the ER.

The radar starts beeping again.

I grab the blood pressure cuff from the wall once he’s settled on the bed and quickly wrap it around his upper arm. We already have a pulse oximeter, a device to check blood oxygenation and heart rate, connected to our central monitoring, and considering no one has run in here, I know he’s not in serioustrouble . . . yet.

“Everything okay?” his wife asks, watching me intently.

I can tell she’s nervous because her hands are clenched tightly in her lap, like the pressure is holding them steady. And I don’t blame her—I’m nervous too.

I plaster on a fake smile. “Yep. Standard to get another set of vitals after a scan.”

The automatic blood pressure reads 82/56, a value which could be acceptable depending on the circumstances, but in this situation, it makes my stomach flip. I pull my stethoscope out of my scrub pants and check the blood pressure manually. Sometimes our machines act wonky and give inaccurate readings, which is what I’m hoping for.

The manual reading is even worse at 76/52, so I leave the cuff on and restart his fluids at a faster rate. Part of my scope of practice allows me to make certain clinical decisions based on my nursing judgment, fluid rate being one of them. The increased flow should help stabilize his pressure while I go get the doctor.

Looking down at my patient, I explain what’s happening as calmly as I can. “Your blood pressure is just a little low, Mr. Morningside. I added more fluids, and I’m gonna grab the doctor to come check you out.”

He brushes the sweat-soaked hair off his forehead. “Do you know what’s wrong?”

I swallow hard. “We think you have a ruptured clot in your stomach. If that’s the case, we’ll just go in and surgically remove it. Hopefully, the scan will confirm that soon, but I want the doctor to see you while we wait.”

There’s no use lying to him. If I’ve learned anything over the past five years, it’s the importance of clear communication with families. Not only does it provide them with updates on the care their loved ones are receiving, but it also helps keep them as calm as possible throughout the chaos. Not everyone has the same level of understanding when it comes to healthcare, so simple details can make all of the difference in the world.

“Will he be okay?” The wife’s lower lip is trembling now.

“You’re in good hands,” I promise, unable to confidently say anything else. “We see this kind of thing all of the time, and we have a great team of doctors who can fix the clot.”

I’m telling a partial truth.

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