Perhaps Dr. Hugh (not his real name©) would benefit from such a course.
I get calls from Outside Hospital every so often - these are usually small community hospitals that are not equipped to deal with trauma patients because they don’t have the personnel, the proper resources, or both. The facility where Dr. Hugh is an emergency physician is not one of these hospitals, but for some reason on this fateful night they had no trauma surgeon available. So I became their trauma surgeon.
At 7:45 PM (at least it wasn’t 2AM - thanks, Call Gods), Dr. Hugh called me with an emergency. He had a 70-year old woman who had fallen down the stairs and landed on her left side, and now she had a dangerously low blood pressure. Normally putting such an unstable patient in an ambulance and transferring her to another hospital would be considered ill-advised, but he wanted to do exactly that anyway.
“We don’t have anyone willing or able to take the case, so I need to transfer her to you,” he explained.
Since she had fallen on her left side, Dr. Hugh suspected she had ruptured her spleen, but he went on to explain that their CT scanner was old and would take over an hour to scan her, so he couldn’t even rule out internal bleeding before shoving her into the back of an ambulance. But because her blood pressure was so low, he was very concerned she was bleeding to death, and he was shipping her to me whether I liked it or not.
I was afraid the patient would bleed to death in the ambulance, but something about this whole thing just felt wrong. I had the distinct feeling that something just wasn’t right here. Little did I know just how right I would be, though for entirely the wrong reason.
Exactly 115 minutes later (yes, I timed it and NO, that is NOT a typo - it took almost 2 hours), Bertha (not her real name©) arrived looking in better shape than most patients half her age. She wasn't pale or sweating and she wasn't in pain, she was just sitting up on the gurney smiling, like she knew some big secret but wasn't about to spill it.
My Inner Pessimist kept telling me that something was definitely awry, though I immediately suspected the problem was more with Dr. Hugh than with Bertha.
“Bertha, do you have high blood pressure?” I asked, the suspicion building rapidly.
“No doctor, I never have.”
Her smile widened. “Yes, ever since I can remember.”
And there it is. “How low does it usually run, ma’am?”
“Oh, usually around 75-80 over 50.” I looked at the monitor, which now read 84/45, exactly where it had probably been for the past 7 decades. “I tried telling that to that doctor at the other hospital, but he wouldn’t listen to me. My husband tried to tell him too, but he wouldn’t listen to him either! He just sent me over here! Couldn't they just give me stitches over there instead of taking all night sending me here?”
I touched her shoulder and smiled gently. “Don’t worry, Bertha. We’ll listen here. I promise.”
Fifteen minutes later I was looking at her completely normal CT scan of her chest and abdomen, and thirty minutes (and 20 sutures) later I was discharging her home with her husband, still smiling.
Many people think stethoscopes, CT scanners, ultrasound machines, and X-ray machines are the most important instruments doctors can use to make a diagnosis. But those people would all be wrong. So what is the most valuable instrument we have at our disposal?