Happy Sunday friends 🎆.
This edition of Sunday Morning Rounds will be a bit different 🧐. While I love discussing topics like studying and productivity, I also want to create space for stories in medicine and highlight the challenges healthcare workers face – including my own 🙋🏽♂️.
Recently, I took care of a patient in the Emergency Department that had an unexpected impact on me.
My patient was a middle-aged man who was brought in by EMS 🚑 for altered mental status. Like with many patients brought into the ED, I didn't have much history to work with 😵💫.
When I evaluated him, I was relieved 😮💨. He was awake, knew his name, and where he was 👍🏻. His vitals signs were normal 🫀. He couldn’t recall what he'd been doing before coming to the hospital, but that's not unusual for these confused patients.
Overall, he was stable.
Until he wasn’t.
Over the next few hours, his condition worsened 🫤. He received IV fluids and oxygen through a non-rebreather mask 💨. I started him on two vasopressors to prevent his blood pressure from dropping🩸, and gave him three broad-spectrum antibiotics for a possible infection 🦠.
But he was only getting paler, sweatier, and more confused 🚨.
I knew I was treating him appropriately, but I didn’t know what I was treating. And I didn’t know why he wasn’t improving. Eventually, as he slowly began to stabilize, I admitted him to the ICU 🩺. When my shift ended, I made a point to sign this patient out to the next physician ⏭️–he'd been admitted several hours ago but was still sitting down in the ED 🕑. Still looking unwell, still with no answers.
I left the ED with a ball of frustration in my stomach.
About a week later at work, I signed up for a new patient and started reading their old notes 🗒️. Suddenly, I read something familiar–my own note for that same patient. That familiar sinking feeling started to creep back.
I hurried over to see him…
And he looked great.
He ended up being diagnosed with multifocal pneumonia that was not identifiable on initial imaging 🩻. He spent several days in the hospital 🏥, got IV antibiotics, and was eventually discharged to finish oral antibiotics at home 💊. He was coming back for some residual chest pain from coughing, but his chest x-ray was significantly improved 👍🏻.
I treated his pain and as I discharged him, I told him how much better he looked than the last time I saw him 💪🏽.
That interaction made my day.
If you work in healthcare, I can almost guarantee you’ve had a patient like this 🙂↕️. A patient who perplexed you, who didn't respond to a treatment you’ve given hundreds of times. A patient you just wanted to help.
⚠️ So here’s your reminder:
No matter the case, you have the skills.
Medicine is a thankless job, and in fast-paced settings like the ED, we often don't get to see our hard work pay off 😅.
But it does.
Even in uncertainty, if we trust our training and do what is right, we are making a difference.
There was nothing "exceptional" about this case–I’ve treated septic shock of unknown origin and managed similar cases countless times 💉. But to find myself with that sinking feeling and then seeing my patient happy and healthy a week later, it was a powerful reminder of why we do what we do, and what a privilege it is to care for others 🩺.
So no matter where you are in your healthcare journey, I hope you remember that too.
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