Emergencies

A physician-mother has two children, both of whom sought medical care at a storied medical institution in the environs of Boston, Massachusetts, in December of 2022, as the city was in the grip of the “tripledemic” of COVID-19, respiratory syncytial virus, and influenza. Following is a summary of each case.

Statistically, to avoid missing a case of appendicitis, one must send to the ER some patients with symptoms of appendicitis whose appendices turn out to be normal. This lesson from medical school is imprinted indelibly on my mind.

In my residency program, if a resident sent a patient to the ER, the resident was required to go the ER to evaluate them, to further their learning. However, this created a conflict of interest—if you had to meet a patient in the ER, you missed out on sleep. Hence I thought hard about the disposition of each patient.

My ambulance partner and I responded to a 9-1-1 call for a person with difficulty breathing at a department store, but we couldn’t find anybody needing medical attention. A worker pointed to the metal ladder at the back, saying there was a guy working on the roof, and they hadn’t seen him in a while.

A hush fell over the room as reality sank in. “He likely will not survive this,” the surgeon said.

The patient’s brow wrinkled in confusion. Why was everyone so quiet? His eyes met mine, pleading for a clue and awaiting my translation.

At 3:00 a.m. one morning, my wife collapsed in our small bathroom with a crash. She was, it turned out, having her first epileptic grand-mal seizure at age 48. Out of the blue! I was able to get her back to bed and then watched her have another nine seizures before calling the ambulance company. Shortly afterward, a fire truck, a paramedic truck, and an ambulance arrived, along with seven first-responders.

“When I went in, it was as if a grenade had gone off in there.” That was what my husband’s surgeon told me after he performed emergency surgery to address the havoc in my husband’s colon and bladder. A diverticular sac had ruptured and eaten a lima-bean–sized hole in my husband’s bladder. This was no mere urinary tract infection, as my husband had thought; it was massive infection, called a colovesical fistula.

My wife and I had just gotten home from work one Halloween evening when we got one of “those calls.” A young, male voice told me our nineteen-year-old daughter, Liza, had gone to her college dispensary with abdominal pain and had been sent to a local teaching hospital several hours before. He told me she had been admitted, and they wanted permission to do an appendectomy.

A stereotypical pathologist, my father was a man of few words and fewer friends. He spent long days in solitude with his microscope, examining tissues and cells. In 1982, almost 20 years before his own diagnosis with metastatic breast cancer, he published a rare case in which breast cancer cells invaded individual chest muscle fibers. He later examined his own breast biopsy.

The clerk at city hall told me I had to fill out a Freedom of Information Act (FOIA) request if I wanted to see the accident report. In the midst of dealing with claims for my vehicle (now totaled) and medical expenses, I wanted to see in black and white an acknowledgement that the other driver was at fault. And there it was: “Failed to yield.”

I was halfway through a busy day as an ER technician when the charge nurse told me to report to Trauma Bay X to help with CPR. I walked fast, knowing my initial view of the patient would be shielded by the overwhelming number of providers who appear during codes. I squeezed my petite body through the blockade of people only to arrive upon an unexpected sight. The patient was a healthy-looking woman under forty years old, a complete contrast to the patients I usually see in cardiac arrest.

The first call came when Dad and I were browsing through Sam’s Club. The second interrupted our drive to admire the fall foliage. By the tenth call, I stopped counting.

The content of each conversation was always the same: “Your mother fell,” the aide from the memory-impaired unit of the nursing home would shout. “An ambulance is transporting her to the hospital. You need to come.” The consequences were also always the same. We found Ma sitting in a bed in the ER, nibbling on Jell-O and confusedly asking, “Where am I?”

Dear Pulse readers,

One can’t listen to the news these days or think about the upcoming midterm elections without feeling that our nation is in a state of emergency–a civic emergency that we can all address by making sure to vote and by encouraging others to do the same.

When it comes to medical emergencies, I realized early on in my training that I was not one of those doctors who relished catastrophic situations.