Tale from “The Pit”

Paramedics brought in a seventeen-year-old youth with a serious self-inflicted laceration to his left forearm. His knife had nicked an artery, not sliced through it. The ends of a severed artery contract and spasm down, reducing blood loss. A nicked artery continues to pump blood through the hole. Our teenaged patient had lost so much blood that he arrived in hemorrhagic shock, despite the paramedics giving him IV fluids and compressing the nicked artery before transport. We stopped the bleeding, …

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Not Only a River in Egypt

My patient was a thirty-something-year-old woman complaining of sudden onset of crampy abdominal pain—a condition for which the lengthy differential diagnosis runs from “nothing-burger” to life-threatening. Often a challenge, even for a seasoned ER doc. On entering the cubicle, I found the patient supine with the head of the bed raised about 20 degrees; she felt most comfortable in that posture. Although not in severe distress, she appeared anxious; worse when a wave of pain traversed her lower abdomen. She …

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Of Cadillacs and Throwing Stars

Once upon a time, in the mid-eighties, luxury automobiles sported fancy hood ornaments at the crown of their long front ends. (I’ll leave the interpretation of that custom to my psychology friends.) Here’s an example from the hood of a 1983-ish Cadillac: These ornaments were not fixed to the hood, but attached via a wire thingy that allowed them to flop flat when needed, for instance in an automated car wash. Sometimes they suffered damage from general use or vandalism: …

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“Time Is Life”

Eight hours into a hectic 12-hour solo-coverage day shift in our community hospital ER, I finally got the chance for a lunch break. I hustled to the hospital’s food court, bought two slices of pepperoni pizza to go, and hurried back to the ER lounge where I popped open a Diet Coke, took a big swig, then dove into the pizza. The head nurse appeared at the door just as I finished the first slice. “Chest pain in One.” I …

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When I Half-Died

Heart rate of 12! I see it on the monitor just behind me. MY heart rate! Not compatible with life! My vision closes down, tunnel-like. I’m sinking through the operating table on which I lay, both arms stretched out and tied down, crucifixion style. I need atropine. The surgeon’s voice, “Cough, Mike.” I cough. I see the resulting blip on the monitor. Cough, cough, cough. Blip, blip, blip. To live, I must keep coughing. Heart rate up to 30. Barely …

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