Intern Year:
Today is my last day on my family practice rotation. I've become so accustomed to spending my evenings wrapped in the coziness of my apartment and in the company of my dear hubby, that it seems unreal that I will again be spending every 4th night at the hospital from now until June. That's life, and it's what I signed up for, but it was amazing how quickly I got used to living the life of mere mortal and not that of an overworked intern. At 6:00 am tomorrow, the gun will sound and off I'll go on a four week race through the surgical world. Based on what I've heard from the intern just finishing her surgical rotation, my new mantras are, "It's just four weeks." and "You choose your feelings." More on that as the month progresses.
Mom tells me that many God-fearing Doctors write about how they often feel like they are an instrument in God's hands, and that He is the true healer. I had my first experience like that this week.
I was seeing Mr. Fernandez (an exciting alias, to be sure) for some abdominal issues that he'd been having. In his 50's, he was pretty healthy, except for that whole hospitalization thing. He was on the upswing and stable. In other words, he was one of those patients that you have a low suspicion that something else will go wrong. In the brief physical exam that we do on patients each morning, we often give a cursory glance at their calves to make sure they aren't swollen, tender or warm. Often it becomes something more like 'reach under the sheets and give each calf a squeeze while saying, "does that hurt"? What we're looking for are blood clots, and redness, asymmetrical swelling, warmth, and pain upon palpation are red-flag signs. Having a blood clot in your legs can be tricky because if it breaks off and heads to your lungs, you could be dead in less than a minute.
So one morning I was in seeing Mr. Fernandez. He looked great and I reached down to quickly examine his legs. I squeezed each, he had no pain, and I was about to leave. But then I thought, "hmmm...was that left calf just a touch more swollen than the other one?" I almost brushed the thought off, but it persisted, so I said, "Can I just take one more look at your calf?" He re-iterated that it didn't hurt a bit, and I saw that there was no redness at all. But, when I looked more carefully, I saw that the left leg was indeed slightly bigger than the right one. After comparing the two legs a few times, I also felt that the left one was a few degrees warmer. Probably nothing, but it was noticeable enough that I thought we should have an ultrasound done to make sure.
I mentioned the finding to my attending, and he initially brushed me off. He probably thought, "overzealous intern." But then he went to examine the patient to follow-up on my findings, and agreed that there was a subtle difference. He wanted to hold off on the ultrasound, though, and see how it looked the next day.
All night I prayed: Please don't let anything happen to Mr. Fernandez overnight, Heavenly Father. If he has a clot, please let it stay put until we can run this test and start treatment.
The next day the swelling was still there and my attending consented to order the test. We left for the day. I didn't get to see Mr. Fernandez the next day, or his test results, because I was helping with newborn nursery. When I walked into lunch at the office, my attending stopped me. "Did you hear about Mr. Fernandez's test results?" "No." "He had several large clots in his left leg. Good catch." I couldn't believe it. It was such a tiny thing. So easily missed. But there was that voice in my head...that little nagging impression that 'shouldn't I just make sure that leg wasn't a little more swollen?'
I felt so humbled. I could easily have missed that, and there could easily have been consequences for that patient. I'm so grateful to know that God can guide my hand, sharpen my eyes, and inform my intuition to pick up things I might otherwise not. He is the healer.
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