The worst day

Putting this one into words may be a little bit difficult.  My aim is to convey a couple of ideas and I need to do it while preserving plenty of anonymity.  On top of this restriction, it's a bit of an emotional issue - so please bear with me as I stumble through this topic.

A number of days ago, we had a remarkably sick patient come through the ER.  Not knowing how sick this person was, I was initially a little unimpressed by the presenting illness - nothing seemed too amiss.  As I presented to my Attending and proposed a workup and treatment plan, I was educated in just how to treat someone with these co-occurring symptoms.  Through this process I realized how ill our patient was (or had the potential to become) and thereafter kept a keener eye on how things progressed.  I was humbled by the experience of having initially assumed our patient was not sick when in fact the opposite was true. 

This brings to mind another point: we have had drilled into us the idea that we need to be able to differentiate sick from not-sick.  Sometimes this is referred to as a doorway assessment or a ten-foot assessment.  One of our instructors would show us pictures of patients and quiz us: "Sick or not-sick?" he would say...  Sometimes it was obvious, others not so much.  Admittedly it was difficult to tell especially for a new student.  I still have a ways to go, naturally.  But it's an important skill and this case illustrates that well.

At any rate, this patient was definitely sick and my doorway assessment was inaccurate.  Our patient became a bit more ill in our department so we got an admission to the hospital set up.  The patient got worse and ended up in the ICU (intensive care unit).

This is where the main point of this post comes in.  One aspect of emergency medicine that is incredibly rewarding is the fact that we often take care of people on their worst day.  Something has brought them to see us that is worse than any other illness or event in their life - something like a heart attack, brain attack, or major accident.  We have the opportunity to make a horrendous event just a little less miserable, sometimes make it resolve altogether.  What a great thing to be able to do.

On this particular day, our patient's worst day, I had the opportunity participate in the care that made it a little bit better.  We helped a family cope with difficult times and cared for a patient who, without good treatment, faced a terrible prognosis.  This is a part of the honor of practicing medicine.

Condensed down into a pithy saying: a patient's worst day brings the opportunity for us to have our best day.  I just hope that, with time and more training, I will be able to fulfill my end of the deal.