Emergency Medicine News:
Letter to the Editor
I was working the night shift, and it was somewhat busier than usual. I was dealing with a high volume of high-acuity patients as well as monsoon-like weather. After intubating my second consecutive patient, I was called to evaluate a GI bleeder. The patient was hypotensive, tachycardic, and actively passing bright red blood rectally. The only problem was I had no GI doctor in house or on-call. This was when my problems began.
I got a bite after making multiple calls to area facilities. I spoke with a gastroenterologist who accepted the patient, but wanted him admitted through the hospitalist service. The hospitalist declined because he believed the patient was unstable, but time was of the essence. I continued to stabilize the patient hemodynamically. He was given more blood, FFP, albumin, and placed on a vasopressin drip. After wasting an additional 90 minutes, his systolic blood pressure was 90-100 mm Hg, which was about as stable as it would get before plugging the leaks.
During this time, the weather took a turn for the worse, and the rain became more intense. The hospitalist finally agreed to the transfer. EMS was called, and we all went into the patient's room upon their arrival. The patient, an old Vietnam veteran, said, “Doc, you're worrying too much. I've been through worse and I'm still here. I know where I'm going when I leave this place.”
He smiled, grabbed my hand with his two, and then said, “Thank you for all you have done for me.” He was transferred to the EMS gurney and placed in the ambulance. I was worried, but confident that he would survive.
About an hour later, we received a call that the ambulance collided with a semi-trailer, and everyone in the ambulance was killed. It made me think, “What if...” We have no control over some things, but it didn't change how I felt after making a decision that resulted in the deaths of three innocents. Why do we do what we do? This job is complex, and on most days rewarding, but not on that day.
Anthony Filippone, DO