She was a 4 year old girl lying wrapped in a blanket on the exam table, eyes red from tears. I was going through my usual routine; I started with an interview of the parent asking about the course of the current illness. I systematically asked the when, how long, is it improving or getting worse, what have you given her to help with the pain and vomiting, etc.
After gathering the story from the girl's mom, I approached the girl on the exam bed and began my exam. She was in clear distress, but it wasn't until I began my abdominal exam that I became really concerned. As I uncovered her and began to feel her abdomen, she began to cry and wail even more. I felt as deep as I could and she continued to be more distressed. Possible diagnoses were coming into my mind; acute gastroenteritis, appendicitis, sepsis, others. I was beginning to be more concerned that she may have need for surgery. I ended my exam and went to present to my resident.
The resident came and did the exam as well, and when she was done she came and presented to our attending. The resident did not at first expect the girl to be in such distress, and after her exam was still unsure whether she had appendicitis or not. Our attending then did an exam, the third time the girl was examined, and decided to do an ultrasound of the girl's abdomen.
Today the resident informed me that the girl's ultrasound did not show any appendicitis or any need for surgery. I was relieved. I haven't had many (or any, really) patients in such acute distress that I was concerned something may be seriously wrong. A little bit of fear like that can make you a bit more alert and mindful of all the details, but it can also fluster you and cause you to lose your focus. I turned into the latter. I'm sure in the future with more experience and seeing more patients, the occasional serious patient will not shake my focus so easily. It was never a matter of not having the medical knowledge for the situation, but having the experience in dealing with these situations without letting the excitement overtake you. I guess that's just part of the process in learning the art of medicine.
After gathering the story from the girl's mom, I approached the girl on the exam bed and began my exam. She was in clear distress, but it wasn't until I began my abdominal exam that I became really concerned. As I uncovered her and began to feel her abdomen, she began to cry and wail even more. I felt as deep as I could and she continued to be more distressed. Possible diagnoses were coming into my mind; acute gastroenteritis, appendicitis, sepsis, others. I was beginning to be more concerned that she may have need for surgery. I ended my exam and went to present to my resident.
The resident came and did the exam as well, and when she was done she came and presented to our attending. The resident did not at first expect the girl to be in such distress, and after her exam was still unsure whether she had appendicitis or not. Our attending then did an exam, the third time the girl was examined, and decided to do an ultrasound of the girl's abdomen.
Today the resident informed me that the girl's ultrasound did not show any appendicitis or any need for surgery. I was relieved. I haven't had many (or any, really) patients in such acute distress that I was concerned something may be seriously wrong. A little bit of fear like that can make you a bit more alert and mindful of all the details, but it can also fluster you and cause you to lose your focus. I turned into the latter. I'm sure in the future with more experience and seeing more patients, the occasional serious patient will not shake my focus so easily. It was never a matter of not having the medical knowledge for the situation, but having the experience in dealing with these situations without letting the excitement overtake you. I guess that's just part of the process in learning the art of medicine.