END NOTE

My one moment of

dramaBY BENJAMIN MARSH, MD

ometimes in medicine it can be dif- struggled with severe nausea Sficult to see the forest for the trees. over the past few days and was Tweaking a medication dose here or on every anti-emetic we could some additional lab results there … all are throw at him. He was a Somali- part of the big picture of a patient’s health American and his mother had that, over years and years, takes the shape been at his bedside day and of something we, as individual medical night. professionals helped form. Rarely do we On this particular evening, get the opportunity to fix something in nausea was not this patient’s problem. His only to give high fives to the imaginary an instant, to be the hero seen on every head was wrenched over one shoulder and crowd of onlookers. medical television show—to see the whole he kept sticking his tongue out between The irony of the situation was that I forest and all the trees. But every once in brief answers to my questions. His eyes only figured it out because I had recently a while, Birnam Woods walks right up to were wide—he looked almost as scared as watched an episode of “ER” (Season 3, Dunsinane, fills up your field of vision and I was. To make matters worse, his mother episode 3) in which a young Dr. Carter gives you the opportunity to be George was in the corner of the room wailing at takes Compazine for nausea and develops Clooney for a brief, shining moment. the top of her lungs, “My son, my son, help an acute dystonic reaction with torticollis. The first assignment I had during my my son!” His nurse looked at me, grabbed Treated with (you guessed it) IV Benadryl. intern year was covering night float on a my arm and said, “Doctor, you must do Four years of medical school learning and busy trauma and surgical service. I spent something!” in the kind of tone I previ- my only dramatic save comes from watch- the majority of the time terrified and ously thought reserved for soap operas. ing a TV show. paging my senior resident to ask if it was I did a neuro exam and it definitely did It’s unfortunate that real life medicine is okay to give patients Docusate. The little not seem like a seizure. Maybe he was fak- rarely as glamorous and flashy as it is on downtime I had between pages I spent ing it to get attention from his mom? Then TV, but that doesn’t mean our hard work watching old seasons of “ER” on DVD in it hit me. “Fifty mg of IV Benadryl, stat!” means any less to our patients. Our sto- the call room. One night, I received a stat I yelled. His nurse gave me a look that rylines tend to be on the scale of seasons page to a patient’s room. After running simultaneously said, “Why?” and, “Please or series, rather than single episodes. But up five flights of stairs, I arrived to find a never say that again,” but she humored me I take solace in the fact that there are still 21-year-old man having what looked to be and drew up the medication. Almost the opportunities for dramatic cures; where a seizure. instant it hit his veins, his contorted face I can still yell, “Stat!”—without too much He had been admitted a few days prior relaxed, his neck released and his tongue eye-rolling from the nursing staff. MM with an appendiceal abscess; a percutane- went back in its rightful place. His mother, Benjamin Marsh, MD, is a fourth-year resident ous drain was placed and he was started on still sobbing, wrapped her arms around in urology at the University of Minnesota IV antibiotics with a plan for an interval me saying “Thank you Doctor, thank you, Medical School. This article was awarded an honorable mention in the 2017 Minnesota appendectomy down the road. He had thankyouthankyou …” I’ll never forget the Medicine writing contest. look of awe on that nurse’s face—as if I were some kind of god. If I had sunglasses with me, I would have put them on as I walked out of the room backward, turning

48 | MINNESOTA MEDICINE | MARCH/APRIL 2018