The Specialist in You

This is a finalist in the 2015 STFM Blog Competition. 

Avelina Sandoval, MD

“You only see what you look for. You only recognize what you know.”

My attending’s words resonated in my mind as I stood there in my short white coat amidst the chaos of the busy trauma bay. It had been an extremely long night.

I was on my mandatory trauma call as a freshly minted third-year medical student. We had heard stories from our upper classmates about what to expect as we left our classroom nest and went off into the hospitals. We would either get to do “doctor-ly” things or we would get stuck with grunt work depending on who was on our team and how busy the service was.

This night was particularly hectic, and the trauma victims rolled in one after another. As medical students, we would each be assigned one patient for the shift. For each patient, we had one job to do that would be determined by the attending or senior resident.

My job at this very moment was to hold this patient’s hand and stare at the vital signs monitor he was connected to. There were so many unidentified people coming in that the nurses resorted to putting generic name labels on the patient’s wristbands until more information could be obtained. I stared down at the one on my patient’s cool hand, “Quann.” That’s odd. I wonder what his real name is. I read on. age: n/a. Race: n/a. Gender: M.

The world around me was so busy, moving from one place to the next to finish another task, to take on another patient. I, on the other hand, had plenty of time to thoroughly evaluate my patient. Battle sign. Raccoon eyes. CSF leakage from the ear.

I tried so hard to remember the recent lecture on trauma I had so intently listened to from the comfort of my favorite seat in our dark lecture room a few months ago. I scanned my patient from head to toe looking for signs to piece together what happened. Trying my best to decipher what the mechanism of trauma had been and what residual deficits he may have were he to walk out from this event alive. It was unlikely, of course, as he was a patient with a gun shot wound to the head. His scalp was ever so neatly wrapped in a bandage, and he appeared to be in a comfortable, deep sleep. 

His neighbors heard a gun go off and called the police. An ambulance had arrived a few minutes later and found him in his apartment alone with a gun next to his quiet body. My pager had gone off indicating his ETA was 4 minutes, and we stood prepared in the trauma bay just as we had been oriented to do so a few hours earlier. Once a patient arrived, protocol was followed. Focus was on organ systems and vital signs. Most people that came through our doors earned a trip to the CT, and each medical student followed their patient through the emergency department as they were wheeled from one place to the next.

Here I was. Standing next to “Quann,” quietly keeping a vigil eye on his vital sign monitor. “If this number goes below this or if that number goes below that YOU CALL ME,” my attending told me as she walked briskly away to the next trauma victim being brought in. That was my job. That was my purpose in life for the next few minutes. “Quann” was most likely brain dead, but I wouldn’t be the one to decide that. Two separate “real” doctors would have to decide that. I stood next to him and waited for those physicians to find time in the hectic ED to make it back to us. They would be performing a series of tests to declare “Quann” brain dead or not.

No one knew anything about “Quann.” There was no way to reach a family member, a loved one, or a friend to let them know what happened or how he was. I couldn’t help but wonder who he was. What his life was like. What would bring him to do this to himself or another person to do this to him? Was he stressed? Was he sad? Was it related to mental or physical health? I wish I knew. I wonder if anyone knew. Did he even have a doctor? Had he been to clinic recently and mentioned something that may have raised a red flag and prevented him from being here with me now? I had so many questions, and now it was too late to obtain answers.

I’ve learned so much about medicine since then. I have experienced so much with my patients and mentors in such a short time frame. In my intern year alone I experienced every emotion under the sun in the clinic and hospital settings. I was overwhelmingly happy as I held the tiny little fingers of a newborn I delivered and overwhelmingly sad as I walked up to a patient’s room to pronounce them dead. Many times in clinic I was ecstatic to see my patients take steps toward their goal for healthier lives, and many others I was frustrated that my patients didn’t seem to care about their health.

As a second-year family medicine resident I’ve grown to appreciate the fact that health comes in many shapes and sizes. Individuals uniquely define their own version of what it means to be healthy, and patients require a tailored path toward achieving that health. The golden rule applies so nicely—if you don’t listen to patients, they probably won’t listen to you. I remind myself that my patients take time out of their day, possibly money out of their bank account, to visit with me for 15-20 precious minutes. Why?

A nephrologist can save a kidney by mastering the balance of electrolytes in the human body. A surgeon can save a bowel with precise excision of diseased portions of gut. An OB-GYN can reduce the burden of menometrorrhagia with keen knowledge of hormonal and surgical techniques to regulate a bleeding uterus. A pediatrician can alleviate a sick child with their exquisite expertise on weight-based medication administration.

What does family medicine mean to me? I am a specialist in you. I can help you investigate what these symptoms mean. I can help you understand what to expect and help you navigate through realizing what is normal and what is not. I can create an action plan with you to get you to your health goal. I can assure you are seeing the right specialist or department for your specific health needs. I can help you streamline what the different specialists are telling you. I can help you find resources that may help make your life a little bit easier. I can do what is in my power to get you the appropriate screening to try to prevent you from getting really sick later in life. I can notice when you are not yourself, and I may ask you some personal questions to make sure your life is not in danger.

I think of “Quann.”  I am reminded of his cool hand and the bandage on his head.  Who knows?  Maybe he would have ended up in the trauma bay that night regardless of any help he could have received from the health care system. But what if someone saw the red flags earlier?

As a family medicine physician I am privileged to care for individuals throughout the course of their evolving life cycles. This affords me more opportunities to catch red flags and help early on with anything that may diminish a person’s health or quality of life. The caveat being that we need to be well versed in their life situation and know who they are outside of the clinic setting. The best way to build this knowledge base is to bond with our patients and get to learn about them over time. “You only see what you look for; you only recognize what you know”. These words echo in my heart as I say goodbye to my last patient of this busy day in clinic.