My Last Patient

This week has been much better. We're going over liver pathology. I like the liver because it has so many interesting functions, and it is also capable of regenerating itself. Those are just some of the reasons why it's my favorite GI organ, but I won't bore you by going on and on about how cool the liver is. Suffice it to say that yesterday we went over viral hepatitis, and today we did gall bladder diseases. (The gall bladder is the organ that stores the bile produced by the liver.)

Today was my last day in clinic. Wow, what a way to go out. My very last patient of the afternoon was a guy who came in because a box fell on his hand. His fingers were all black and blue, and he will probably lose some of his nails, but there didn't seem to be any major problems otherwise. I was going through the review of systems (ROS) with him, and when I asked him about chest pain, he said yes. I asked him more about it, and he said that it was a kind of tightness more than a pain. Did it radiate? Yeah, to his left arm. When did it start? About half an hour ago. Had this ever happened before? A few times within the past month. At this point, I excused myself and went to get my preceptor. We personally walked the patient over to the ED so that he could be worked up for an MI (myocardial infarction, popularly known as a heart attack).

I was most struck by the fact that if I had not asked this man about whether he had chest pain, he would not have ever told us about it. He didn’t fit the normal demographic for a patient with coronary artery disease (CAD) that I had learned about in school. He didn’t think his chest pain was important enough to mention to the doctor. I've gone through the ROS so many times over the past two years that it's practically perfunctory and mechanical by now. This experience re-emphasized to me how important it is to not take shortcuts, to ask every patient about life-threatening symptoms like chest pain. You will never have the opportunity to save a person’s life with one simple question unless you ask it.