INNER GUT Feeling

In my ten years working as a physician in the Emergency Room I have seen all kinds of patient cases. Cases ranging from a small blister on a finger to a full code with CPR in progress. Each patient interaction caries a certain level of comfort and familiarity just from the repetitive exposure of similar patients and from the teachings and guidance during our residency training.

Unfortunately, the one thing that you can only pray that you develop, that really CAN'T be taught is that....

"INNER GUT FEELING".

I teach residents and medical students during each clinical shift how to recognize and treat the different disease processes we might encounter. They learn to develop a comfort level with applying the basic ABC's of stabilizing the critical patient. So when the GI Bleeding patient who is vomiting bright red blood with a low blood pressure of 80/50 and heart rate of 140 (normal BP-120/60, HR-60-100) arrives in the ED, they immediately go into the step by step process of:

A-securing the airway,
B-making sure the patient is breathing,
C-improving the circulation ie. blood volume that has been lost.

It really is bread and butter application. Or maybe it's the patient that arrives breathing 40 breaths per minute (nml rate @12-19, diaphoretic (sweating all over) and barely sitting on the stretcher pulling hard to get air into their lungs because they're having a bad asthma attack, severe pneumonia or maybe their lungs are filling up with water (congestive heart failure). Again...ABC's are applied over and over.

See, these are the kind of cases that everybody watches on the TV shows where the ambulances are rushing VERY sick patients into the ED, everybody starts running into the room and moving at lightening speed to get the VERY sick patient stabilized. I guess I would have to admit that it really is intense as it appears on the TV shows. Adrenaline is rushing, folx' are nervous and the ABC's are kicking in. NO doubt you must appear as though you have it all together despite the chaos that is ensuing and the fact that you have the life of someone in your hands.

BUT...this is not the hard part in being an ER Doc. It's up there on the list of stressful causes but its not the hardest thing in being an ER Doc. This is the stuff we're taught to handle.
What can't be taught is that patient that comes into the ED with the non-threatening appearing complaint, laughing and talking with staff or family and within hours, sometimes minutes is DEAD.

How do you teach that to these new docs? Well, you really can't. You either have that INNER GUT Feeling or you don't. You have to have that small thorn in your side that keeps nagging you into a feeling that something is wrong. Often there are little sutle signs that can help us improve that feeling.

- Sometimes patients have a look like "I'm doing OK" but when you have that INNER GUT feeling, you actually see someone that looks sick as hell. I walk into the room after the resident has given me that "not-so-sick version" of the patients complaint and I finish my exam and think..This person is VERY SICK.

- "The open mouth sign". If I walk past a patient room and the patient is elderly, sleeping on the stretcher without movement AND the mouth is wide open...I get worried. Immediately, I move that patient up on my mental list of "sick patients".

- The altered patient who can't tell you whats going on...is always, always, VERY, VERY sick in my book until proven otherwise.

- Of course most of the credit for this feeling would have to go to GOD. I think HE literally puts that feeling in my spirit because I can't put my finger on why I have that "something just ain't right" energy.

Whatever the case may be, I PRAY that your doctor whether in the ER or in their private office has been blessed with that gift of an "INNER GUT Feeling".
It improves with time and experience, but it's not taught. It's inert and I can only hope that the new doctors that I train daily will recognize and LISTEN for that "INNER GUT Feeling".