PHYSICIAN-IN-TRAINING/MEDICAL STUDENT CATEGORY
2015 RICHARD SPEAR, MD, MEMORIAL ESSAY CONTEST
ing, radiating to both arms and made him sweat, brought on by
an emotional event and now gone. His ex-wife drove him to the
hospital against his wishes because he ‘almost passed out.’ EKG was
non-specific. His troponin came back moderately elevated and I
called the cardiology team about the patient and ordered heparin.
Easy NSTEMI dispo, this guy will need an urgent cardiac cath.
When I returned to the room to discuss his plan of care, he had
another episode of crushing chest pain, so he ‘snuck out for a cig to
calm the nerves.’ After explaining that he had a heart attack and the
need for acute intervention, he says ‘sorry Doc, my son’s funeral is
today and I can’t stay in the hospital.’ Where’s the app for this one?!
Case #3: Late 40s male well-known to our Emergency Department,
comes in occasionally from EMS usually after drinking too much
and being found on the side of the road. He is a smoker, drinker, has
a part time job, no PCP, and sometimes stays with his aunt. Today is
no different, he is passed out in a chair in the back, vomitus around
mouth. He is arousable but we avoid this because he gets agitated. I
order a chest x-ray to rule out aspiration. He admits to drinking and
has no complaints, so I don’t order labs. An hour passes and a call
from radiology. “Have you seen this guy’s x-ray?’” I admit, “Nope,
haven’t even looked at it yet.” He’s got a suspicious large nodule in
left upper lobe, not good, especially in a long time smoker, he’ll need
some close follow-up. I’ve dealt with this before, in fact, guys like
this with a lung nodule don’t