“Bask in the glory, toots. You deserve it!”
I received this text message from my very dear friend a few days ago after an extraordinary occurrence.
I’m a retired internist, and recently my clinical acumen and intervention saved another friend’s life. That is a statement of fact, not a boast. And that’s why I’m writing about it.
The patient, a retired surgeon, hosted our circle of friends’ New Year’s Eve party a little more than a month ago. He looked fine, but complained of mild fatigue. The following week he developed pneumonia and was hospitalized, treated with antibiotics and discharged. He didn’t recover his strength, and his wife reported that he had no appetite and was losing weight.
After two falls, he was again hospitalized, presumably to continue treating his ongoing pneumonia. During the night, he was transferred to ICU for hypotension. When I came to visit him the following morning, he was a shell of the man I had seen a month earlier at his party. Although mentally alert, he was pale, lethargic, thin and weak, unable to stand, and barely able to talk.
His monitor displayed a BP of 84/50, normal pulse and pulse ox. He was not on pressors. A head CT done the night before was normal. He was afebrile and not coughing. When the pulmonologist came in, I asked him what his working diagnosis was. He shrugged. “We’ll give him different antibiotics,” he said. Apparently, he only saw an old frail man with recent pneumonia, but I saw a recently vital man with no underlying diseases and on no medication fading away before me.
Addison’s disease popped into my mind, and when I suggested it to the doctor, he reluctantly agreed to draw a cortisol level. His facial expression showed me that he was just humoring me. The hospitalist arrived about an hour later, after the family had permitted me to read his chart. My friend had a mild anemia, normal WBC and diff and a sodium of 127. His potassium was normal, as were his renal function and liver tests. Despite his hypotension, he was being fluid restricted in an attempt to raise his sodium level.
Again, I stressed the need to intervene more urgently and said that since he clearly wasn’t septic, a trial of IV steroids would not be contraindicated. I also reminded him that my friend was his patient, and treatment was, certainly, his decision to make.
“I’m only making a suggestion,” I told him, fingers crossed behind my back.
To my relief, he ordered a cosyntropin stimulation test and started my friend on IV Decadron. Six hours later he was sitting up in bed with a smile on his face, having eaten his first meal. A few days later, the test results validated my diagnosis. By then he was up and walking, normotensive and ready for discharge.
He, his family and the rest of our circle of friends have thanked me profusely for my intervention and for saving his life.
My response, of course was gracious. “I’m so glad I was able to help.” But how did I feel about it? Happy and gratified, of course. Proud? Not really.
We physicians all do extraordinary things throughout our careers and rarely stop to pat ourselves on the back for a job well done. It makes us uncomfortable to acknowledge our personal successes- to bask in the glory, like my text message had suggested.
And that’s the problem. We physicians are trained to do what we do, and success is not congratulated as easily as failure is shamed, both by our colleagues and ourselves.
Even for a life saved.
Another friend emailed me, saying, “It must be a fantastic feeling to know that you helped save someone’s life, let alone a friend’s.”
“It is,” I responded, “but I’m still getting my head around it.” I wasn’t ready yet to fully own that I had saved his life.
I have finally absorbed the enormity of what I did and I am proud of myself. Rightfully so. No apologies.
Judy Salz is an internal medicine physician.
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