It was 4:45PM on the last day of my Pediatrics rotation. Our last patient was brought into an exam room, and I noticed something a little out of the ordinary: the patient, a six or seven year old boy, was being carried by his father. The medical assistant asked the father to put the boy down on the scale, but the boy refused. He was curled up in his arms and did not want to move at all. His father said that he has had a pain in his stomach for the last two hours and he has not walked since then.
At this point, I had a few thoughts going through my head, and all of them were pointing to an emergency. The boy was brought back into an exam room and I quickly went to find the attending who I was working with. She had just come out of a room from seeing a patient and was writing up the note.
Normally, I would wait a few minutes and allow my attending to write her note before presenting the next patient. Instead of waiting, I just started talking, and said, “I haven’t seen the next patient yet, but something feels very ‘off’ about the situation to me. He has had abdominal pain for two hours and is unable to walk. I think he has appendicitis.”
My attending looked up at me, saw that I looked serious, and she dropped what she was doing and said, “okay, let’s go see him.” We walked into the waiting room and got a brief history: horrible stomach pain for a few hours with a single episode of vomiting. He let the doctor touch his stomach (which most people with appendicitis won’t do), but he was in a lot of pain when we pressed down in various areas of his stomach.
My attending agreed with my initial impression, and said that his appendix could have already ruptured or it could be the beginning of appendicitis. We explained to the father that his son needed to be taken directly to the Emergency Room.
I took a risk going to my attending with a diagnosis before even talking to or examining the patient. I trusted my gut, and, in this case, the patient benefited because he was able to be seen quicker and transferred to a facility that was better able to assess his condition.
After the father and son left for the Emergency Room, my attending told me how she was impressed that I was able to organize my thoughts so quickly and recognize that something was very wrong with the patient. It was an exciting end to my rotation in pediatrics, and it further reinforced my desire to go into Emergency Medicine.
by Justin Capasso, Class of 2014