If you or someone who know is considering going into the medical field, maybe read these stories beforehand!
All posts have been edited for clarity.
“Once I had a patient who had to be flown in from another state for escalation of care. She was a middle-aged woman with no prior medical history and she was transferred for intracranial hemorrhage. It was pretty standard stuff.
What was nuts was per her family, she tried smoking reefer for the first time in her life and she coughed so hard that it ruptured a vessel in her brain.
She survived the surgery and during her post-operation recovery, her heart stopped and she went into cardiac arrest.
Thankfully I was there and with the code blue team for rapid sequence intubation and Advanced Cardiovascular Life Support. We were able to bring her back.
Right as everything calmed down and everyone had packed up and left, I was just chilling outside the room reviewing my patient list when she went into cardiac arrest a second time. Everyone had to sprint across the hospital again to handle it.
I had never seen the code blue team so out of breath. She had a ruptured aneurysm, hemorrhagic stroke, two cardiac arrests back to back, and lived.”
“Abdominal Pain And Nausea, Something Minor”
“A pregnant woman came into our medium-sized community hospital in the Canadian West in the night with some abdominal pain and nausea, something minor. Her doctor determined she was not in labor so we just treated her with some medicine and she started feeling better. She was about to be sent home in the morning when the new obstetrician for the day noted that the patient’s blood pressure had dropped.
The new doctor felt the patient’s uterus and it was exquisitely tender, and the patient started feeling very faint. Then the diagnosis was likely uterine rupture, basically a hole burst in the womb, so she was rushed to the operating room for an emergency C section, and that was when I got called in to help my staff.
The uterine rupture was bad enough, but when they got in there and removed the tiny pre-term baby they discover that it wasn’t a uterine rupture but a placenta percreta. That’s when the placenta grows through the wall of the uterus and into the surrounding organs, in her case into the bladder. We rushed the patient from the small operating room to our biggest operating room, called in more surgeons including a urologist, and two other anesthesiologists, and I started a massive blood transfusion protocol as she had bled so much.
Her condition was usually able to be screened for on prenatal ultrasound, but the patient had skipped hers. If known beforehand, she likely would have been sent to Toronto for the risky and delicate surgery. If she had gone into labor to try to deliver normally, she would have very likely died.
She and the baby did totally fine. A couple of hours after her several-hour surgery, she was awake and chilling with her healthy baby.”
“She Didn’t Come Back Out” Part 1
“I had a patient last week who had an AV fistula placed for dialysis. Essentially, we created a link between artery and vein which gave good access for the dialysis catheter. He kept picking at the wound so the skin didn’t heal over it. He ended up creating a pseudo-aneurysm with the wall of the fistula poking through the skin looking like a little tiny blood blister.
We were looking at it in the office trying to figure out what exactly we should do about it when suddenly it popped. The patient was sitting in bed and the blood sprayed so high over our heads it hit the ceiling and we had time to move out from under it as it fell. Nobody got sprayed on by some bloody miracle.
Then, we put pressure on the wound which was spurting blood several feet in the air with every beat of his heart. We end up placing a tourniquet and taking him to the operating room urgently. The guy leaked like a faucet the entire operation but eventually, we managed to repair the fistula and close the skin nice and clean. It was disgusting but thankfully had a good outcome.
I saw a patient on the medicine service who had a history of kidney cancer and was in remission. He came in from an outside hospital with some imaging allegedly showing a focal mass in one kidney. It didn’t look like it would spread. If it was actually just a focal lesion we could chop off the tip of his kidney and cure him while retaining most of his kidney function. It was a bad situation but not awful. The surgeon wanted better imaging so we sent him to radiology pre-operation.
We picked up the phone and spoke with the radiologist attending. The cancer had spread just a little more than we thought to involve the renal veins. Essentially taking him from stage two to stage two. It was bad but still not terrible. We could work with that. Then the radiologist mentioned he saw shadows in the liver and brain. After the dust settled, everyone agreed that the man actually had severely metastatic disease, stage four, and very advanced.
The worst part, in my opinion, was telling him. Remember, the man came in thinking he would likely have a short surgery and go home cured.
The surgeon walked in and said, ‘I’m sorry, but the cancer has spread and you most likely have about 6 months to live.’
His son, about five years younger than me, was standing there next to him when the lead surgeon told him.
This was probably two years ago. I often think about the man and his son. I hope he was the miracle exception but the doctor brain in me tells me that probably didn’t happen.
The worst started when a teenage girl was taking a nap at home one afternoon. As she slept a reckless driver crashed into her house, her father who was in the kitchen died at the scene from a traumatic injury. The crash caused an electrical fire, which ignited a ruptured gas line from the crash and set the entire house ablaze.
She made it out, along with her sister, but went back in to try and rescue her dad and dogs. She didn’t come back out.”
“She Didn’t Come Back Out” Part 2
“The firefighters dragged her out. Ninety-five percent of her body was covered in second and third-degree burns. She had smoke inhalation injury, fried lungs, carbon monoxide poisoning, toxic inhalation, cyanide poisoning. It was a miracle she even made it to the hospital. She survived the initial presentation to the trauma unit and she was transferred to the burn unit.
Fun act, third-degree burns actually aren’t painful at all. The fire destroys the nerve endings. First and second-degree burns are, however, exquisitely painful. She had mostly third-degree burns but enough second-degree to where she was in agony despite a near-constant morphine drip. It was a mess. The only intact skin on her body was a small area around her inner thigh. Her hair, face, and lips were all gone. Even her eyelids burned so badly they fell off in the emergency room which caused several nurses, techs, and residents to vomit.
We did what we could with moist sterile dressings and debridement plus broad-spectrum antibiotics. She looked like a mummy fully wrapped by the end. There was no chance of her having a normal life ever again. The chances of her surviving were in the single digits.
We were silent but we all thought the same thing. We secretly hoped she would die soon rather than having to suffer for weeks or months. We hated ourselves for it. We hated the world would do such a thing to an innocent person. We pushed those thoughts down and went to our work. We followed the evidence, went above and beyond. We hoped she didn’t suffer, but if she was to survive we would make sure she has the best shot possible.
After a few days, the infection began to set in. All the dead tissue was basically a breeding ground for all kinds of nasty bugs. The first thing we noticed was the smell, I’ll spare you the details but trust me it was bad. The only thing we could really do to encourage healing at this point is an IV, Topical antibiotics, and debridement. Basically, large wounds heal better when they are scraped or shaved to expose the wound bed. This removes dead cells which hamper growth and encourage new skin formation. It takes weeks of treatments. This is an unpleasant process for a small burn or wound. We had to do this essentially all over her body. We essentially had to scrape her burned skin raw essentially everywhere. Multiple times per week. Anything dead had to be removed. I remember a particularly nauseating moment when I was trying to gently scrape around her fingernail, to save it, and the entire tip of her fingernail pulled off with some dead skin.
By this time the infection set in hard. Multi-organism, resistant, fungal co-infection, you name it. The fungus was the worst part because it just ate away at her exposed tissues. We would debride an area and the next week it would be full of little pockmarked holes. Those holes were full of cheese-like fungus and they burrowed down deep. To the point where after we cleaned the fungus out, we could stick a finger in the hole and feel the slippery fascia overlying the muscles below. We could literally touch the muscle. We spent hours digging out those little holes down to the muscle. All over her body, legs, and back.
That was the day I said out loud in the operating room, ‘This is the worst thing I’ve ever seen in my life.’
Several years in medicine later the statement remains true. On the same day, a surgical resident sat with me at lunch and we both broke down.
He said it was all cruel and pointless because she would probably die from the massive infection and the poor patient suffered these weeks for nothing.
I even heard a lead surgeon say, ‘It would have been better if they didn’t come out of the fire that day.’
She survived the next few days, and we started with the skin grafts. We tried to re-build her face, and cover her body. The grafts would regularly get infected and have to be peeled off. She needed so many grafts we gave up suturing them in place and began stapling them in place except on the face. We were careful to build as perfect a face as we could for her.
Her average operating room time was about ten hours per procedure. Of course, we had to keep the operating room at ninety-eight degrees because burn patients went hypothermic quick. So we spent tens of hours on our feet working with our hands in full scrub gear in a nearly hundred-degree high humidity room. It was brutal. I tried not to think about what the patient was experiencing.
The patient could communicate by pointing with her eyes. She could speak a little bit too but not much. With no un-burned skin to lie on, she had to lie on her back with her dressed burns touching the bed. She was mostly immobile, so she just had to lie there in pain for hours and hours wrapped up in itchy dressings over her burns. She had no eyelids and couldn’t blink as you would expect a human to do. She had no lips and couldn’t close her mouth. She didn’t look human.
It terrified me and for a while, I hated myself for feeling this way. I rotated out of the burn unit not long thereafter.
The last I heard was she survived and went home after four months. She really had a will to live. She’s much stronger than I am.
The driver of the vehicle survived with a moderate leg burn. He spent a week in the burn unit and went home. He was in the room next to her.
Her sister almost needed to be admitted to the psych ward because the situation messed her up so bad.
Her dog lived. She threw it out the second story window down to her sister before disappearing in the smoke.”
“A homeless man was brought into the emergency department by EMS for a foot wound that was giving him trouble. We eyeballed his foot that was poking out from the blanket as he was rolling by and it was a little roughed up but didn’t seem too bad. We went in to get his story and he said he hurt his foot a few days ago and that it just hurts to walk on. We asked if we could take a peek, so he whipped off the blanket to show us his other foot, the one that was actually hurt, releasing a horrific stench cloud in the process.
We knew we were in for a treat.
The guy had his foot bandaged in a very dirty ace wrap. His toes were completely black and necrotic, and there was maggot butt wiggling near the edge of the ace wrap.
We tried to remove the wrap, but it was stuck together with blood, dirt and who knows what else, so time to cut the sucker off. As we cut more, maggots began to present themselves, and the smell of dead flesh just kept getting more and more intense.
We finally made it through and go to pull away the wrap and I swear at least a hundred maggots fell out of this thing. But that wasn’t the worst part. The entire bottom of the man’s foot was stuck to the wrap and just fell away from the underlying muscle and bone.
We told the man we were unfortunately not going to be able to save the foot, to which he responded, ‘Oh man, really? I didn’t think it was that bad.'”
“A Little Rough”
“A patient arrived with complaints of spotting. She later revealed she had been bleeding for two days, not very heavy, but she was experiencing a little pain. She said it started after her female partner had been ‘a little rough’ during their last intimate experience.
The physical exam revealed a complete tear through the posterior wall into the rectum consistent with what we would usually see during difficult childbirth. The situation was a bit fishy given the amount of trauma and the back story so I ordered the usual tests. In accordance with operating room protocol, we tacked on a urine pregnancy test even though she denied the possibility of pregnancy given her preferences. The pregnancy test came back positive. Needless to say, this opened a huge can of worms.
It turned out she had delivered a child two days prior in secret but didn’t tell anyone. She had been hiding the child from her family and girlfriend. CPS, the police, EMS, pediatrics, and an ON/GYN all got involved in a matter of minutes after her revelation. They found the child in her apartment under some towels alone in her home. It was a doozy of a night.
This happened five years ago and I have seen the child since. She’s doing well with her grandparents who have full guardianship.”
“This happened probably about fifteen years ago. This patient of mine had severe diabetic vascular changes against the retina and required laser intervention as soon as possible. She scheduled her surgery and on the day of the surgery decided to take a workday instead of her surgery.
Her job was cleaning, and on this fateful day, she inhaled some of her cleaner fumes which caused her to sneeze spiking her blood pressure. She blew the fragile blood vessels in both of her eyes wide open and blood started gushing into her eyes.
As you might imagine, blood is opaque. You can’t see through it. She was instantly and completely blinded in both eyes in a matter of seconds.
It took three years, multiple surgeries, and a complete lifestyle change, but this patient did recover to have actually fair, but not good, vision.
I still see her now for her annual visits.”
“It’s The Patient Who Was Brought In With This Guy”
“When I was a medical student on my surgery rotation, I was working a twenty-four-hour shift and was with the trauma team. I was ‘observing’ a simple repair of a duodenal perforation in the operating room when my trauma pager went off. I asked my senior if I could leave to see what was going on and he gave me the go-ahead.
I ran into the trauma bay and a young gentleman was brought in on a stretcher with the lower half of his body covered in blood, but very obviously awake and coherent.
He screamed, ‘They shot my balls! They shot my balls man!’
And they had.
He had been shot fifteen times all below the belt, one of which had gone straight through him. We were doing an evaluation on the distraught man when a code was called in the next pod over in the emergency department.
That was weird because they usually don’t call overhead for codes in the ED.
Someone popped their head into the trauma bay and said, ‘It’s the patient who was brought in with this guy.’
Several of us ran away from the stable guy who got shot in the balls and into the next pod to see a young woman lying on a stretcher receiving CPR.
I asked, ‘What happened?’
They responded, ‘We don’t know, she just crashed.’
We went to roll the patient to get her clothes off and noticed she was bleeding out of her back out of the tiniest exit wound.
She was an unintended victim of the drive-by. She was then our patient.
We took her to the trauma bay and immediately took off all her clothes to perform the primary survey. She wasn’t breathing and had no pulse. Once we got her entirely exposed, we saw a very small entry wound right into the center of her chest. The ultrasound confirmed a massive hemothorax. We placed a chest tube and two liters of blood gushed out onto the floor.
Someone suggested, ‘We need to convert to open.’
The resident I’m with immediately took a scalpel and created a longitudinal incision along the inferior aspect of the rib spaces and used a pair of medical gardening shears to clip the sternum in half. Basically, the patient has had their chest pried open horizontally in a crazy procedure called a ‘clamshell thoracotomy.’ At this point, we could visualize the heart and notice there was a clean entry and exit wound straight through this patient’s heart. All of the blood and fluids we were pushing were just drained right out of her heart and into her chest. The surgeon attending was performing manual cardiac massage, CPR with your hands on the actual heart.
They said, ‘We need to go to the operating room.’
We rushed down to the operating room with the patient and one of us attempted to sew up the holes in her heart. Just as she was putting the final sutures into the patient, I began to notice the patient oozing blood from every single opening in her body.
She said, ‘Doc I think this patient is in DIC.’
The patient was experiencing a phenomenon known as ‘disseminated intravascular coagulopathy,’ which is basically when you use up all of your clotting agents and just bleed out of everywhere.
The doctor responded, ‘Okay we need to close for now.’
The patient was transferred to the SICU where I monitored her progress for three whole weeks. She had watershed infarctions across her entire brain from how long it went without perfusion. She couldn’t talk or move. We had to have end-of-life discussions with the family about a young woman who wasn’t even old enough to drink. I left the service and followed her progress until one day I didn’t see her name anymore.
The next day, I was in surgery with the trauma attending and she said, ‘Hey our shooting patient went home today. She’s a quadriplegic, but she’s alive.’
I responded, ‘That sucks.’
Fast forward six months and I was working in the SICU again. I brought up the patient to a neurological intensivist attending because I thought it was a cool story.
Her eyes opened so wide and she said, ‘I saw that patient in the ICU and told the family she was going to die. When she didn’t die I told them she would be a quadriplegic. Then a month ago I had a follow-up visit with her and she walked into my clinic with nothing to show for her experience except a scar from her thoracotomy.'”
“I worked as a medic back in the day, specifically a mountain medic at a ski resort. Most of the time, like ninety percent of the time, it was people who fell on the mountain. About the most exciting thing was a broken femur, in which case they were getting their pants cut off. On a rare occasion, we would have other medical events, but most people on skis are fit and healthy adjacent.
Most of the non-accident stuff happened at the lodge, and since the fire station was literally across the parking lot, they would just call them first. Their jump bags were better equipped for medical rather than trauma.
They got called for a heart attack and weren’t in the station because they were transporting to the hospital. A lady in her forties had slipped and fallen on some ice. She appeared fine, but we needed to medically clear her, so they called us down the mountain from our clinic at the upper lodge.
I have no idea why I grabbed it, but I threw our cardiac bag in the sled and we ran down on the snowmobile. I didn’t think I would need it and because typically we have to transport someone in the sled we didn’t pack it unless the call seemed we might need it.
So I got to her and started asking questions, palpating for broken bones or dislocated joints. I did a quick neurological evaluation and she seemed fine, but there was just the slightest weakness in her left arm. I probably would have thought nothing of it because everything else was fine. But then I asked her history and current symptoms. It was odd but then she mentioned she was taking tums. I asked why and she said she had woken up that morning with really bad heartburn.
So I insisted she come with me to a private clinic room we have. It’s really just a cramped closet with a few chairs and a desk. She refused, but I insisted. I told her I wanted to put a four-lead ECG on. She’s insistent that I didn’t, but I finally convinced her that I’m not a doctor, so I’m probably just being paranoid, but I really just wanted to be careful.
So we popped her shirt open and quickly get the leads on, and yep, she was having a heart attack and it was pretty bad. I had no clue how she was standing, but women tend to have less of the big early symptoms and are tough as nails.
So we got in a helicopter and went down to the cardiac center.
The air medic always passed me back status on my bigger patients. I liked to know when I saved a life. She survived, but if she had waited until it was bad enough for her, she would have died before she would have gotten to a hospital.
So, a minor slip and fall of a healthy young woman saved her life.”
“I had an elderly patient once who went into cardiac arrest and was brought back. She had an extensive workup done, but we never found a great reason for why she went into cardiac arrest. Then, just as she was getting better and had her breathing tube removed, she went into cardiac arrest again. We did CPR and were able to get a pulse back, but she remained super sick all night. We were supporting her heart with a mechanical device and she was on high doses of medications to keep her blood pressure up. We were doing everything possible but things were not looking good.
We ended up calling her elderly husband and asked him to come in as we were worried she would not survive the day. Her husband told us he would be there within the hour.
Well, two to three hours passed and he didn’t show up. We tried calling and couldn’t reach him. Then somehow someone found out that he was actually in our emergency room. It turns out he had left his house, fallen, and broken his hip. As we hastily tried to arrange a way to get him upstairs from the emergency room to see his dying wife, she went into cardiac arrest again. We were actively doing CPR as they wheeled her husband on a stretcher in a casted leg to her bedside, at which point he called off the code.
Everyone was crying. It was pretty awful.”