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Medical Student Learns Valuable Lesson

In his book Better: A Surgeon's Notes on Performance, Atul Gawande recalls a patient he encountered during his final year of medical school. The older woman's complaint was simple and to the point: "I don't feel too good." She was achy, tired, and suffering from a mild cough, but she showed no signs of a fever, and her blood pressure was fine. Besides a high white blood cell count, she was fine. Gawande visited her twice each day, and she stayed the same. Thinking she was suffering from a mild case of pneumonia, he put her on antibiotics and waited for her condition to clear up in a few days. Nonetheless, the woman's condition never got better. One morning, after the woman had suffered through insomnia and night sweats, Gawande's senior resident simply said: "Keep a close eye on her." Gawande decided he would check on her each mid-day, around lunchtime. Meanwhile, the senior resident had decided to check on her himself twice that morning—which would teach Gawande a valuable lesson as a doctor and surgeon. He writes:

It is this little act that I have often thought about since. It was a small thing, a tiny act of conscientiousness. He had seen something about her that worried him. He had also taken the measure of me on morning rounds. And what he saw was a fourth-year student, with a residency spot already lined up in general surgery, on his last rotation of medical school. Did he trust me? No, he didn't. So he checked on her himself.
That was not a two-second matter, either. She was up on the fourteenth floor of the hospital. Our morning teaching conferences were…on the bottom two floors. The elevators were notoriously slow. The senior resident was supposed to run one of those teaching conferences. He could have waited for a nurse to let him know if a problem arose, as most doctors would. He could have told a junior resident to see the patient. But he didn't. He made himself go up.
The first time he did, he found she had a fever of 102 degrees and needed oxygen flow through her nasal prongs increased. The second time, he found her blood pressure had dropped and the nurses had switched her oxygen to a facemask, and he transferred her to the intensive care unit. By the time I had a clue about what was going on, he already had her under treatment—with new antibiotics, intravenous fluids, medications to support her blood pressure—for what was developing into septic shock from a resistant, fulminant pneumonia. Because he checked on her, she survived. Indeed, because he did, her course was beautiful. She never needed to be put on a ventilator. The fevers stopped in twenty-four hours. She got home in three days.

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