Perspective
Stepping Stones
A medical student comes to understand the importance of the work she’ll do.
By Kimberly Schoonover, M.D., with Therese Zink, M.D., M.P.H.
A teenaged girl lay on a back board with her head strapped in a cervical stabilizer. Her mother stood next to her in the emergency room, concerned but not hysterical. I stood next to the ER doctor as he was finishing his initial assessment and then introduced myself. “I am Kim, a third-year medical student working with Dr. Williams, the general surgeon. He’ll be here shortly.”
Except for the bruising on her legs and the lacerations to her extremities and stomach, Tina looked like a cheerleader—muscular and athleticly built. I glanced at the monitor: blood pressure 120/70, pulse 88. Her heart sounded normal and her lungs were clear. She groaned slightly as I touched her abdomen. I excused myself and joined the ER doctor in the hallway.
“Look at her CT,” the ER doctor said, viewing the image. Her liver and spleen appeared to be in several pieces. “Despite these injuries, her vitals are stable,” he said to Dr. Williams, who had just arrived. Together, we examined her labs; everything was normal, including her hemoglobin.
I joined Dr. Williams as he went in to assess Tina. As we talked with her mother about Tina’s injuries, the details of the accident became clearer. Tina had been speeding and overcorrected the car going around a curve. She hit the steering wheel and flew out the window as the car rolled into the ditch. The car was totaled.
After the assessment with Dr. Williams, we arranged for Tina to be taken by helicopter to a Level II trauma center.
I stayed with Tina while we waited for the helicopter. She kept asking for water, saying “I’m so thirsty.”
Since she was about to go into surgery, I grabbed a spongy wand, soaked it in water, and moistened Tina’s lips. She sucked on the sponge with as much effort as she could muster. “Every football team has a waterboy, so I’ll be your watergirl,” I said.
Tina managed a tiny smile.
From then on, if I stepped away to help the nurses who were preparing for Tina’s transfer, Tina summoned me, croaking out, “Where’s the watergirl?” As the minutes ticked by, we talked about her friends, the upcoming prom, and boyfriends. The nurses continued to check Tina’s vitals. Tina’s mother tried to contact her father. After a while, Tina didn’t want to talk anymore. Her pain grew worse. She was constantly thirsty.
I called Dr. Williams, who reexamined her. “Feel her abdomen,” he said. “It’s tighter.” After the lab tech drew another hemoglobin from Tina’s arm, I palpated her thin abdomen, now taut like the skin of a drum. Her blood pressure had fallen; it was now 110 over 70.
Finally, the helicopter arrived. As the crew prepared for her transfer, I helped the nurses complete the papers they needed. We pushed Tina’s gurney toward the door to load her into the whirring helicopter on the asphalt landing outside. Tina’s parents kissed her goodbye and headed out to their car to make the several-hour drive to the trauma center. Just as we were ready to wheel her through the doors, the lab tech ran toward us and yelled, “Tina’s hemoglobin has dropped from 12 to 6.” In that instant, everything changed. If we weren’t already in go-mode, we were now.
Dr. Williams spun around and directed a nurse to call the operating room, “Prepare for a STAT operation. Call the on-call surgeon.”
The operating rooms had just been cleaned, and the surgical day staff was heading home. As the ER team moved Tina to the OR, I found her parents and told them not to leave. Then I rushed to the OR. The nurse anesthetist and nurse were next to Tina, getting her and the equipment ready for surgery. The nurse looked at me and said, “Scrub.”
I stepped up to the sink alongside Dr. Williams and opened the package containing the betadine sponge and rubbed the brown soap over my hands and forearms. I suppose if I had been an observer at that moment, I would have been pacing back and forth; but next to a calm surgeon, I too was composed—at least on the outside. Inside, anticipation boiled. Soon we were gowned and gloved. As the nurse finished painting Tina’s abdomen with the yellow-brown betadine, the scrub nurse handed Dr. Williams a scalpel and me the only suction available.
“Her pressure is falling,” the nurse anesthetist said loudly.
Dr. Williams looked at me and said, “Get ready!”
I nodded and stared intently at Tina. Her abdomen was so tight. She was decompensating before my eyes. I remembered an episode of ER, in which the TV doctor had seen a near-dead patient whose abdomen was rigid. He had taken a scalpel, similar to the one Dr. Williams had, and sliced the patient’s abdomen. Blood sprayed all over, and then the patient was better. No further drama. Quick and easy. I wished that that would happen.
Dr. Williams cut a straight line down the middle of Tina’s abdomen. Blood erupted. Red was everywhere. I suctioned and suctioned. I cannot remember the sound of the suction device, I can only recall the inadequacy of it. Finally, after seconds that felt like hours, the scrub nurse shoved another more powerful device into my hand. Blood covered my gown, soaked the bottoms of my scrub pants. It saturated my white socks and new white tennis shoes (the shoe covers failed to protect them).
The surgeon’s hands were deep in Tina’s abdomen trying to stop the bleeding. The nurses hung bag after bag of blood. A second surgeon arrived. At this point, I moved out of the way to let the surgeons work. I watched as they toiled to tie off the vessels that were causing the bleeding, their hands moving quickly and gracefully. Few words were said, as everyone was intently focused on what needed to be done.
As the surgeons worked, I put my bloody, gloved hands on the stained sheet that covered Tina’s right leg and prayed more fervently than I had ever prayed in my life. “Please God, please God,” I said over and over. Eventually, I began to do what people do when things seem dismal. I tried to strike a bargain with God: I would go to church if he let Tina live. A silly compromise, but I could not think of any thing else.
Eventually, after continual decreases in blood pressure and hemoglobin, Tina stabilized enough to be transferred to the trauma unit at the other hospital. Her hemoglobin rose thanks to the blood she had received, and her vitals were within a safe range.
I walked out of the hospital that night with my feet in clean surgical booties because my shoes and socks were too blood-soaked to wear home. The chilled air and bright stars greeted me. I wanted to get home quickly because I needed to be back at the hospital in six hours to round. But at home, I could not sleep. Instead, I sat on the hay bails outside of the farm house that I was renting and relived the night.
I thought about how this sort of drama changes a person’s perspective about medicine. Until Tina, I had focused on hurrying to clinic, hurrying to scrub, hurrying to finish so I could see my family. When Tina came into the hospital, the hurry stopped. I realized the decisions that were to be made would affect someone’s very existence. Suddenly, the details of writing notes and retracting them faded and what emerged was how knowledge was connected intimately to the power and ability to save someone’s life. If it weren’t for the expertise and care that everyone involved demonstrated, Tina would not have lived.
Experiences like these are stepping stones to becoming a good doctor. Despite the knowledge and ability of Dr. Williams and his staff, Tina’s case was a challenge. I had learned how humble a doctor can feel during a medical crisis. At the same time, I had experienced the power of a feisty teenager fighting to survive. Doctors had their part, but so did God and the patient.
More than a year after Tina’s accident, I received a call from my own father wishing me luck on the board exam—my last step before graduating from medical school. After small talk, he said, “You never told me about how you helped save Tina.”
“How do you know about Tina?” I asked.
“I ran into Tina’s mom at the gas station,” he said. “We went to high school together. She told me to tell you how grateful she was to you and to tell you that Tina still talks about her watergirl.”
Tears filled my eyes. That day was as vivid as it was then. Dad told me that Tina was doing well, that she was back in school. After I hung up the phone, I thought back to my surgery rotation and my bargain with God. I had found time in my busy schedule to go to church and pray for Tina’s recovery. MM
Kimberly Schoonover is a first-year resident in internal medicine at the College of Medicine Mayo Clinic Program in Rochester, Minnesota. This story is based on events that occurred during her elective with the University of Minnesota Rural Physician Associate Program. Therese Zink, a professor in the department of family and community medicine at the University of Minnesota, assisted with the writing of this story.