What's the smartest thing you've heard come out of a doctor’s mouth?

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What's the Smartest Thing:

He came in with the handle of an ice pick just barely sticking out just above his bellybutton. And he was a pretty thin guy. But he was sitting up on the gurney, talking, unconcerned. There was just a little rim of bloody staining around the entry point and no active bleeding.
I was a surgery resident, just a few years in. When I first saw his injury, I felt a little panic rising in me. Then I saw how stable he was, and I figured it couldn’t be that serious. We all did. A lot of people get stabbed and it doesn’t go any deeper than the fat or muscle, nowhere near the vital organs. He didn’t even have much pain. I remember stopping to joke with him as my colleagues and I went through the ritual of our usual blood tests and X-rays, I can remember him smiling, laughing…And then I noticed the bead of sweat on his forehead.

 The next 4 or 5 minutes were a mad blur as we intubated him and scrambled to the OR. The anesthesiologist stood at the head of the bed, white-knuckled, replacing his total blood volume once, then twice over with transfusions. His blood pressure was still barely detectable. I looked down, scalpel in hand, and my eyes bulged. My once skinny patient now appeared 10 months pregnant with twins. I made my cut and the tidal wave hit.
It was okay though. Because I was operating with my hero. My attending. My residency director. He was something out of Grey’s Anatomy, I swear. A spectacular trauma surgeon, good with his hands, great with his brain, an adorable goatee — and I had just the tiniest crush. But, aside from that, purely objectively, he was still an amazing doctor. So I nearly shit a brick when, with one hand compressing the aorta, he looked calmly across the table at me with those dreamy green eyes and announced,

We’re gonna Need Help.”



We ended up calling in another team to open the chest from the left and cross-clamp the aorta proximally, so we could move all his guts over, get to the back of his abdomen and repair the abdominal portion of his aorta properly. (The ice pick went all the way through and nicked his spine, but not the cord, thankfully.) We now had two extra sets of hands to help, which was nice, but more importantly, we had the extra eyes. The extra brains. Someone to bounce stuff off of. Maybe even moral support because the stress is real, people. And anyone who says they’re cool with chatting up a patient one minute and then wading inches through their blood the next is either a sociopath or in deep denial. He lived. My patient lived. I was literally joking with him again the next day. He was 15 years old. I met his parents and baby sister.I’ll never forget that night. Or my attending. Still the best surgeon I know. Because he asked for help. (Thanks for the A2A, Sean— you’re my hero. I wish I could write half as well as you. And Athena, that wasn’t a dig against sociopaths!)

ADDENDUM:

I got a lot of questions so here goes: he was attacked and stabbed on the street. I don’t know who stabbed him or why, only that it was not someone he lived with. The police were notified.
What did the bead of sweat signify? Weren’t his vitals being monitored? Yes, his vitals were being monitored continuously and were stable. Everything was done right, strictly according to protocol and standard of care. Children and young adults are notoriously good at maintaining their vital signs. Then they crash spectacularly, “all of a sudden,” as he did. He probably moved, or coughed, and the clot broke free from his aorta, the large vessel leading directly from his heart to the belly. When bleeding starts, the blood vessels squeeze down to prioritize where the remaining blood flow goes. The skin is the first organ to lose blood flow (long, long before the heart rate or blood pressure is affected). Decreased blood flow to the skin manifests as pallor, light sweating and a forehead that is cool and damp to the touch. I had published the results of my experiments in pigs demonstrating this objectively: don’t know. It probably had been growing for 20 years.”

That statement explained a lot.

Twenty years' worth of GI distress that was never really serious enough to explain to my PCP. Twenty or more years of a lingering weakness that I couldn’t explain well to my husband or others.
Twenty plus years of, “Gee, I just don’t feel that good,” taken for apathy or laziness. Two years ago, in June, I suddenly felt a sharp pain in my sternum. It felt like a really bad gas bubble. The sharpness spread across that area of my chest and seemed to feel better after drinking some ginger ale. That was on a Sunday evening. I stayed in bed on Monday,

drinking ginger ale and eating table water crackers, my go-to “meal” when my GI was in a funk, with nausea and/or loose bowels. By Tuesday, I felt well enough to teach a church women’s group in the evening, though I did snap a bit at a couple of women who made some “dumb” comments, causing another woman to tell me I don’t suffer fools gladly. She’s correct.I don’t really remember much of Wednesday or Thursday. By Friday, June 30th, the pain was still there, right in the center of my chest, a strong penetrating but dullish pain that didn’t get better didn’t get worse. I didn’t think it was a heart attack, but, yes, it could have been, but it wasn’t.

I Decided to Finally Go To The Doctor.

Sigh. Whenever something like this happens, and I go to the doctor, I’m always told it’s nothing. Or, it’s a little something, maybe needing a week of antibiotics. Like a UTI. I had had those on and off for about a decade. I couldn’t figure out why though. And, I had had a kidney infection two years prior to this event and that also was inexplicable. I drink only water and I drink around 100 ounces in a 24 hour period. I eat a very healthy diet, in fact, my good cholesterol level is 74.
My PCP saw me at the very end of the day

. He had me take a urine test. Then, he told me to go to the hospital. I did. In the emergency room, an ultrasound was taken of my right side and the surgeon on duty said it was my gallbladder, something was wrong with it. In fact, he would rush me asap to surgery, but I was too septic and needed to be on antibiotics for at least twelve hours. I was sent up to a room and put on two antibiotics. Gee. Everyone was making a big fuss. And, the pain in my sternum wasn’t even hurting that bad anymore. I felt guilty and worried that I would have the hospital staff angry at me for wasting their time. I really thought that those words up above. And, my gallbladder? It’s up under my right breast/chest and that area didn’t even hurt. I was confused.
Around 9 a.m. on July 1st, I was taken to surgery. I was in good spirits. I remember the two women who brought me down. The surgical room was cold and the operating bed was narrow. I began to shiver and a warm blanket was put over my legs.

The Anesthesiologist, a Woman, 

was the only unpleasant person in the room, in that she was a bit put off that I had so many drug allergies, specifically to all opioids. Morphine administered during my hysterectomy nearly killed me. She asked if I could have this or that and I didn’t know any of the names of the new drugs she listed. I couldn’t say yes or no to any of the drugs. She said I had to have something for pain as the pain I was about to experience would be too great otherwise. I told her I put my life in her hands and to give me what she thought wouldn’t kill me. She was a bit grumpy about all this, but I believed she wouldn’t let me die. Too much pride.

I woke up in Recovery with the words: Breath! Breathe! I was horribly cold and felt wet all over. Shivering. I just kept hearing those words about breathing and thought, I’m alive; aren’t I breathing? My gurney was put in a bit of an upright angle to facilitate my breathing and I was taken to my room. Where I was put on oxygen and continually told to Breathe! The surgeon came later in the afternoon. He told me my gallbladder had died and he removed it. He said the surgery took much longer than usual because he had tried to go in laparoscopically but couldn’t find my gallbladder, so he had to make a larger incision. He said I had two gallstones and one was really large. I asked if I could have the large gallstone (you know why because it’s just so weird not to have it) and he said it had been sent to pathology. But he had photos if I’d like to see them. He came back before his shift ended and handed me a thick slick sheet of photocopy paper with four gridded photos. They were a bit dark and I couldn’t tell what I was seeing. The surgeon saw I was puzzled.

“Your Gallbladder Had Gangrened.

 It’s the black shriveled thing in the front. I couldn’t find it because gallbladders are usually green in color. Those are your two gallstones. The small one is about the size of a small crouton. The large one looks like a black chicken egg and is the size of a chicken egg as it is two inches in length.”
“Why is that gallstone so large,” I asked. I don’t know. It probably had been growing for 20 years.” With that, the surgeon gave me the photo sheet and left. I found out from my PCP that my gallbladder was gangrenous necrotic. I never found out if the gallbladder had died on the Sunday before when I first felt the pain or not. I was horrified that I had had gangrene inside my body. I was terrified that I might still have some particles of death inside me. My PCP assured me I’d be dead already if that were true. Lovely.

The smartest thing coming out of my doctor’s mouth, the surgeon’s mouth, was that the large stone had grown over at least two decades. The four days I spent in the hospital was spent recalling those two decades and all the bouts of nausea and GI distress, lack of appetite, and general malaise I experienced. The past two decades snapped into a shape I finally understood and could explain.
I didn’t feel guilty any longer. The weight of that black gangrenous gall “egg” had been lifted off of me. The surgeon’s words freed me and let me live life again in a new manner. I had the words to explain why I eat the way I do. Why I drink water the way I do. And the words to explain why I don’t do other things people normally do.