Physicians Reflect on Their First Life-Saving Interventions
Split-second decisions can mark the boundary between catastrophe and survival.
Split-second decisions can mark the boundary between catastrophe and survival. Early-career physicians — not yet seasoned by the relentless pressures of life-and-death scenarios — must rely on their expertise and instincts in these moments that carry immense weight.
It's the calm under pressure and the decisive actions they take that highlight the quiet heroism embedded in modern medicine.
The Curious Case of the Swallowed Razor Blades
Daryl Eber, MD, diagnostic radiologist and nuclear medicine physician, never forgets one of the first times he recognized something that led to the swift save of a patient who otherwise would have likely died.
As an attending physician at a hospital in Miami, Eber and a senior resident were covering in the emergency department one evening. One patient's scans showed — to Eber — the presence of razorblades, which the patient must have swallowed. But Eber's senior resident and the ER doctor disagreed. The patient even denied it.
But Eber stood his ground and, eventually, the patient went for surgery.
Eber's confidence was finally vindicated. A surgical resident reported that not only were the two razors Eber saw but a third hiding in the small bowel.
It was Eber's expertise in reading CT scans that helped save the patient's life.
When a CT scan is done, Eber said, a scout-view image is taken at the beginning to help guide the main scan's position and settings. Though it is not a diagnostic image, the scout view serves as a reference to accurately position the patient.
'Most residents don't look at the scout view,' Eber said. 'They skip that and look at the images…but if you look at the scout view — which is a 2D image instead of 3D — you could see the two little holes on the blade where you attach the razor blade [to the handle]…. I've used these kind[s] of razor blades before…that's why I was so sure.'
Eber is now owner and cofounder of 3T Radiology and Research in Miami and serves on staff at Jackson Memorial Hospital in Miami, as well.
Running With Bags of Blood
While moonlighting during his final year of emergency medicine residency, Eric Bassan, MD, tried to stop a patient from bleeding to death after a spleen rupture with limited resources.
'It was a community hospital, not a trauma center…we had an assembly line of people running back and forth giving the blood product, running back to the blood bank and getting a new one…by the time somebody went to go pick up one, there was someone behind them picking up the next blood product. We kept on cycling people to try to get as much blood and products into this patient,' recalled Bassan.
The patient initially presented to the ER with rapid respirations and heart rate after falling from a ladder. Besides abdominal pain, there didn't seem to be any other urgent symptoms to address. Bassan, being well attuned to what a sick trauma patient looked like, felt something wasn't right.
'I saw in the corner of my eye [that] he didn't look good…his vital signs were fine, he was talking normally, but he was mainly complaining of abdominal pain,' said Bassan.
Bassan put an ultrasound on the patient's abdomen and did a Focused Assessment with Sonography in Trauma (FAST) exam. A FAST exam evaluates potential spaces where free fluid can accumulate and assesses areas of internal bleeding or other areas that may require surgery.
Bassan saw fluid in the patient's abdomen. Because he was moonlighting and wasn't yet board-certified in his specialty, he had to run everything by the attending physician on duty, who wasn't familiar with trauma scenarios.
Though Bassan wanted to transfer the patient to a trauma center, the attending physician wanted to send the patient to get a CT scan first.
'I didn't feel comfortable sending him to the CT scanner for an hour given how unwell he looked,' Bassan said. 'So, I went with him…his blood pressure slowly started declining…eventually as low as the '70s systolic, which is usually a sign of hemorrhagic shock.'
Bassan called the attending so they could activate their mass transfusion protocol. In the setting of trauma, the protocol is for 'any time you need to give a large amount of blood products to resuscitate somebody…not just red blood cells but platelets and coagulation factors,' said Bassan.
Bassan soon discovered that because they weren't at a trauma center, the facility didn't have a mass transfusion protocol. He continued to urge the attending physician to give the patient as much blood as possible.
Upon viewing the patient's CT scan, Bassan could see a spleen rupture. Because the spleen is a vascular organ, if it ruptures, one could quicky die without proper surgical or blood products because of hemorrhaging into the abdomen.
This started a race against time. Bassan and his colleagues had to run blood products back and forth from the blood bank as the blood bank would only give one single unit of blood or fresh frozen plasma at a time.
'We had people at the bedside just for the purpose of squeezing the bags as hard as they can to get as much [blood] as we could into him,' said Bassan.
The patient's vital signs improved, but he was too unstable to transfer to a proper trauma center. Bassan got in touch with a surgeon from the hospital's call list who was able to come in and successfully remove the patient's spleen in the operating room.
The patient lived and walked out of the hospital a few days later.
Though Bassan's efforts helped save the patient's life, the experience was eye-opening for him. 'How do you take a situation where a hospital is not equipped for these specific emergencies and utilize the hospital's protocols in order to work for you? And you really have to do whatever it takes to make sure that a patient is cared for and to make sure that they're in the safest situation possible, despite what the constraints are.'
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Additionally, men who skip routine screenings or simply don't feel comfortable openly discussing their symptoms also miss out on the treatment and relief they could experience. This all feels like a 'chicken or egg' scenario: Will starting testosterone therapy motivate men to exercise more and manage their health better, or should we first address lifestyle and health issues before considering hormone therapy? These complexities highlight the importance of personalized conversations between you and your health care provider. In my practice, I always focus first on lifestyle: Are you getting quality sleep? How high are your stress levels? Are you physically active? How healthy are your personal relationships? By tackling these areas first, many of my patients see noticeable improvement without falling into the testosterone trap. Get inspired by a weekly roundup on living well, made simple. 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