Mr. H

“Well Mr. H, looks like we are going to get to know each other well tonight.”

I was a third year medical student, working my first shift in the emergency department (ED). After showing up at the wrong time, with the wrong clothes, I had finally settled into team center C. It was the weekend and not much was happening in the ED. My first case had been a 4-year-old with 5 days of cough and fever. I succeeded in making the mom so nervous as I clumsily wielded the wooden tongue depressor that she asked the resident to please take over, strong emphasis on the please. Trying to get an ECHO for a woman with chest pain started off better, but I soon relinquished the probe after failing to achieve an acceptable view, my hand covered in jelly since I had forgotten to put on a glove. With not much to do on a quiet Saturday morning, the resident pulled me into the stabilization room as a patient was brought in after a motor vehicle accident. We rifled through drawers and, before I knew it, I was outfitted with glasses and a drill. I stood, wielding my tools with what I am sure was a look of excited terror, waiting to see if I would have the chance to place my first intraosseous needle.

I did not.

A wave of disappointment intermingled with relief washed over me.

The course of events that day was not entirely new to me. I had already experienced similar frustrations tied to my role as a medical student in the hospital. We are transient players in the game of medicine, in and out of hospitals, on and off teams. There is rarely a true need for us to be present. Most of us have deep wells of cerebral knowledge but often lack the technical skills to perform even the simple tasks of placing IVs or bandaging wounds. We do our best to be useful but have a hard time knowing what useful looks like. And so, we fumble along. I have mostly accepted this reality but still find myself at times yearning for immediate purpose, the gratification of a job well done, that comforting sense of accomplishment. Such was the reality of my first day in the ED. That is, until Mr. H arrived.

Mr. H was a 60-something-year-old man, I cannot remember exactly. Nor can I recall where he worked (a factory?), how many grandkids he had (I think 5) or what his other health problems were (hypertension had to be one of them). I was pulled along to meet him without time to look at his chart. There were no presentations to attendings, no discussions of differential diagnoses, and no complex workup. Mr. H’s problem was straightforward: nosebleed. He had a history of nosebleeds, often in the winter when it was dry. Not too long ago, he had a bleed that resolved on its own. Today though, it was different. His nosebleed started suddenly at work and did not stop. He was worried that something sinister was causing the bleed, and who could blame him? That much blood coming out of your body must be unnerving. One of the residents came over to finish gathering the history, and I looked on, peeking over her shoulder. When she was assured that no trauma had occurred, no drugs had been ingested, and we knew the patient’s current medications, she explained that we had a few options to stop the bleeding which we would now attempt systematically. First step, applying pressure. She turned to me and asked, “Will you hold his nose, please?”

Hit the lights! . . . Cue the band! . . .

FINALLY! No one else needed me, no one else would miss my presence. I was at the same time completely disposable and finally useful! My skill set was the perfect match. I stepped up to the side of the bed, introduced myself to Mr. H, and clamped down on his nose with my right index finger and thumb. A strangely intimate way to begin a patient-provider relationship. While the team buzzed around, looking for Afrin and gathering nose balloons and wads of cotton, Mr. H and I chatted. We talked about how nervous he was. How much he loved taking care of his grandkids. How he had made a life for himself here in Minneapolis. As the minutes ticked by, I was reminded that I had an asset most others in the busy stabilization bay lacked. I had time.

When applying pressure did not work to stop the bleeding, we tried Afrin. No dice. Next came a small cotton plug. Still, the bleeding continued. At this point, we explained to Mr. H that our next option was to insert a longer stick of absorbent material deep into his nose and yes, it would be very uncomfortable. He and I had been talking about this earlier as I interpreted the resident chatter around us. He was ready for “whatever it takes,” and who better to do the honors than the medical student who had been dutifully holding his nose for 38 minutes. As I pushed the stick straight back as far as it would go, he winced a little then said, “That wasn’t bad.” My heart swelled with pride. The bleeding slowed and then stopped. The attending physician approved our patient for discharge, and the nurse brought over his papers. As I said goodbye to Mr. H, he smiled and thanked me, taking my hands between his.

Maybe I do have a role on the team after all.