Beyond the Usual:  Ordinary Moments, Extraordinary Stories 

High acuity situations in emergency medicine can feel like a whirlwind. The excitement of heroic resuscitations and the thrill of saving a life is unlike anything I’ve ever experienced. But some of my most cherished memories come from what one might consider typical encounters, interactions where I have communicated effectively and made a lasting change or learned a valuable lesson. It is in these everyday encounters that I’ve felt the most growth as a physician and often felt the closest to my patients. 

Earlier in my intern year, while working a busy shift with a young attending (a supervising physician for residents), I picked up a patient who had come in for chest pain. He was in his late fifties, Spanish-speaking and a blue-collar worker. I entered the room, introduced myself, and sat next to him. It was clear from the beginning that he was the type of person who did not seek medical care unless something very significant was happening. 

That morning, he seemed worried while relating his story about a sudden chest pain while loading the tarp on his truck. Followed by nausea and lightheadedness, the pain, which he described as “heaviness,” had persisted for several minutes before resolving. When I asked, he said he had never felt anything like it in the past.

I reviewed his electrocardiogram with my attending and concluded that it showed no concerning signs that would require activating the “cath lab.” But given his very concerning story as well as his overall risk, we proceeded with laboratory blood work, knowing that even if the workup was negative, we would suggest admission to the hospital under the chest pain protocol for further investigation of unstable angina ( a condition in which the heart doesn’t get enough blood flow and oxygen). The rest of his visit proceeded uneventfully. 

After much back and forth identifying and delineating what I believed was going on as well as the risks and benefits of admission, and with some convincing, he agreed to stay. For a moment, it felt as if our cultural similarities and my ability to connect and communicate clearly with him distilled an unspoken trust. After his admission, I followed his case to check his status and ensure he was doing well. He underwent further testing that suggested a likely obstruction in one of his coronary arteries, the vessels that supply blood to the heart muscle.

A cardiologist had been consulted and recommended a procedure that would diagnose and treat his condition. I was surprised to see he had undergone the procedure the next day and read the report describing the degree of obstruction and the successful placement of a stent to keep the vessel open. I knew he would soon go home, so I visited him one last time. 

When I entered the room, I was greeted by multiple family members, and he seemed genuinely happy to see me again. I smiled shyly as he told his wife, “This is the doctor I was telling you about.” We talked briefly, and I wished him well, stressing the need to take his medications and follow up with a cardiologist as instructed. As I was exiting the door, he said, “Doctor, if you don’t mind me asking, where is your office located? Do you have any available appointments this week?” I was surprised, as I thought of myself as just a lowly intern in emergency medicine. All I had offered this man were a few words of encouragement, a workup mainly driven by my attending, and suggestions to see more qualified physicians.

It could have been that I could culturally relate to him or that I spoke his native language; perhaps it was the few laughs we shared. Whatever it was, he trusted me enough with his care to want to see me again. Even though my role was limited, my participation made an essential contribution to his care, and I knew I had made a lasting impression.

“I don’t have an office,” I told him, “I work in the emergency department.” I smiled and politely excused myself to begin working my shift.

As time moves on, I continue to come back to this experience, which taught me that any member of the healthcare team can make a lasting impact by finding common ground, building rapport, and treating patients with kindness.