The Great Doctor Thomas Moore

Learning My First Medical Lesson

I just kept my calm while Emma said in a decisive tone:

"Enough both of you, this isn't a civilized way to speak between fellow doctors."

I looked at Emma gratefully, as I knew she was trying to help me out, but that blue uniform Sara didn't give up, as she said pointing her index to me:

"He is lying, senior sister Emma, as I just checked the list of the full intern doctors of this year, and guess what?"

She looked towards me with a sarcastic smile and glaring eyes like she found my weak spot while adding slowly:

"His name isn't one of them, so he is a liar and we need to report him immediately."

As I was about to defend myself against this false accusation, Emma was faster as she said in a more decisive tone:

"I said ENOUGH!"

I felt that if I opened my mouth and said anything, I would be subjected to her wrath, so I swallowed what I intended to say.

"I just checked the list that came today; he got that position with a decision from the dean himself, so chill it out and stop arguing over nothing."

Sara looked at me with wide rounded eyes of hers, though they were beautiful, to me they were toxic. Emma turned to look at me and just as she was about to say something, a nurse entered through the door in a hurry as she said:

"There are seven cases outside."

Emma moved rapidly in a way I didn't notice. As she passed to the door, I noticed that the other three girls moved with her, so I moved as well.

I left my bag in a hurry on one of the chairs after I took one small notebook that fitted the pocket of my coat, and the two pens I took from that security man. Once I rushed after them, I heard Emma asking the nurse in a calm tone:

"What happened?"

"A big traffic accident happened."

Emma looked at the seven patients who were surrounded by many nurses trying to help the paramedics in moving these patients to the beds. I heard their screams, cries, and begging for help.

I recalled that distasteful words of Sara just now, although she was very mean, she had a point here… this wasn't college anymore, this was the real deal.

"Thomas, you just stand here and watch. You can't take part in this now."

"Yes, Senior."

I couldn't reply except with an agreement to Emma's order, as I already felt all the contents in my stomach were about to revolt. The color and smell of blood were so nauseating, that even made me recall the early days at the college morgue.

I watched these doctors and nurses act in unison in a way that seemed chaotic in the beginning, but slowly it turned out to be based on a certain rhythm. I followed Emma from far while she took the heaviest injured patient to examine.

She was an expert, as in moments she had evaluated what this patient needed and started to issue orders to the nurses around her. That patient came with a severe deep wound in his right thigh, accompanied by traumas all over his body. just as nurses were executing her orders, she asked in a voice audible to me:

"Tell me, Thomas, what is the most dangerous thing here about this patient that we must confirm first?"

Oh, she asked me, was she testing me? I just finished my sixth-year exams not a while ago, so all the knowledge I studied were still fresh in my mind, so confidently I replied:

"I check the pulse, breathing…"

She interrupted me as she said:

"These are the basics which you should assess with just one look, so what else? I want a specific answer based on this patient."

That was new, all I know was the long clinical examination sheet that I use when I enter any clinical test. I looked at this patient anxiously as my heart beats increased with my head feeling warmer than ever. I didn't notice I was sweating except after I answered with great difficulty:

"Well, we should stitch this wound and stop the bleeding."

I thought my answer was good and waited to hear her words of praise like I used to have from all the doctors who tested me, but I was disappointed. Emma turned her head as she looked at me with a regretful look while saying:

"What a waste, I thought you are better than this," Then she turned to look over the patient again as the nurses brought some surgical instruments to her while she added, "Never close a wound before exploring it to be sure you didn't leave a leaking vein or artery. Although this might be considered the right answer, it's not the most correct answer here.'

I didn't understand her words, so I tried to ask cautiously:

"May I ask what the difference is?"

She wore surgical gloves with the aid of one nurse while another one helped her to wear a one-time use surgical scrub while she replied patiently:

"The difference is immense. At college, it's just one of the multiple answers that could give you the right mark, but here it could determine the difference between life and death.

For example, our patient here, he got through an accident, with a deep thigh injury and multiple traumas. After the initial basic assessment that I routinely did, I have to exclude the most worrisome issue here, abdominal internal bleeding.

If I acted as you said and went over to treat that wound perfectly, then after I finish stitching this wound, I might find my patient entered into a shock from blood loss."

I suddenly found a portable ultrasonography device that was given to Emma by the help of one nurse. Emma, professionally, held the probe of it and applied the gel over the patient's abdomen as she started to move it while concentrating over the screen.

Honestly, I peeked over to see but I didn't understand a thing, the whole screen was black with some random white lines and weird shapes appearing all the time like they were dancing.

I noticed Emma was moving the probe rapidly as if she knew what she was looking at. I wanted to ask her about this, but I knew I might be delaying her actions so I didn't.

"If you understood what I said, then you must have a question in your mind right now, right?"

She said that while observing the monitor of the U/S device. Oh man, dealing with Emma was stressful; every word she said was exactly on the spot.

I had many questions in my mind, but I feared this wasn't an easy question, as I smelled deep intentions buried in it. In moments, I found a suitable logic answer as I replied:

"Why is internal bleeding more dangerous than an open deep wound?"

She remained silent for a while as she was immersed deeply in watching the monitor. Then she put the probe away after she wrote something over the ticket of this patient.

Every single patient entered the hospital would have a long paper which we call 'Ticket'. This ticket is the patient passport to receive treatment here. Emma gave the ticket to one of the nurses while ordering seriously:

"Give the order to the surgical room to be ready upstairs."

She then moved with her chair to adjust her position, she was now prepared to intervene with that wound. I hated the look and smell of blood, but as I was about to leave under any excuse, Emma said again:

"Your answer is the most appropriate one. If you answered wrongly or took a long time to reply, I would have become very disappointed in you."

I knew I was right, but I asked back:

"The most appropriate means it's correct, right? And if I took longer, my answer would even be considered as a failure?"

"Yes, patients aren't going to wait for you forever to think rationally and select the best treating plan or investigation or procedure. Your delay equals the deterioration of the patient's condition, which means your previous assessment couldn't be applied now.

You must think rapidly, interpret all the data efficiently, and select the most appropriate approach here. As for our patient here, he had internal bleeding from a ruptured spleen, and now I'm just finished stitching his major injured vein here.

He will go for a ride upstairs to have a surgery… I'm finished here; let's go to the other patient, please. One nurse must stay here and monitor his vitals for me."

She then moved while she removed that scrub and gloves and threw them at a red basket in the corner while she said:

"You fear what is hidden and can't be detected easily than that is obvious in front of you. Internal bleeding in the abdomen cavity is very tricky, as it had no sign at all, so you needed to exclude it first by sonar, do you understand?"