by Jason Spears
It was Father's Day and I had just completed my first year of medical school and had gone home to visit my parents for the weekend. In my household going to church is a weekly occurrence but this Sunday would be entirely different.
For starters, my Dad lost his wallet and spent all morning looking for it because we had traveled the previous day. It got to be late in the morning so texted the church pianist to determine what part of the service they were at and it it made any sense to even attempt going to service.
Well, we decided to go but would be arriving late.
Got to church, took my seat in the back so as not to disrupt service.
The prayer was completed and not ten minutes after my arrival I hear a commotion in the choir loft.
A lady stands up and is shouting, 'Oh Lord, this pain is too great!" I look up and think this is interesting as she begins to clutch her right side and continues to shout even louder disrupting the entire service.
Some of the men go to assist her and I'm still in my seat taking everything in.
She is screaming in pain and trying to exit the choir loft and I'm running through a potential differential of appendicitis because of how she is clutching her right side and in excruciating pain.
Finally, other members of the church have terrified expressions on their faces and the pastor announces from the pulpit for someone to call 9-1-1.
At this time, I decide my services are probably needed and proceed to get up from my seat and make my way to the front of the church and to the lady in question.
I calmly approach because in a previous life I had been a Sports Medicine Aide while in college so fully trained in responding to emergencies. I introduce myself to the lady and try to get a sense of what is going on. Need to inquire what's hurting, where and why and duration.
She states needs to get downstairs because she doesn't have kidneys and does self dialysis at home with the catheter attached at the umbilicus.
As I am interacting with her, she screams out and absolutely collapses to the ground right in front of the altar in the sanctuary on the right side of the church.
At this point things are stepped up a notch and I'm thinking ABC...have to assess Airway, Breathing and Cardiovascular. Things begin to speed up and I ask for the lady to be laid on her back.
I hear someone mention about there are too many people around the lady, move away she needs air to breathe. The someone goes, "He, needs to stay he's a medical student." I'm working hard thinking about what my next steps are going to be at the moment.
Then, I decide to make the call to perform an abdominal exam and state, "Does anyone have something to cover the patient?" I turn to our patient and say, "I'm going to have to perform an abdominal examination on you right now and will have to remove articles of clothing."
With this mentioned I began to work on visualizing the abdominal area and thinking of how to perform the exam based on what we were taught in Physical Diagnosis and performing an OSCE on the same topic.
I noticed an extremely rotounded abdomen and our patient was still in extreme pain and stated her girdle was causing a lot of discomfort and she thought it needed to be removed.
As a male, I am not too familiar with girdles and thankfully the older women of the church knew about them and they tried to remove the straps but couldn't. With no other options it was decided to cut the girdle with scissors. As soon as the girdle was removed the lady's pain subsided immediately.
But she then went to grab the catheter in her umbilicus and I'm thinking this is not good at all.
To prevent any mishaps and help her calm down, I asked for her to take the hands of two others and if she had any pain or needed to do anything just squeeze the hand she was holding.
I went on to perform a rather focused abdominal exam and checking the catheter for any blood or bodily fluid and noted none was found.
As the lady was still on the ground I began to reassess her radial pulse to determine if there was a change upon removal of the girdle and they came back within normal limits of 50-90 beats per minute.
The lady was feeling much better on the pain scale and now as I had her calm there was really not much more that could be done until the EMS arrived.
They finally, arrived and walked down the center aisle of the church to our patient on the ground up front. I went over and gave them a quick summary of events and answered their pertinent questions surrounding the event.
EMS used stethoscopes to take blood pressure, also used a pulse ox, and took a blood glucose read since our patient also disclosed she was diabetic.
Her blood sugar came back at 227, which for novices is very high.
She left the church without incident and was praising God as she was led to the ambulance to be taken to the hospital for an evaluation.
After church, many members approached me and thanked for my efforts. Another person asked questions about what had gone on. Others told me that they absolutely thought the person was dying before their eyes.
At this point, I received and update about the lady who was in distress her hospital stay wasn't just in and out, except she was admitted to the hospital for a period of multiple days. This attests to the severity of the situation.
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