One day before she was transferred to the

One of the cases that I had seen a lady of 35 years old who presented to the emergency department where I am working as an emergency medicine fellow she was admitted to the female urgent unit with shortness of breathing known as an end-stage renal disease with fluid overload. I was the F2 doctor who was treating her.

She was a transient passenger traveling to her country brought from the Airport when she developed shortness of breathing she was alone with no family attending with her, she was extremely anxious. I really felt her feeling of being very sick alone in a country which she never attends before.This Lady 35 years had been diagnosed as end-stage renal disease on hemodialysis three times per week she missed one session when she was busy at a business work when she was in a vacation out of her country, she told me that she felt tried to go to the dialysis unit , she kept telling me that to take care of her as she was worried to die alone and she wanted to go back to her home for her kids , I reassured her but I had a deep feeling that maybe she was going to die or she will get very sick at any time although her vitals parameters were all normal except mild changes in the EKG looks as hypokalemia changes which I gave for her a replacement medication and labs was sent for checking her electrolytes . She was being hemo dialyzed in the renal unit on the same day before she was transferred to the female urgent area. I kept her under frequent monitoring with keeping my eye on her, suddenly the nurse called me that the patient turned blue unresponsive with no pulse detected, I was so shocked that she so I quickly get sick We started to resuscitate her I felt very upset for her condition still remembering what she told me about her worried to die alone however what happened next was truly amazing.

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She got a return of circulation after two shocks and CPR. I was lucky to have an excellent staff nurse we worked as great Team, after I shifted the patient to the resuscitation room, I went back to see her again she was totally awake and started to cry, very scared of death ,I realized that the patient looked at me as a doctor who saved her life and that made me feel proud and important. I held her hand and told her she will be fine to reassure her. I had a mixed feeling at that time was happy to save her life and the good comments from my consultant and then the staff nurses on another side I felt upset that what I could have done better than I should keep following the lab results which had been delayed to check for hypokalemia although I started for her on oral potassium as her VBG was showing mild hypokalemia . I had seen patients with hypokalemia many times and was confident to treat her but this was a rare case presentation of EKG changes with mild hypokalemia leading to the cardiac arrest with this situation and fortunately the lab results came back was not critical also. I hadn’t realized that there were non-clinical skills that I needed to work on like communication skills with lab and informing the nurse in charge to keep calling the lab for fast results.

I still feel confident about my clinical skills and appreciate that I will continue to develop. This is what I think I will do next time and then look back at this and see how much I have learned from leadership skill and communications skills.


I'm Gerard!

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