“Is that it?” I asked.
“Oh. Uhm. Hemoglobin on arrival was…nine point two,” Martin continued. “We started two units of packed red cells and he has been stable. Vitals are holding. Blood pressure is one-fifteen over seventy, heart rate is ninety-two, respiratory rate is eighteen on room air.”
I let the silence stretch for a beat. Then another. Martin’s confidence started to crumble around the edges.
“Hemoglobin was nine point two when?” I asked.
“Uhm…” Martin blinked. “On arrival.”
“What time was that measurement taken?”
He glanced down at the chart, fumbling with the tablet. “Oh-three-hundred hours,” he answered quietly.
“And what time is it now?”
He looked at his watch. His Adam’s apple bobbed when he swallowed. “Seven fifteen.”
“So why do I give a shit about that number?” I asked. “Your patient has a grade three laceration. He’s losing blood. You presented based on labs from four hours ago, so you don’t know if his hemoglobin is stable, dropping, or crashing.”
I kept my volume level but firm. I did not need to yell to make my point clear. Rounds were a time to learn, and sometimes learning looked like a reprimand.
“So what should you have done before report?”
Martin’s face went pale. “I should have checked recent labs first.”
“You should have checked recent labs first,” I parroted. “Dr. Martin, if your patient is bleeding into his abdomen and you’re presenting to me based on outdated information, what does that tell me about your understanding of trauma as a practice area?”
“That I don’t understand it well enough, sir.”
“You don’t understand it well enoughyet.” I looked at the other residents, all of whom suddenly found the floor interesting. “Anyone else want to present a trauma patientwithout current vital information? We’ve got time to waste in the ICU, right?”
Three heads shook in unison. Nobody made eye contact.
“No, of course not. Martin, get current labs and a repeat abdominal exam. If his hemoglobin has dropped below eight or if there is any change, I want to know. Then we will talk about whether we are taking him to the OR. The rest of you, I want updates on your patients in one hour, and I want those updates to include data that’s less than thirty minutes old. Go.”
They scattered like I had fired a starting gun. I watched them disappear down the hallway, then pulled out my phone to check the time. Seven seventeen. Morning rounds on Friday always ran long because the interns’ brains were already on weekend time.
I pocketed the phone and headed down the hall. I had three post-operative patients from earlier in the week who needed checking, and if Martin’s trauma patient was still bleeding, I would need to schedule an emergency splenectomy.
Two nurses at the main station had been talking, heads bent close together in a conspiratorial way that meant they were discussing something they did not want overheard. The conversation stopped the instant they saw me. One of them, a younger woman whose name I could not recall, smiled at me. The other, Karina, actually blushed and looked down at the computer screen in front of her.
I nodded at them and kept walking toward the computer station near bed three. I logged in and pulled up his chart. Vitals were stable, blood pressure was holding, heart rate had come down slightly. Oxygen saturation was ninety-eight percent.
I walked to the bedside. The patient had a full sleeve of tattoos visible on his right arm where the hospital gown did not cover. His eyes were closed. I did a quick physical exam. Hisabdomen was tender when I palpated the left upper quadrant, but it was not rigid. Bowel sounds were present.
“Dr. Vaughn?”
I turned to find Karina in the doorway, her dark hair hiding under a surgical cap. She was holding a tablet close to her chest.
“Yes?”
“Dr. Martin asked me to let you know the labs are ready for his patient.”
“Thanks.” I swung to the nearest computer and pulled them up. Hemoglobin was eight point eight; down from nine point two, but not catastrophically low. “Could you page Dr. Martin and tell him if hemoglobin drops below eight, start another unit and call me immediately? And someone needs to check him again in four hours.”
“Will do,” she said with a smile. I gave her an appreciative nod. Karina had been working in the ICU for five years, making her more valuable than half the residents on any given day.
Which was why it was odd that she just…stood there. Usually, the nurses hurried away after getting instructions. Lingering wasn’t part of the ICU routine—there was too much to do.
