I heard the phrase “if you hear hoofsteps think horses, not zebras” countless times in medical school. And I’ve echoed that quip with students and residents often since then.
This pithy comment reminded us not to overthink our cases. If a patient is of child-bearing age with nausea, fatigue, and cramps—for instance—start with a simple pregnancy test and hold off on the contrasted CT scan of the abdomen.
Like timid medical students, our tendency—most of us—is to overcomplicate the journey from where I am today to where I would like to be. We overdiagnose our “issues” and fail to make the bold, simple, right decisions that can get us unstuck. The x-ray image shown above is one of my Top 10’s from the trauma bay because it drives my point home (cheap pun I know) in dramatic fashion.
Whenever a charge nurse pages me and says, “this is a good one—just get in here” I get extra curious about a case. On a Sunday afternoon a few years ago I walked into a trauma bay without any preparation for what awaited me. Two anxious priests blurted out “when will she go to surgery? We will stay all night if needed!” The charge nurse whispered playfully, “told you it was good…she’s probably got a dark side and pissed God off.” And the patient? Well, she just smiled and raised her eyebrows, causing the key in the side of her head to wave at me (the ER is rich with twisted comedy).
The 75 yo lady—I learned—was making her way down the cascading stairs at her church. She had just pulled her keys out of her purse when a friend called her name. Distracted, she slipped (wearing 3-inch heels) and fell onto her side. On her descent, she planted her clenched fist against the pavement with her apartment key sticking skyward. And like paper being slapped onto a receipt spike, her key punched through the thin bones of her orbit (eye) as her head contacted the ground. After seeing the impaled key, the priest walking with her fainted.
I brushed my hand back and forth in front of the patient’s face to confirm that her eye movements were unrestricted. She then read my name on my hospital jacket without any difficulty as I studied her symmetric, reactive pupils. Her CT scan and physical exam convinced me that despite the bizarre scene before me—she was fine. So, I could have prepared everyone in the room for my next action, but that would have been so…boring.
I walked over to her left side; tapped her firmly on the forehead for distraction; and pulled the key out. The younger priest dropped onto the chair behind him. The other gripped the rail of the gurney in horror. The patient looked up at me and smiled—oblivious that anything had changed—as a trickle of blood slid down her cheek. I asked the nurse to irrigate the wound and put a “wet to dry” dressing over it. The woman was discharged an hour later with antibiotics (to cover against staphylococcus infections) and when I saw her in the clinic a week later the wound was nearly healed.
Life has scary, sensational moments, but rarely are these decision points as complicated as we think. What situation in your life could you boldly walk into and pull out the “bloody key” today? Maybe all your wife needs is a hug in the morning and a compliment before bed to set her heart free. Perhaps the employee that has been driving you crazy for months needs you to finally let him go, so you can both move forward. Could it be that in your exhausted state of looking left and right for answers you need to get on your knees and look up? For many of us, the simple act of asking a professional for help is the key to breakthrough.
As you consider a simple, bold, right action that could move you forward today, remember that your courage will benefit both you and those close to you. When I removed my patient’s key, her family, priests, friends, and the nursing staff were all set free to move forward with their life too. Unlock simplicity today. That’s a STAT order my fellow zebra chasers.