MY OWN SHOCK | Maxwell Wilberding
Being wheeled from the triage doors, through the emergency department hallway, and finally to the trauma bay, I hoped the familiar surroundings would bring comfort. As hands swarmed my sides, rolled me onto a gurney and placed two peripheral IVs, I sought reassurance from established vitals and proper access. Pierced with additional needles in my left wrist and injections to both thighs, I prayed the right medication delivery would end today’s nightmare.
And… that’s your blood pressure.
My first experience with anaphylaxis in over a dozen years, and I am left wondering how I ended up on the gurney of the same trauma bay I started clinical rotations in only months prior.
Medical students are often blessed with medical student roommates. Mine combine for nine years of EMT experience in addition to their years of graduate education. Within five minutes of my hive outbreak, they bypassed the dreaded line of “What did you eat?” questioning in favor of 100 mg of Benadryl, a home blood pressure cuff, and an argument about which roommate deserved the honor of delivering the mid-thigh epinephrine injection.
Although an EpiPen has never failed me before, I couldn't blame my continued deterioration on its expiration last year. While I won’t delve into the price hikes of a life-saving device whose sole ingredient fills an anesthesia cart for two dollars, I can certainly question the scientific evidence behind its supposed eighteen-month expiration date.
Questions of my responsibility aside, the future internal medicine roommate, with his superior stethoscope skills, informed me that my breath sounds were indeed decreased. Coupled with my doubling in lip size and an itch that would be relieved by mosquito bites, it was clear I was not improving. However, we determined that we had enough time to get an Uber instead of an ambulance enroute to the ER.
On arrival, I was grateful for two things: the presence of my medically-informed patient advocates (equipped with hospital badges), and that we didn't choose the “Wait and Save” feature on Uber. While my champions expressed the dire situation to triage, I fumbled my way to the nearest chair and sank, drifting off into a state of white noise—no itching, no labored breathing, no vision—just rest.
A nurse promptly removed me from her desk chair in favor of a wheelchair moving swiftly down the hall. The sounds of infusion pumps and curtain draws told me we were rolling down the main ER bays. Interspersed with the occasional sympathetic remark, my nurse asked, “You’re not going to throw up on me, are you?”
“No, I’m fi—” My wheelchair and new scrub pants were ruined. After a brief shared sigh, she handed me a bag for any future misinterpreted feelings. I couldn't help but chuckle as she patted my shoulder, “I’ve been doing this a long time, honey.”
Upon arrival in the trauma bay, I was relieved not to recognize any of my former residents or attendings. Everyone was poised at their respective stations, set for action. Knowing the drill, I stepped off the wheelchair, removed my sweatshirt, and flopped onto the gurney with my arms extended as if the IV was waiting on me.
“We got a pro here,” someone in the bay joked. As the familiar questions echoed around me, I did my best to assure everyone that this was in fact anaphylaxis, not a drug overdose or septic shock. With one IV started, a throat check completed, and an EpiPen injection administered, everyone waited for the blood pressure cuff to cycle. The novelty that their patient was a current medical student had spread, and I engaged in as much playful banter as I could muster through a mounting breathlessness and blindness.
And… that’s your blood pressure.
No one laughed for the next half hour. I later learned I had bottomed out at 58/29, which is quite low. With the insertion of more IVs and repeated throat checks, I teetered on the edge of consciousness. My hands and feet went from cold to tingling to numb with pain. A familiar voice broke the brisk silence—a PA student I had worked with months ago was here, asking if I needed anything. Eyes still closed, I pointed to my feet and then to where I imagined the bay's corner storage to be. Moments later the weight of warm blankets dropped across my legs, and a surge of pressure enveloped my feet. I squinted to just piece together my former co-student gripping my feet in a tight clasp against her abdomen. Lying back, the rush of blood flow to my feet prompted a long exhale and smile.
I was roused from my reverie by the pressure of plastic against my left cheek. A new face introduced himself as Matt from the MICU and asked if I had ever been intubated before. I recognized the plastic as an oropharyngeal airway. Reflexively, I responded, “No, no, we are not doing that.” After a few minutes of explaining that I wasn't a DNR/DNI (do not intubate, do not resuscitate) patient, I was confronted with true fear. Surrounded by the best emergency team I could imagine, I had never considered that it might not be enough. One pushed more meds, another started an epinephrine drip, and a third climbed up on a chair, squeezing a bag of elevated fluid to get as much into me as possible. Yet, I wasn't feeling better, and no one seemed less concerned. For the first time, I realized my situation was not under control.
An attending leaned in and asked if there was anyone they should call for me. My body was in no state to cry, but my eyes welled nonetheless. I thought about my parents, my partner, my roommates waiting outside the bay. I would like to blame it on the injected adrenaline, but I genuinely believe I have never been more scared. The attending clasped my hand in hers and promised to call my mom, assuring her I would be okay. It took the bay another hour and the MICU all night, but she proved right.
My own shock taught me the emotions of being a patient. I have spent the last few years learning how to diagnose illness and prescribe the right regimen of medications to slow, alleviate, or even cure that illness. I study classes of drugs, their dosages, their side effects. Yet when I lay on the gurney myself, I could not even tell you if they were using saline or lactate ringers for my fluid resuscitation. I had no idea if they gave me any steroids or Benadryl, no clue what the appropriate epinephrine titration was. I did, however, know the unbearable itch, unrelenting nausea and exhausting dizziness. I knew my feet were cold. I knew I was scared.
I also experienced the support of my roommates, the kindness and humor of a nurse, the warm clutch of a PA student, and the assurance of an attending. Their care is all I truly remember, the reason I look back on my shock with the fondness only life lessons can bestow. I walked out of the MICU the next day because of the care they provided me as a person just as much as the medications they prescribed me as a patient. After all, that is what I always hoped it meant to become a doctor.
Maxwell Wilberding is a fourth-year medical student at the Northwestern University Feinberg School of Medicine. He earned a Bachelor of Science in Biomedical Sciences and a minor in Creative Writing from The Ohio State University in 2021. Wilberding pursues writing as a tool of reflection and communication through the trials of medical training and as a token of appreciation for all the patients along the way. IG: @MaxwellWilber