ONE day, 1987, when I, as a very unexperienced doctor, was on duty at the emergency department of the little hospital in Lycksele in Northern Sweden I got a telephone call from an even more unexperienced doctor. He worked in a small place nearer to the Norwegian border, some 300 km away. He told me he wanted to discuss a couple of patients. The first was a man who had acquired an inguinal hernia, with pain but without alarming symptoms and signs. He was very detailed describing this man. Later, more or less by the way he mentioned: “And then I have a Norwegian tourist here who got abdominal pain in intervals with radiation to his back, while driving his car…”
I could have said something else but said: “The first man you can send an ordinary referral on by mail, but the Norwegian guy you have to send here to Lycksele at once.” (Remember the distance.) The other doctor said: “Shall I let his wife drive him to you?” I could have said something else but said: “No, send him by ambulance, as his condition could become worse.” (This was before helicopters came in more frequent use for transports over distances.)
The hours flew away and was busy with other patients. Just before it was time for me to leave the hospital for the day I heard someone say: “The Norwegian tourist has arrived!” I went into the small examination room and found a man 60+ ash-grey in his face and sweating. Obviously he had abdominal pain. I put my hand on his abdomen and felt a huge resistance bulging and pulsating. I immediately called in the surgical team and the patient was informed about the seriousness of his condition. He took a possible last farewell of his wife before he was rolled into the operation theater. The operation took many hours, and I was assisting the surgeon. Of course the patient had an abdominal aortic aneurysm but it had also ruptured! The hole, thick as a finger, was lucky for him, directed backwards into the retroperitoneal spatium which was filled with a liter or two of blood. (If it had ruptured at the ventral aspect he would have been dead within a minute.) Luckily it was possible to cut the aorta safely under the renal arteries and he got a teflone-graft in the shape as a pair of trousers. The man’s life was saved and he could some days later return to Norway.
I was lucky too, making a series of correct decisions. It wasn’t by experience obviously. Was it good intuition? Was it gut-feeling? Or was I advised by my Guardian Angel…