I worked for a short time in general surgery after years in family medicine and gynecology. One morning, as I was arriving late to work due to a dental appointment, I was quickly informed that a patient 2 weeks post-op gastric bypass surgery had incorrectly arrived a week early for an appointment. Sensing the distress of the office receptionist, I went directly out to the waiting area to talk with the patient.

She (Ms P) and a friend were waiting, laughing, and talking. They were both in their early 70s, neatly dressed, and pleasant. I greeted them and asked if they knew that they were a week early. They quickly admitted that they somehow wrote it on the calendar wrong.

Ms P’s friend said, “Just this morning we were talking about it, but [Ms P] was so out of breath that she couldn’t talk.”

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“What?” I quickly questioned.

“Yes, she couldn’t get dressed. She was hassling so.”

“How were you yesterday?” was the next question that I asked.

“Fine, walked to the mailbox fine,” replied Ms P’s friend.

“Pain? Chest? Legs?” I asked.

All were okay.

This lovely woman looked well. She was not cyanotic. She had no tachypnea. Without a second thought, I knew that she had a pulmonary embolism. It may have well been written across her face. Our clinic was one-half block from the hospital emergency department.

I asked gently, not to alarm her, “Where is your car?”

Her friend replied, “I parked it at the curb just outside the door.”

Then without thinking, I broke every protocol rule, without hesitation. “I want you to take her straight to the emergency department door (we could see it across the parking lot).

I explained that I was concerned and that I wanted her to go there now to be checked out. With a steady gaze at the friend, I said, “Do not stop. Go directly there, now.”

The couple did not hesitate, nor were they alarmed. I picked up the emergency department phone and spoke to the charge nurse.

“Meet her at the door, she has a pulmonary embolism. Do not let her wait.”

The charge nurse called me back in less than 30 minutes. Ms P had a large pulmonary embolism on CT. But the patient was stable, with no distress, and was doing well.

“You saved her life,” the nurse said to me.

In retrospect, I questioned whether I should have had her checked in for vitals and called the paramedics. But I had no doubt at the time. Time and calmness were critical. After many, many years of experience, I know there is a second sense that cannot be measured—a Divine guidance. Years of stories, sights, smells, and touches take over.

Three weeks later, she and her friend came down the hall looking for me with big smiles and hugs. I was only working in this area a short time, but I know it was for this one event, and I am grateful to have been a part.—Deborah Underwood Brown, FNP-C, Holly Springs, N.C.

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.