Just another night in major emergency

By the age of three it was apparent that Telisha Smith-Gorvie would become a doctor. Growing up in Winnipeg, one of four sisters, little Telisha would mix household items into margarine jars, then place them in the freezer overnight in hopes that they would turn into a magical remedy that she could use to treat an illness. Today, Telisha is more often referred to as Dr. Smith-Gorvie, a 28-year-old, fourth-year resident in the emergency wing of St. Michael’s Hospital in downtown Toronto. It’s shortly after 4 p.m. on an early August afternoon, and her eight-hour shift has just started.

She pulls a yellow hospital gown over her clothes, straps a medical mask around her head and enters Room 5 of St. Mike’s major emergency ward. Inside, doctors from the intensive care unit and internal medicine are tending to a man in his late 30s who is dry heaving violently. He was en route to the intensive care unit after being brought in with severe breathing problems, but in the past few moments his symptoms have worsened to the point where he may need to be intubated—a process that involves inserting a plastic tube down the throat directly into the trachea to protect the patient’s airway while providing a means for mechanical ventilation. He frantically sways from side to side on the bed, struggling to inhale while constantly lunging forward as the doctors attempt to restrain him. Smith-Gorvie hovers at the foot of the bed staring at the heart monitor over the patient’s left shoulder, ready to help out with the intubation procedure if needed. And then the man’s symptoms abruptly subside and the doctors and nurses gently lie him down to rest. Smith-Gorvie realizes that her presence is no longer needed and leaves the room. “They have enough people in there,” she says. “I’m not totally sure what the problem is. Might be an asthma attack or an infection of some sort.”

As a fourth-year resident doctor, Smith-Gorvie is hardly ever on the periphery. In the first two years of her five-year residency program she, like all other resident doctors across Canada, worked under more senior residents and full-time staff doctors to learn the ropes. But as a senior resident, she is responsible for running the department under the supervision of a staff emergency doctor, and she handles her own patient load while working side by side with more junior resident doctors, helping them develop their skills.

To get to this stage of her career, Smith-Gorvie put eight years of university education under her belt—four years of undergrad and four years of medical school—followed by this ongoing residency experience. She did a bachelor of science in microbiology at the University of Manitoba, graduating with an average of between A and A+. She stayed on to pursue her MD. And when Smith-Gorvie graduated in the spring of 2005, she moved to Toronto after one of her tutorial leaders at U of M suggested that it was a great place to begin a career. “I spent the first 25 years of my life in Winnipeg,” she says. “I love the city, but I wanted a change.”

After exiting Room 5, Smith-Gorvie walks toward the main desk of the major emergency wing, and sits down with first-year resident Dr. Albert Allen to review the status of patients who have recently been admitted. His shift ended 20 minutes ago and Smith-Gorvie needs be brought up to speed before he heads out. The first case is Margaret (first names only are used throughout this story to protect patient privacy), a 58-year-old diabetic with a history of strokes. Allen ticks off her symptoms: weakness in both legs, blurry vision, sore throat, loss of voice. He then reviews her medical history. Margaret has high blood pressure and cholesterol levels, and just three weeks ago suffered a stroke. Her symptoms began to worsen at around noon today. Allen does most of the talking while Smith-Gorvie listens. She then asks for Margaret’s electrocardiogram (ECG), which traces a person’s heart rate to pick up abnormalities, and probes him about Margaret’s trouble with her vision. “Is she having problems seeing out of both eyes, or just one in particular?” Allen is unsure. “Let’s go see her then,” says Telisha, quickly rising. She heads toward the end of the emergency department, where Margaret is lying on a stretcher in the hallway corner, her husband by her side. Allen follows close behind.

When they arrive, Smith-Gorvie introduces herself and begins conducting tests. “How many fingers am I holding up,” she asks, repeating the test on each eye, and varying the number of fingers in front of Margaret’s face. Allen peers over Smith-Gorvie’s shoulder, listening and taking notes. Margaret looks frail and tired and her replies are barely audible, forcing Smith-Gorvie to lean in close. The patient’s husband adds that the blurry vision has been happening off and on for about four days. The two residents consult and they decide that Margaret should be sent upstairs to radiology to have a CAT scan. The CAT scan could show if there is any damage inside the brain that might have resulted from a new stroke. But as Smith-Gorvie discusses with Allen as they walk away, since Margaret is recovering from a recent stroke, and it’s not her first, the CAT scan may not be able to distinguish between old and new damage.