I never realized how physiologically and literally a rupturing abdominal aortic aneurysm (AAA) resembled a bomb inside someone’s abdomen.

That was my initial thought as I began my busy evening resuscitation shift in the emergency department (ED). The patient’s chief complaint was dizziness, but it turns out that he had been found unresponsive in his parked car. A bystander had phoned 911, and the paramedics transported him to us, the nearest ED. All the patient could remember was this rapid onset of abdominal pain and then feeling dizzy, so he had pulled over to the side of the road.

He lay on a stretcher, looking…waxy. It doesn’t take 13 years of postgraduate training to recognize this urgency, and my suspicions were quickly confirmed. As the ultrasonographic probe touched skin, it revealed a 9×9-cm pulsatile mass with clot in it that looked almost like the ignited fuse of a bomb. The patient had no free fluid in his abdomen, and now, despite looking near dead, he was mentating, his blood pressure had normalized, and he began to tell me his story.

Unfortunately, I had to cut it short as we needed to transfer the patient to our vascular surgery center. I then asked the patient’s nurse to start some extra intravenous lines. “How many?” she inquired.

“I don’t care if you make him look like a pincushion” was more or less my response.

Thankfully, it was a weekday and the vascular surgeon on call was in house. The paramedics rolled in, scooped up the patient, and raced across town to the accepting hospital. It’s now 16h20 ( was that just 20 minutes?? ), and I moved on to see the next patient.

The next morning, I received a text from a close friend, who happened to be the ICU attending. “Kudos to the pick up on the AAA yesterday. He’s doing great. He would be dead were it not for you.” I read the full ICU admission note. “ Unfortunately, in the elevator prior to arriving to the operating room, the patient had a cardiac arrest requiring 10 minutes of cardiopulmonary resuscitation. He was emergently intubated and a non-sterile emergent laparotomy was performed and an infrarenal aortic clamp was placed….” Phew…close one.

While I think full credit should be given to the surgeons and anesthetists who brought this man back to life, and to the intensivists who meticulously see patients like him through the risky postop period, I must admit that the whole situation felt…amazing. Awesome, actually. The 20 minutes my team interacted with him started a complex sequence of events that did , in fact, save his life.

We are the make-work specialty. We call others in the middle of the night and ask them to solve problems that we can’t (and shouldn’t) tackle. We face anger from patients (wait times), from peers (handover), from nurses (“Does this patient really need another ECG?”), and finally from consultants (“What’s the white count?”). We deal with so much uncertainty and unpredictability and we have our fair share of bad outcomes.

Yet we rarely celebrate our saves. The times when things line up perfectly and when you actually prevent someone from dying. We don’t celebrate picking up the encephalitis when others thought it was just delirium. We don’t celebrate activating a stroke code in record time and seeing a near-paralyzed person up and walking a short hour later.

We don’t do what we do for kudos and thanks. Rare are the patients who will thank the emergency physician who diagnosed their brain tumor when everyone else thought it was just a chronic headache (and who can blame them? The fact that they are in the ED usually isn’t a good sign to begin with, and now we are delivering probably the worst news of their lives). Also rare are the consultants who thank us for recommending a patient for admission or for taking care of their postadmit complication. But I would argue it is even more rare for us to thank one another , or ourselves , for a job well done. Once in a while, I think we should take time to celebrate what we, and only we, do well. It’s time for Amazing and Awesome rounds. Perhaps to be tagged on after morbidity and mortality rounds to remind us why we do what we do. Oh, and that patient? Discharged in perfect health 11 days postop. Amazing.