I grabbed a few beach pillows, put on my old worn-out blue beach button down, poured myself a glass of whiskey and walked down to the beach from our villa to watch the sunset. My four friends and I were ten days deep into a two-week vacation. We had already toured Seoul, South Korea for three days, Tokyo, Japan for four days and Hong Kong for three days. So, I welcomed the two days of rest and relaxation that accompanied the beach resort of Vinpearl in Nha Trang, Vietnam.

I remember laying down perched up on a pillow or two to support my head. The fine, white sand of Nha Trang starting to stick to my almost empty but still cold glass of whiskey. I was in my own little world. The sun was just about to slip behind Vietnam’s mountain range in the distance when I heard a commotion coming from our villa. I sipped the final remnants of Johnny Walker from my glass when my friend Demitri approached me with a worried look on his face. He knelt down onto one knee next to me and said, “I just puked blood.”

I immediately gathered my pillows, stood up and lead Demitri to our beachfront villa. I brushed the sand off my shirt and pants and switched to doctor mode. Demitri was tremulous and hunched over due to his abdominal pain, and his physical symptoms were matched with the anxiety of being potentially sick in a foreign country.

Back at our villa, I could see that my three other friends were almost as anxious as Demitri. “I got this guys,” I assured them, “can you grab us some bottled water please?”

While one of our friends was fetching water, the other two explained that they were hanging out when Demitri felt nauseous and began to vomit. After retching a third time, Demitri saw blood. They didn’t know what to do so they did the only logical thing — they went and got the doctor off the beach.

With water bottle in hand, Demitri explained that he was feeling lightheaded. I laid him down on the beach chair and lowered its head flat. The differentials ran through my head quickly with infectious etiologies being the highest. Unlikely arrhythmogenic in nature given lack of gross physical exam findings with no past medical history in an otherwise relatively young and healthy adult man in his late 20s. His lightheadedness was likely due to orthostatic hypotension likely complicating his underlying issue given that he was vomiting and had decreased oral intake over the last 12 hours.

I tweezed out that he had no other associated symptoms including fever, chills, diarrhea, black, dark or bloody stools, and he had no major past medical history. No meds or allergies. His physical exam was benign except for six firm abdominal masses which we deduced was his rock hard abs. He was in great shape with a regular heart rate and strong peripheral pulses. He was an otherwise healthy guy until today.

In the end, it was a scant amount of blood in the bowl, but it always looks worse than it is. Like adding a drop of red food dye to a bowl of water. He had something to eat earlier that day that disagreed with him and likely caused some gastritis. Highly unlikely for this to be a manifestation of a Mallory-Weiss tear or something potentially life-threatening.

Eight mg of ondansetron, or Zofran, which I keep with me when I travel helped his nausea and stomach pain and his vomiting did not return. He began to feel better within a few hours, and a lack of diarrhea pushed me to hold off on giving him antibiotics, 1g of Azithromycin that I bring with me on tropical vacations in case of traveler’s diarrhea.

As a medical professional the experience made me realize a few things. First, that as physicians one of our most valuable skills is our ability to triage. To be able to tell someone, “You are sick and need to go to the hospital immediately,” versus “take two and call me in the morning.” To be able to separate the inconvenient medical issues from the potentially life-threatening.

Second, that half our job as doctors is medicine, but the other half is humanism. Sure, nobody will care about how good your bedside manner is if you aren’t a smart doctor and are unable to do the medical part of your job. You know, diagnose and treat and all that jazz. But what separates the good from the best is the ability to connect with someone rapidly, show them you are listening and to quell their fears and anxieties that accompany being sick.

Lastly, that as a medical professional, be it a nurse, PA, or physician, you never know when you will be the only medically trained individual in an emergency situation, be it on an airplane, on the street or a beach in Vietnam. You will be the person that civilians will look to for help. So regardless of what level of training you are at, be it fellowship, residency, or medical school, use every day as an opportunity to learn and absorb everything you can. It might just help you save someone’s life one day.

Marc N. Katz is an internal medicine resident who blogs at KittyKatzMD and can be reached on Twitter @KittyKatzMD and Instagram.

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