Everyday emergencies: “It’s the journey that matters”

We often hear "It’s the Journey That Matters," but this took on new meaning for me one evening on a train. I realised surgical problems begin long before the first incision—sometimes in the everyday moments, often unnoticed.

It had been a long day, my mind cluttered with unread emails as the train hummed on. Suddenly, a shopping bag slipped from an elderly woman’s hand, spilling groceries. She barely reacted, staring at her hand as her grandson scrambled to collect the items. “Nan, you dropped everything!” he laughed, but she didn’t respond. Her eyes met mine, blinking as if clearing a fog. Her voice, slow and slurred, murmured, “Sorry, I just feel a little off”. Something felt wrong. This wasn't mere clumsiness but a silent alarm bell, a surgical emergency unfolding amidst the mundane.

Introducing myself, I gently inquired about her symptoms. "Can you raise your arms?" I asked. Her left arm wavered; the right remained motionless. Her history, reluctantly revealed, included a recent ‘tumble’, a detail she'd dismissed as trivial. My mind raced—could this be a stroke? An intracranial haemorrhage? The "FAST" mnemonic, a staple of stroke diagnosis, flashed through my mind: Facial droop, Arm weakness, Speech difficulties, Time to call emergency services. Without scans or senior clinicians, what was once just a memory aid from a lecture now felt very real. If this was a neurosurgical emergency, ‘Time’ was critical.

I turned to her grandson. “Nan might need help, but we’ll do this together, alright?”. He nodded, fear in his eyes, helpless from seeing someone once invincible now fragile.

As a medical student, I couldn’t diagnose or treat, only support, monitor, and escalate. I helped her sit up, calmed her grandson, and delegated nearby passengers to alert staff for an ambulance.

When the paramedics arrived, I quickly handed over whilst they took her vitals. After discussing, one said, “We’re concerned about a possible subdural. She’ll likely need a hospital transfer.”

A subdural haematoma—a slow brain bleed that mimics a stroke and can be fatal if untreated. Had she gone home, she might not have woken up.

Days later, on another train, I reflected. I had always imagined surgical problems unfolding under bright lights, scalpel in hand, with a team prepared for complications. But that night, I learned they can begin in everyday moments, before anyone realises a life is at stake. Managing them isn’t about a perfect diagnosis and solution, but knowing when to act, despite uncertainty. The outcome may be unknown, but the impact along the chain of care, is what matters.

That evening mirrored surgery itself: Trust, Triage, Timing, Technical Thinking and Teamwork. Yet, I experienced all five—not in the sterility of theatres, but in the unpredictability of a train ride. Perhaps as a future surgeon, I’ll remember that train ride; when I realised that managing a surgical problem is as much about the journey to the operating table as the decisions made on it.