Four in the morning, en route to Prisma Health Baptist Hospital in Easley, paramedics called emergency room attending physician Dr. Ryan Duhé to assist with a complex medical emergency.  

“Sirens blazing, EMS calls ahead to the ER and says we need to talk to the doctor,” recalled Dr. Duhé, Prisma Health Emergency Medicine attending physician and assistant clinical professor at School of Medicine Greenville.  

The patient, a male who just recently had major surgery due to laryngeal cancer, was in acute respiratory stress and bleeding from his neck.  

Working tirelessly that early morning, Dr. Duhé and emergency room staff successfully treated the patient. In the weeks and months that followed, Dr. Duhé would not forget the patient encounter. He wanted to document it as a clinical case study, to educate physicians to appropriately address similar catastrophic situations, thus potentially saving lives in the future. Approximately two years later, a catalyst for the project came when SOMG medical students Gracelyn Metts and Evan Stravolo — both medical students in Dr. Duhé’s skills course — offered to assist with research and writing the case report. The trio began the challenge of documenting the complex medical case. Beginning in the summer of 2025, in meetings and online collaboration, the team began “putting pen to paper,” Dr. Duhé recalled. 

The team’s work was published in September, in the American Journal of Emergency Medicine. 

It was a profound experience that resulted in publication in the premier publication in the field of emergency medicine and impacted the medical school experiences of Metts and Stravolo, opening their perspectives to the variability and nuance of real-life clinical situations, teaching them to be ready for anything, while also helping affirm the plans of both medical students to pursue medical careers in emergency medicine.  

“As medical students, we're taught to recognize classic symptom patterns, link them to textbook diagnoses, and follow standardized treatment protocols,” said Metts, a second-year medical student at SOMG. “This ‘by-the-book’ approach is critical in developing our clinical reasoning skills and providing a structured framework for problem-solving.” 

“However,” Metts added, “one of the inherent limitations of all early medical education is that patients are often presented as textbook-perfect cases. We're taught that if a patient presents with symptoms A, B, and C, they likely have condition X  —  and that condition X should be managed with treatment Y. While this model is critical for our learning, it can unintentionally foster a rigid mindset that doesn’t account for the complexity, variability, and nuance of real-life emergency clinical scenarios, which was reinforced to us through this case.” 

The key learning point of the American Journal of Emergency Medicine article is that people who have had a total laryngectomy breathe only through their neck stoma. Emergency medicine clinicians must never try to give oxygen or place breathing tubes through the mouth or nose — as it won’t work, and could only make patients sicker by filling their stomach with air. In emergencies, quick recognition of this altered anatomy and acting directly at the stoma can be lifesaving, as it was for this patient, said Dr. Duhé.

“The paramedics were not sure how to handle this incident as the patient was bleeding heavily from his stoma, and there was a large blood clot blocking the opening,” said Dr. Duhé. “His oxygen levels were dangerously low, and we needed to intervene quickly.” 

“We were able to manually remove the clot, which immediately improved his breathing,” said Dr. Duhé. “We then controlled the bleeding by applying pressure to his neck, giving him special medications to help his blood coagulate, and replacing the blood he had lost with transfusions. Once he was stable, he was transferred to Greenville Memorial where he was seen by the ENT service and eventually stabilized in the ICU. They found that the bleeding was caused by erosion inside his trachea.” 

“Prepared for anything”   

For both Stravolo and Metts, second-year medical students at SOMG, the case highlights how every patient and each medical case in emergency medicine can be unique. And as aspiring emergency medicine physicians, they will have to be prepared for anything.  

“There are patients in our community that are going to need a specialized point of care rather than a standard process of care,” said Stravolo. “Both relying on everything we learn in medical school and remaining quick on our feet in sudden and challenging situations will be crucial.”

The case in the ER, that early morning, illustrated how acute cases can be addressed in emergencies. Furthermore, the patient couldn’t speak adding to the complexity of the situation.   

“The coordination among team members in the ER to readily assist in a timely, supportive, and precise manner is both thrilling and deeply inspiring,” Stavolo said. “The leadership and collaboration required to manage such high-stake cases is what continues to motivate medical students today.”

Often physicians address how symptoms or problems would normally present and a standardized way of addressing those issues. But this case taught Metts she will have to be “ready for anything that might come along.”

She added, “I love the chaos and thrive in situations not knowing what is coming.” Additionally, in the ER “you treat the entire population and can make a big difference in that aspect.”

As for their future careers in medicine, Stravolo and Metts know they want to help patients in emergency care, and they feel the training and learning opportunities at SOMG continues to prepare them for the future.