Nathan J Romero

My experience with Nathan Romero in the emergency room left me deeply concerned about the level of medical accuracy and openness to clinical nuance. During my mother’s visit, I asked whether it was possible for a patient to have hepatic encephalopathy despite normal ammonia levels. He stated definitively that it was “not possible.” That response is not aligned with widely accepted medical understanding. Hepatic encephalopathy is a complex clinical diagnosis, and ammonia levels alone are not considered a reliable or definitive indicator. Numerous reputable medical sources and guidelines acknowledge that patients can present with hepatic encephalopathy even when ammonia levels are within normal range. A simple review of current literature reflects this. What was most troubling was not just the inaccuracy, but the certainty with which it was delivered. In emergency medicine—where lives and outcomes hinge on careful consideration—there should be room for clinical uncertainty, curiosity,… and a willingness to explore beyond a single data point. Patients and families rely on providers not only for treatment, but for informed, thoughtful judgment. In this case, I felt that a more thorough and evidence-based approach was warranted.