Tuesday, October 09, 2007

Idiot Wind

I meant to write this up a few days ago. I was out with a few friends, one of whom revealed he reads this from time to time. Clearly not very frequently, as he was complaining I'd not written anything for months. Anyway, I've been meaning to write for a while, but everything seemed very bleak, and I wasn't sure self pity was what's called for.

I'm on the Paediatric ICU for a month at the mo', which is frankly terrifying. More of that later. Most of the cases I've seen in the ED have been either 'mundane' or depressingly bad news. Possibly more of them later, too.

A few days ago, we got a all too familiar call. A gent in his 70s had been found collapsed by his wife in the bathroom, in the middle of the night. The Ambos reported him agitated, irritated. "Irritated" has a particular medical meaning. It, usually, does not mean that the patient is in a bad mood. The implication is that there is something irritating the patient's brain, and that there behaviour is irrational, disturbed. The irritant is usually blood.

I am sure you don't need me to tell you this is not ideal.

This fella fitted the pattern. Lights on, no-one home. Large bruise over his right eye. Not much else to see, but high blood pressure. Forcing blood into his tight swollen brain. The whole thing smelled grim.

The usual pattern - a modified rapid sequence induction, with intubation; waking a groggy radiologist to fix the scan; the long dark walk to the scanner.

In the meantime, there's always the family. I still hate this bit. I guess it's alright. Once I start enjoying it, someone needs to take me out back and shoot me.

Most-times, the family know. They may not be ready to accept it yet... but they know. We talk through the possibilities, the 'maybe's, the 'might-have's, and the 'what-will-be's. It's difficult, because in my heart, I know this guy's gonna have an huge bleed. I know I'm going to be back in here in half an hour, with the scan results, telling them there's no hope for a positive outcome...

And they know I know. We can see it in each other's eyes. I think I'm getting worse at lying with age.

So... scan is normal. Yup, normal. No bleed. Which doesn't mean he hasn't had a big fuck-off stroke. (And, yes, that's the technical term) It might just mean it's thrombo-embolic, and that we can't see it yet.

Will he wake up? Time to find out. My friendly gas man turns of his milk of amnaesia, and up he comes. We pull the tube...

There is the usual coughing and spluttering, and then his eyes... focus. He looks around, confused, and his words are husky, but he knows his name, he knows his date of birth. His neuro is exam is normal.

This case, which I knew was going to be a bleed, to be a disaster; which I knew was going to end in me ruining another family, was probably micturition syncope and a minor head injury. Well, minor-ish...

I go to see his family, and I have never been so happy to be wrong.

(There y'are J...)


Calavers said...

Nice to have you back.

What great news! I think it must be a defence mechanism to steel yourself and brace yourself for the worst?

DrShroom said...

Thank you...
I'm not sure it's a defence mechanism, so much as cynicism born of experience... but maybe that's just semantics?