Friday, November 23, 2007

Smug Mode

Inspired by the brag-file post I referred to in the previous post, a tale from Shroom's days on the Expensive Scare Unit:

As a 'non-specialist' specialist I always enjoy the opportunity to demonstrate that I actually know stuff. On this particular night, I was asked to review a young-ish man in respiratory distress. He was a local drug user admitted with a progressive neuro-muscular weakness. A brief history, but with features highly suggestive of Guillain-Barre syndrome.

This fella actually has a few atypical features, particularly in his cranial nerve exam, and his Donald-Duck - esque speech. Very eminent men and women had consulted on his case, and pronounced: the diagnosis was Miller-Fisher variant GBS. He had been deteriorating on the ward, and now his respiratory muscles were dysfunctional. His blood gases had gone off enough to qualify him for an entry to the free ventilator prize draw. A chance for healing through the medium of 24cm of semi-rigid plastic.


When I got the phone call, something just didn't seem right. I freely admit that this was mostly because I knew little about GBS, and foxtrot alpha about the Miller-Fisher variant. Nonetheless...

Has this fellow got a fever?, I wondered...

Why, yes he has.
And he's a drug user... Does he have an abscess?

Um... yes he does. On his bicep.

AHA! Cries the Shroom.

This is not GBS; this is botulism. Wound botulism, say I.

I like to think that the whole hospital fell silent with amazement. It didn't, and in fact we admitted the fella and treated for both diagnoses until the mouse lethality bioassay confirmed botulism.

(Yes, they inject mice with the patient's serum, and wait to see if they die. Their fur stands on end first, and they develop narrow, waspish waists. Go figure; if you think that's weird, the botulinum anti-toxin comes from a special horse, living it large in Wales, somewhere. Ah, medical science...)

Smug mode activated...

(I didn't tell anyone I'd seen an identical case a few months before. I still dine out on this story...)


911DOC said...

dear dr shroom.
i hope you don't mind if i add you to my blogroll? also, how does one train for emergency medicine in the UK? love your blog.

911DOC said...

wound botulism? you sly dog. mice? really?

911DOC said...

sounds like the same deal for me. 4 college, 4 med school, 4 residency, near burn out. obtw, i tested out as superhero william wallace. i like that.

911DOC said...

I have a feeling that you came out of high school and went into your six years of university/medical school. Is this correct? This would explain the apparent discrepancy. I did four years of college, then four years of medical school, then four years of residency. Sill, your time in training seems long. If it's done with better hours than we have then I'll trade with you!

911DOC said...

We've got to get this thread one one page or folks will think we are crazy. More curiosity... when you speak of your training after medical school, it sounds as if there is some variability. My residency included an internship (rotating) through many services and included many 36 hour call nights. My three years in Emergency Medicine was a bit brutal and likewise included many call nights and 90 hour weeks. It seems as if the UK and NHS do it much differently. Rather than exlaining it to me is there a site that details your path?

Medblog Addict said...

"We've got to get this thread on one page or folks will think we are crazy."

I think most people already know y'all two are both a little crazy. That's what makes your blogs so much fun to read. Although, Dr. Schroom, I haven't come across any other doctor who has posted such a revealing picture of himself (not your blog pic, silly, the shirt pic) hee,hee, yes, I still remember.