Tuesday, September 29, 2009

One By One

South Coast General provides pathology, thick and fast. One by one, sometimes all at once.

Today's shift provided more good evidence that empiricism lets you down. A fella came to us, pinged ahead by the MobiMed, a computer link up with the Ambos, allowing them to flag patients and their ECGs. Telemedicine, I guess we should call it.

It offers real time comms with the Ambos, and sometimes, the opportunity to see the poor buggers go off, en route, in real time. The first message forewarned of a patient with a headache and left-sided weakness. Otherwise, stable, so far, nothing so unusual, unfortunately. Within minutes, they pinged back. His Glasgow Coma Score had dropped to 5. This is a score ranging from 3 (which even a corpse would score) to 15. 5, you can deduce, is bad.

Minutes later, he had dropped to 3, and was fitting.

He was still fitting when he arrived, and the thought going through all of our heads was one of a head full of blood. Haemorrhagic strokes, or intra-cerebral bleeds produce cerebral irritation, and, in my experience, often result in seizures. The outcome is always bad.

We stopped the fits, relatively straightforward, and prepped him for the CT scanner, anticipating the dread images that would allow us to decide his fate. The family were unprepared; they always are, to varying degrees. This family, especially unprepared, left devastated by my visit, sold an awful bill of rights by my 'pep-talk'. It's hard to offer hope when you don't believe here is any.

Whilst he went to the scanner, the Department coughed up its next surprise - a woman described as 'normally fit and well', looking as far from those words as I've ever seen. To start, she was the very definition of morbidly obese. Her BMI approached that of Tonga, and any skin that wasn't parchment white, was mottled purple. Apart from her eyes, bright, and frightened, she could have been one of our failures.

The only history, from her niece, was of abdominal pain. Her belly was ice cold to the touch, and firm. I was sure her abdominal wall was rigid, the hallmark of peritonitis, a diffuse inflammation of the lining of their abdominal cavity. This can be caused by many pathologies, all of hem highly undesirable. Intestinal perforation, for example.

I don't wish to blind any of you with science, but having a belly full of shit should be high on people's list of things to avoid happening to them. This woman looked as if she'd been harbouring a belly full of shit all week, and was just about ready to give up the ghost.

To be fair, there was some debate as to why she was so ill, but actually, when you're that sick, the exact cause is, probably, somewhat moot in the initial phase of resuscitation.

Either way, I had now managed to stack up two families, next door to one another, for whom I represented their worst day. Families united in grief, never further apart.

As it happened, the first chap's CT wasn't as bad as I feared, although I worry this will only prevent the inevitable final delivery, and the second showed a belly full of pus, not shit.

Worth trying to keep track of your tampon, it would seem...

1 comment:

jon said...

"Her BMI approached that of Tonga" - nice turn of phrase.