Paramedics bring in a three year old girl who was hit in the head by a television that had fallen off some shelves. It appeared to be a glancing blow – with some bruises to the side of the face and a bump to the back of the head. The only problem was that she was just crying on the backboard and she wouldn’t move her arms or legs.
Take a pen and squeeze the barrel against the base of your fingernail. Hurts like heck, right? I did that to the little girl a few times on each hand and all she did was cry. Didn’t flinch. Didn’t pull her hands away. Just cried. I lifted her hands up and dropped them over her face. Usually patients will pull their hands to the side. She let her hands flop right onto her nose.
I reached through the collar and pressed on her neck. Didn’t feel any step-offs or other abnormalities. Again, she just cried when I touched her neck.
“Can we get her off the backboard?”
On the inside, I was freaking out a little. “Ummmm … NOOOOO. Are you out of your MIND? Can’t you see she’s paralyzed?”
On the outside, I stayed calm. “Just to be safe, we should probably leave the collar on until we make sure nothing is broken.”
So I bit the bullet and ordered CT scans of her head and neck.
She was over in the radiology department for quite a while. I kept checking the PACS machine to look for the films.
Finally, the images showed up.
Normal head CT.
Normal cervical spine CT.
At least that’s the way that I read them.
I went back into the room to check on her. She was up off of the board, her collar was removed, and she was playing on her mom’s iPad. Back to normal. I did another neurologic exam and everything was now normal.
Wow. Complete neurologic recovery from ionizing radiation?
So I mentioned to the patient’s parents that I was a little worried about her when she wouldn’t move her arms or legs on her initial exam.
Her dad says “That? Oh she always does that when she gets upset.”
“You mean she always just goes limp?” I asked.
“Yeah. She comes around after 20 minutes or so. Just like she did tonight. We tell her not to do that, but … you know three year olds.”
I smiled and nodded … and I thought to myself “why didn’t you tell me that BEFORE I messed my undergarments?”
And I think back to the medical school gurus who used to tell us that 90% of the patients will tell you what is wrong with them if you ask the right questions.
Not sure how to add this fact pattern to the history, though.
This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.