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The Last Patient of a Long Night Shift

Sunday, February 17th, 2013

By Birdstrike M.D.

 

My first night shift in a stretch of 7 was almost over.  It was 6:15 a.m. and I had to keep moving otherwise the minute I would stop, my eyelids would drop like two ton shades and I’d fall asleep.  That never makes for a good drive home after a night shift.

“Got time to see one more?” asked Jenny the nurse.

“Do I have choice?  The door-to-doctor time storm-troopers would have it no other way,” I grunted back, eye lids drifting closed.

“Febrile seizure,” it said.

Good, this should be quick and easy, I think to myself.  We’ll give some Tylenol, reassess in 30 minutes and this baby will be happy, smiling and bouncing off the walls.  That way I can get out of here at 7 a.m. and be home in bed with my eye blinders on drifting towards sweet REM sleep at 7:20 a.m.  My sanity depends on it.  15 feet away, I head towards the room.  Looking into room 4, I expect to see the usual post-febrile seizure toddler, sitting up in bed, recovered, awake and well appearing.  First I see the child’s mother, well put together, attractive, smiling and relaxed.  I cross the threshold to the room, look down on the hospital stretcher and I see a child, about 1-year-old, still seizing.  Still seizing?  I think to myself.  This isn’t right.

“Jenny, get in here!  We’ve got a seizing baby,” I say.  I look down at the child, who is pale, head turned to the right, with the left arm twitching violently.  “Call respiratory!  Jenny, you get the IV, I’m going to start bagging.  Someone get the Broselow tape and some Ativan.  Let’s stop this seizure.  Get some diastat, too.  We may need it.  As I bag the child, Jenny quickly gets an IV in.  We give a dose of Ativan and the baby stops seizing quickly.  The O2 sat is 97%, the baby is breathing spontaneously and I stop bagging.  I put an O2 mask on the baby.  I feel the brachial and femoral pulses.  They are bounding.

Considering the baby has normal vitals, I turn to Mom hoping to get some history while hoping the baby will quickly awaken from the post-ictal slumber.  “Mom, hi, I’m Doctor Bird, tell me what happened please.”

She looks at me and smiles.  Her lips spread apart and reveal a soul-sucking brown smile.  Why is she smiling?  Her baby just got done seizing?  Why isn’t she panicked?  I look towards Jenny the nurse whose face is beet red and stressed like mine, after a 12 hour night.  I shoot a glance at the clock and it’s well after shift change now.  I’m fried.  I haven’t slept in over 24 hours.  I look back at Mom and I realize she’s the calmest one in the room.  There’s something really, really wrong here.  In the corner of the room is a man sitting on a chair that I hadn’t noticed before.  He’s smiling.  I look at him.  “Hey doc!  How’s it goin’?  Havin’ a good night?” he asks with a smile and a laugh as he slaps his knee.  Having a good night?  I’m having a horrible night, I think to myself, and I’ve got a seizing baby on the stretcher in front of me.  It doesn’t seem to be cramping his style too much, however.  I feel the energy drain right out of my chest.  At that moment I know exactly what the diagnosis is, and I feel like I might puke my guts out.

“Charge nurse?  Please escort them to the family consult room.  Thank you.   Suzy, call the chopper, now.  Jenny, let’s get this baby tubed.  Tell CT to clear the table, we’ll need a scan in 2 minutes.  Call PICU at —–  —— Medical Center.  We’re flying this one out!  Call Social Services and the Police, too.”

Once intubated, stabilized and after another dose of Ativan we shoot over to CT.  I watch the image slices appear on the computer monitor one by one.  My stomach turns over.  I see just what I feared: massive bilateral subdural hematomas (bleeding around the brain.)  There are skull fractures.  There is a brain that looks obliterated.

The helicopter crew arrives and prepares the toddler for transport.  As they wheel out the door with our tiny toddler in tow, Jenny the nurse, the respiratory therapist, Suzy the unit clerk, Bob the charge nurse and I all just look at each other.  Nobody says a word.  What is there to say?  We all know as much as we need to know.  Off we go, out the ED doors headed home, exhausted as the sun comes up after a very long night shift.

A few days went by.  We all tried to work through the next few shifts pretending like nothing big had happened.  It’s “just a job,” right? A few muttered comments here or there but most everyone tried to work past it.  In a case like this, despite knowing you did all you could do, it’s hard not to feel like somehow you failed, since at the end of it, a child remains brain-damaged or worse.  I tried to forget about the case and move on, but I had to get some follow-up.  In a rare slow moment, during a shift a few days later I asked, “Suzy, why don’t you call down to the PICU at —–  —— Medical Center.  Let’s see how the baby from the other night is doing.  I’m sure we could all use some good news right now.” I was hoping that my worst suspicions would be proven wrong, and my cynicism would lose out to wishful thinking.  I sat down to check the internet for the weather while I waited.  Already up on the screen, was the local news site.  The headline said:

“Shaken Baby Dies: Mom and Boyfriend Charged with Murder”

“You know what Suzy?  Hang up the phone.  We don’t need to call.  I’m sure everything turned out just fine.  You all did a great job with that baby,” I said.  I headed to see the next patient, chief complaint: “Itchy nose.”

“Hello, Mrs. Jones, I’m Dr. Bird, how can I help you today?”

 

 

………………………………………………………………………………………………………………………………………………………………………………………………………………….

This author does not divulge protected patient information or information from real life court cases.  Any post that appears to resemble a real patient or trial can only be by coincidence. This author does not post, has not posted and will not post factual identifying information about real patients.  To the extent that any post is based on the real life experiences of the author, names, dates, ages, sexes, locations, diagnoses, and all other factual information are routinely changed to the extent that it should be considered fictional.  Any opinions expressed here are of the author alone and not those of epmontly, WhiteCoat, my employer or any of the hospitals with which I am affiliated.

Open Mic Weekend

Sunday, December 16th, 2012

OK, so I didn’t get home until late yesterday, so it’s only a half-weekend.

So between shopping trips, you can still post any medically-related comments, questions, or observations in the comments section. I’ll try to answer any questions on Monday or Tuesday.

As usual, the only rules for comments are that there are no personal attacks and that the comments/questions have to be medically-related.

Have a safe and enjoyable weekend. Only 9 shopping days until Christmas, you know.

Open Mic Weekend

Saturday, November 17th, 2012

It’s time for another episode of Open Mic Weekend and our special guest is … you.

All weekend everyone is welcome to post any medically-related comments, questions, or observations in the comments section. I’ll try to answer any questions on Monday.

As usual, the only rules for comments are that there are no personal attacks and that the comments/questions have to be medically-related.

Have a safe and enjoyable weekend.

Oh, and Go Irish!

Open Mic Weekend

Saturday, October 20th, 2012

Welcome back for another edition of the Open Mic Weekend

What’s been on your mind since last month?

All weekend everyone is welcome to post any medically-related comments, questions, or observations in the comments section. I’ll try to answer any questions on Monday.

As usual, the only rules for comments are that there are no personal attacks and that the comments/questions have to be medically-related.

Have a safe and enjoyable weekend.

Medically Cleared

Monday, October 1st, 2012

Chief Complaint: Claustrophobia

HPI: Arrested after beating girlfriend with a wooden table leg. Put in jail cell. Began shaking uncontrollably, flopped about on the floor of jail cell, and screamed repeatedly that the cell was closing in on him and he has terrible fear of enclosed spaces.

PE: Wiry multiply tattooed patient sitting in room with two deputies laughing and jawing about football game on TV. Vital signs normal. Physical exam normal.
Mentioned to patient that he was in an enclosed room in the emergency department (door closed for patient privacy, of course) and was having no symptoms, so claustrophobia did not appear to be the cause of his underlying maladies. Deputies began laughing at him. Patient let loose with string of obscenities and said he was able to control his fears when he was with other people.

Diagnosis: Aggravated domestic battery with acute onset of jailhouse blues.

Plan: 5-12 years in the Greybar Motel. No, you’re not getting a doctor’s note saying that you don’t have to go to jail and you’re not getting a Xanax prescription, either. I can write on the discharge papers for you to be kept away from wooden table legs if you’d like.

We may be forced to give a couple of days off of work for questionable reasons to keep the patient satisfaction scores up, but a note for 5+ years off of jail just ain’t happening.

Have a nice evening and a pleasant decade.

———————–

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.

 

Is It A Full Moon?

Thursday, September 27th, 2012

[Rrrring … rrrring]
“Hello, Metro General Emergency Department, how may I help you?”
[Man with voice kind of like Steve Harvey] “Yeah, do you all do DNA paternity testing down there?”
“Ummm, no. No emergency department does paternity testing that I know of. You’d have to get that done through your doctor’s office.”
“I don’t have no doc-tor and I need the results by tomorrow morning. My old lady’s trying to take my kids to California and she’s gonna try to make me pay child support for them. I don’t think they’re mine. I gotta get a court injunction or something to stop her.”
“You’d have to discuss that with a lawyer or with a judge. We don’t do that stuff here.”
“Whatever”
[click]

Ten minutes later …
[Man with voice kind of like Steve Harvey faking like he has a cold] “How long’s the wait to do DNA testing tonight?”
“Sir, I told you before, we don’t do DNA testing in the emergency department.”
“That wasn’t me.”
“Then it was someone calling from the same phone number. We have caller ID, you know.”
“You get me the supervisor, then.”
“Sir, she’s going to tell you the same thing. We don’t do paternity testing in the emergency department.”
“Whatever.”
[click]
“Did you try Maury Povich’s emergency pager?”

Turns and looks at me.
“I want those three minutes of my life back.”

———————–

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.

My Three Patients

Monday, September 10th, 2012

I’m not going to tag anyone else for this meme, but I liked the idea that Ramona Bates (Sutured for a Living and @rlbates) put out on her Twitter feed from Wing of Zock. Play along if you want and drop a comment in the comments section if you do. I’d like to read them.

Describe the three patients that had the greatest impact upon you and how they shaped your career as a physician.

Not exactly sure I can say how each of these patients shaped my career, but below are three of the patients who have had a large impact on me.

The first patient I ever saw in an emergency department as a student was probably what turned me on to emergency medicine. Before my emergency medicine rotation, I was pretty much set on going into orthopedic surgery.
It was kind of a crazy situation. Inner city emergency department. Patients stacked up in the hallways. People pushing me out of the way. Me getting lost. Where is the attending around this place? Then one patient on a bed in the corner caught my attention. She was yelling at another patient down the hall. He’d yell at her. She’d yell back at him.
(more…)

Open Mic Weekend

Saturday, August 18th, 2012

Back for another open-mic weekend.

All weekend everyone is welcome to post any medically-related comments, questions, observations in the comments section.

Only rules are that there are no personal attacks and that the comments are medically-related.

Have a safe and enjoyable weekend.

Open Mic Weekend

Saturday, July 7th, 2012

Back by popular request …

All weekend everyone is welcome to post any medically-related comments, questions, observations in the comments section.

Only rules are that there are no personal attacks and that the comments are medically-related.

Will try to respond Monday or Tuesday with answers.

Stay cool over the weekend.

Format Change

Thursday, May 17th, 2012

I decided to stop posting Healthcare Updates every Monday. For one, if I get overwhelmed on a Monday (like what has happened a couple of times in the past month) and can’t get everything out into a post, then it doesn’t get published. Plus, there’s a delay in getting the stories out there and I want to get fresh stories to the ten or so of you out there that regularly read the blog.
Instead of a weekly Update, I’m going to try to publish a group of 5-8 stories whenever I get to that number. Maybe it will be daily. Maybe it will be a couple of times per week. We’ll see how it goes. If I get ten angry e-mails, I’ll change it back to once a week.

As always, if you have any suggestions for content or stories, drop me an e-mail or leave a comment below. Always happy to republish patient stories as well.

Thanks!

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