1) Another anaphylactic shock. She came to the ED within 15 minutes of eating pizza with a “lump” in her throat and tightness in her lips. she got .5mg of subQ epi STAT and felt much, much better.
2) A man who developed a rash to his antibiotic after nasal reconstruction surgery for a deviated septum was told by his surgeon to come to the ED if he developed trouble breathing, being concerned about an anaphylacitc reaction like the lady above. He came to my ED at 2 AM. OUr dialogue went like this:
“Are you having trouble breathing?” I asked.
“What do you mean,” he asked back.
“Is it difficult to get enough air?” I restated.
“Well, I can’t breath through my nose,” he said.
You do the math…
3) Toxic Shock Syndrome in a preteen due to a superinfected poison ivy!
Sorry…make that concentric circles and fields of kittens.
The smallest loop around the lake (without getting wet) is about 4-5 miles, but bikes are not allowed. I had to take my first bike rides “around” the lake by doing smaller partial loops, going down one side, turning away from the lake and circling back in. An hour or so on gravel roads alongside Amish teenagers on horseback is a great way to spend a summer evening. But as I’ve gotten stronger, I’ve expanded my loops, first turning to the east of the lake, then to the west of the lake.
Finally, the other day, I went for it…a full circle. I had no idea how far it would be, but was fairly certain I could do it. I finally added a complete concentric circle to the forbidden footpath around the lake. About halfway around, as I trudged up a long steep hill, I passed a perfect farm on my left, with a red farm house, a weathered barn, a cornfield, and a plowed field of hay next to the road. As I almost did track stands on my way up the hill, a family of about six kittens gathered in the mowed hay to watch me work. THey lined up, one by one, a calico, an orange fluff, a black fuzzy, a white puff, taking a break from hunting field mice, just long enough to see me to pedal by.
I spoke with God the other day. She was 24, and had recently suffered her second miscarriage. God’s boyfriend sat in the corner of the room crying. She told me that she loved everybody, that there was no war in Iraq and that the government was testing her. “I’ll prove myself to the government if I have to.”
Overall, she was very peaceful to talk with, very serene. We were all OK, she told me. Strangely I found that comforting. The mother of God convinced her to be admitted to the hospital so she could come to the conclusion that she was not, after all, God. As I cosigned the voluntary commitment form, I wondered why we had to destroy her delusions…just so that the rest of us would not have so much to live up to? I felt sorry for all of us.
OK, really, my enthusiasm has not returned. I’m just letting my bitterness and cynicism simmer for awhile. I’m focusing on becoming faster, more efficient, making quicker (better?) decisions. The more patients I see, the more practice I get. You’d think at some point it would become rote.
Today, I saw a 2 year old boy who hit a car. That’s right, the car didn’t hit him, he hit the car. He ran out into the road, and hit the side of the car as it was moving. He hit his noggin, got thrown back on the ground, passed out, then woke up crying. A short helicopter ride later, he was an hour and a half from home in my emergency department. Imagine trying to take a history from a 2 year old whose parents are en-route over an hour away!
So I did the basic advanced trauma life support workup. No brainer for most of it…labs, c-spine, chest, pelvis films. Other studies are at the discretion of the examiner. He had a big bump on his noggin, and had passed out. Easy enough…CT Head. But what about his belly? He had a scrape on his right lower rib cage, didn’t look too bad. He’s not crying, he’s stable, but…he’s not a very good historian. I waffled back and forth while he was getting his plain films done. If he was a 22 year old drunk acting the same way (but age appropriate)I’d probably get a CT of his belly, but somehow, I enjoyed the simplicity of a workup including just the barest of essentials. He’ll have to be admitted, I reasoned, for observation anyway. They can scan him later if he gets worse.
Well, sometimes I just need a kick in the can to do what’s right. Radiation to babies bodies aside, sometimes it’s just better to scan it all. I sent my attending in to see him. “I’ve missed too many liver lacs,” was his conclusion, “scan his belly.” I thought it was a wild goose chase. But wouldn’t you know it. Not just one, but TWO liver lacs! Man, my boss is smart!