Wednesday 31 October 2012

Knowing better

Everyone knows the saying "Doctors make the worst patients", and it's completely true. Even though we know something's wrong, we tend to neglect ourselves in order to take care of others first. It's selfless and altruistic...and stupid. But some people know exactly what's wrong with themselves and still choose to put not only their own life in harm's way, but others' as well.

A woman was brought to me around 8PM a few nights ago after she lost control and rolled her car over several times. The medics informed us that when they arrived on the scene of the accident, the patient seemed "post-ictal" - like she had just had a seizure. That report always makes me very nervous because a seizure can be a sign of a serious head injury. This time was no different.

Or was it?

We did our workup, and she didn't appear to have any serious injuries. Her X-rays and CT scans all looked completely normal, as did her physical examination. As I was finishing her exam, she told me that she did, in fact, have a seizure disorder. She swore that she took her anti-seizure medicine that morning just like every morning. But she also admitted that what typically brings on a seizure for her was fatigue.

Sound strange? Oh, just you wait.

It turns out this was her first day back to work after having a baby three months ago. Now in case you weren't aware, babies make you really, really tired. No, let me rephrase that - babies make you so tired that you forget what sleep feels like. But not only was it her first day back to work, she decided that a double shift would be a great idea.

BZZZT! Wrong! It was a really stupid idea that made her exhausted. An even worse idea, one that put her and every other person on the roads (including my wife and children) at risk, was to drive home. She could have called her husband for a ride. She could have asked a colleague to drive her home. No, she drove herself.

As I was explaining how lucky she was not to have injured anyone, I glanced over to her bedside stand and noticed an ID badge from another local hospital.

"Oh, you work at a hospital?" I asked her.

Yes, she told me. She's a nurse. I felt my ire rising. "What field of nursing are you in?"

She couldn't even look me in the eye when she told me: neurology.

That's right, she's a damned neurology nurse who takes care of seizure patients on a daily basis, one who has had a seizure disorder herself for several decades, one who knows exactly what triggers her own seizures, and one who deliberately broke nearly every possible seizure rule and is lucky she isn't dead. I made sure that her husband was in the room to hear all this. From now on, I told him, if you can't drive her to work, make sure she takes the bus.

Whenever I see a stupid driver, I want the power to revoke driving licences. Never has that desire been stronger than that night.


  1. Just a question Doc, I thought people who suffer from seizures regularly aren't allowed to drive? My friends epileptic and I recall her saying she isn't allowed to get her license unless she's seizure free for at least three years, or am I totally off base with this?

    1. In Georgia you have to be seizure and syncope free for six months and MD's can petition the DMV to temporarily revoke a drivers license. It varies by state.

  2. I'm thinking that it depends on your place of residence and considering some of the spelling tendencies Doc displays, I don't think he lives in the States. With that in mind, I'm almost certain that his place of residence simply hasn't addressed the issue.

  3. Something tells me she has 'do as I say, and not as I do' tattooed across one of the hemispheres of her brain.

    And 'several decades'? How old was she, Doc?


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