Monday 9 March 2015

Dead wrong

I've spent several decades compiling my lexicon, and I must admit I'm quite proud of it.  Along with all my fancy-schmancy medical terminology that I also sling around, it allows me to sound as arrogant and haughty as possible (or so the readers at the Daily Beast would have you believe).  I may not quite be a master of language, but I'm fairly proficient, regularly adding to my repertoire when new words and phrases arise.  For example, I just recently (and extremely grudgingly) added "selfie" to my personal dictionary, though I had to take several showers afterwards and continue to feel guilty about it.  There just isn't any other appropriate good word for it.  Yet.

Anyway, while I do occasionally add words and phrases, I very rarely remove anything since I seldom find that to be helpful or useful in any way.

After meeting Teresa (not her real name©), however, that philosophy was thrown all to hell.

So what word or phrase was removed?  Stay tuned.  You know I'll get there.

In medicine just like in the rest of the world, common things happen commonly.  In the trauma arena car accidents are common, falls are common, assaults are common.  Gunshot wounds and stabbings are common.  Hangings, on the other hand, are rare.  I've only seen a few, and they tend to be prisoners who "pretend" to hang themselves just to get out of jail for a few hours.  Real hangings don't typically make it to the hospital, but sadly Teresa fell into that rare category of those who do.

Teresa had a long history of depression and had taken several different anti-depressant medications over the years with little improvement.  She had been texting with her daughter early one afternoon, and nothing seemed awry at the time.  When her husband got home later that day, he was shocked to find her half dead, hanging by a bed sheet slung over the balcony in their front foyer.  He immediately lifted her up and let her down, but she was unresponsive, barely breathing.  He called emergency services immediately, and when they arrived she remained completely unresponsive.

She stayed in that state until she was brought to me about 20 minutes later.  On my initial assessment her skin had a grey tinge to it, her eyes were closed, and her only movements were decerebrate posturing, an extraordinarily bad sign indicating very severe brain damage.  She didn't have any other injuries, so after putting in a breathing tube and starting mechanical ventilation I got a CT scan of her brain and cervical spine.  As expected I didn't find any acute injuries.  Anoxic injuries (ie those cause by lack of oxygen) typically take several hours to show up on a CT scan.

After reviewing the scans, I took a deep breath and went out to speak with her family.  Her husband, children, parents, and at least 20 other family members were there - I've never seen the family meeting room that full.  Clearly this was a woman who was very much loved.  Regardless, I was blunt, direct, and thorough as I always am.  I told them very carefully that though I didn't know how bad her brain injury was, it looked bad.  Really bad.  REALLY BAD.  As in, I-don't-expect-her-to-last-through-the-night bad.

I went to check on her the next morning before leaving the hospital, and nothing had changed.  Though her vital signs were stable, she was still comatose.

So I went home, awaiting the inevitable.  And exactly as I was anticipating, I got the expected phone call later that afternoon from the intensive care unit.  "Hi Doc, I'm calling about Teresa."

"She passed?  What time?" I asked.

"Oh no, she's doing really well, she's extubated, she's talking, she's awake and alert, and she's following commands appropriately.  We want to transfer her out of the ICU to the trauma ward."

It takes a lot to render me speechless, but I must have sat there in stunned silence for what seemed like an hour (but was probably closer to 2 seconds) before I managed to stammer my excellent, eloquent response:

"Wh . . . wait, she's what?"

When I walked into her room to see her the next morning, she looked right at me with a big smile on her face.  The only one in the room smiling bigger was her husband.  She was completely awake and alert, though she had no recollection of any of the events from the previous two days.  There was not a single sign that she had nearly died less than 24 hours prior, save for a few minor abrasions on her neck.

After consulting with a psychiatrist (obviously), I transferred her to the psychiatric ward the following day.  She clearly needed some major help, though not of the physical type, and much more specific aid than I am capable of offering.

While I thoroughly enjoy being right, sometimes I don't mind being wrong.  This was obviously one of those times.  But just how wrong was I?  Flat wrong?  Completely wrong?  100% wrong?  Categorically wrong?

Maybe.  But thanks to Teresa, I'll never again claim to be dead wrong.


  1. I recommend retaining it, not because I expect you to be dead wrong, but because I am sure someone who fails to meet the critical qualification to become your patient will because HE (or she) is "dead wrong" about the safety of an action.

    meanwhile, we have a similar state, which my father has trained me to avoid, known as "dead right" - which we apply to such situations as a person struck by a car while in a crosswalk.

    1. Mom always said, "yeah, they'll put it on your tombstone: 'But I had the right of way!'"

  2. (not to be confused with "Dead, Right There")

    1. There is no "like" or thumbs up button here, so I had to let you know that this made me laugh out loud.

  3. I hope her family doesn't attribute this to any higher power. :S

    1. Honestly, why not? I'm irreligious, but if others take comfort from belief, why is that a bad thing? As long as it isn't taken to the extreme of "We don't need doctors or medicine, just prayer" (which is rarely the case), I don't see what harm it does believing that her second chance was due to a god, rather than luck or chance. In this case, it isn't ignoring the effort of a doctor, because as DB said, as far as he could tell, she was not going to recover. It was just one of those things that happens for unknown reasons. Who cares what they ascribe those reasons to?

    2. It's a good a reason as any. She's been given a second chance. The question of why is up to her to find the answer.

      To quote Life of Pi.
      "The world isn't just the way it is. It is how we understand it, no? And in understanding something, we bring something to it, no? Doesn't that make life a story?”

  4. This comment has been removed by a blog administrator.

    1. Anon - it was funny the first time, less so the second, and now it's just disgusting. Stop.

  5. Had an elderly status epilepticus en route to our ER have a respiratory arrest in the ambulance due to bensos via the Paramedics. I promptly intubated her on arrival. Had flack from the admitting Internist (WHY did you intubate her, she's old and has COPD ???!!!). He promptly extubated her, pumped her full of more bensos for intermittent seizures, and told her family she'd had a huge stroke precipitating the seizures, and would not survive overnight (no CT done). The look on his face when she slept off the bensos, sat up in bed and asked what was for breakfast ? - PRICELESS. She lived at home, happy, for another 8 years...

  6. Nothing to do with this posting, but I thought you might enjoy this link:
    Made me chuckle!


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