July 14th, 2007 by Dr. Val Jones in True Stories
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This story is from my intern year diary. It’s a quick snapshot of a patient who had overdosed on heroine, coded, and was resuscitated. I think about him sometimes… especially when I read about the rampant drug abuse problem in the US.
—————
I poked my head into the 4-bed communal room on the sixth
floor. The nurse had called to say that
one of the patients was agitated and required restraints. I was asked to assess the situation.
It was immediately clear to me which of the four patients required
my attention. In the far, right corner
was a pale young man, stark naked and thrashing about in his bed. He was babbling something about Ireland and how
he needed to get home. I had gathered
from a quick review of his chart that he had overdosed on heroine, was
resuscitated after coding in the E.R. and transferred to the floor for
observation as he detoxed from the overdose.
I approached the flailing body tentatively. “Hello.
I’m Dr. Jones. You appear to
be quite distressed. What seems to be
the matter?” I said as I pulled a sheet up from the bottom of his bed and
placed it over his genitals.
The young man, barely in his twenties, lay very still as I
spoke to him. He stared at my face with
bulging eyes, speechless for a full 10 seconds.
“Are you alright?” I asked.
“Where am I?” asked the man in a quiet voice.
“Where do you think you are?” I asked, using the opportunity
to assess his mental status.
“I’m somewhere in Ireland,” he said, head turned
towards the window with a view of the Chrysler building.
Seeing that his reasoning was not intact, I replied kindly,
“Well, actually you’re in a hospital in New
York City. You
took an overdose of heroine and your heart stopped…”
“Wow, that sucks,” said the man, sincerely surprised by the
news.
“We were able to resuscitate you in the emergency room,” I
added.
“Cool,” he said, as if the event had transpired in another
person’s life.
“So right now you still have a lot of drugs in your system
which is why you feel confused,” I said, “I think it will take several days
until you return to your normal state of health.”
“Sounds good,” nodded the man.
“Do you know where you are right now?” I asked, suspecting
that his short-term memory had been completely lost.
“I’m in Amsterdam,”
he said, undisturbed by his delirium.
I sighed as I realized that nothing I said to him would
register for longer than a second or two.
“Such a young person, what a waste,” I thought.
The man started to thrash about in his bed again.
“What are you doing?” I asked.
“The back stroke,” he said, surprised that I didn’t know.
I glanced at the man in the bed nearby. He was watching our interaction with some
amusement. He had been reading the New
York Times with a book light. He was a
private patient on a heparin drip for a deep venous thrombosis behind his right
knee. I nodded at him and shook my
head.
Weeks later I heard that the young man’s thoughts were no clearer than they were that night, and that he was transferred to a nursing home for long term care. The brain damage that he suffered from his drug use (and lack of oxygen during his cardiac arrest) had caused permanent, irreparable damage. Another tragic victim of a brain on drugs.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 21st, 2007 by Dr. Val Jones in True Stories
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One day I was consulted on a patient in the surgical
ICU. It is uncommon for rehab physicians
to be called to the SICU, and so en route, I pondered what I might find. Maybe a multiple trauma patient who needs a
walker or chest PT?
As it happened, the patient was a 21 year old male who had
gotten into a fight in the West Village. He was hit on the head with a blunt object, resulting
in a subdural hematoma and severe brain injury.
He was intubated, sedated, and expressing decerebrate posturing (a
really bad sign).
The surgeons had called me because they were concerned about
pressure ulcers and contractures. They
wanted to initiate physical therapy and stretching exercises to make sure that
his Achilles tendons didn’t shorten irreparably as his feet were pointing
downward in the bed. Although I thought
it was great that the surgeons were planning ahead like that, truthfully I didn’t
think the patient would ever walk again, or perhaps even survive the SICU. The level of brain injury was just too
severe.
I wrote orders for daily physical therapy, got him some Multi Podus Boots, and recommended frequent turns in bed.
I figured I’d never see him again as I was scheduled to change rotations
and transfer follow up of this consult to another resident. It was a tragic case.
About 2 months later I began an inpatient rotation and was
listening to the story of several patients whose care was being transferred to
me. As the resident presented the final
one, I thought the story sounded familiar.
A young man out partying with his friends, got into a fight, sustained a
severe brain injury after being hit in the head…
“This isn’t the guy I saw in the SICU 2 months ago, is it?” I asked the resident.
“Yeah, that’s the one!
I remember seeing your note in the chart. The PTs did a great job with his ankles – he could
stand on them just fine when he got up.”
“Dude, no way! When I
saw him he was posturing in the SICU… this guy actually recovered?!”
“Yeah, I know… he’s the first one I’ve ever seen like this. Do you wanna see him?”
“Heck yeah,” I said, “I’ve got to see this with my own eyes.”
My colleague led me down the hallway to the occupational
therapy kitchen. As we got closer, a
wonderful chocolatey smell filled the air.
“What smells so good?” I asked.
“Oh, the patient is making cookies with the occupational
therapists. He’s learning how to cook
and take care of himself.”
I rounded the corner into the kitchen and there was a young
man, handsome and healthy, pulling a tray of cookies from an oven – I could barely believe it was the same
person.
“Hey doc,” he said to me – not recognizing me of course, but
friendly nonetheless. “You want a
cookie?”
“I’d love a cookie,” I said, remembering the last time I had baked them.
“I believe that this is the best cookie I’ve ever tasted,” I
said, looking at the man with tears in my eyes.
He grinned from ear to ear.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 20th, 2007 by Dr. Val Jones in True Stories
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An elderly woman had had a
cardiac arrest and was resuscitated long after a lack of oxygen had permanently damaged her brain. Her daughter remained at her side day in and
day out in the Medical ICU, keeping watch on a hopeless situation.
Many staff had encouraged her to go out and get some fresh air, to take
care of herself… but she was compelled to stay with her mom 24-7 for reasons I will
never know.
I spent some time gazing at the patient’s face – it was delicate
and quite beautiful, with flowing white hair framing fair, soft skin. I wondered what she was like when she was
herself, if she had a gentle disposition, or a fiery wit. I wondered if she had loved her husband, and
if she had had a happy life… I wondered why her daughter was clinging to her,
barely able to leave her for bathroom breaks.
The situation continued for a few weeks – I was a medical
student, and wrote some very bland and unenlightening notes about the patient
each day, describing her unchanging condition.
I felt sad as I watched the daughter slowly come to realize that her mom
was already gone.
One day the daughter looked at me and said, “I think I’ll go
out for a bite.” I smiled, knowing that
this was a turning point for her, and gave her a hug. “I’ll watch her for you,” I said.
As it happened, the patient was on the “house service” –
assigned to the teaching attending of the month. She didn’t have her own doctor, so she was
followed by a team of rotating residents and attendings. The new team started this day, and were
somewhat unfamiliar with her case. I
dutifully updated them on the history and events over the past few weeks.
As I stood there with the team, rounding on the patient –
they noted that her lungs were becoming harder and harder to ventilate. “ARDS,” they said. “She’s going to code any time now.”
And then the unthinkable happened. The new attending, who was a bit of a cowboy,
said “let’s just end this madness. Turn
off the ventilator, it’s done.” The
residents looked at one another – one protested, “I don’t think we should do
that.”
“She’s already gone – look at her! Her oxygen is dropping, she has no pupillary reflexes,
she’s on maximum pressors…”
“But wait,” I said, “Her daughter would want to be here.”
“It’s better for her not to have to go through this,” he
said. And he turned off the machine.
I gasped. “What will
we tell her daughter when she comes back from lunch?”
Annoyed by my persistence he snapped, “Tell her she coded
when she was out.”
Thirty minutes later the daughter came back to the ICU. As she walked towards her mom’s bed, the
residents scattered. Frightened, I
approached her. She could see from the
look on my face that something bad had happened.
“She’s gone,” I stumbled… “it just happened after you left.”
She looked at me as if I had convicted her of the crime of
abandonment. At that moment, her
greatest fear of leaving her mom’s side had come true – she wasn’t with her
when she died. She ran into the room,
saw that the machines were off and all was quiet. She fell to the floor and screamed.
That scream still haunts me to this day.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 3rd, 2007 by Dr. Val Jones in News
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A Canadian news story piqued my interest today – apparently, a man living near Edmonton, Alberta was bitten by a bat during his sleep. Curiosity got the better of me as I tried to recreate the scenario in my head. First of all, “vampire bats” (the kind that feed on the blood of livestock) don’t live in Canada, so this little guy was probably a generic “brown bat.” Brown bats are shy creatures who live on insects primarily, so we know that this bat was in a pretty wacky frame of mind to boldly mistake a sleeping human for a beetle.
Stranger than the behavior of this culinarily confused little mammal, was the behavior of the sleeping victim. Apparently he was unconcerned by the bite and went back to sleep afterwards, never seeking medical attention. I don’t know about you, but if I woke up in the middle of the night with any wild animal sinking its teeth into my flesh, I’d probably not shrug and roll over.
Anyway, the sad news is that this man didn’t get his life-saving rabies shots. Rabies is a very serious condition with a 50% mortality rate! The rabies virus (transmitted through infected animal saliva) wreaks havoc on the brain and nerves. The CDC describes it:
Early symptoms of rabies in humans are nonspecific, consisting of fever, headache, and general malaise. As the disease progresses, neurological symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation, difficulty swallowing, and hydrophobia (fear of water). Death usually occurs within days of the onset of symptoms.
Isn’t it strange that “fear of water” is part of the rabies syndrome? I’d like to get an explanation of that one from a neurologist…
Anyway, human cases of rabies are quite rare (about 7000 cases/year in the US) and are usually caused by raccoon or skunk attacks. So if you come face to face with a raccoon or skunk “gone wild” my advice is to run away. But if you do get bitten, please go to the hospital immediately and get your rabies shots. You can prevent progression of the disease.
Now, if you’re curious to see if you’re in a rabies “hot zone” check out the CDC’s skunk and raccoon tracking maps (can you believe that someone’s job is to create these?)
And for a good spoof of dangerous animals – check out Dr. Rob’s recent warnings against the common goat. You can tell that he must enjoy Monty Python style humor.
Are you an animal lover? Know of some funny websites or links about animal antics? Do share!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 14th, 2007 by Dr. Val Jones in News
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Technically, the jury’s still out on this one, but Dr. Ellen Bialystok’s (cognitive psychologist) work is very interesting. She has compared cognitive skills in monolingual and bilingual children, as well as a fairly recent study comparing dementia rates in monolingual and bilingual adults in Canada. I wanted to go back to the original source articles, but I wasn’t willing to pay the journal article fees. Sorry. Still, this seems to be what she found:
Bilingual children were ~55% more able to block out misleading information than their monolingual peers.
Bilingual adults tended to show the first signs of dementia at an average age of 75, but monolingual impairment began at an average age 71.
Yes, there are a gazillion unanswered questions here: does it matter what age you become bilingual? Does it matter which languages you speak? Do you have to speak both of those languages all the time or can you have learned a language back in college and not use it now? What about if you speak 3 languages?
Still, there are some interesting findings here worth a deeper look, wouldn’t you say?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
