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06.12.08 - 10:28 p.m. Sorry it's been so long since I updated. I have had things to say, but little time or willpower to say it. My ENTIRE immediate-ish mom's side of the family, with the exception of my brother, has gone to a wedding I wish I didn't have to miss. It's strange because I keep meaning to have lunch with them or call them at home and that has become quite difficult. But I had this kind of interesting case that was worth writing about, so I shall. This fifty-ish year old lady is brought in by EMS for mental status changes. She was found facedown someplace in town. According to the ambulance sheet, all she would tell them was, "I'm very sick." When she got to our triage, she was alert and oriented x 2 (knew her name and where she was OR her name and what year it was, it didn't say which) and she was laughing at inappropriate times. So I go to see her expecting some looniness. She was a little odd. She did laugh at inappropriate times (while telling me something about her husband dying or something like that) as if something was actually funny. But she was alert and oriented to her name, the year, her location, knew where she was when they found her facedown and knew that someone else had called the ambulance and told me that she didn't know why she was in the hospital when "I'm just tired and need to rest." So, crisis averted and whatever was wrong with her was getting better on its own. I have learned these past few years, however, that things are not always as they seem and she might have some funky thought process deficit that would prevent her from being safe at home by herself, which is how she usually lived. So I wanted to speak to someone who knew her, like family, before I made up my mind. "Do you have any family--brothers, sisters, parents, or children?" I asked. "I don't know," she replied. Okay, so that was a strange response. But I had a trick up my sleeve! She had on a cheesy bead necklace, CLEARLY made by a grandchild. "Who made you that necklace?" I asked sneakily. "The devil made this necklace," she stated matter-of-factly. Well then. So I told her we'd be getting a CAT scan and she got upset, saying, "I'm refusing it, it's within my right to refuse the CAT scan." And normally, she'd be right. But when Satan has made any portion of your jewelry, we get to figure out what's wrong with you. It was so odd, though, because she immediately returned to sensicalness again enough to state that she could refuse the CT. But her rights were basically all surrendered at that very point, something I find so strange. It makes sense--we can't let her die from a brain bleed or meningitis she wouldn't let us diagnose because of the bleed or the infection. I have no problem avoiding tests a competent patient doesn't want, if they can give us a reason, but from "the devil made my necklace" she didn't get to choose. So I gave her a mild sedative, waited for her to fall asleep, and ordered the CT. She woke up and refused when they came to get her. So I gave her Haldol (a pretty strong anti-psychotic that knocks people out) and I ordered the CT again, and this time she didn't wake up enough to refuse. The CT was normal. So I went to do a lumbar puncture and she got upset: "You're not sticking nothing in my back!" (The haldol had worn off.) So I gave her more Haldol, went back, and did the lumbar puncture while she slept through it. It's a pretty safe procedure, so I was okay with it, but it's still strange to have enough power over a human being that you can just knock them out and do whatever you want to them, like expose them to radiation or stick four inch long needles into their backs. She got admitted for mental status changes and I left before the lumbar puncture results could tell me whether she had meningitis or not. I need to look that up. It was an interesting case because it reminded me of something I love about my job (where else do you get the massive paradigm shift from "odd but thinking pretty clearly" to "the devil made my necklace") and something I hate about my job (going all Guantanomo on her and holding her against her will without representation while performing tests she didn't want). And now I must sleep.
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