Spinal Taps and Retinal Defects

As you may recall, we have “preceptorships” for which we are assigned to a community physician to shadow and/or assist once a month. Most students were assigned to internal medicine, family medicine, PCPs, cancer docs and the like—but I was assigned to an emergency medicine pediatrician. You may also recall my trepidation given my a priori disinterest—nay, aversion—to both pediatrics and emergency medicine. Yet my experience thus far has demonstrated that I am prone to misjudge my own interests. Pediatric emergency medicine is… amazing. Allow me to describe (while doing my best not to violate HIPAA) the coolest afternoon I’ve had all year.

[Note: patient demographics have been altered to protect privacy]

The fun started the second I walked into the ER. I arrived precisely on time.

“Good afternoon, as of… now!” I said to my preceptor physician.

She pointed to two large monitors behind me. “Andrew, look at those CT scans. What do you see?”

Even if I weren’t in the throes of the Neuroscience block I would have known exactly what I was seeing, because it was unmistakable.

“I see… a brain herniating through a skull with multiple fractures. How…”

“A car accident,” she said. “The poor kid won’t survive.”

What a way to start the afternoon. Soon after, we were standing at the computer while she discussed patients with one of the residents. Afterward, she started to scan the patient list to determine who to see next.

“Room 30, a 7 year-old boy has a foreign body. I want you to take a history.”

“Wait… what? Me?” I thought at first she was talking to the resident.

“Yes, you. I want you to ascertain the chief complaint and take a full history and report back to me.”

“Uhh… well, what’s the foreign body?” I asked, stunned.

She smiled, “That’s for you to find out. Have fun!”

I had never taken a history from a real patient before—just standardized ones (actors, really). However, my CAPS class trained me well and I gathered all the information I needed. A CT scan later confirmed that he fell on a piece of glass two weeks ago and it had recently become infected.

Amidst the myriad other things that occurred, I witnessed three spinal taps, two of which were performed on infants. In all three cases, viral meningitis was suspected pending the results of the CSF (cerebrospinal fluid) analysis. In order to perform the spinal tap on the 9 y/o girl, she had to be kept sedated with propofol so she wouldn’t jerk around too much when her spine was punctured. Yes, propofol—the drug on which Michael Jackson overdosed. It was a milky-white fluid pushed IV throughout the course of the lumbar puncture because it has very acute barbiturate effects. The girl regained consciousness almost immediately after the drug infusion was stopped. Why Jackson’s “doctor” was using it to help him sleep is beyond me.

Following a very successful Neuroscience 1 exam on Friday, I had an awesome weekend. It started that evening at the Olive Garden with Garrett (that is, after we drove to another location upon discovering that the one to which Garrett’s GPS directed us was boarded-up) and watching Boondock Saints before bed.

On Saturday a bunch of us went downtown to The Big Bang, a dueling piano bar. We stayed half an hour longer than anticipated because it was more fun than any of us imagined. I was particularly unenthused since I’m not a big pop-music person (somehow I doubted they would perform classical music), but once again I was wrong to pre-judge. I was at least familiar with most songs, and sang along to nearly half of them. Most of the fun and excitement results from the personalities of the performers. I think we laughed more than we sang…

Afterward we headed to a wine and cheese party hosted by med students, where I proceeded to over-sample different kinds of wine. Well, first we had to drive back downtown because Garrett forgot to sign his card out at the piano bar. You see, like me he’s scatterbrained--but much worse. I’ve lost track of the number of times he’s left important things at my house and other places (phone, keys, etc). The extent to which it’s endearing outweighs the fatigue on my ocular muscles from the exhaustive eye-rolling.

Sunday was another exciting day. After recovering from the wine, a bunch of us went to see Sarah in RENT, performed by the Emerald City Players. It was entertaining, except for a few very pitchy singers (not Sarah, of course). Then we celebrated the purchase of a new grill by hosting a BBQ at our place (officially called “OMGWTFBBQ!”). We had 20 or 25 people over, and lots of food. Good times were had.

Finally, I discovered something interesting about myself at my eye exam today. Apparently, I have a small hole in the upper corner of my left retina. They told me there’s nothing about which to be immediately concerned, but they want me back in 6 months to see if there’s any change. In the meantime, I’m to be on the lookout for any flashes of light or other bogies out of the corner of my eye. Worst case scenario? My retina will become detached. Is this likely? Fortunately, no. If the hole were a small tear there would be greater cause for concern, but unless I suffer brutal trauma to the eye it’s unlikely to become exacerbated. Normally they tell patients about a quarter of what they told me regarding this anatomical flaw, but they said since I’m a medical student I could probably handle fuller detail. I appreciate that. On the other hand, as a medical student I’m already a hypochondriac and overly concerned with slight medical maladies.

In short, I’m not terribly worried about this slight retinal defect. I am worried, however, that I won’t be able to read my music at band rehearsal tonight because my pupils are still super dilated…