Neuro: the Fly-By

The majority of our patients thus far have been Strokes. Stroke is brain injury due to a burst brain vessel (hemorrhagic) or due to a tiny clot that blogs the vessel that causes the brain to die (ischemic). Such a tiny little cause with so much damage. People actually do come in with text book weakness of a limb, drooping one side of their face, or can't quite talk to you even tho they are trying (aphasia).  I read about these in school and spent two solid miserable months trying to learn what lesion went where. But i still feel like i have no idea what is going on. I have no idea why things in text is so much easier to think through than when the patient is staring at you. Maybe because their deficits are just so devastatinig. We use CTs and MRIs to show them the area of the brain that is damaged and usually its something tiny. But the desperation in their eyes says all they want to hear is if it will get better. And again its something we can't answer.  So we tell everyone, the rule of 3's :  3 hours to know the extent of the brain damage, 3 days to know if it will start to resolve, and 3 months until symptoms start to stabilize.

We had one patient who honestly told the neurologist he thought someone was stalking him. Every time he turns around he can see someone try to hide. He was legitimately afraid. I thought, man this guy is crazy, but the neurologist just laughed. Turns out it was his own arm he couldn't get away from. It was so bizzare that i couldn't actually believe it. Probably one of top three weirdest things I've seen yet. 

Also on that list. Get called down for a neurosurg consult and we get there and there is a 2 year old boy sitting on the bed looking at us with a NAIL in his brain. Just sticking out. He's just sitting there. Very disturbing. Apparently, he had pulled on a blanket in the garage with paint cans and nails.  I guess the nail and the paint can fell just right.... sounds unlikely right? We called child protective services no worries.  We pulled the nail out, there in the ER. It was also disturbing. There was no surgery to be done, but the kid hasn't used his left arm since. But we are confident that his brain, as young as it is, will compensate. We hope. 

One of my patients is 50y.o. F whose name is Bonnie (fake name).  She seems fine and talks fine. But when you ask her her name, She responds as such "umehmehmeh.  No. That's not right. My name is Umehemeh. Umehemeh! Shit. I know my own damn name. I swear I know it."  She goes on like this for quite awhile. Its heart breaking and oddly unbelievable.  Its like she's messing with me (maybe too many hours spent in the ER), but she really isn't.  And I should clarify it isn't just a certain sound that she can't say, because she can sometimes say her name, the problem in the part of the brain that retrieves thoughts and makes them words. So any question that she has to THINK about (which is probably half of what you say) she can only babble.  Talk about frustrating! After spending even 5 minutes alone with her, I began to get uncomfortable, even angry. Not that I acted on it or showed her that.  The patience required to be Bonnie is now higher than my threshold and the patience required to be her husband.... I can't even imagine. I get a tiny glimpse of what it means when he said "for better or worse" in his vows.

Speaking of which, one of the residents (did i mention all the neuro residents are ER residents doing their month of neuro?) anyway he discovered that I was not married. Apparently, he had assumed I was and was offended. So he decided that his goal this month would be to try to get me a boyfriend in the hospital. I thought this was hysterical. I've never had guys try to set up a girl before. So I went along with it during out lunch discussion answering a bunch of questions not really thinking he was all that serious. Then he conferred with another couple of residents and they decided on the first candidate, this ortho resident. And they wanted me to 'assess' him so they took me on a 'Fly -by' which consisted of walking past him in the ER about a million times and then finally going up to talk to him and introducing me as a "very single med student."  (not obvious at all).  It was a funny joke and i went along with it good natured-ly.  But then this guy comes up to me the next day and asks what i'm doing this weekend and if I want to hang out. Say what?       O.O    Crazy Crazy. Since when did the hospital become a dating scene? (please don't say grey's anatomy)