A whole raft of stuff

Loose ends

God Only Knows What Woman went home yesterday, beautiful smile and all. She's lost fifty pounds in the last few months, so moving her on to a stretcher was like lifting a kitten.

Mystery Man wrote *again*. I think this might be a record.

And Man A sent a nice note in response to a condolence email I shot off on the spur of the moment yesterday. I think this might be detente. Even if I was/am temporarily insane, it would be nice to have a long-time buddy back.

Bizarre Diseases

Into the category of Bizarre Stuff That Can Go Wrong shuffles a disease I'd only vaguely heard of before now: Ehler's-Danlos Syndrome. There are six types, all having to do with a genetically-linked problem with collagen. Type IV, or vascular EDS, is the most dangerous, as it affects the integrity of the blood vessels, both arteries and veins, and can cause ruptures and hemorrhages and other fun things it doesn't do too well to think about.

Life expectancy with EDS type IV is shortened. Appreciably. And of course, who should come in with EDS type IV but a beautiful, brilliant young woman with a loving family and a hell of a lot of potential?

Warning: Medical Detail, some of it not in English, Ahead:

She had come to us for a pulmonary function test. She'd been coughing up blood for several months, and the docs decided to see if there was some sort of major problem lurking undiscovered. Since the type of EDS she has causes blood vessel troubles, they were concerned about an aneurysm somewhere in the vascular bed of her lungs.

We talked politics and summer internships while I took her history. During her PFT, she'd had to breathe in, then blow out that breath, hard. That raised her intrathoracic pressure (the pressure in her chest, in other words) and caused--my theory--some of the vessels to collapse or become less efficient at carrying blood to her head.

She had one arm and the opposite leg go dead, one side of her face droop, and her speech go kerfuffled. That was bad enough, but then her frontal lobes decided to take a little vacation, and she started laughing and crying uncontrollably and was unable to do anything but babble incomprehensibly. All of this happened in the presence of the poor pulmonary test technician, who had no clue as to what to do.

So they sent her up to us.

At one point yesterday, a well-meaning cardiology resident suggested that she try to recreate the symptoms while having an EKG, so he could see if her problem stemmed from some sort of heart arrhythmia. It was all I could do to maintain some veneer of calm (this was near the end of the day) rather than screaming down the hall, hair afire, to tell him what a BAD IDEA this would be.

Nurse Jo: "Um...are you following Patient X?"

Cardiologist: "Yeah. What's up?"

NJ: "You realize that her Ehler's-Danlos is type IV? That she has vascular bed compromise?"

C: "Yeah..."

NJ: "Um, well, if you get her to try to get those same symptoms to show up again, it might do damage that we can't repair. I mean, she had a transient cerebral ischemia, and I'm not certain that it would resolve this time."

C: (backing away rapidly, in a metaphorical sense) "Er...well, we can have her just, er, you know, breathe deeply. I'm looking for any fib, you know?"

NJ: "Deep breathing is fine. Just don't raise her ITP, okay? I don't want to have to call for an emergent EC/IC bypass at sixteen on a Friday."

The EKG was normal, she stayed asymptomatic throughout, and she's going home today. Or, rather, back to her internships with two enviro-political groups and her life inside the Beltway.

And dear God, I wish her well.

In other news

It strikes me that I'm running out of creative cuss words that don't sound like cuss words. You can't trot down a hallway saying "Fuck fuck fuckety fuck, fuckety fuckety fuck fuck fuck" and still look professional. Therefore, I'm thinking of asking the Cute Goateed Greek Neurologist, who has a sense of humor, to teach me some really foul phrases in Greek to supplement the Danish I already use. There's also a Presentable, Dignified Russian Pulmonary Fellow who might unbend long enough to tell me what "lousy pustulous sonofabitch" is in Russian.

Next time I wanna be a hero by taking six patients and then settling in a seventh, somebody please remind me of yesterday.

I was planning a three-day drunken orgy of self-pity this weekend to celebrate The First Anniversary of the Debacle, but I'm far too cheerful to do that. Instead I think I'll wear a dress at some point and also wash my car.

Time for more coffee.