Saturday, April 15, 2006

First things first....

Blogger has a bug which disallows comments on the newest post on every page, unless you're using some combination of IE and luck which I've only hit on once. I know some of you have encountered that bug, and I apologize. There's no way I know of to fix it in the template, so you'll have to keep either emailing me with comments or wait until a new post comes up to comment on the second-newest.

Today, as I was manhandling a casserole into the fridge, I caught the third finger of my right hand against the corner of a drawer I had carelessly left open. The corner (being that weird melamine veneer stuff) ripped a swath of skin and meat off the first knuckle of that finger. For the first time in a very long time, I looked down after doing myself an injury and saw I was bleeding.


Luckily for me, it didn't involve a fingernail. I'm sure I've told this story before, but I once sliced a chunk out of a fingernail with a mandoline as I was slicing some vegetable or another. I actually fainted when I had to change the bandage on that finger. I had foreseen that possibility and so had a friend standing by with ammonia and Scotch and ice packs, all of which she put to good use.

So I stood there, watching in fascination, casserole forgotten, as I bled. I don't usually injure myself with sharp or penetrating things; my hurts tend to be more of the blunt-trauma, falling-over variety. Or of the roundhouse-to-the-left-kidney variety, one of which I sustained a week ago and am only now feeling normal after.

One of our patients with no risk whatsoever for seizures had a seizure. He's a big guy--six-eight and three hundred pounds at least, and not fat. We're talking Olympic athlete standard of fitness and muscles from here to Toledo. And he, of course, is the one who has the tonic-clonic seizure to end all tonic-clonic seizures. I've never seen anything like it.

His wife screamed out over the call system, so the charge nurse and I hit the door at a dead run. Credit to the charge for saying simply, "Shit." and turning on his heel for oxygen and Ativan and the crash cart, but I had to stay in the room and get this guy on his side.

Down goes the bed--they're heavy when you grab the CPR emergency release--and I hauled the patient over on his side so he wouldn't choke on the blood and vomit and foam that was seeping out from between his clenched teeth. A rigid, tall, heavy, muscular patient who's in the grips of a seizure that's made every muscle tetanic is not easy to get over onto his side; it amazed me that I could manage. But I did.

He seized long enough that we could run for a mask, for more Ativan, for a suction setup and O2 monitor and blood pressure monitor and EKG leads and he *still* hadn't finished. Conservatively, I know his seizure lasted at least forty seconds, and probably more like two minutes, with no dimunition until after we'd given him a total of 4 milligrams of Ativan, fast push.

Then it was suction and Venti mask and EKG leads and where the hell's that respiratory therapist and more sedatives and Jesus Christ somebody get me a four-by for all this blood, then reasoning out that the goose-egg on his forehead came from his repetitive pounding of said head against the bedrail during the clonic portion of the seizure, and then off to CT scan.

And I went away and gibbered for a few minutes, even though he wasn't my patient, because if there's one thing I hate more than a code it's a seizure. And this one...dear sweet Christ on a crutch, I can honestly say I didn't know the human body could make such sounds. Or that eyes could roll quite like that. Or that people actually, really and truly, *foamed at the mouth*.

Years ago, when I was still at PP, a patient's boyfriend had a seizure that culminated in one of our waiting-room chairs being kicked through a tempered-glass window. This one was much, much worse. I'm just glad that we had three bedrails up; there's no way I could've held him on the bed without the support of the rails. Even so, one was bent so far out of alignment that it's not usable.

And at some point I sustained a really lovely bruise over my left kidney. I'm not sure if I got it during the scrum to get Ativan into the guy, or if he whacked me with a flailing leg without my noticing, but it's there. It's *still* there, I should say, and still makes me wince when I roll over in bed. I guess I'm lucky not to be peeing blood.

Just thinking about it makes me gibber some more and feel sort of shaky.

The best part? Dude had a bladder infection from a catheter we'd had in him during back surgery. We gave him Levaquin, which apparently lowers seizure thresholds in otherwise normal folks.

So his risk factor, looking back, was a commonly-used antibiotic.


I think I'll tough-out the next sinus infection, thanks.

And go put an ice pack on this flank.

1 comment:

Anonymous said...

Sheesh, nice thing to read after my third day on Levaquin. Makes your easter dinner taste odd too.