So, yeah. It was a bad day the other day.

She'd been fine when I saw her at 0730. A little groggy, yeah, but that was because she was on tremendous amounts of Neurontin and various painkillers, a result of her having had a spontaneous epidural hematoma. (Note to Googlers: spontaneous epidural hematomas are extremely rare; two of my patients on the same day had had them. Such is life at Sunnydale General.) At any rate, she was moving all the limbs that she had been moving before, and could speak fluently, if sleepily, in response to questions.

Then, at ten past eight, her daughter called. She was concerned because Mom wasn't picking up the phone. Daughter is the sort of thorn-in-the-side, pain-in-the-ass advocate for a patient that we simultaneously dread and admire: she'd enlisted the help of a couple of family friends who were nurses, and she called regularly for updates. 

Anyway, Mom wasn't answering the phone. This wasn't unusual, as Mom tended to sleep in. Plus, as I'd said before, she was groggy that morning anyhow. But, because my Spidey-Sense started to tingle, I went into her room anyhow, to see if she needed help ordering breakfast.

I found an obtunded patient who couldn't move her right side and couldn't speak. She'd stroked out at some point in the last forty minutes.

After the usual stat CT scans, administration of Narcan and a bolus of normal saline in the vain hope that this was merely dehydration, rushing around notifying family members (thank God I didn't have to do that), and transferring her to the ICU, I sat down with the intensivist for a post-mortem of what might've happened.

Turns out she'd had an episode the day before of having one arm go dead. Her legs were already gone, thanks to that spontaneous epidural hematoma, and we couldn't feed her coumadin or heparin or any of the usual anti-clotting drugs, thanks to that spontaneous epidural hematoma. Although she'd recovered her arms in a matter of seconds the day before, the fact that she'd lost one at all (and by "lost one" I mean "lost all motion and sensation") led us to believe that she had some sort of clotting disorder besides the original one.

And, sure enough, she had a previously-undiagnosed bit of atrial fibrillation. A-fib, as we call it in the biz, is a condition in which the top chambers of the heart don't squeeze regularly. Instead, they sort of shiver. This doesn't affect how you feel, much, but it allows small clots to form in the backed-up blood that isn't cleared from the atria. When the heart muscle finally gets its shit together and manages to actually contract the atria, clots can shoot into the brain.

Which is what happened in this case.

The bitch of it is, the utter, total, black-furred bitch dog of it is, there was nothing at all we could've done. Some part of her clot cascade was impaired to the point that she had an eleven-inch long hematoma in her spine with no rational cause, so it's not like we could anticoagulate her. Doing so would've caused the hematoma to restart, and would've certainly killed her.

So, instead, she gets to live with only one (partially) working arm, no speech, and no ability to recognize her daughter.

The daughter was on the way to the hospital later that afternoon. I am not looking forward to seeing her. Even though there was nothing I could've done differently, and nothing would've changed even if I had witnessed the stroke, I still feel responsible.

Can we all please just take a deep breath through our masks?

As some of you might have gathered through careful perusal of this blog, I live in Texas. I live, in fact, not too terribly far from San Antonio, where several cases of THE MOST HORRIBLE PANDEMIC AWFUL ZOMG FLU EVER SEEN were discovered.

And yet, I am not locking myself in my house and refusing to go out. (Well, actually, I am, but that's for reasons totally unrelated to swine flu. It's more like that's my normal routine.) I am not panicking or avoiding large public spaces like the grocery store. I am not dousing myself in bleach or drinking whole pots of green tea. I am not stocking up on ammo or bottled water. I am, in short, while not sanguine, not freaking out.

How come?

Because epidemics *happen*. Once one gets started--and there's ample evidence that this particular flu bug has been moving around both Mexico and the U.S. all season, quietly infecting people--there's not a whole lot you can do besides quarantining the infected and washing your hands. Even before one gets started, there's not much you can do to stay away from viruses on a daily basis besides avoiding sick people and washing your hands.

Given that I can't exactly avoid sick people unless I want to move into a cardboard box, I'm washing my hands. I'm brushing up on the management of cytokine storm (for you non-medical types out there, that's an immune reaction that goes overboard and overloads your organs and kills you) and reviewing what I know about things like respiratory and droplet isolation. I'm gonna put an extra set of scrubs in the car today, since it's likely that at some point, if this dadratted bug continues to spread, I'll be killin' time at the hospital rather than at home.

I'm more worried about the level of ignorance in the general public about viral infections and the transmission of the flu than I am about the flu itself. I'm seeing comments on public message boards from people who want to stock up on antibiotics or just start taking Tamiflu as a preventive measure (neither will work). I'm seeing evidence that most people don't really understand the difference between viruses and bacteria and how their infections differ. I'm hearing talk from people here Deep In The Heart about moving off to Wisconsin and building a hideout.

If there's going to be fallout from this bug, it'll be because people are kinda dumb, not because they fall over dead.

Unless the Gubmint reports that this particular strain of swine flu turns people into zombies, I will continue simply to wash my hands and cover my mouth when I sneeze. I ask you all to please do the same. 

And maybe next time there's a scary epidemic, it can happen *during* the  Nationally Recognized Music Festival, so NRMF will get closed down and I can finally find some parking near the bar. That would be nice.