How scary it must be, to be locked inside a brain that cannot express itself. She was able to see but not identify, hear but not understand, talk but not be understood. Sometimes a little medical knowledge is a little to much. AS I performed a systematic neurologic exam on the older woman, her entire family interferred in ways I never imagined were possible. First her husband started answering for her about what was wrong, why was she here. I told him that I wanted to see what his wife could tell me. She could tell me nothing basically. Recognized noly her husband. IT was painful for the family to watch, but only by them being quiet was I able to determine her mental status. Her exam was difficult to perform because she had such a hard time following directions. When I asked her to close her eyes, her daughter reached over and put her hand in front of her face. When I asked her to lift her leg, her other daughter reached over and lifted it off the bed. When I checked her reflexes, I could feel the families’ hands right behind me, sympathetically tapping her tendons along with me. I had collected more than enough information to know what my initial laboratory and imaging workup would consist of, but the family was already two or three chapters ahead of me wanting to know what was wrong, why did she have a fever, when would she get better. The first step is a CT scan, i said to the family and quickly walked out of the room. I dreaded going back to order her vitamin K and fresh frozen plasma. They had so many questions that I could not answer…couldn’t they see that the longer they kept me, the longer it took to get the neurosurgeon to come and see her? I appreciated their input, but did not appreciate there help with my neurological exam.
So I admitted her to neurology.
Later on, the neurologist told me that he would be glad when I left the program. I guess he was upset that three people with neurologic defecits came in within the same hour. Three workups completed within the same hour. THree patients for him to see within the same hour. So he took out his frustration on me, telling me face to face, in front of 2 other residents and my staff physician that he couldn’t wait until I left.
All I can think to myself is…twenty four shifts to go.