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Angry Betty and the Unresponsive Kid

Chid StatueThe nervous voice on the call over the radio already sounded bad.
“Emergency One en route to Interstate 88, mile marker 177 for report of car on side of road with parent witnessed performing CPR on child.”
CPR on a kid? Damn. Kids aren’t supposed to need CPR.

There was an eerie silence at the nurse’s station as everyone waited for the next radio report. Finally it came.

“Metro General, this is Emergency One. Do you copy?”

You never think much about how much information can be inferred from the tone of a paramedic’s voice until you’re in a situation like this. In this case, the paramedic was calm and taking his time. As soon as they heard his voice, three nurses, a secretary, and two doctors let out a sigh of relief.

The nurse picked up the radio microphone. “This is Metro General, go ahead.”
“Metro General, we have a ten year old male with no local doctor who reportedly had a witnessed cardiac arrest while driving on the highway with his parents. He regained a pulse after his mother performed CPR on him for a minute or so. Mother is a cardiologist and is accompanying us on this transport. ETA is 6 minutes. Over.”

Everyone looked at each other. Female cardiologist? Nahhhh. It couldn’t be her. Not Angry Betty. Whenever you had a patient with chest pain, you HOPED that Angry Betty wasn’t on call. No matter what you said, she’d always disagree with you and then talk down to you for not knowing your stuff. Then she’d ask some esoteric and often irrelevant fact that you never were able to answer quick enough and she’d nose breathe into the phone for what seemed like an eternity while you looked for the answer.
Sometimes you’d get all the labs laid out on the desk in front of you just to try to beat her.  
“How stenosed was the RCA on his last angiogram and what was the date?”
“40% on October 13″ [fist pump in the air]
“When was his last ophthalmology exam?”
“June 2012″ [HA! Double fist pump]
“What was the last homocysteine level?”
“Ummmm. Hold on.” [eyeroll ... she won again]
[constant blow of air into the receiver of the phone]
“I don’t see one in the computer.”
“You don’t see one or it was never done?”
“Well I can’t see what was ordered at other facilities, but there hasn’t been one done at this facility.”
[more nosebreathing]
“I’ll order it.”

Six minutes later, everyone’s fears were realized.
Paramedics wheeled in a stretcher with a 10 year old boy playing on his iPad. Angry Betty was running alongside of the stretcher with her stethoscope glued to his chest.

“Your patient,” says the other ED physician working that day.
“No. YOUR patient.”
“Sorry, I’m going on break.”
“OK, paper/scissors/rock.”

Figures. I lost that one, too.

“Hi, Dr. Angry. What happened with Angry Junior today?”
“We were driving on the highway heading downtown when I looked in the rearview mirror and Junior was unresponsive.”
“Unresponsive?”
“Yes. Unresponsive. His mouth was open wide and his eyes were closed. I yelled his name and he didn’t answer. I had his sister slap his face and he barely flinched. So I pulled over, started CPR, and called 911.”
“I see.”
“By the time these paramedics arrived, he had return of his circulation. They did an EKG in the ambulance that was normal, but based on the symptoms, it appears cardiac in nature.”
I looked at Angry Junior. He looked up from his iPad and shrugged his shoulders.
“I see.”

“What happened to you?” I asked Angry Junior.
“I think I fell asleep,” he responded.
Angry Betty interrupted. “You did NOT fall asleep. You were unconscious and difficult to arouse.”
“I see.”

So I started my exam.
Vital signs normal. Heart monitor normal.
HEENT exam normal. Wait. There are a couple of scrapes on his cheek.
“Is this where his sister slapped him?”
“No. I accidentally scraped him while I was trying to do a finger sweep of his mouth.”
“I see.”
I guess that explains the gouge out of his soft palate, also.
Heart exam sounds like a sinus arrhythmia – normal. No murmurs.
Lungs fine. Abdomen fine.
Neurologic exam normal.

I turned around to face Angry Betty, but she had left to go to the computer and enter orders for lab tests.
I looked across the room and the other doc gave me a smug grin. Bastard.

About 45 minutes later I went in to recheck Angry Junior and brought some of the preliminary lab tests results with me. Angry Betty was on the phone with the pediatric neurologist from across town.
“So EEG then MRI then we’ll see you in the office Thursday? OK. Sounds good.”
Oh. My. God.
Angry Junior seemed annoyed at losing his game of Temple Run when I interrupted him to take his blood pressure.

“Well, everything looks pretty normal. His vital signs have been stable. All the labs you ordered were normal. His mental status hasn’t changed.”
I wanted to hedge my diagnosis. Couldn’t tell her that her kid probably nailed the diagnosis when he came into the ED. So I casually said “I’m wondering whether it may have just been a vasovagal event? That is a relatively common cause of syncopal events in kids, you know.”
“I’ll take care of it from here. He has an appointment for a Holter monitor and he’s seeing the pediatric neurologist in a few days.”
“OK. Sounds good.”
“The only thing is that I’ll want to keep him home from school for the next couple of days. Would you mind writing him a note?”
I hesitated.
“It’s no problem if you don’t want to. I’d just rather be safe than sorry.”
“Sure. No problem. Off until Thursday when he sees the neurologist.”
My inner self was arguing back and forth whether it was going to make my mouth blurt out “WHAT WAS HIS LAST HOMOCYSTEINE LEVEL?”
Then something strange happened.
Angry Betty smiled.
Then she said “Thank you.”

I was going to end the story with me then waking up on the floor of the room to a little kid slapping my face and a woman gouging my cheek with her fingernails.

In reality, Angry Betty wasn’t so angry after that. She was nicer on the phone to all the staff when we paged her. The requests for extraneous information plummeted. She even brought us candy.
And all the tests on Angry Junior turned out just fine. His mouth healed up just fine, also.

Amazing what a sleeping kid can do for staff relations in a hospital.

———————–

This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on Dr.WhiteCoat.com, please e-mail me.

 

One comment

  1. Great post! Glad it worked out.

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