Cameron Bell - post 4

At about 2:00 am, the ER was fairly quiet. The patients in the rooms had been there nearly all night and were stable when the phone began to ring with a weird, low pitched buzz. It startled me, but the nurse calmly walked to the phone and answered as if it was a regular ring. She mumbled a few "okay's" and a "see you soon" before hanging up and turning to us. She reported that an unconscious man was on his way in and that he had stop breathing, so they intubated him in the ambulance. We got our trauma room ready and I, along with 5 other doctors and nurses, stood chatting until the man was brought in the back entrance. His body looked sickly and decrepit, his hair grey, long, and mangled, and his face was relaxed as he was unconscious with a tube down his throat. The paramedics explained that they received a 911 call from his friend, whose house they picked him up from, when he went unconscious. They reported that no drug paraphernalia could be seen on scene. In a frenzy, the doctors and nurses worked around the man to quickly identify his diagnosis. They stripped off his clothes and we discovered that he had lost bladder control. Although unconscious and unresponsive, the man's body was convulsing - his arms would lock straight as his hands would turn down and outward as his head went back and whole body tightened. This happened every 30 seconds or so. Dr. Rose explained that these convulsions can indicate a brain bleed on the upper hemisphere of his brain (because of the direction in which his hands were turning), so once he was stable, he was sent to get a scan of his brain.
To our surprise, the results came back negative - no bleed - so we continued our investigation. We pulled back his eyelids and found that his pupils were the size of pinpoint needles. Dr. Rose looked at me and I replied, "drugs?" He nodded. We did a blood screen and about 20 minutes later, found a positive result for opiates. With an "ah ha!" he explained to me that opiates, when taken in too large of doses, can shut down the respiratory system.
It was very fun to feel like I was a part of diagnosing a patient. It was the first time that I really got to be in on a specific case and follow it all the way through. His diagnosis was a mystery for about 45 minutes, but we finally figured it out and treated him correctly and effectively. It was a very thrilling night!