Sunday, August 06, 2006

Pathos

The patient's name has been changed in the following post.

I dialed 0 on the phone. It's quicker than looking up a number, and in the hospital, you know you'll hear a human voice immediately and not a recorded menu.

"Hospital operator."

"ICU please."

"One moment."

The phone rings and the ward secretary answers, "ICU."

"This is Dr. Cory in radiology. May I speak to Andrew Johnson's nurse?"

"They're on the way back from radiology." The patient had come down on his ICU bed accompanied by his nurse. The tech had brought me the films before they got back upstairs.

"Could you take the report on Andrew's brain scan, and tell the nurse when she gets back?" I asked the secretary.

"OK."

"Tell her the brain scan confirms that he is brain dead."

"All right. I'll tell her."

And so an eighteen-year-old patient was one step closer to being an organ donor. The kid had come into the ER a week ago, unresponsive. He had had a fairly minor operation ten days before that, and had developed the unexpected and catastrophic complication of meningitis. When I saw the CT scan of his head obtained in the ER, the ventricles of his brain had already started to dilate as the infection blocked the normal flow of cerebrospinal fluid, causing increased pressure in his head. I alerted the ER physician to that fact and a neurosurgeon was immediately called. Unfortunatley, Andrew was already too far gone by the time the surgeon put a tube into his brain to drain the fluid. He deteriorated over the next week, suffering several strokes.

Before the plug can be pulled, brain death has to be established by clinical exam, EEG and nuclear medicine brain scan. My job is to read the brain scan, and in Andrew's case it was clear there was no blood flow to the brain. Of all the possible bad news that medical images can convey, this is among the worst, and in a young person it's even worse. This type of case is one reason I chose a so-called non-patient-care specialty. I'm removed from the burden of having to face a family losing their loved one.

I'll close with these words from A.E. Houseman's "To An Athlete Dying Young:"

To-day, the road all runners come,
Shoulder-high we bring you home,
And set you at your threshold down,
Townsman of a stiller town.

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