A doctor never knows when his skills may be needed. For example, one of my attendings in med school once delivered a baby in a Disney World restroom. I recently had my own chance to be a first responder.
I took my family to Disney World about three months ago. I hadn't had any time off from work since early fall, so I was looking forward to a fun, much-needed vacation. The trip started off uneventfully and we were enjoying Hollywood Studios on our third day when the vacation suddenly got more interesting.
We were vacationing with several family members, so we spent some of our time separate and some together. By mid-afternoon, we had reconvened to go on Star Tours before having dinner. We breezed through the line, enjoyed the ride, and navigated the exit that (naturally) let us out in the gift shop. We were just leaving the gift shop when I saw my soon-to-be patient. He was overweight, in his mid-40s, and apparently alone. He was standing next to a garbage can about ten feet from me and making an odd grimace. Just as I noticed him, he made some grasping motions at the garbage can, then collapsed on the ground and began to seize.
If you've ever seen a genuine tonic-clonic (AKA grand mal) seizure, you realize how frightening they can be. The man fell down hard and the back of his head visibly rebounded on the asphalt. His entire body began to convulse violently. My first thought was, "This man needs a doctor!" I'd been caught off guard, and it took a couple seconds for me to realize, "Wait, I'm a doctor!"
I pulled out my "Dad voice" (the same voice I use to let my kids know that the goofing off needs to stop and they need to start listening) and announced, "Out of the way, I'm a doctor!" The crowd that had already started forming parted and I was at the patient's side almost immediately. My stepfather quickly started doing crowd control; he was joined within seconds by Disney employees who formed a circle to keep the gawkers back. I was joined at the patient's side by my mother, who is a cardiac nurse with twenty years of experience, as well as a man whom I don't know; I'll call him Mr. Smith. My mom checked the patient's pulse while I verified the patency of his airway. Good pulse, good respirations, so we knew at least that we didn't need to start BLS (or CPR, for you laypeople).
In the hospital, I have ready access to benzodiazepines, which are first-line therapy to break a seizure. I also have access to and technical proficiency with airway adjuncts and monitoring devices. None of that was available in front of Star Tours. The only thing we could do was ride out the seizure. I stuck my foot under the patient's head so he wouldn't crack his skull on the ground; my mom and Mr. Smith tried, as best they could, to keep the patient from migrating across the pathway. Someone said, "here give him some water!" but my stepfather wisely kept them back. The last thing this patient needed was to have something poured in his mouth when he was unable to protect his airway.
The seizure lasted for probably about thirty seconds, although it felt much longer at the time. Finally, though, the patient stopped jerking and was still. We rechecked his pulse and breathing, both of which were fine. Someone passed me a cell phone and said 9-1-1 was on the line; I gave them what info I could and handed the phone back.
Over the next couple of minutes, the patient began to stir. Many people don't realize that lots of seizures are followed by a period of confusion; we call it a post-ictal state. The absence of a post-ictal state can be one clue (of many) that a person may have faked a seizure. Other clues include: collapsing but managing to miss every obstacle on the way down, protecting the head and face while falling, and maintaining bladder control. We were sold on this patient's seizure being real: he had a huge goose egg on the back of his head and the front of his jeans was wet. We also found he was very post-ictal. What that means in practical terms is that he was big and he was very confused. He started to thrash about in a dazed, mostly-asleep state. He wouldn't answer questions or follow commands; he gave no indication that he even understood us or was aware that we were there. It took me, my mom, Mr. Smith, and a couple other people to restrain the patient so he wouldn't come to any further harm. This continued for a couple minutes before the patient regained his senses enough to settle down.
As our patient awoke, we found him to be a pleasant man who had been enjoying a pleasant vacation that was about to end rather unpleasantly. He was from Nevada and was at Disney World with his family. He didn't have a cell phone and he didn't have his wife's number memorized, but the Disney employees assured him they'd figure out how to contact his family. (It was about this time that I noticed many of the bystanders were filming this whole thing on their phones or camcorders. Note to self: kill these people.)
The EMTs arrived more quickly than I had thought they could, and they smoothly and professionally packaged the patient up for transport to a local ED where he would undergo further evaluation. I told them what I could about the patient and helped move him onto their transport gurney. That was the last I saw of the patient.
Medical education is a long process during which progress comes by baby steps more often than by great leaps and bounds. Just a few years ago, I would have felt completely overwhelmed if that situation had been presented to me. Now, with one year left before I become an attending anesthesiologist, I felt comfortable managing that patient's acute care. Sure, I felt rather helpless since I didn't have the equipment or drugs to handle things more definitively if necessary; but at no point did I panic or feel that I was in over my head. In fact, I felt confident and more-or-less in my element as I evaluated and cared for my fellow vacationer. After the EMTs took him, I resumed my afternoon with my family; I didn't even feel drained like you do after an adrenaline rush. More than anything else, I felt comfortable and prepared for that situation.
So in closing, I'd like to extend my gratitude to every professor and attending who's taken the time to teach and guide me. Your hard work and patience have made an incalculable difference. Thank you for all you've done.
I took my family to Disney World about three months ago. I hadn't had any time off from work since early fall, so I was looking forward to a fun, much-needed vacation. The trip started off uneventfully and we were enjoying Hollywood Studios on our third day when the vacation suddenly got more interesting.
We were vacationing with several family members, so we spent some of our time separate and some together. By mid-afternoon, we had reconvened to go on Star Tours before having dinner. We breezed through the line, enjoyed the ride, and navigated the exit that (naturally) let us out in the gift shop. We were just leaving the gift shop when I saw my soon-to-be patient. He was overweight, in his mid-40s, and apparently alone. He was standing next to a garbage can about ten feet from me and making an odd grimace. Just as I noticed him, he made some grasping motions at the garbage can, then collapsed on the ground and began to seize.
If you've ever seen a genuine tonic-clonic (AKA grand mal) seizure, you realize how frightening they can be. The man fell down hard and the back of his head visibly rebounded on the asphalt. His entire body began to convulse violently. My first thought was, "This man needs a doctor!" I'd been caught off guard, and it took a couple seconds for me to realize, "Wait, I'm a doctor!"
I pulled out my "Dad voice" (the same voice I use to let my kids know that the goofing off needs to stop and they need to start listening) and announced, "Out of the way, I'm a doctor!" The crowd that had already started forming parted and I was at the patient's side almost immediately. My stepfather quickly started doing crowd control; he was joined within seconds by Disney employees who formed a circle to keep the gawkers back. I was joined at the patient's side by my mother, who is a cardiac nurse with twenty years of experience, as well as a man whom I don't know; I'll call him Mr. Smith. My mom checked the patient's pulse while I verified the patency of his airway. Good pulse, good respirations, so we knew at least that we didn't need to start BLS (or CPR, for you laypeople).
In the hospital, I have ready access to benzodiazepines, which are first-line therapy to break a seizure. I also have access to and technical proficiency with airway adjuncts and monitoring devices. None of that was available in front of Star Tours. The only thing we could do was ride out the seizure. I stuck my foot under the patient's head so he wouldn't crack his skull on the ground; my mom and Mr. Smith tried, as best they could, to keep the patient from migrating across the pathway. Someone said, "here give him some water!" but my stepfather wisely kept them back. The last thing this patient needed was to have something poured in his mouth when he was unable to protect his airway.
The seizure lasted for probably about thirty seconds, although it felt much longer at the time. Finally, though, the patient stopped jerking and was still. We rechecked his pulse and breathing, both of which were fine. Someone passed me a cell phone and said 9-1-1 was on the line; I gave them what info I could and handed the phone back.
Over the next couple of minutes, the patient began to stir. Many people don't realize that lots of seizures are followed by a period of confusion; we call it a post-ictal state. The absence of a post-ictal state can be one clue (of many) that a person may have faked a seizure. Other clues include: collapsing but managing to miss every obstacle on the way down, protecting the head and face while falling, and maintaining bladder control. We were sold on this patient's seizure being real: he had a huge goose egg on the back of his head and the front of his jeans was wet. We also found he was very post-ictal. What that means in practical terms is that he was big and he was very confused. He started to thrash about in a dazed, mostly-asleep state. He wouldn't answer questions or follow commands; he gave no indication that he even understood us or was aware that we were there. It took me, my mom, Mr. Smith, and a couple other people to restrain the patient so he wouldn't come to any further harm. This continued for a couple minutes before the patient regained his senses enough to settle down.
As our patient awoke, we found him to be a pleasant man who had been enjoying a pleasant vacation that was about to end rather unpleasantly. He was from Nevada and was at Disney World with his family. He didn't have a cell phone and he didn't have his wife's number memorized, but the Disney employees assured him they'd figure out how to contact his family. (It was about this time that I noticed many of the bystanders were filming this whole thing on their phones or camcorders. Note to self: kill these people.)
The EMTs arrived more quickly than I had thought they could, and they smoothly and professionally packaged the patient up for transport to a local ED where he would undergo further evaluation. I told them what I could about the patient and helped move him onto their transport gurney. That was the last I saw of the patient.
Medical education is a long process during which progress comes by baby steps more often than by great leaps and bounds. Just a few years ago, I would have felt completely overwhelmed if that situation had been presented to me. Now, with one year left before I become an attending anesthesiologist, I felt comfortable managing that patient's acute care. Sure, I felt rather helpless since I didn't have the equipment or drugs to handle things more definitively if necessary; but at no point did I panic or feel that I was in over my head. In fact, I felt confident and more-or-less in my element as I evaluated and cared for my fellow vacationer. After the EMTs took him, I resumed my afternoon with my family; I didn't even feel drained like you do after an adrenaline rush. More than anything else, I felt comfortable and prepared for that situation.
So in closing, I'd like to extend my gratitude to every professor and attending who's taken the time to teach and guide me. Your hard work and patience have made an incalculable difference. Thank you for all you've done.
Seizures are about the scariest thing I can think of! A boy in my high school choir class had a grand mal seizure in the middle of class one day and it scared me to death!! My cousin devleoped epilepsy during her first pregnancy and continues to suffer with seizures. They are horrifying! I'm so glad you were there and not me! And so is your patient!! Great job...to you and your Mama!
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