Night shifts in the middle of the week get pretty slow. The senior residents know about any major ambulance cases before they get there, and always go to see those. Which is fine with me, because if you want a nonsurgical airway in a hurry, the ER residents are better than me. (And surgical airway too, for that matter; but I’m planning on learning those.)

Which leaves me with the cases that nobody wants: drunk guy found in the parking lot, what shall we do with him? The whole hallway of “female complaints.” (Which I went into surgery to avoid having to deal with; I guess you never really escape.) All the “vague abdominal pain which might really be something, so let’s let the surgery resident see it” – thank you so much.

And then, finally, the surprisingly good case: A woman sitting in a darkened room, whose face and manner flashed “psych issues/pain issues” warning bells all over. Her story, to start with, had me trying to decide between discharging her, and consulting psych. But as she kept going (for a change, a patient who wanted to tell the main points in a logical order – no temptation to interrupt), she started to sound more and more worrisome. Although her old records showed signs of drug-seeking behavior, today she wasn’t asking for any pain medicine at all. She just wanted to know why her arm had been feeling swollen for a week – and incidentally twitching non-stop the whole time. And by the way, she had been blacking out once or twice a day for the last few days. By this time she had my attention: clearly new partial seizures – caused by meningitis? brain tumor? Then her face started twitching while we were talking, and I realized she must be having multiple small seizures almost continuously. At which point I left to find the attending. I’d heard of status epilepticus with generalized seizures before, but I couldn’t believe I was seeing it happen with these focal seizures as well.

Neuro didn’t give us any argument about admitting her immediately.

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