In the Nick of Time
When the ringing woke me at 3:00 a.m., I hoped that it was my alarm clock. For a neurologist on call, middle-of-the-night phone calls mean trouble; as a rule, you don't get awakened at that hour unless it's something really serious.
At 6:00 p.m. the prior evening, a young man had shown up in the ER of one of our satellite hospitals with a severe headache. He'd been diagnosed with a tension headache and discharged with a prescription for acetaminophen with codeine. No imaging studies had been done.
Nine hours later, the patient presented to the ER at our main hospital. He was no longer fully alert, the ER doc told me. I told him to get an immediate CT scan of the head. I was out of bed and through the door in an instant, worrying about this young, otherwise healthy man with a severe headache and reduced alertness. It's amazing how fast you can drive in the dead of night when you're nervous that a life may hang in the balance.
I parked in my usual spot, right by the ER entrance, and ran inside. The nurse told me that the patient had been sent upstairs to get his CT. I dashed to the elevators and got to the CT suite in just a couple of minutes. By now I was running on adrenaline; as I swung the door open, I could feel my heart thumping in my chest.
Again, my timing was off; the patient now was on his way down to the ICU. I couldn't believe I'd missed him again. Luckily, his films were lying on the counter, and I slapped them up on the viewbox. When I saw what was on those films, my heart really started to pound. They showed a massive enlargement of the ventricles (fluid-filled cavities, normally quite small) inside his brain. The resulting increased pressure inside this young man's skull explained his headache and grogginess. I ran even faster down the stairs to the ICU, where I finally caught up with him.
To my surprise, he was still on the gurney, just as the transport people had left him. He was unconscious, his ER chart resting on his chest. Apparently, the nurses were in the middle of changing shift; no one there had even taken a look at him. He was just lying there, unattended. I couldn't believe what was happening; it was as if I were in the middle of some horrible dream.
After a few seconds' assessment, I realized that he was in the process of herniating: The increased pressure inside his head was pushing his brain down through the opening at the base of the skull, through which the brain and spinal cord connect. His left pupil was widely dilated and unresponsive to light, and he showed signs of damage to the motor pathways controlling his left side. Unless I acted immediately, he could be dead in a very short time.
I shouted to the nurses that he was herniating, which really got their attention. I told them to immediately give him a large intravenous dose of mannitol, a powerful diuretic.
Within seconds, as I anxiously watched over him, his pupil shrank back down to normal size. It was working!
After only another minute or two (or so it seemed; I was so amazed and overjoyed that it was hard for me to judge), he woke up! My patient, who had been on the brink of death just moments before, was now alert: He knew his name and where he was, and he could move all four limbs. I felt euphoric.
Walking on air, I approached the small room by the ICU where his mother and father were anxiously waiting. From their expressions, I could tell that they expected the worst. As I delivered the hopeful news, I fully realized the enormity of what had taken place: Had circumstances been just slightly different, I would have been informing them instead of their son's death.
Even now, after all these years, my eyes mist over when I recall that night. If I had missed just one more traffic light, or lingered in bed just a couple of minutes longer, or if there had been no parking spot right by the ER entrance, I believe that my patient would have died. (His symptoms, it turned out, were due to a noncancerous tumor inside one of his ventricles; following a successful operation, he made a full recovery.)
On that night so long ago, it seemed to me that some higher power, or fate if you will, placed me at that young man's bedside at exactly the right time. It seems a bit fantastic to me now, but back then it made perfect sense. I'm no longer a strong believer in fate, but when I relive that night in my mind, a powerfully spiritual feeling still comes over me.
I never again found myself in a situation in which my split-second actions at a precise moment in space and time allowed me to save another's life. Every time I think about that night, I thank God that I was lucky enough to have done just that.
About the author:
Barry Thompson MD is a graduate of the University of Southern California School of Medicine. After engaging in the private practice of neurology for fourteen years, he left medicine in the late 1990s to become first a ballet photographer and then a psychotherapist. He lives with his wife and two children in the Pacific Northwest.