The ED is a remarkable place; it’s where you get to be on the frontline of all emergent (and non-emergent) medical presentations. You get to step in at the very onset of disease, or at the worst day of someone’s life you get to be the big difference. You may also get a case that really really gets under your skin, not because of the intricate, complicate nature of the presentation, but because there sometimes may not be a medical problem to rectify.
I once had a patient (I am glad it was once!) who came in with what I had been told was a headache. I didn’t read the card, and I called the patient, and took them to a nearby cubicle to for my assessment. She was a youngish female, accompanied by her mother, and the patient walked comfortably into the room, and onto the examination trolley. The only outward sign of anything being wrong was the large pair of sunglasses on the patient was wearing; it was after 10 pm.
I introduced myself and asked her what had brought her to ED today. Presumably because she was so unwell, she couldn’t really tell me, so her mother volunteered the information that her daughter had had an MRI scan that had damaged her brain somehow and caused her internal injury. I stared at them, blankly. I looked down at the ED card in my hands. This is what it said in the presenting complaint (I kid you not): Had MRI today which was severely painful. Mum concerned that scanner has ?burnt brain. Why, oh WHY did I have to pick up this card? *sigh*
‘Come again?’ I managed. Both mother and daughter sighed deeply. ‘My daughter had an MRI today. She began to get a headache during the scan, and not knowing whether or not this was to be expected, she went on with it, she has a very high threshold of pain you see. My daughter is very brave. After the scan we also noticed that her right cheek looked very red and sunburnt! Please do something, because I have a feeling if this is what is happening on the outside, who knows what’s going on on the inside! Her brain might be burning!’
I just continued to stare. They seemed ok, IQ-wise. Both looked like they were respectable, well-educated, well-dressed. They genuinely thought this situation was a medical possibility, bless them. It was a good few seconds before I realised they were looking at me expectantly. I offered Mum a tissue (she seemed to be in tears!) and the patient a glass of water. I tried to ascertain if there had been any trauma to her head or her face while getting the scan done. She experienced no nausea or vomiting, no dizziness, no other ill effects at all. She had no metallic implants that would have caused a problem during an MRI. She still had the headache, even though a good 10 hours had passed since her scan. I tried to convey to her that there was no scientific or medical reason for her to experience these symptoms from being ‘exposed’ to an MRI scan, as it did not actually entail any radiation exposure. But apparently a relative or family friend had done some research into the hazards of MRI scans and reckoned she needed to come to ED because of radiation exposure, and ‘maybe they had targeted the radiation to the wrong place’. I took a deep breath, explained how the MRI machines work, and that it was basically just a large magnet and it was basically testing the alignment of various particles of the body, and formed an image based on how each particle moved in the magnet’s field, based on what tissue it was a part of. There were no x-rays or radiation involved. I tried the reassurance method. Then I tried explaining the science. But both mum and daughter were having none of it.
Her examination was (surprise!) unremarkable. It was more of a therapeutic examination rather than me actually looking for any abnormality caused by having the MRI. But I had to make sure I dotted all my ‘i’s and crossed off all my ‘t’s, before I told her that essentially there was nothing wrong with her and that the MRI is the safest scan modality requiring no radiation etc whatsoever. Did she believe me? That would be no.
Against my better judgement, I sought senior advice; I could see this conversation was going nowhere. I requested one of my seniors to come review her independently, see what conclusion he arrived at, and to then tell the patient his independent findings. When this happened, wouldn’t you know it, she apparently got convinced, and was happy to go home.
So yes, the ED is an amazing place. But some interactions may make you decide that you do not want to live on this planet anymore.