It was approaching lunch time and it had been an unusually uneventful morning in the Emergency Department.  Three patients had been fortunate enough to receive medical student attention this morning.  The first, a gentleman seventy-eight years young that had a possible case of neutropenic sepsis following his most recent round of chemotherapy.  Essentially, chemotherapy drugs had killed all his white blood cells and there was the possibility his immune system was struggling to fight an infection.  However, after a chat and some antibiotics, he was doing fine.

The second patient was a young girl that had taken far too much paracetamol.  She had some abdominal pain but was under the care of one of the consultants and was now doing fine.

The final patient was a lady with mild dementia that was adamant that she had been in the Department for five days because of something related to her chest.  Despite a lengthy conversation, neither of us were entirely sure of the specifics of her situation, but if one thing was clear it was that, you guessed it, she was doing fine.

So, everyone was doing fine.  An excellent situation to be in, if a little dull from an educational perspective.  I strolled idly towards the Resuscitation Room in search of the record book.  The lull had provided the perfect opportunity to find a patient to present at clinical reasoning.  When I arrived however, Tom was already doing just that.

“Good day, mate?” I enquired.

“Yeah not bad thanks, pretty quiet to be honest.  Everyone seems to be doing fine.  You?”

“Yeah same.  Have you found a patient yet?”

“Nah.  Just looking now.”

“Who’s in there?” I mouthed, gesturing in the direction of the only drawn set of curtains in the room.

“Apparently, it’s a possible subarachnoid,” a very dangerous type of brain haemorrhage.  “Some old guy that’s had a collapse and been complaining of headaches.”

Raising my eyebrows, I nodded slowly, mildly interested.

For the next few minutes we nonchalantly perused through the record book that detailed all the cases admitted through Resus.  Judging from the record book, today was unusually quiet.  Even the one bay that was occupied was subdued, the only activity being the occasional rustle of the curtain around the bed. Observing the adorning pattern of the material soon became an eyesore, pastel sheets of glacial blue were broken suddenly into irregular shards by the vulgar, convoluted ornamentation.

There were lots of cases, but few were appropriate for a trauma presentation.  Just as we began to tire of searching, a nurse drew back the curtain around the only occupied bay, marching purposefully through the double doors at the end of the room.  Out of curiosity I glanced in the direction of the patient.  An elderly man sat in the bed, his face familiar somehow.  He half-smiled, an action that I mirrored, if slightly confused.  My gaze returned to the record book and it was in that split second that I realised why that face was so recognisable.

The man in the bed was Earl.  Earl, who 24 hours earlier had been sat in this very Department being assessed for a head injury by Tom and myself.  I elbowed Tom sharply in the ribs.  He looked up, outraged, but as his eyes settled on Earl it was clear that he was experiencing the same thought process that had just transpired in my own head.  He turned back to the book, furiously flicking through the pages in search of Earl’s patient number while I grabbed his notes.  According to his son, Earl had not been himself since the fall, an entirely conflicting report to those given to us by Earl and his son-in-law the previous day.  We hurried over to the computer and brought up the CT scan of his head.  Two pairs of concerned eyes darted rapidly across the screen, carefully examining every millimetre of the black and white geography of the scan, searching for any sign of a contusion.

It was normal.  We turned towards each other and breathed a heavy sigh of relief, the terror already subsiding.  He did not have a bleed on his brain.

“Time for lunch?”


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