Today in my life, on call as a clinical epileptologist (and neurologist)………...
Jolted out of my bed early this morning by my rather loud cell phone, the nurse calls me to tell me that my patient whom I admitted for a "pre-surgical" video EEG study was busy having seizures. I logged in remotely to look at her spells, and lo and behold - she is not having epileptic seizures at all, but rather non-epileptic behavioral events. I told the nurse to give no Ativan and that I'll be in shortly.
Teeth brushed, body showered, face shaved, I left home with a banana in hand as I drove the 30 minutes to my hospital. En route, I take 3 calls (on handsfree of course) about 1 patient with agitation, another patient with "continuous seizures" and another patient whose stroke and the swelling associated with it was worsening this patient's headache, and he was becoming lethargic with nausea and vomiting. Orders given, directions to ensure each patient's safety were provided and then I arrived.
First off, the ICU where I'm confronted with a patient, having just been extubated following his convulsive status epilepticus, was in the throes of a horrible case of post-ictal psychosis with visual hallucinations, agitation and aggression. Zyprexa was my best friend at that moment.
The stroke guy with the headache, mannitol and a neurosurgery consult were in order. He didn't need neurosurgery to relieve pressure, but needed a neurosurgeon to familiarize himself with the patient, in case the neurosurgeon's services were truly needed.
The continuous seizures lady - her seizures stopped from the Ativan and Cerebryx given. Got her hooked up to video EEG monitoring and started her on a maintenance medication, keppra, of course.
Next up, the pleasant 86 year old man who came in last week with partial seizures - he would see flickering lights in the right side of his vision before he would smack his jaws and get confused. His MRI came back (it was ordered for a suspected stroke, in addition to seizures) and unfortunately it showed some micro-hemorrhages in both sides of his brain. Stopped his aspirin and discussed with his family that he most likely has amyloid angiopathy and despite his stroke risk factors; aspirin and anticoagulation are contraindicated in this clinical scenario.
The day continued on…..ended up seeing 23 people today - only took me 17 hours. Now I'm home, I'm tired and I'm unwinding with some free prose. I love my patients and care extremely about them but, don't know how many more years of this I can take. Its getting harder to compartmentalize all the crazy shit I see and manage performing at my best. I'm burdened by there not being 36 hours in a 24 hour day and the fact that my 2 boys are growing up, not seeing Dad that much.
Guess i'll publish this, unedited.