A little behind

Whoops...I've been slacking just a little recently.  So now might be a good time to make up for that a bit and write about one of the more interesting kids I've seen over the last couple of days.  The patient I remember most vividly was a teenage girl who came in complaining of abdominal pain in the right lower quadrant.  She and mom were particularly concerned about appendicitis, and with some reason.  The onset of the pain had been rapid and severe, and it had kept her from wanting to eat or drink anything.  It was worse with moving around, and had been excruciating when they had hit bumps on the way in.  But she didn't have any fever, her appetite was starting to return, and her pain was improving as time went on (very rare with appendicitis).  We still wanted to try to rule it out, so we ordered a CBC and an abdominal / pelvic ultrasound.  The CBC came back stone-cold normal with maybe a little left shift.  Probably not appendicitis, we thought then, so what could it be?  Our temporary theory was an ovarian cyst -- many of the symptoms overlap.  When the ultrasound came back, we found out we were half right -- the ovary was involved.  Instead of a cyst, however, there was a solid mass of unknown origin.  When we broke this news, both patient and mom were pretty upset.  After all, when you tell someone about a "mass," the first thing they'll think is "tumor."  The only comfort we could offer at the time was that it was very unlikely to be cancer given her age and background.  The radiologists backed us up on that -- we had ordered a CT scan at the behest of pediatric surgery, and it was read as showing an adnexal mass, probably benign.  So at the tail end of my shift (by which I mean two hours after I was scheduled to leave, but worth every minute), we went back to tell her this as well as let her know that surgery would be down to see her.  I guessed that since she was feeling much better they would probably decide to send her home and have her follow up as an outpatient.  When I went back in the following day, I had a rare moment of down time which I used to check and see what had ended up happening.  Peds surg had, in fact, evaluated her and decided to take her to the OR, where they had discovered a ruptured ovarian cyst and a medium-sized benign-looking mass that they had sent for biopsy (results on that were still pending...I should check and see if that was ever completed).  It was a bit of a zebra, definitely not a common pathology, but we had managed to come up with a (mostly) correct diagnosis and now it sounds like the problem should be permanently taken care of.

Sorry, bit of a long story there, but definitely a good case (especially since she had a good outcome) and one I was glad to be a part of.  And that's true so often in the emergency department -- it's nearly always a blessing, one way or another, to be involved.  Some cases are tragic (for example, the 10 month old with a depressed skull fracture and massive subdural bleed that were 100% non-accidental; even if she survives she'll likely be neurologically devastated), but it's still a privilege (not to mention a valuable learning experience) to be involved.  Every day, unless you actively avoid doing anything, you'll be making a difference in someone's life, and occasionally, that difference is profound (sometimes even the difference between life and death).  You get to make kids' lives better, to watch them heal right in front of your eyes.  They come in sick or broken and they leave healthy and whole.  It's a feeling unlike any other in any job one could possibly imagine.

Anyway, that's all for tonight...I'm exhausted.  I likely won't be posting tomorrow (I'm working 5P-1A) unless I actually get home reasonably close to 1 (it normally seems to be closer to 3 or 3:30), and I'm working the same shift on Wednesday, so unless I get some unexpected free time, it may be a couple of days before I'm posting again.  But I'll be back.  Till then, peace and God bless!