Brain turns to mush

The hardest part of Peds to me is when a child suffers an injury or gets a chronic disease that changes their lives forever. A permanent injury or chronic disease is a tragedy to anyone. The sad fact that it happens early in life makes it more tragic.

We have been caring for a previously functional, to most accounts, normal, 6-year old girl. Over the course of a few short weeks, she has transformed from a talkative 1st grader to a hemiplegic (one-sided paralysis), non-verbal body in a bed. Her eyes open and she grunts and cries when you approach her. She does not recognize her parents or grandparents.

What happened?

The truth: we don't know for sure. It has not been for lack of trying to find out. Last week, we went the final mile and did a brain biopsy -- understandably a last resort diagnostic. The neurosurgeon who performed the procedure reported dismally to the family that the consistency of the brain indicated breakdown and the sample he obtained may not have been sufficient.

After considering and rejecting multiple hypothesis, we now believe that this a form of post-influenza encephalitis -- a rare complication of the flu (which she had in early March).

It is our best guess that the changes that have occurred in this little girl are for the most part irreversible. I have no more to say in this case: the rest cannot be put in words.

Walking from room to room on a Pediatric floor in a hospital reminds me of that verse in the Bible: "Weep with those who weep and rejoice with those who rejoice."

Surfin' USA

Well, I'm back in Pediatrics for the final 4 months of my training. On call this weekend, I learned something new about American culture: car surfing. The trauma code pager went off and announced a 'Level II Peds trauma'. Gathering information from the field reports on this soon-to-arrive patient to our ER, I overheard a dictation describing the 'car surfing accident'.

Car surfing: what's that. A nurse nearby smiled and told me that there was 'car surfing' and 'car skurfing'. Apparently, (according to this local authority, anyway) car surfing is when you stand on the roof of a car while someone else drives. You then put your hands out in the air (allegedly, to steady yourself) to 'surf' the wind. Skurfing is when you're on a skateboard and hold onto a bumper or some other part of a car while it drives.

Back to our trauma. A 17-year old female had climbed onto the roof of the car and getting ready to stand up on it and 'surf'. Unfortunately, her boyfriend started the car in motion a moment too soon to her and she 'wasn't quite ready' and fell off. 'Fortunately', the only injury she suffered was a nondisplaced skull fracture.

There you have it: surfin' USA.