its not a tumor...

Before I could sit down last night, the loudspeaker crackled overhead asking for "KEG to Trauma 1". With fresh legs, I jumped. I moved quicker than expected and took the hallway in a few quick strides. Two weeks off from the ER leaves each synapse exploding with double-shots of neurotransmitter. As I walked through the ED, its prep time. Images of tragic trauma victims strobe through my mind. In those precious few seconds, I've learned to feed off the past. I instinctively conjure the worst cases I've seen, for there is nothing scarier than the unknown...

I push open double doors to find a pale, confused, twenty nine year old. His startled eyes were staring into the bright trauma bay lights, pupils as wide as shiny black peacoat buttons. Awake and no one home... and all I could think was 'bad'... severe head injury, intracranial hemorrhage, tumor, anticholinergic toxidrome. When you're holding a hammer, everything looks like a nail.
One of the nurses says something about a history of inoperable brain tumor. As I quickly examined him I called out for a stat head CT. "Let's get him to scan in 3 minutes".

I made my way back into the thick of the ED. A few more had trickled in and I jumped right in. Postcoital headaches, a bevy of unexplained abdominal pain, new onset congestive heart failures, and of course, a host of unexplained chest pains. As I circled back to Trauma 1, I saw that the room was empty. Good. He was in CT.

"Dr. Patel to CT"

I ran to radiology. There are few times when ER docs run. Getting paged to radiology is always bad. As I walked in, I found him, mouth frothing, with arms and legs rhythmically shaking. I immediately turned his head, laced the oxygen cannula under his nose, and called out for some ativan. In my relatively short career, I've already seen enough bad to know this was going to be bad. He rolled through the scanner and we hustled him back to the main ED. A few moments later, I cautiously opened up the PACS to bring up his images. Family just showed up.

I wondered how I would break the bad news. As I scrolled through the images, I saw the angry mass lodged in his left frontal lobe. As I was reviewing the CT, his friend ambushed the nurses station and started apologizing. "I'm sorry I took so long... I had to park the car. We were driving and he started shaking in the car and foaming at the mouth. I think he had a seizure...He hasn't been taking his medicine for the last 3 days..."

Its okay. You're right. He's had a seizure. But the tumor looks unchanged. No bleeding in the brain. In my line of work, I love being wrong...