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If you’re a nurse over the age of 40, you probably grew up believing that doctors were “superior beings” who possessed great wisdom and knew all things. That is, of course, until you became an experienced nurse or went to work in a teaching hospital…
There once was a patient who we shall refer to as “Mary.” Mary had every possible system in her body fail during the YEAR in which she stayed in our teaching hospital. She was every resident’s nightmare because there was no escaping her! She was being seen by every service through which they all rotated: pulmonary, surgery, renal, endocrine, cardiac, neuro, etc. The only specialties which did not involve Mary were pediatrics and OB.
One midnight in the ICU (Mary’s home), the nurse noted that she could not get Mary to respond to any stimuli. This was back in the day before CT scans were running 24/7–it took at least a full hour to do a brain scan.
The resident of the month for neurology, a rather brash, cocksure and arrogant young man, arrived in his green scrubs and white coat, proceeded to go through his bedside exam and then decided that a lumbar puncture was indicated. So we collected the necessary equipment, arranged Mary in the desired position and stood by to assist.
At first all was well. The site was cleansed with the proper solution and numbed up. The area was draped and the equipment was ready. All that remained was to insert the needle and tap the spinal fluid to see if it was clear, measure the CSF pressure and collect samples.
(At this point it must be said that this particular resident, during his FIRST week in the Med/Surg/Trauma ICU, announced that all of the nurses there were morons. But that’s another story…)
He then picked up the spinal needle, inserted it and attached the vertical manometer–which immediately CLOTTED off! He was SO excited! He looked around and announced that Mary had suffered a “massive cerebral hemorrhage” and “YOU (nurses) are all witnesses!”
Even when I asked him: “Are you SURE that you did not hit the vein?” (because you do at least try to save these people from themselves), he stated: “Absolutely NOT! Mary has ‘stroked out’ and I found it!”
He then ran to the station and wrote an ENTIRE page of notes relating this event for the record.
But (and this is the punch line) just before dawn, Mary WOKE UP!
She then had a CT scan of her brain, which showed absolutely NOTHING. The attending neurologist repeated the lumbar puncture, which was crystal clear and with a normal pressure.
She continued to haunt the residents for many months after that eventful night.
“Experience is a brutal teacher, but you learn. My God, do you learn” –C.S. Lewis
