Playing Doctor

Initial Visit?

Monday, February 28

Doctor Erik’s Science Project

Hour One

I’m working in the Medical Intensive Care Unit and get called down to the Labor and Delivery area.

A 23 year-old girl who is 22 weeks pregnant (22 divided by 4 means she is about 5 and a half months pregnant) has come in with altered mental status.

‘Altered mental status’ is a catch all phrase meaning someone is acting strange. It can mean anything from batshit crazy to comatose.

The OB/GYN resident told me that apparently the girl had been having abdominal pain for a week or two and was taking all kinds of over the counter medications to relieve it. None of it was working. This morning, her husband woke up to her moaning and not able to talk to him. The resident told me her Tylenol level had just come back and was at toxic levels.

I went in to examine the patient. She was lying on the bed moaning and writhing about in some amount of distress. She was visibly pregnant, slightly overweight, but not obese. She did not appear jaundiced. She responded appropriately to only the simplest of questions, able to tell me her name and that she felt bad ‘all over.’ She was breathing rapidly, but her breaths were not labored. Her heart was beating fast. (125 bpm) Her belly was not tender and her pregnant uterus could be felt just below her belly button. For her stage of pregnancy that is a bit low.

Her husband, who appeared about her age, sat in the corner, reading a Tom Clancy novel. He looked up once or twice during my exam. It must have been a good book.

The labs showed she had sustained acute liver toxicity. The drug screen was otherwise negative.

A quick word about drug overdoses.

Tylenol is one of the worst drugs to overdose on. It usually does not kill you, but can cause irreversible liver damage. More than ten 325 mg tablets over a day are enough to cause some damage. (3000 mg is the daily limit in most hospitals.) Tylenol overdoses are one of the most common causes for overdose hospital admissions in the United States.

By way of comparison, if someone overdoses on certain types of sleeping pills and does not die, they will simply wake up in a couple of days. This happened to Sinead O’Connor, who was horrified to find no one had missed her after sleeping in a hotel room for 48 hours with a ‘do not disturb’ sign on the door. She had to call a journalist to report her suicide attempt. (This is one several Sinead O’Connor stories that I love.)

While I was looking over her records, the tech was going in with the ultrasound machine to examine the fetus.

Tomorrow, hour two through four of…

Doctor Erik’s Science Project


Blogger Damon writes:

That's a terrific Sineado story. I love cries for attention where they literally have to cry out for the attention.


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