Best Case Ever 30 Rob Rogers’ Mother

I caught up with my friend and education innovation mentor Dr. Rob Rogers at ACEP in Chicago where he told me the tale of his mother’s devastating illness – the only EM Cases occurrence of a second Best Case Ever. This powerful story begs many questions, some of which we discuss in the podcast: The importance of considering a lumbar puncture in the setting of altered mental status NYD, cognitive de-biasing strategies and the importance of being a humble patient advocate. We discuss a diagnosis that we should never miss in the ED, how to recognize it early, some pearls and pitfalls, as well as how to manage it effectively. We touch on how to recover from personal tragedy in anticipation of his upcoming SMACC talk in June 2015. Enough of this…..listen.

 

Published by Anton Helman November, 2014

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About the Author:

Anton Helman
Dr. Anton Helman is an Emergency Physician at North York General in Toronto. He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine and the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute. He is the founder, editor-in-chief and host of Emergency Medicine Cases.

4 Comments

  1. katze1956 November 19, 2014 at 8:27 am - Reply

    Thanks Rob for telling us about your mom, my thoughts are with you. I am a critical care nurse, CCRT (critical care response team nurse), a nero ICU nurse, burn unit nurse, CCU nurse, medical surgical ICU nurse, peritoneal dialysis nurse, post anaesthetic recovery nurse, CVICU nurse and vascular nurse, now working is a small town emergency semi retired. I have worked mostly in teaching hospitals, and in those situations I have felt the care for a patient was very collaborative with the physicians. The egos were not as high on either side. Now being back in a small town emergency I have had several situations where I new the Dx, the problem and the solution, however, I have had to dumb it up. I have had to use my words carefully and try and make the Doctor believe they feel that it was them, that have come up with the problem, and apply a solution. If I don’t, they turn off, as you say I am the doctor, I know what to do. I am not frustrated I am used to it, and sure there are times I could be completley wrong in the problem and yes the doctor is correct in that kind of response. Fortunately over the past three and a bit years in this small hospital I have gained some respect of my experience. It would be real nice if the doctors could respect the experience of a nurse who has been around such as I. I would say in most cases, if I think something is not right, and I say out loud, well I don’t know what is going on, but my red flag in the back of my neck is really flapping, I get their attention. Too bad it has to be that way, I enjoy the collaborations that I had in the teaching hospitals. When I was a CCRT nurse for four years, the first year was difficult, as when I arrived to the floor with a poor situation, it was I that had to take control, make the decision to move the patient, it was a nurse directed program. I also worked way up north where I did DX Rx and discharged, I am not a doctor, and I am proud to be a nurse. I find the younger doctors are more prone to work with me, work as a team to find the problem and apply the proper treatment. I have had two situation where a bear hugger (blanket warmer) was ordered for a patient who is in cold sepsis, in both cases I said I don’t think that is such a good plan, both times the Docs put their backs up and demanded it be applied, and of course we lost their pressures. In both cases, the doctors just did not have that experience, after they would ask how I new. I would say it is my experience that I know. As a nurse, we see the subtle changes, and we know something is going badly, because of our training we may not quite know what is happening, but we know it is, often before the s-hits the fan, but have been ignored, brushed off. As you say we are for the service of the patient, it is a service orientated profession, a good fun job. Thanks for your story, and including nurses as a good source of information.

  2. Simon November 19, 2014 at 6:09 pm - Reply

    Thanks – great post! Sometimes patient’s relatives are most knowledgeable about their loved one. I had an A&E consultant deciding not to CT Brain a patient with delirium with no obvious cause. Turned out the patient had brain met (unknown primary).

  3. Nasser January 28, 2015 at 6:33 pm - Reply

    thanks for Rob for sharing his story, i just wanted to tell that i had more sad full story of my mom, and even more devastating pathway.. she’s been a warfain patient,and had tripped at home, i came back home and she was ok ,took her in a short round in my car but she had a sudden severe headache and vomiting while we were in a mall ,collapsed,took her to ER ,CTS showed big epidural, neurosurgeon was kinda reluctant to do any drill now considering her warfarin, he kept her 3 days in ICU trying to reverse the warfarin, she was conscious,completely talking and conversing with us, given Vit K,FFP, as well as factor 8! . by the 4th day she was taken urgent to OR for drill as she had sudden unconsciousness ..
    CTS showed complete MCA thrombosis with major devastating rt hemisphere infarction! ( It was apparantely clear it was because of her aggressive warfarin reversal )
    it took long for us/ as well as for her to finish this suffer, she passed a way in 2 years after huge post infarction event, and huge expenses,and follow up ,pain and great impact on our life ..
    my comment that ,such cases of fall/ brain hemorrhage under warfarin effect,should they be fully reversed by all FFP,Vit K,and factor 8? what is the best method ? and what % of MCA infarction if we trying to reverse any brain hemorrhage after a fall?
    i really think if we could have a case of such incident on best case for ever..
    i still have those questions in my mind since that time, and just can’t find the right answer ..

  4. Nancy February 3, 2015 at 6:13 pm - Reply

    Thank you such valuable insights to learn from

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