I will always wonder

Categories Medical

I was on vacation when she died.  I’m not sure that not being on vacation would’ve made a difference, but I’ve often played the scenario through to a different end.  She called in on the morning of her death complaining of a bad headache.  When questioned about neurologic symptoms, there were none and she didn’t want to come to the office.  She was told to try Tylenol and to call back if not improving.  When she called again, her words were garbled.  My medical assistant was shaken as she told me the story.  My assistant called 911 on the other line while telling her help was on the way.  But, she was dead when the ambulance arrived.  Subarachnoid hemorrhage caused by a brain aneurysm. 

As a medical student, we are taught if someone complains of the worst headache of their life, they go immediately to CT.  They do not pass go, they do not collect $200.  They call 911 and go immediately to CT.  The mortality rate of a subarachnoid hemorrhage is close to 50% with 15% dying before reaching the hospital.  But, what we are not taught in medical school and what we figure out along the way is that some people won’t complain of the worst headache of their lives even when they have the worst headache of their life.  And, more often, many patients will complain of severe pain, when it is obvious they do not understand severe pain.  The only way to know the difference is to know your patients.

So, what if I had gotten that morning call?  Would I have remembered that she had her son with no epidural or that she walked around for two days on a broken ankle?  I might have recalled that she had no history of headaches.  Mostly I would know that she never called with a complaint.  Ever.  She came in for her routine hypertension visits and when her foot was so swollen it wouldn’t fit in her shoe, but she was not the  ”call the doctor” type.  She was a single mother of a 4 year old at the time of her death.  I don’t remember her name.  I remember she was always in an attractive matching skirt and jacket.  I don’t remember her job.  I remember she was buried in a light blue skirt and jacket.   And, I remember wondering if she might be alive had I not been on vacation the day she called.  I guess I’m still wondering.

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