Sunday, April 1, 2012


    It was middle of the week. It was 11 am . I had office at 1pm . but due to semi emergency , the office had scheduled new patient at 12-30 pm . If I have no opening in next 2 or 3 weeks we sometimes schedule patients at 12 -30 pm. So it was going to be busy day. And I got page from the ER and at the same time got a call from another doctor . There was a patient in ER , that was being admitted ti Intensive care and I was consulted . The ER doctor wanted to give me the 'short' story and so did the admitting MD . I spoke to both of them .
     This was a 32 years old female who came to hospital or was brought in , to the hospital and then became   unconscious . So for the airway protection was intubated and was put on respirator and I was asked to help out. (when patient is unconscious, they could vomit or could not swallow their saliva and it could go in the lungs, called aspiration . To protect the patient we put patient on respirator even if their respiration may be OK. )So I was going to ER. , but then I was told that she was being transferred to ICU , so I went to ICU.
     When I went to ICU there was no new information . There was no one with her and there were no telephone no. on the chart, that I could call. She was 32 years old black woman and was on respirator. Her blood pressure was quite elevated and rest of the vital signs ,like heart rate ,  temperature , etc was normal . Her physical examination , including lungs and heart was normal . Her blood count her electrolytes, her chest x-ray all was normal . And to my surprise her drug screen was negative . ( whenever someone is found to be unconscious 1st that comes to mind is drug overdose , and then low blood sugars or the stroke .In younger patient stroke is very less likely and drug overdose is more likely. ) Her ct scan of the brain was normal .and now I was not sure what we were dealing with. Except for being very 'large ' woman, and elevated blood pressure and some swelling  in both legs there were no positive findings. I thought of 'encephalitis ' --which is infection of the brain. This is little difficult to diagnose , but  MRI can be helpful . I consulted the neurologist and infectious disease specialist and started her on treatment for encephalitis. (the common cause is herpes encephalitis. )I also requested for the lumbar puncture .( by examining the csf , the fluid which flows around the brain and the spinal cord, the infection of the brain , or more specifically the meningitis can be detected. )
    The lungs were OK and I did not have to do much . The other 2 consultants came and agreed with plan and did not add much to the treatment . But even though they did not add , there agreement withe the plan of treatment was great help . So next day there was no change , in spite of the treatment . The MRI of the brain  was normal . and the CSF , the spinal fluid was normal . So we had no diagnosis. Some how I had an idea. I knew that , she came to the hospital on her own .So she must have had her own clothes  and may be some Identification or some contact information . So I called the security and got all the patient's belongings . I was successful in getting a phone no . and got hold of her mother . The mother came to the hospital quickly . But that was of no help , as she had no new information, other than the daughter had high blood pressure. We had sedated patient and done good control of the blood pressure .
     we were coming to dead end in all the directions . Every time I thought we were doing some progress we had no success. The encephalitis , the drug overdose etc were proved to be not correct .
      I decided to look at all the report again . Sometimes looking at the data again or looking at it together may give me some 'clue' . So when I was looking at the labs , I saw a "pregnancy ' test being ordered . Our computer system does show test that are ordered and the results are pending . I was not sure who had ordered the pregnancy, and why . But when I went back to the labs. after looking at all the x-ray reports, I was shocked . THE PREGNANCY TEST WAS POSITIVE !!! This means she was pregnant and because of her obesity and lack of the history , we did not know it . ( even the mother did not know that the daughter was pregnant. )
    I called the ob-gyn on call and she was taken to operating room for the c -section and had a baby boy . The post operative course was short . She was awake and so we took her off the respirator and she did well and went home in next 2 days. ---on no medicines. I never knew if the patient knew that SHE WAS PREGNANT.

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