The clinic was buzzing with activity when I arrived. The parking lot was filled with cars and pickup trucks, and dozens of patients sat in the reception room, and on the benches lining the clinical corridor. More cars and trucks pulled into the lot and were parking along the street.
My wooden box was already filled with patient charts, and my nurse for the day, Lillian Ashley, had already placed a family in my room. Four young children, aged 7 months to six years, all with sniffles and some chest congestion, and their young mother. Each was examined in turn, all afebrile, and looking well and each was given a prescription to get at the pharmacy down the hall. Two were given immunizations.
Kahn, Anderson, Donnely, and Cioffi, were all seeing patients this morning, but the patients kept on coming, as fast as we all could see them. At 10:15 AM, I just happened to be at the rear of the clinic, near the emergency exit doors to the parking lot, when the doors opened and the police van appeared, backing up, rear doors opened. The man who I had seen as a patient late last night, was lying in the rear of the truck, on the bare metal floor.
“We bringing this guy back, Doc. Something is wrong. He’s not moving”.
I looked into the emergency room, which was not being used, and I signaled for the two policemen to bring the guy in, and as soon as they bent down to lift him up, his body still completely limp and drooping between them, one grabbing his arms and the other his feet, I realized that he was a quadriplegic, and that in believing he was drunk, I had completely missed the diagnosis last night.
I shuddered and became acutely depressed and anxious, both for this poor man, with a broken neck and a delayed diagnosis, and for myself, for my utter stupidity and the embarrassment of having missed the now obvious diagnosis hours earlier.
They placed his limp torso onto the table, and I reached for the safety straps, as I had done before, my mind rushing, despite my fatigue of having slept one hour in the past 48 hours, about what to do for myself, and for him. He needed to be examined, to confirm this new clinical impression, and then he needed to be taken to Albuquerque to a neurosurgical unit, where his broken cervical spine could be fixed. But the damage to the spinal cord was already done before he was brought to see me last night. It was done by the original injury, whatever that may have been, and it was worsened and complicated by the way his family handled him and by the way the cops carried him from the site of the injury to the police station, and from the police station to the clinic, and so on.
But I was rationalizing, as I always did, and as most humans always did, to make myself look and feel better. I had made a mistake, and had missed the diagnosis, despite what in retrospect were obvious signs of paralysis last night. He had been flaccid and uncommunicative, and I had not smelled alcohol on his breath.
I removed the man’s boots and stuck a pin into the skin of his feet, one at a time, and into his palms. No reaction. I stroked the bottom of his foot with a tongue depressor for a Babinski reflex, and it was absent.
“He has a broken neck, and he’s paralyzed. We have to arrange for a flight to Albuquerque, to the neurosurgical service.” I was speaking out loud, virtually to myself. The two Navajo cops were there, but had little interest, I thought, in the nature of this man’s injuries or in his disposition for treatment. I wondered to myself, especially after seeing a Navajo policeman beat a man right in the clinic in front of me, earlier the night before, whether the police had been involved in this man’s injury and his quadriplegia? They certainly hadn’t helped me learn the correct diagnosis earlier, by telling me that he was drunk, and by failing to question him properly about his paralysis. But I couldn’t blame them for my failures, and I couldn’t blame my fatigue, and the language barrier, and the lack of a Navajo nurse at the clinic to assist me. I knew the rules and I had failed to examine this man properly, and I had missed the diagnosis.
|