Forums > Social Discussion > Circling the drain
Login/Join to ParticipateHOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
So I've taken a 2 1/2 year old girl. She came in with what looked like a little nose cold kind of thing...except she kept going limp and turning blue around the mouth.
So she did it right in front of us today. Turns out she's got fluid around her heart and her heart's infected with a virus. The muscle is damaged. Her heart is racing trying to keep the blood going to her organs...and yet her blood pressure keeps dropping...and her heart keeps going faster and faster...and because it's not pumping much blood with each stroke, it's not going anywhere. Her oxygen saturations are dropping. We keep giving her more and more oxygen.
The next step is ECMO, Extra-Corporeal Membrane Oxygenation...basically an artificial set of heart and lungs outside her body. ECMO is a BAD thing... The problem with ECMO is that once you go on it...it's tough to tell exactly when you can get off.
30% of children with a viral infection of the heart (viral myocarditis) recover fully.
30% have decreased cardiac function but can be managed with medication
30% require transplant.
So 60% of the time, the news is bad.
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
Carpal \'Tunnel
3,533 posts
Location: Hampshire College, MA, USA
....and the other ten percent? pardon my insatiable curiosity
sorry, that must make you feel terrible.
-James
"How do you know if you're happy or sad without a mask? Or angry? Or ready for dessert?"
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
The other 10% go down the drain.
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
Sporadically Prodigal
2,758 posts
Location: Sydney, NSW, Australia
Just curious - why do you use a drain analogy?
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Altyd Brandend
149 posts
Location: Orange County, California, USA
Sorry to hear that you had a bad day Dr.L
Spinning makes my world go round
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
Going "down the drain" is...
...bad.
It comes with a headstone.
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
Scientist!
578 posts
Location: Waterloo, Ontario, Canada
I think he meant in the title of this thread "Circling the drain".
Mike, I'm sure no matter what happens that she and her family will appreciate what you are doing for her. One of my best friends got pneumonia as a child, and her life was saved thanks to a Dr like your self, and I know that there are millions of other people out there from doctors like you.
You're doing a good job mate, keep up the good work!
Educate your self in the Hazards of Fire Breathing <img src="/ubbthreads/images/graemlins/smile.gif" alt="" /> STAY SAFE! <img src="/ubbthreads/images/graemlins/hug.gif" alt="" />
Sporadically Prodigal
2,758 posts
Location: Sydney, NSW, Australia
I know what 'going down the drain' means, Lightning - I was just curious as to why you use that specific analogy to describe death. No biggie.
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HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
I dunno. It's just what we use. The jargon of the field.
She's doing worse, BTW. Her blood pressure AND heart rate are dropping. Her heart's getting tired. And probably more damaged.
She'll need ECMO.
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
1,463 posts
Location: Florida
I think down the drain is an amazing metaphor... If you think that we go through tunnels of consciousness as we die and are born... Much like information travels through wires to reach points where they are told where to go... So upon death our soul must begin a journey and if on earth we cannot see it then the person would go down a drain away from living humanity....
And Mike, you cant help everyone! I think the fact you made it through rigorous uni years makes you rugged and fully prepared for situations like this. Admit that you can only help how you can help and the rest is in 'God's' hands.
Huggles!
drome
JUGGLEwithyourmind!
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
Update: She's on ECMO. It happened this morning when her pressures dropped.
He heart stopped working. I documented the CRAZIEST physical exam today:
Heart Sounds: not heard
Pulses: not felt
Blood pressure: 76/76
Oxygen saturation: 100%
Wow...
Signs that things are not as they should be. -Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
Scientist!
578 posts
Location: Waterloo, Ontario, Canada
indded very strange stats :O
I hope she get better soon, for her sake, her family's and yours.
Educate your self in the Hazards of Fire Breathing <img src="/ubbthreads/images/graemlins/smile.gif" alt="" /> STAY SAFE! <img src="/ubbthreads/images/graemlins/hug.gif" alt="" />
Carpal \'Tunnel
4,172 posts
Location: Hastings, United Kingdom
my prayers go out to her and her family.
The Ministry of Manipulation
2,523 posts
Location: Bristol, United Kingdom
Good luck
Self-Flagellation Expert
3,414 posts
Location: Bogged at CG, Australia
Being non-spiritual, i can't say that my prayers go out.
I do, however, hope that she pulls through, for her sake, for her parents' sake, and for yours.
You've taken on a hard profession, not just the physical/mental difficultness, but the emotional side as well. keep caring, and you'll stay a better doctor than most others
Is pumping the liquid around her heart out an option? probably been considered, but im curious as to possibility.
"beg beg grovel beg grovel"
"master"
--FSA
"There was an arse there, i couldn't help myself"
--Rougie
Carpal \'Tunnel
5,814 posts
Location: Perth, Australia
I feel for her and her family. One day you have a well child, next thing she has a cold, then in nothing flat she is on ECMO.
The child is so young and her parents really must be shell shocked. How can the child have an understanding of what is happening to her.
We expect miracles from the medical profession and so often they are delivered but sometimes as health care users I think we barely understand the pressures our medical staff are under.
Look after yourself Mr Lightning as well as your precious patients.
Is it the Truth?
Is it Fair to all concerned?
Will it build Goodwill and Better Friendships?
Will it be Beneficial to all concerned?
Im in a lonely battle with the world with a fish to match the chip on my shoulder. Gnu in Binnu in a cnu
what goes around comes around. unless you're into stalls.
4,030 posts
Location: Bali, Australia
Hey Mike,
How's it going?
And I 'm very curious about the comment that once on an ECMO it's hard to know when to get off.... is that because it is risky to have to rely again on a person's own functioning.. or where the person will not be able to sustain their own life but it's a legal wrangle about who makes the decision to 'turn off' the machine?
.....Can't juggle balls but I sure as hell can juggle details....
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
We had a miracle with her. She's off all IV medications. She was walking today. Slowly...haltingly (She's been flat on her back for two weeks). But she recovered...100%.
Amazing. Absolutely amazing.
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
*slou?
6,554 posts
Location: Adelaide, Australia
HoP Magic!!! 1,662 posts
Location: Bristol
i read this but didn't post, but now i just have to say
wooooo! life's little niricles - amazing & happy
I had a dream that my friend had a
strong-bad pop up book,
it was the book of my dreams.
Carpal \'Tunnel
3,899 posts
Location: Austin, Texas, USA
it's no miracle - it is just Dr. Lightning's fine work!
-v-
Wiederstand ist Zwecklos!
1,662 posts
Location: Bristol
well done sir!
I had a dream that my friend had a
strong-bad pop up book,
it was the book of my dreams.
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
No...she did the work. Her heart put itself back together.
However, also lost two kids last week.
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
Carpal \'Tunnel
3,533 posts
Location: Hampshire College, MA, USA
that's really cool! (not that last bit, obviously, the little girl) congratulations, that must really make you feel on top of the world.
-James
"How do you know if you're happy or sad without a mask? Or angry? Or ready for dessert?"
journeyman
61 posts
Location: Minneapolis, MN, USA
congratulations about the young lady.
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
She SMILED at me today. I never saw her do that before...
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
Carpal \'Tunnel
4,172 posts
Location: Hastings, United Kingdom
aww
Carpal \'Tunnel
3,136 posts
Location: Warwickshire, United Kingdom
are you allowed to talk about patients publically?
1,803 posts
Location: Wonderland igloo, Vic, Australia
awww
hope you smiled back! .:Pink Exocutioner:.
I am Jack's Raging Bile Duct...
Loving you from the deepest part of my loins.
Carpal \'Tunnel
3,899 posts
Location: Austin, Texas, USA
I think he can as long as he doesn't give any information that would allow anyone to identify her (I think)
I'm sure there are enough little girls around the hospital that no one could possibly hope to figure out who he is talking about
-v-
Wiederstand ist Zwecklos!
Carpal \'Tunnel
3,136 posts
Location: Warwickshire, United Kingdom
fair enough
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