Can't Help Everyone

A few weeks ago I blogged about now being able to save everyone. I wrote about it after I had signed up for a "simple" back pain that ended up dissecting his aorta from the arch down to his iliacs. Yesterday I came to the realization that not only can you not save everyone, but not everyone can be helped either.

Yesterday I signed up for a patient with a chief complaint stating, "General complaint." These complaints are always interesting, the "Lets make a deal" of the emergency room, because you never know what you're going to get when you open the door. Usually it's a young male with penile discharge that was too embarrassed to tell the female triage nurse about his recent escapades.

I walked in the room yesterday and saw I young male unable to sit still. Every one of his extremities jerking, almost violently, in a random pattern. I look at him with his arms and legs flailing all around as he and his wife told me his story. He was diagnosed with an unknown movement disorder two years prior. He was initially started on one medication regiment that significantly improved his dystonic jerks, but later was recommended to try another regiment to see if it would it further improve his symptoms. Not only did it not improve, but when he return to the initial medication regiment that had provided relief, it no longer helped.

I asked him why he came in to the ED yesterday as this had been ongoing for two years and he had a nuerologist.

"I'm tired of it all, " he replied. "I just wanted to see if you all could help."

Looking at this poor fellow reminded me of the news story/youtube video of the chearleader that developed a dystonic reaction supposedly after receiving the flu vaccine. http://www.youtube.com/watch?v=cEN5KGwNGeo

This guy had seen numerous primary physicians, numerous neruologist and even medical doctors at the state level. I'd like to think that I'm not a stupid person, but I fill pretty confident that I'm not going to think of anything that hasn't already been pondered.

The only truly beneficial option, although not practical for obvious reasons, was to RSI the guy so at least he could get some sleep for a while. Alternatively, I told him to start taking benadryl 50mg every 6 hours and started him on some Cogentin telling him to see his neurologist again this week.

I felt really bad for the guy, but in the end I'm an emergency medicine doctor, and he needs help I can't provide. Hopefully he find some who can help.