Untold Stories of the E.R. Exclusive: Q&A With the Doctors
Case: The Littlest Stroke
A six-year old boy is brought into the E.R. with paralysis on one side, unable to talk. An MRI confirms that he’s had a rare massive stroke. Dr. Abanses must make some fast and unprecedented decisions in order to save the boy from severe brain damage. However, the cure could be as dangerous as the ailment.
Q: What was your initial reaction to this case?
Dr. Abanses: My first reaction was boy, this child is in trouble, and we have to work fast. My next biggest impression was how brave he was being. This 6-year-old who could not talk to me would still follow my every command. Being taken to an E.R. is a scary enough event, but to not even be able to communicate with the people around you had to be terrifying. Yet, through it all, he did everything we needed him to do and would try it with all his might. In my eyes, that took a lot of courage by a young man.
Q: What was the trickiest part of the case?
Dr. Abanses: There were two very distinct tricky parts for me in the care of this child. The first tricky part was explaining to a mother whose husband had just died that I wanted to give her child a medication not tested on kids to see if it would work in helping her child. Explaining the complications of this medication and risk for profuse bleeding and possible death was not an easy thing.
The second part was after I gave the TPA (Tissue Plasminogen Activator), the child, who had a heart race around 110, suddenly dropped his heart race to 44. That was scary. Was he herniating his brain from massive internal bleeding, or was his heart going to stop and go into cardiac arrest? I had to choose to give him atropine to treat his heart, which could potentially decrease the blood flow to his brain, or I could choose to not give it, which could also decrease blood flow to the brain and the rest of his body.
Q: How is the patient doing now?
Dr. Abanses: I was thrilled to hear that this young man now plays basketball. My favorite picture of him on the show was seeing him climbing the rock wall - such an accomplishment. To see him using all those muscles on both sides of his body getting up that wall contrasted to that memory I have of him raising his right arm and tears flowing down from his eyes - such a sharp contrast and an end to an amazing story.
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