From Blackhawk to Brain Surgery to Bride
On a blustery, rainy Saturday nearly two decades ago, in my first year of practice, I went to my office after rounds, put my feet up on my desk, took a sip of lukewarm coffee and leaned back in my chair to relax after a busy morning. Within seconds, I felt the pager clipped to my belt vibrate. I set my mug down on the desk and called the number back. An emergency room doctor from another hospital immediately picked up and identified himself.
“Doc,” said a clipped voice, “we’ve got a 9-year-old girl who was a rear passenger in a two-car collision about two hours ago. She’s just arrived. The scan shows a three-centimeter subdural hematoma on the right side of her brain. We’re a small show. Can you take her?”
“Yes,” I said immediately. “What’s her exam?”
“Her right pupil is blown and she’s posturing on the left.”
The pupil typically dilates on the side of the brain with the increased pressure, in this case the right side, as the brain is forced down and away from the blood clot. The nerve responsible for pupillary function basically goes haywire and starts to enlarge in response. The term posturing describes a movement pattern that comes from damage being done to the part of the brain that deals with movement. Both are outward signs of high brain pressure. Put bluntly, this girl was sick, getting sicker quickly, and the window to save her was closing.
https://www.nytimes.com/2020/02/29/opinion/sunday/doctors-medicine-military-emergency.html
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