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Blind people in Emergency!

Hey people
Hope everyone is doing well . People who are messing up , bhai hum saath saath hai.

I do embarrassing stuff quite many times. Good stuff comes in between but mostly it's embarrassing stuff . I am so used to it that the biggest embarrassing thing does not last for more than a day in my mind. I have learnt to move on.

There were a couple of incidents when I met a blind people and I could not  make out that they were actually blind even though my nursing staff could. Dumb girl alert!

Incident #1
A 70 year old man who is brought into the emergency room by his relatives with history of weakness and has upper and lower limbs and inability to speak. Like any other emergency physician I was more inclined towards keeping his ABC secure so I looked for his gcs he didn't move his limbs I kept giving him the pain stimulus and it open his eyes neither did he open his eyes  ,all I could see is a response to deep pain stimulus , inappropriate soundsand I obviously give him a lot gcs score.

Being junior then I quickly went up to the family explain them about his low responsiveness and his drowsiness that required is there way to be secured first so I explain the need of intubation that is mechanical ventilation . Yes ,there is a difference between an experienced and amateur emergency physician so my senior walks in  and says , Wajeeha I think you can wait . Meanwhile I was looking for his pupillary response I found something not a right I went back and ask about his history and what do I get to know. he was a known case of myasthenia gravis and optic neuropathy , parkinsonism , on anti TB therapy. I slowly clenched my teeth only to be saying that incubation can wait for some time at least because the GCS is better and  look like pathology that made it appears that gcs was low. moral of the story was better go through the entire history before intubation and rescue patient if its an elective intubation.

Incident # 2
3 a.m.  I was totally tired after handling continuous priority one cases and a priority 3 case walks in with his with her husband.She didn't want to be evaluated all the wanted is pain management and  would walk away so you cannot force anyone to spend a money or investigation so I applied I believe that pain while the pain medication were on in infusion. The  husband refused to move from bedside . Annoying part was he got three little kids who were holding him not willing to go. I got busy with my pending tasks of the previous 5 I turn back to see that none of them had left. I repeated myself again and again only to be annoyed that none was willing to leave the patient alone.To my dismay he took the other empty bed and dozed off.

I was so tired of repeating the words that I left them there in them at the end when they had to sign the start against medical advice form I passed the paper to the husband and said sir please sign here he said , " Where mam ? I put my hand there and pointed here sir.
He asked the same question again.  I was even more annoyed.

  He said I am sorry I am blind I cannot see where you are pointing.
Trust me it was one of the most most embarrassing moment of my residency.  I was very rude and mean to somebody without it was not intentional but yes!
He didn't wear those goggles . He had crutches .
It was because he was blind that he his children helping him out it was because he was blind that he refused to go wait outside and wanted to be with some one who was aware of the place for this kids safety he refused to set alone in the dark .
I felt very guilty I think I quitely took the signature apologized and discharged them.

Incident # 3
60 year old female with acute gastroenteritis, urinary tract infection in altered sensorium but what bothered me again this was about six months after the first incident so what I so was a dehydrated lady refuse open her eyes do I did consider it as a low GCS but I inform the consultant that is not opening eyes she was talking but not opening eyes . Not as low as that intubation would be required.

Physician walked in looking for his patient . He looked at the patient and said , " Ah! This lady... She cannot see right? He asked the attendants. I turned around in surprise... I was mentally kicking myself for not properly analysing her.

Beta she looks alright na , not that sick. My mind was not working right.I said to myself .

so far so much!

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