This is a story of a patient I took care of in the intensive care unit (ICU) during my training. As luck would have it, this young man was hit by lightening right outside the hospital. Medics arrived at the scene almost immediately and found him in ventricular fibrillation, an erratic heart rhythm that can result from a large electrical shock. This rhythm is ineffective in pumping blood. The resultant lack of circulating oxygen rapidly leads to brain damage and, eventually, to death.
Just like in the television dramas, the medics gave the patient a quick cardioversion shock, which caused his heart to return to a normal pumping rhythm. They then bundled him up and brought him into the hospital.
In the emergency department, the patient’s heart was beating fine. Though still unconscious, he was coming around enough to thrash about and he vomited a very large amount of undigested food all over himself, the gurney and the floor.
Now, I have a lot of experience with vomit. I have vomited many times. I have been with family members many times when they have vomited. In the emergency department, having patients vomit is just a way of life. So, to be noteworthy to me, a particular episode of vomiting must be pretty amazing. This one was.
The patient’s vomitus was filled with discs of pressed meat about the size of a mouth. It was clear he had recently eaten a deli sandwich by biting and swallowing big hunks without chewing any of it. This left the round pieces of meat intact when swallowed. They came back up the same way. I had never seen anything like that before.
Now back to the lightening strike victim. We sedated him to keep him from thrashing around and admitted him to the ICU. Since his heart rhythm was now stable, the big question was whether he had suffered brain damage during the time his heart was not beating. We would only know that when he woke up, if he woke up.
The next day, we took him off of sedation so we could start to assess his mental state. Our initial reaction was of disappointment. Though the medics had saved his life by rapidly getting his heart beating again, it was obvious he had suffered brain damage. The patient gave us his first name and asked for food, but he was clearly not normal. Since the patient came in the hospital with no identification, we asked him about his family. He could only come up with the first name of his sister. Another indication of his brain injury was that he seemed completely unconcerned about his situation, content sitting in a hospital bed getting all the food he wanted.
The following day a young woman came to the hospital. She read in the newspaper about our unidentified lightning strike victim and wondered if it were her brother.
After talking with her for a minute, I felt comfortable taking her in to see our patient. I was filled with some trepidation, wondering how she was going to handle it when she realized he was brain-damaged.
It was immediately obvious they were siblings. As she walked into the room, she rushed to give him a hug and he called out her name. It was a touching scene, but my emotions were complicated. I wondered how I was going to help her recognize his loss of mental faculties. How would she handle the realization that her brother was not what he used to be?
As soon as things calmed down a little, I gently shared with the sister our observations about her brother, describing what we believed to be brain damage caused by his time with no oxygen flowing to his brain.
As I talked, she got a puzzled look on her face. When she finally got the big picture, she kind of laughed. “Oh, no,” she said. “This is the way he always is.” He then got dressed, she took him home and they all lived happily every after.
This shows how his metal necklace burned his skin when it was heated up by the lightening. He also had a burn where his bicycle was leaning against his hip.
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