Trust Your Instincts
If there's anything I've learned in the past few weeks, it's to trust my clinical instincts. It's going to take a long time for me to identify adverse events with certainty and confidence, but for now, I need to rely on that "gut feeling" I get when something doesn't seem right. And for now, that's been enough.
Twice in the past month, I got a bad feeling about the way a patient was presenting. In the first case, I had been working with a patient who sustained multiple subdural hematomas and facial fractures after surviving a pretty bad car accident. To put it kindly, he was not the friendliest nor most cooperative patient; however he would agree to treatment with encouragement.
One day, he looked like his normal self, but he wouldn't respond to me with anything other than a shoulder shrug and a sigh. Even though this wasn't far from his baseline, something just didn't feel right. After speaking to other members of the team who noticed similar changes, we informed the doctors. As it turned it, his subdurals had re-bled and he had another craniotomy to evacuate the masses.
The second time, I was working with a patient who developed encephalitis due to Lyme disease. By the time he got to us in rehab, he was a superstar. His balance, endurance and cognition were all near baseline, and we anticipated his discharge within a week. Then one day, he was complaining of low-back and anterior thigh pain, as well as paresthesia and weakness. It wasn't presenting like radicular nerve root pain, though.
My first thought was that there was intra-articular hip joint pathology, and I feared it was some sort of systemic process as a result of the Lyme disease. Unfortunately, the cause was a polyneuropathy and demyelination of his peripheral nerves, similar to a Guillain Barre presentation. I'm not saying that my "early catch" changed anything, but at least it sparked the conversation and subsequent examination.
I'm glad to know that somewhere in the depths of my knowledge, I know what's "right" and what's "wrong." I'm excited to grow as a clinician and be able to confidently identify these types of adverse events when they begin.