Friday mid-morning.
EMS Phone rings: “27 Female. AMS + N/V. +EtOH. 10 min.”
Triage nurses look over. “Ha, what you think doc, Thirsty Thursday happy hour special?”
“TGIF” I joke
Ambulance backs up to the bay, they unload and roll her in
Eyeball the patient. She looks all too out of place for the ER
She’s young. Pretty. Hair carefully done. Makeup that had obviously taken time, though now a little smeared. She’s wearing a decorative top, fitted jeans. Clearly hadn’t planned her outfit to be hanging out under the fluorescent lights of the ER.
She groans a little as they roll her past towards a vacant room.
One of the medics is new. Young guy, probably not even 20. He does his best to give report.
“27 female…Uh... She was out drinking last night. Threw up everywhere. Friends called when she didn’t come to work, wouldn’t answer her phone. Vitals…umm… heart rate 120-ish, blood pressure a little high at 150. 100% room air. Glucose 115”
“Any history? Anything on scene? Drugs? Meds? Signs of trauma, sexual assault?”
shrugs “Nah dude… she’s just really fucked u---"
Senior medic cuts him off with a glare “We didn’t see anything like that doc. Wellness check, police got no answer but could hear her inside. They got in, saw her like this and called us. Apartment was crystal clean. Just her on the floor, vomiting and from looks of things, in her own urine as well. Her friend called it in, here’s her number.”
Hands me a crumpled piece of paper with a phone number sloppily written in it
‘Sarah’
I address the room to get her moved over to the bed, on the monitor and ask to get some fluids/Zofran going. The basics. Nurses see no previous chart encounters populate when her information is entered. I go through my exam
No obvious trauma.
A bit tachycardic and tachypneic but otherwise stable vitals show up on the monitor
Glucose confirmed normal.
She’s moving all 4 extremities but doesn’t follow commands. She’s just groaning incoherently and occasionally flops from one side of the stretcher to the other.
Pupils equal, 4mm. Sluggish.
She’s got vomit on her but not actively vomiting. Airway okay for now I think to myself. At least we’ve got a little time to figure things out first.
The nurse for this room looks over “We gonna have to intubate her? She looks pretty off”
“I sure hope not. Let’s see if we can get the vomiting to stop while we figure this out. I’d love to avoid tubing a 20-year-old for tequila.”
---
Step away and call the friend.
“Hey this is Dr. Reflection calling from Middle of Nowhere Podunk ER. Is this Sarah, Katie’s friend?”
“Yes! Oh my god. What’s going on with her?”
“Can you tell us a bit more about what happened?”
“I don’t really know. She was texting me getting ready to go out with this guy she met on a dating app, she doesn’t really date much so she was excited but nervous”
“Does she drink a lot? Do you know this guy, is it possible he gave her something?”
“Katie barely drinks! And the guy, well, I don’t think so. This was their first real date. We met for coffee like a week ago to check him out. Seemed normal, or at least, didn’t seem like a creep… He was kind of a nerd but he clearly really liked her”
She pauses
“Although last night she didn’t really eat before she went out. Was complaining she didn’t feel good. Said she had a headache”
“Any other symptoms? Does Katie get headaches or have any medical issues?”
“No. Not that I know of.” *She laughs, “*She was mostly upset that she was going to have to end the date so early. I think she was bummed. I’m sure the guy was.”
“Did she say anything else?”
“No, just a bad first date”
Exchange a few more details but Sarah tells me she last heard from Katie in the Uber back and she didn’t seem drunk at the time. She also gives us mom’s contact info.
---
I go briskly back to the room. Tell the nurses to pack her up and get her to CT. We call the techs en route to get her on the table. CT gives us a little shit for “clearing the table for a drunk girl” but they do so while getting her set up quickly. I stay with them to see the scan results in the reading room.
Non-con images flash up on the screen
The nurse doesn’t react. CT tech’s eyes widen as they look at the screen.
I feel an immediate iciness wash over me as I utter a slow, one syllable word.
There it was. Like the North Star.
I always recall, during residency, there was a neurosurgery resident a few years ahead of me. Whenever we called her for any type of brain bleed, her first question would always sarcastically be “how big is it, like can you idiots see it?”
I could see this. I couldn’t fucking miss it.
“Start a CTA right now” I say to the techs who jump out of the room. I turn to the nurse, “Call RT and pharmacy. Get them to her room. As soon as we get her out of the scan, keep the head of the bed up.”
Nurse looks bewildered, not quite having known what we were looking at. I scroll through the image and point
“That’s blood”
“It doesn’t look that bad, I’ve seen ones the size of a baseball” she says
“They call this the Star of Death” I say with exasperation while dialing the transfer center to talk to neurosurgery.
---
Return to her room. More vomiting ensues, forcing our airway decision. Intubate. Hypertonic saline. Keppra. BP monitoring. CTA ends up showing the aneurysmal origin. She’d been a time-bomb her whole life and never knew it.
Transfer arranged. Flight is a no-go because of weather and the metro ETA is an uncomfortable number.
Katie’s mom arrived somewhere in that time.
Then Sarah. Then seemingly everyone else in that small town.
About 20-25 people, coworkers, sorority sisters, former roommates and siblings. All piled into a conference room we made use of because the consult room was too small. With mom’s blessing we debriefed the group together
There was a deafening silence…
Followed by quiet sobs and whispers.
Mom’s complexion turns to pallor; her stare pierces the wall as tears stream down her face
I can hear Sarah say, “I thought it was just a bad date”
---
Katie gets transferred.
In the ensuing days she undergoes drains, decompression, trach/PEG, innumerable medications for seizures, agitation, and blood pressure.
None of it ends up being enough. I followed her chart for a little while until the inevitable became apparent.
Katie’s name sits in my list of patients still, with a little italic word next to it.
Deceased
---
Today, I think of my wife.
I think how we met through a dating app ourselves. Coincidentally, we were 27 years old at the time too. I’m sure I came off as a nerd then. In fact, I’m sure I still am. I wonder if she texted her best friend at the time the same way. Was she nervous and excited like Katie was?
I think back to our first date. I had to drive to the town she was living in just to meet her. I’d never been there, so I had to google dinner/drink spots just to come up with a suggestion. When I made my recommendation, her response was, giggling as she said it “oh, ha-ha no, not that place” before her offering her alternative location that would become our first date.
I think about how she looked. The outfit, the makeup, the hair. How she would have looked so out of place in an ER as well.
I think of all the years between now and then. The story we’ve written for ourselves as we’re currently playing with our first child. Maybe Katie was beginning to write her own story that night. We’ll never know. It was supposed to be their first date, but it ended up being her last.