Everybody in medicine has stories about patients who were memorable or made a significant impact on them. This time of year, when my pre-dawn commute to the hospital is lit by sparkling holiday lights, one particular patient immediately comes to mind. A quick note: specific and identifiable details about this story have been changed to protect patient privacy.
This story took place during my ER rotation in medical school. It was getting to be just about the holidays, and even as far south as I lived, a bit of a chill had set in. Incredibly, I actually scraped ice from my windshield in the pitch-dark that morning, which was an unexpected way to start the day.
When I got to work, there were two PEA codes in a row within an hour of the start of my shift. The last one was particularly bad—the patient was semi-conscious with us in the room and then suddenly lost it. His daughter was there with him and went pale white as the rest of the team ran in. The dyspnea ended up being a saddle pulmonary embolism. Her screams of anguish when the time of death was called shook me.
I was sitting in the ER bullpen wiping my forehead with a towel after that when another EMS call came out over the dispatch receiver. Somebody with a very poor sense of humor had set the ringtone to be the Exorcist theme, which played whenever an EMS unit was coming in.
“EMS inbound, 7 minutes,” the receiver crackled. “68 year old male, stroke symptoms with right sided hemiplegia and garbled speech, duration under an hour, witnessed.”
“I’ll call the neurologist,” said my attending, mask grooves running deeply across her face from running the code minutes before. “We have to get pharmacy down here for TPA if we need it.”
When EMS rolled the patient in, he was wearing crimson red velvet pants trimmed with white fur. He had a thick black leather belt with an ornate golden buckle, engraved with little holly sprigs in the leather. His face was round and plump with a thick, flowing white beard like new-fallen snow. On his chest—the sleeves cut to establish IV lines—was a grey sweater with glittery letters that spelled out “BELIEVE.”
I helped my attending do a neurological exam on the patient. He was speaking unintelligibly but fluently, a garbled mix of nonsense words in response to questions. He had some degree of flaccid paralysis on the right side of his body.
“Get him to CT!”
The patient’s CT was clear and the neurologist authorized TPA. Within about 15-20 minutes, he began to regain speech fluency and orientation.
The patient’s wife arrived shortly after that and told us that they were Santa and Mrs. Claus actors who traveled around the country in their red-and-green RV all year long to entertain children and do charity work. They had been eating breakfast together when “Mr. Claus” got a strange look on his face and the symptoms started.
A Christmas miracle
Within about an hour after thrombolysis, Mr. Claus had appeared to make a complete recovery. He was observed overnight in the ICU without incident.
“It’s a Christmas miracle!” Mrs. Claus said, without a hint of irony.
At discharge, Mr. Claus handed my attending a golden coin that said, “You’ve been caught being good.”
Being a doctor means being prepared for anything that might come through the door. You never know when you might just save Christmas.