Life crosses the different stages in its journey. There are days which are sometimes tiring, sometimes boring, sometimes chill. So are the internship days. They carry memories and learnings for life. How we travel the journey of life is more important than the stage of life. During my internship
a few years back, there came a hit and run case of a child in emergency room in one busy evening. He was 6 years old. A bike hit him and threw him a few metres distance on a road. He was conscious and alert. There was no obvious fractures on examination. He had fine scratches only which seemed to heal with time. His vital examination was normal. He had regular normal pupils. I informed my senior about the case and followed the instructions accordingly. It was a rush at that time.

When investigations were ready, I called my senior. He asked me to show the child’s CT scan head and FAST scan abdomen report. Guess what was there ?

He had some white spots in the ventricles , which could be intraventricular hemorrhage. He had minor contusion in left frontal region as well. I thought if it were calcification only. It was no big mistake to be confused with calcification for an intern. As a rule, obnoxious things should be ruled out first in emergency. We sent the CT scan report to the neurosurgeon and consulted with on duty radiologist as well. The consensus made us consider the possibility of white spots inside lateral ventricles to be hemorrhage. His FAST scan abdomen report was normal.

I admitted him on observation unit of neurosurgery ward as per the instructions. He was doing fine for 24 hours. He was about to get discharged from the hospital.However, his repeat baseline lab reports made us think again. What do you think was abnormal ?

Unexpectedly he had a drop in hemoglobin by 2 units, which was really significant. The bleed in his brain was no explanation for the drop in hemoglobin. The consultant ordered CT abdomen contrast after seeing the report. I didn’t get the reason then. What do you think the CT abdomen report revealed ?

You guessed it right. It was intra-bdominal bleeding from the splenic rupture. It was a new learning for me. I was curious about the mode of injury. When I digged into the history again, the child’s father said that he was hit by the bike and sustained primary impact on his abdomen. The minor intraventricular hemorrhage put us in the dark and distracted us from reading between the lines of the case.
Morale: Read between the lines while taking the history from patient.
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