Beyond Science

My twenty-year-old patient squirmed, asking to get up and go home. His story sounded innocent enough, but paramedics had dutifully strapped him to a backboard and placed him in a cervical collar. I carefully examined his helmet as he told me what happened.

He’d slowed his motorcycle and swerved to avoid a car that had stopped abruptly. He’d laid his bike on its side, slid it across the road and bumped into the curb at low speed. Wearing full protective gear, he seemed to have escaped serious injury.

He hadn’t lost consciousness, and had no evidence of injury, not even a headache. I examined him carefully and determined he met none of the evidence-based criteria for imaging his head or neck. I was about to let him get up and leave when I felt a sickening feeling, like I was about to make a serious mistake. Intuitively, I felt I should scan his head, even though I couldn’t justify it medically. He joked about the unnecessary test and told me to go ahead.

Photo by MART PRODUCTION from Pexels. Not my patient; does not show intracranial hemorrhage.

Normally, I’d get results via the computer 40-60 minutes after the scan. This time, I got a phone call immediately. Arterial blood was accumulating so quickly within my patient’s skull, the radiologist saw swirls in the images.

When I checked on my patient, he was already becoming drowsy. Because I worked at a level-one trauma center, a neurosurgeon drained the hematoma twenty minutes later. My patient was probably back on his motorcycle within a few weeks. Had I sent him home, he would almost certainly have died.

Many colleagues would criticize me for subjecting my patient to the cost and radiation of a CT scan without a clear medical reason. I concede that. On the other hand, I’m deeply humbled and grateful for an intervention science can’t explain.

Some portion of our essence transcends the physical. I believe that portion of my patient communicated with that portion of me. It’s happened too many times for me to count.

Honor your intuition. You have it for a reason.