One Radiological Halloween Night

It was my turn to “read out” the post-call resident. Halloween might not be an official holiday, but it has the potential to bring as much craziness to the ER as occasions like Independence Day or New Year’s. Expecting a glut of preliminary cases to review, I went in early to get the fatigued resident out of the hospital as close to on-time as possible.

The resident looked typically weathered, but the caseload wasn’t all that bad. What seemed to be yanking his chain when I arrived was a growing stack of new work. His beef regarded three patients, still in the ER, being imaged for trauma. I asked him what the big deal was.

“Nobody seems to know what’s going on with these cases. Every time I think they’re done with their imaging, another round of studies shows up. They repeat studies even before I can read the previous ones. When I try to slow them down or at least find out why they’re radiating these patients so much, nobody gives me any answers.”

I had a quick look at the cases. He was right; it was a bunch of redundant studies – mostly CTs of heads, faces, and necks. No major pathology was jumping off the screens at me-superficial contusions, subcutaneous edema, etc. Injuries seemed pretty random, too-bilateral, anterior/posterior, high and low. I asked the resident what kind of trauma was involved.

“That was one of the first questions I had when these studies started getting out of control…and the ER staff brushed me off. Said I could go see the patients myself if I cared. The only history other than ‘trauma’ they gave was for the first round of scans; seems one of the patients was working with a ladder and struck the other two with it.”

This didn’t explain how the ladder-carrier had gotten hurt or the ensuing rounds of trauma. I had noticed that, as I browsed through the studies from older to newer, the sites of superficial injury grew more numerous. Odd. Well, there was still half an hour to go before the resident was due to leave; I decided it was time for him to stretch his legs a little and maybe learn something. So I told him to go show the ER staff how to take a proper clinical history and see the patients himself.

He was gone longer than I expected, and when he got back he looked much the worse for wear. Not that he’d been immaculate when I showed up, but he looked like he’d stopped for a Halloween shaving-cream (and maybe egg) fight on the way; blotchy stains all over, with puffs of white stuff hither and yon. I raised an eyebrow as he settled heavily into his seat, but he didn’t notice.

“So you already know these guys got started with a ladder-I guess one of them was carrying it and kept losing track of where the other guys where. Turned around, struck one in the face, the other in the back of the head. It actually happened multiple times, but they kept on talking over each other while I was trying to interview them, and I missed some details. I guess the two who were injured got angry and beat on the ladder-guy.

“Anyway, the mutually-inflicted trauma kept on going even after they’d been picked up by EMS and brought here; these guys seem pretty quick-tempered. Which is kind of peculiar since they never actually use bad language; they just call each other things like ‘knucklehead’ and ‘wise guy.’ That is, when they’re not smacking each other in the head, poking eyes, twisting noses, or boxing ears.”

I could feel my eyes widening and my jaw slowly dropping as he’d been talking, but the resident seemed oblivious.

“So, after the last round of scuffles, security finally got stationed at their bedsides, but I was pretty much done anyway. Then, Food Services showed up with breakfast trays…God knows why the kitchen sent along a bunch of cream pies, but somehow these guys got their hands on them and suddenly the pies were flying everywhere. In all the commotion, they chased each other out of the ER.”

I couldn’t contain myself anymore. I refrained from grabbing his shoulders and shaking him as I exclaimed, “Three guys? ‘Knucklehead’? A pie fight? Don’t you know what this means???”

The resident wiped some of the pie-cream from one of his eyes, and gave me a post-call thousand-yard stare.

“Yes; it means we don’t have to hurry with their orbital X-rays to rule out metallic foreign bodies from the pie-tins. Clinician was ordering MR next. Can I go home now?”