The emergency room was jammed, and 10 patients were waiting to come back from triage. Maria, the charge nurse, stared at the list of patients’ names, trying to find a way to open up some beds.
“If some can be seen in the hallway, I’ll be glad to start taking care of them,” I said. “We can start clearing out the backlog while we open up some spaces.”
“Works for me.” She asked the triage nurse to bring back a group.
The first was Joey, a blond 15-year-old who’d been having cold symptoms for six days. Good. Should be quick.
“Any other problems?” I asked, turning from the boy to his father.
“Just his runny nose and a sore throat,” his dad said.
“Nothing. Except he can’t walk.”
“Can’t walk?” Nonsense, I thought. Joey was a trim, muscular teenager.
“He’s wobbly,” his dad said.
Joey shrugged. “My feet aren’t right.”
This was looking less and less like a quick fix. “Joey,” I said, “touch my finger, then my nose.”
I wanted to see if his cerebellum, the part of the brain that handles coordination, was working normally. I expected precise movements from this fit young man, but when he reached out, his finger waggled like a palsied old man’s.
“Does he usually have problems with his coordination?”
“No,” his dad said. “He’s an athlete. Plays basketball.”
“Let’s see how his walking is,” I said. “Joey, take a few steps.”
Joey swung his legs off the stretcher and tried to walk. His feet wobbled from side to side, and he had to clutch my arm for support. This was serious.
“You can sit back down,” I said, helping him back to the stretcher. “He’s had a fever. Any other problems?”
“Well,” his dad said, “mostly this cold.”
“What about a headache?” I asked the teenager.
“Yeah, kind of.”
“Does the light hurt your eyes?”
“Here,” I said, “let me nod your head for you.” I gently moved his head forward and backward. Not really stiff. I was worried about meningitis, a bacterial or viral infection of the membranes surrounding the brain, but if he had that, he’d be sicker by now. Emergency room doctors tend to think of the worst things first, rule those out, and then work back toward less serious causes.
“I need to examine him,” I told his dad. “I’m going to move him to a place with some privacy.”
I pushed his stretcher past the other patients lining the hallway down to the psychiatric holding room, the only available space. Once we were out of the hall, I did a quick physical exam.
“Your neck looks puffy here.” I pointed to the sides of his neck.
“It’s always like that,” his dad said.
I was doubtful. Necks aren’t normally puffy. “Have you been feeling tired lately?” I asked.
Could it be mononucleosis? That condition results from viral infection, but movement problems aren’t common.
“Touch your chin to your chest again.” Any stiffness in his neck would support a diagnosis of meningitis. But Joey could move his head without any discomfort.
“Do you do any drugs?”
“Nah, man,” he said. “I’m an athlete.”
“I didn’t think you used drugs,” I said, “but I had to ask.”
Bacterial meningitis was the only treatable cause I could think of, but it would be unusual to appear this way. And he was too young for a stroke.
“He hasn’t hit his head, has he?” I asked his father.
His dad looked at his son. Joey shook his head.
I patted Joey on the shoulder and turned to his father. “This could all be due to a virus, but I’m not sure,” I said. “I think we should give him some antibiotics and do a CT scan and a lumbar puncture, just in case it’s meningitis. If it is bacterial meningitis, we don’t want to fool around.”
His dad shrugged. “OK.”
I found Maria. “We need to move someone else out into the hallway to make room for the kid with the cold. He can’t walk.”
Maria gazed at the board. “Room 4 can come out.”