cordial

During my ICU rotation, we had a very sick patient. The traditional cocktail of medications and machines were doing nothing and we, as residents, were stumped. We appealed to the Big Boss - what were we missing? What secret twist or turn would bring this patient back?

He shrugged. "I guess we could try methylene blue?"

And so we hooked a bag of blue dye to the patient's vein. It looked like a melted popsicle was running through the IV. Over some days, the patient did get better.

My boss couldn't explain why or how it had worked, just that he sometimes tried it, "When I'm out of ideas".

This case keeps coming to mind as I run through cases and old exam questions. Yes, on paper, the patient has A, we give B and the outcome is C. It's formulaic and relies on pattern recognition and memorisation.

In the ER where I work, I have yet to see a formulaic patient. The 7 year old girl with seizures? Could have been heat stroke, could have been meningitis. The 70 year old with a stroke? Also had renal failure and a cardiac event. The guy who shot himself with a nail gun? Well, actually, he was pretty easy to manage (pliers and a strong counterforce).

It reassures me, as I shuffle piles of paper and sort through antibiotic classes. Even my senior bosses sometimes have no idea. My patients haven't read the textbook. My nurses "smell" the diagnosis before I've walked in the room. The cops tell me someone is "hot and crazy" and know what to do.

Now I just have to convince a panel of examiners that all this is true.
When in doubt, give methylene blue.