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This story is from the Anamnesis episode called Is There a Doctor in the House? at 13:46 in the podcast. It's from Jennifer Rubin, MD, an attending physician at Ann & Robert H. Lurie Children's Hospital of Chicago and an associate professor of pediatrics at the Northwestern University Feinberg School of Medicine.
It's an occupational hazard as a pediatrician, particularly a child neurologist, to be unable to relax wherever danger is possible -- swimming pools, beaches, playgrounds, football games, oh, and grapes. You only need to see one kid on a ventilator because of choking on a grape to be scared of fruit salad.
But this particular day started as an ordinary one at a Cubs game. My family shares season tickets with several other families, and we attend a few games a year. Our kids are now old enough to sit still in their seats, go to the bathroom by themselves, and actually enjoy the game -- so I can just relax and do the same.
This day was one of those absolutely perfect summer Chicago days that we tolerate the painfully cold and long winters for, and I was grateful to have a day off after a long and busy winter season of sick patients.
The game on this day was earlier than usual, and I hadn't yet had my coffee. So I spent the better part of the first few innings searching unsuccessfully for coffee instead of beer. Guess that's hard to find at Wrigley.
My Call to Action
Enjoying the game completely sober but still uncaffeinated, I saw someone out of the corner of my eye running up to a security guard. The doctor in me, or maybe it's the mother in me, is just never able to turn off the worrying part of my brain -- even when enjoying my favorite team up to bat in a tied baseball game.
Then I overheard, "something ... mumbling ... seizure ... something ... kid."
Well that was my call to action, like the bat signal was a giant reflex hammer over the outfield. I followed the security guard up to the family where a young teen was on the ground between rows of stadium seats, eyes open, tense, having a convulsive seizure. I quickly introduce myself to the parents, told them I was a child neurologist, and asked about their seizure action plan.
They said this was his first seizure. Dang it.
Seizures themselves are typically self-resolving and brief, but without knowing how long it would last I worried about not having any medication on hand to intervene and stop the seizure. I instructed security to call 911, but fortunately, they'd already been called.
In the meantime, the child was safe on the ground, with his parents gently cradling his head. I instructed them to turn him a bit onto his side. We do this to prevent people from choking on their secretions. I spoke to him calmly, stroking his back. Although he was unconscious and may not have appreciated it, the gesture helped reassure his parents -- and probably me.
Although I knew intellectually he was going to be okay, and the seizure would soon stop, I always feel a bit helpless just watching someone have a seizure. This was even more difficult as we were outside the safety of the hospital, and I wasn't sure how long it would last.
A small crowd had formed and people were shouting out suggestions. I mostly stopped the bystanders in the crowd from providing unnecessary but probably well-meaning interventions, like putting anything in his mouth or starting CPR. I mean, I love CPR, and everyone should be trained to perform, just not on a seizing, breathing patient with a pulse.
The treatment for seizures is to keep the patients safe until the seizure stops on its own, usually within a few minutes. If it doesn't stop, then we give a rescue medication, typically a benzodiazepine, which we didn't have with us in the stands.
Time Stands Still and Lasts Forever
Fortunately, after what felt like forever, but was probably less than a minute, the seizure slowed and stopped, and he closed his eyes. As he woke up, I knew the seizure was over and he was going to be okay. By the way, it's impossible to ask parents to estimate the duration of a seizure -- time both stands still and lasts forever.
Around this time, EMS had arrived and the teen had been helped into a sitting position. It was a hot day, so I offered him a cold drink of water, but the EMT chastised me for letting him drink anything, worried about aspiration risk. Ugh, they were probably right.
As the boy started to speak, and answer questions, I could see his parents shock and fear melt into relief.
As the EMTs prepared to take him to the hospital, I warmly gave the family my name, told them to have the ER call me with any questions. I recommended an outpatient EEG [electroencephalogram] and a visit with a child neurologist. And I couldn't miss the opportunity to remind them that he doesn't need a head CT. Although it's hard to imagine how a worried ER doctor was going to skip one.
I went back to my seat to watch the rest of the game to find my kids absolutely amazed at my superhero actions. I mean, recall I didn't really do anything. I briefly assessed the kid, reassured the family, minimized interventions, and supported him through a brief, self-limiting event. But this is what we do as pediatricians, right? Often we just support, reassure, and avoid doing too much.
However, even to me, intervening at a baseball game did feel a bit out of the ordinary and especially nerve-wracking without my usual resources on hand. Over the years, I've attended to and witnessed many kids and even adults experiencing seizures, and it's always an emotional experience -- a combination of calm confidence the seizure will stop on its own in a few minutes, and the inner quiet panic that it will not stop and will need additional interventions and medications.
We were fortunate on this day, at this game, with this child, it was the former -- it stopped on its own and he was going to be totally fine.
The next day at work after the incident, I checked with my colleague on call to see if she fielded a call about this patient. They said the child was actually admitted to the hospital for observation, so I stopped by to see them. But not before I reviewed the emergency room notes.
Remember, it was a hot summer day at the Cubs game, but our seats were actually in the shade. I think the ER team wondered if the event was really a seizure. I think they thought he maybe just passed out.
Their notes stated, "Differential includes seizure versus syncope," which is passing out. "But of note, our child neurologist, Dr. Rubin witnessed the event and told the family it was a seizure." Yeah, I guess the history of a spell is more accurate when it's witnessed firsthand by a child neurologist as a first responder.
The family was pretty surprised and grateful to see me. It's not every day someone gets out-of-the-hospital care followed by an inpatient visit the next day. I reviewed his test results and was able to continue my care for him by explaining everything to the family and guiding additional evaluation and management.
And this is how the teen from the Cubs game became my patient. We started him on medication to prevent additional seizures, and he's been doing very well since with no further events. We still chat at every visit about how relieved they were that I was at the Cubs game that day to hold their hands. And how grateful they were to be in the cheap seats where a child neurologist shares season tickets instead of the more expensive ones, where an orthopedic surgeon may have been their first responder.
Check out the other stories from the Is There a Doctor in the House? episode , including "From HIIT Workout to Hair Apposition" and "A Code Blue While Dressed in Red."
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