A Train Wreck* With Two Car Wrecks

(* American medical slang for a patient with major medical problems)

Carlos Sanchez was lucky to have survived the accident. His almost brand new car was totaled, and he was taken to the hospital, strapped on a rigid back board with a cervical collar. No fractures were found; he was sore all over, and didn’t remember much of the accident, but it was the first snowstorm of the winter and it was assumed he had driven too fast for the road conditions and simply lost control of his car. I signed the copy of his emergency room report and his chart went back to our clinic’s medical records room.

One week later, Carlos’ chart was on my desk again. This time, he totaled his rental car, and again he escaped serious injury. What an unusual thing to happen, I thought. Carlos seemed like such a slow-moving, sensitive young man; why would he be out crashing cars every week? I signed off on his report, and his chart went back to be filed again.

The next day was Friday and I was looking forward to my weekend off. My wife and I were planning a trip to town for some Christmas shopping and a late dinner at our favorite restaurant.

Just before five o’clock, Carlos showed up at the front desk and said, “I just don’t feel good”.

I took one look at him, and agreed with his assessment; he just wasn’t right. He had some sort of encephalopathy, that was clear, and he had an unusual pale, yellow coloring. My wife came to join me, and we headed up to town, with Carlos willingly in the back seat. We swung by the emergency room, dropped him off with a few words exchanged with the clinician on duty.

The final diagnosis was acute kidney failure; he was admitted, underwent emergency dialysis, and some time later received a kidney transplant. Last year he rejected his new kidney, so he is back on dialysis, waiting for another kidney.

The moral of the story is that even car accidents during the first snowstorm of the season may happen for a reason, and when someone has two car wrecks in a short period of time, the onus is on the treating physician to ask why.

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