Blue Christmas by Melissa Yi

Author:Melissa Yi
Language: eng
Format: epub
Publisher: Windtree Press

The True Story Behind "Blue Christmas"

Once upon a time, I was an innocent resident attending Grand Rounds in Montreal.

Grand Rounds is supposed to be a good opportunity for medical students, residents, and staff to learn together once a month.

Instead, it can become an academic bloodbath where everyone tries to prove who has the biggest, er, brain.

Grand Rounds usually follows a simple algorithm: the presenter, usually a resident MD doing post-graduate training, presents a case. The audience has to yell out questions to reveal clues in the history and physical exam and investigations.

The presenter tries to present a case that stumps the doctor audience, and the audience tries to make the diagnosis first. It's sort of like a game show where you win bragging rights instead of $100,000.

My friend Anna once presented on how to treat nuclear radiation because, no matter how much training everyone had gotten, she figured that they wouldn't be well-versed on nuclear warfare or accidents.

She was right. Her presentation was greeted mostly with silence, which was better than derision.

Side note on the medical hierarchy: emergency medicine residents doing a third year of fellowship are considered "lower" than the five year ER residents, so I kept my mouth shut during most rounds. I did my part presenting and analyzing cases at journal club, but mostly, I listened.

If you looked past the posturing, you could learn a lot. Not all of it was especially useful to me. The Australian doctor showed so many slides of poisonous sea creatures native to his country that my brain summed it up as, "In Australia, there are many beautiful things that will kill you. Wash most stings and bites with salt water, but the blue-ringed octopus will paralyze you."

Although the nuclear radiation and octopuses were eye-catching, this was the case that caught my eye:

Paramedics are called to an apartment because five adults (three men, two women) of Middle Eastern descent feel light-headed and dizzy. Two of the men are vomiting. The younger woman is unconscious. Their skin is cyanosed, or turning blue. All of this started after dinner.

A third man, who didn't eat anything, feels fine.

At the hospital, all five patients are visibly cyanosed. Their oxygen saturations range from 72 to 96 percent instead of the usual 92 percent and up.

When lab comes to draw their blood, it looks black.

The five patients receive methylene blue after the staff talks to the poison control centre and presumptively diagnose methemoglobinemia.

Within 15 minutes, their cyanosis resolves, their oxygen levels come up, and the three affected men feel better. Both women need ventilation, one for two days and one for four days, but all five of them recover completely.

Law enforcement agents and the health department investigate the case as a possible terrorist incident. No chemical or biological weapons are found in the building.

Within 48 hours, the lab results come back. Every patient tests positive for methemoglobin at 21.1 to 87 percent (normal is 1 to 3 percent).

Now the investigators examine the household meal of meat, rice, and and vegetables.

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