Concussion

A family brings their teenage son in with “delayed concussion” from football on a Saturday afternoon. The younger brothers and sisters, Mum and Dad are all crowded around, anxious to help out in any way. I struggle with his history in so many ways. For starters, I’m a bit of a novice with head injuries at this stage. And then there’s the casualty nurse occasionally popping in to interject my question with a similar but wordier one before the patient can answer me. Not to mention the boy’s mother, who is worried about her son and tries to answer all the questions for him. And then there’s the boy himself, who obviously has amnesia and can’t remember anything of the game or afterwards. As we wait for the doctor to arrive, I ask him a few questions.

“Who did you play today?” I ask

“I can’t remember his name” announces the boy after lengthy deliberation

“Do you know where you played?” I ask, wanting to know which town the game was in

“It would have been the wing” – the boy hazards a guess at his usual position

Hard to say whether we would have this much trouble communicating without his head injury, or if he is trying to compensate for his amnesia, but it's pretty serious and the doctor doesn't waste much time before calling an ambulance to ship this boy off to a bigger hospital.

As we're waiting for the ambulance to arrive, the doctor sends me back into the room to assess the boy's lower limb reflexes. He has a lot of trouble with the instruction "just let your leg go loose", and we struggle for a while as he first lifts his leg straight up and then forces it down on the bed, but eventually I manage to bend his knee for a patellar tendon reflex. Everything is normal until we get to the Babinski. I turn the tendon hammer around and use the scratchy end on the sole of his foot. As his left big toe curls upwards his girlfriend, who has just arrived, mumbles, "that's so weird". She has no idea.