Gee, maybe electronic medical records are a good idea

12 year old girl with vomiting and abdominal pain. Transaminases up in the 200's, and biliribin around 4 in US numbers (that's liver problems for you nonmedical types). 2 years ago similar thing - neg viral studies, saw GI guy who worked her up for autoimmune hepatitis (and for Wilson's disease that can act just like autoimmune but is way worse and caused by copper accumulation in the liver). She had normal ceruloplasmin, and slightly elevated serum copper. Liver biopsy did not show any sign of autoimmune hepatitis, but he treated her with steroids for a couple months anyway. Couple more similar episodes of symptoms, but without the transaminase rise in the intervening 2 years.

So, I'm scrounging through her old charts trying to figure out what is going on and find misfiled among the "correspondence" a pathology report - labeled as "amended" - of a copper concentration from the liver biopsy that is 8 times the upper limit of normal, and twice the level considered diagnostic of Wilson's in UpToDate. UpToDate notes that ceruloplasmin and serum copper are imperfectly sensitive for diagnosing Wilson's, and the definitive test is the biopsy. Talked to several folks, including 2nd hand to the original gastroenterologist, and we don't know if there was an original erroneous report that got amended, or if he never saw the report since it was misfiled, or what. But, everyone seems to agree that , OH SHIT!, she does have Wilson's.

Since Wilson's can abruptly transform into fatal fulminant liver failure, good thing that the kid didn't do something too bad in the interim. Probably a good thing that this time she was seen by an anal-retentive attending rather than by a house officer who might have paid no attention to the misfiled report. (And, yes, Wilson's was on my mind and I was specifically looking for the copper studies going through the chart.)

Yesterday's Launceston newspaper had 2 editorials: one was the lead editorial talking about the failure to fund the biggest local nursing home, so that they have refused new patients - leaving a number of people at LGH for months to over a year because there is no nursing home to transfer them to. Of course, that backs up into the ER - yesterday had 16 boarders at beginning of day, down to 11 by late afternoon. That's of 19 real beds - expanded to 25 including the hall, "pit", and doubled up room beds and not counting the times when beds are just parked everywhere side to side, end to end, and chairs are elbow to elbow with really sick folks sitting in chairs.

The other was a letter to the editor saying how nice the doctors and nurses were during her 48 hours in the ER with no chance to sleep, lights on, noise, etc. But, she asked, couldn't it be made just a wee bit better. (Hold on lady, the new facility might open in less than a year. Better than the bigger ER will be the additional 10 acute medical beds.)

Last night's LP of the night: intern chickened out, Registrar chickened out, fools rush in........ so fat that I had to indent the skin by about 2 cm with the hub of the needle - actually had no idea where the spine actually was, but after the first time that I hit bone I figured that I must be in the area. 1 RBC! I was going to make the intern by me champagne, but 1 RBC foiled me. All this because some stupid neurologist in Melbourne told a GP that a lady needed an LP - when she had a straightforward post-concussion syndrome.