I get called to start an emergency laminectomy for a patient who has a large mass compressing his spine, causing paralysis and urinary incontinence. The background story is the patient showed up in the ER two days ago complaining of back pain and leg weakness. He was discharged from the ER accused of being a drug seeker. The patient has a friend who is a physician who tells him to return to the ER the next day when the symptoms got worse. When he is wheeled into the ER this time, he gets an MRI which shows spinal cord compression and the neurosurgeon is quickly contacted. The surgery goes well but the patient still can't move his legs. Only time will tell how much recovery he'll have.
While I was doing the case, I kept thinking about the Happy Hospitalist's algorithm for how doctor's think. I think this case will lead down the arrow that points to the PANIC button, don't you think?