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I got the call in my hotel room in Los Angeles at 07:45 on a Saturday morning in April 2001. I had gone back to LA to visit some friends for the weekend. The resident on the other end of the call informed me that the young man (AA; all names have been anonymized and the clinical details of this case have been changed) that I had discharged Friday before I left had been re-admitted and died shortly after emergency surgery early Saturday morning. Needless to say, I was sad and stunned. And then I was scared.
Six days earlier AA had been smoking marijuana and then decided to go skateboarding with his friends. He fell, hitting the left side of his head. He was taken to our emergency room where he was noted to be neurologically intact but complaining of a headache. He had never lost consciousness. A CT scan revealed a 5 mm left frontal parenchymal hematoma. In light of his mild symptoms and stable examination, I elected to watch him in the ICU. I didn't foresee the long string of dominoes that that decision would set in motion.
His hospital admission was unremarkable. We watched him in the unit for 3 days as his headache gradually resolved and then another 2 days on the ward where I would routinely find him walking the halls and flirting with the nurses. Repetitive scans demonstrated no change in his hematoma. That Friday he was anxious to go home and I couldn't justify keeping him in house any longer. I remember talking to his mother earlier in the week about his marijuana use and about the importance of wearing a helmet while skateboarding. She seemed disinterested in both issues. I only saw her that one time during his hospital stay.
AA went home that …
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.