Last week, a young man came through the emergency department complaining of intractable nausea and vomiting for two days. He was severely dehydrated, dizzy, and lightheaded because he hadn’t been able to keep any food or drink down for some time. The first things you think about in your differential for an otherwise healthy-appearing 30-year-old guy with nausea and vomiting are the flu or a simple viral gastroenteritis. Fairly routine.
Talking with the patient and getting a better idea of his medical history revealed that just a few months earlier he had undergone a complete resection of a craniopharyngioma. These tumors are usually benign masses that grow near the pituitary gland in the brain. The term benign can be somewhat misleading, however, because the growing brain mass can cause increased intracranial pressure, disrupt function of the pituitary gland, and damage the optic nerve simply because of its location in the brain. These changes lead to symptoms like nausea, vomiting, balance issues, hormone imbalances, and problems with vision. Craniopharyngiomas rarely metastasize, which is why they are usually designated as benign.
With this new information, the next step in figuring out what was going on was to get a CT scan of the patient’s head to make sure the tumor was completely gone. We also had some imaging of his abdomen done in case we could find anything there that might be causing his nausea and vomiting. When the results came back, it was my job to tell my patient what we found. I sat down next to his bed, and he looked at me already knowing what I was going to say. He started to tear up before I started talking. The reason he’d been so sick is because his brain tumor that was resected less than six months ago had come back. I also told him that we found a new lesion in his liver. I explained that he still had a number of options. There’s surgery, chemotherapy, and radiation. The lesion in his liver might be nothing at all. You try to stay positive in situations like these, but it’s very difficult not to focus on the negative, and it’s more difficult to maintain your composure with a tearful patient.
I like working in the emergency department because, most of the time, you’re able to see a problem, fix it, and send your patient on his or her way. Unfortunately, sometimes all you can do is give them a little more information than they had coming in and refer them to someone who might be able to help.
That night, I went home and unwound much like I usually do. Video games help me relax by taking me somewhere completely fantastical and so out of touch with reality that I forget what went on at work. I played one of my favorite franchises, Assassin’s Creed. It’s a historical science fiction series about a war between the order of Assassins and the Knights Templar. The games are set in various time periods and locales ranging from the Crusades in Jerusalem to Renaissance Italy and 14th century Constantinople. As an assassin, you are tasked with ridding your cities of the oppressive Templar regimes by any means necessary.
Typically, the games reward you for stealth and strategy more than wanton destruction. But that’s not how I played that night. That night, I was brazen with my attacks. I cut paths of murder and destruction from one end of the city to the other with no goal or objective, no in-game reward to reap. It was cathartic.
Video games get a lot of flack for their consequence-free destruction or violence – and in many cases, rightfully so. Without the proper maturity, the desensitization they cause can be dangerous. Sometimes, though, it’s precisely this desensitization that I play for. When the horrible things that happen on a daily basis in medicine can be blocked out, even momentarily, it makes the impact, the care, and the life of even a single patient that much more important. That’s why I play.