My Day

Medication is a powerful thing. The medicines we prescribe and take can change the lives of people.

So when they stop using the medicine the change is phenomenal.

On the train back home, I watched an old lady suddenly turn her head and fall to the floor while convulsing. I responded and identified myself and then began to administer aid.

There is not much you can do in a grand mal seizure. It looks terrifying with the patient thrashing about and unable to do anything but shake and twitch and jerk. Their eyes roll and they may even bite their tongue.

But the thing to remember is that you should not give them anything to eat or drink or put in their mouths. So what ensued was a quick education for the people in a crowded train. Don’t give water, don’t give food, don’t put your fingers in their mouth and don’t try and put anything inside as a gag.

Just clear the area and stop them from hurtiing themselves. When settled take them in for a proper consult with a proper plan of treatment from an expert. In my case it would be to stop the seizures using a simple plan of treatment for status epilepticus and call for a consult form neurology.

It’s a 40 minute ride with the patient to the nearest town with a hospital. We cannot turn the train around to get to mine so we do the best we can. We call an ambulance and tell them to bring phenytoin. I can start the line at the station to control the seizures earlier.

Phenytoin treats close to 98% of all sudden seizures. We go to the hospital where her son arrives bringing treatment history. She’s a new epileptic. Undiagnosed from childhood and on meds for less than a month. The cause for her seizure?

She stopped taking the meds. She was not told what would happen if she left the medicine she was taking. She didn’t like the taste.

There is always gratitude from people for doing this but people never realise that I and many other people would do this irrespective of gratitude. We want to help and we are fundamentally good as people. There was no amount of people who helped today. From the entire carriage of standing people who hopped out of the train to let us carry this thrashing woman through. To the train driver who used his train as a bridge to help us not take the stairs with a seizing woman between platforms. To the countless dozens of strangers who tried to help.

And then in my next train I nearly got punched when a fight broke out because people were pushing to get out… Strange right?

And that’s how my day ended.

And that’s where we learn the point of keeping to prescriptions and the point of teaching patients why they should stick to their medication. And that people are fundamentally good if they aren’t under pressure.


  1. says

    I helped someone who was seizing like that once, in high school, we were practicing in the music room, my soundproof cube was opposite hers, and I saw her fall off her chair and go into full seizure. Fortunately, I had literally that weekend had my militia first aid training – which, yes, focuses a little more on traumatic amputation and sucking chest wounds than the usual course, but did cover the basics of the common things too – so I was able to just do the first bit of what Avi did, called for someone to call an ambulance, stayed near her and kept others off her, moved her chair and stand and instrument and stuff away, and waited til the ambulance arrived. She was okay, I saw her the next day and she said thanks, that they were trying to change her meds and they hadn’t found the right dosage yet.

    One girl was freaking out thinking the girl had demons, seriously, what kind of religion thinks this is good for you? To see a person suffering from something, and conclude it’s invisible spirits which must be prayed away? I mean, I know I was in the untutored wilds of Scarberia, the Frozen Waste of Hockeyjacketland*, but still.

    * Joke for the Torontonians, in these trying times, with a capering criminal jackass for a mayor.

  2. Acolyte of Sagan says

    That’s certainly a day of contrasts. The lady was lucky you were on board the train, what with you being a medical professional and all; who knows how it might have turned out if the first respondant had been an advocate of the power of prayer!
    My mind boggles at the thought of anybody trying to force food or water into a person having convulsions, but it boggles more to think that schools world-wide waste time teaching religion – time that could be better spent teaching basic first aid procedures. Maybe there’s a project for you when you get a spare few hours which will be in 2032 or thereabouts, at a guess.

  3. Mary L says

    I have a seizure disorder and want to add – protect a seizing person’s head from injury. It’s not great but no big deal if legs or arms smack into something. But, please, a wadded sweater, a leg, something, should be inserted under the head. You can also turn our head to the side if it seems necessary. Avoid the mouth for your and our safety. I keep an extra Dilantin in my wallet, or a pocket, at all times. Family and friends know this. i can’t take it until the seizure is over to avoid the possibility of choking. Trust us if we say we’re tired or weak after the seizure and if we have no memory of it. The damned things can play hell with our brains.

  4. says

    I thought it goes without saying! I forgot to mention it. Never interfere with a seizure. Just keep objects out of reach unless it involves the head. Protect The Head and if possible pad the area out with things that aren’t going to hurt if the person smacks their shin into it.

  5. keresthanatos says

    Was at a particularly bad seizure once, decided to try and cradle the womans head in my lap right before the worst of it hit. Full blown convulsions, her body comining off the ground. Wound up with bruised liver, she had several fractures, but no skull damage. One of the scariest things I have ever been through in my life. Avi, like most doctors, nurses, and health care professionals, you are a true hero, you help people to live. I feel honored just to read your blog.

  6. TGAP Dad says

    In the states – as yet another example of how broken our medical system is – the likely reason for discontinuing medication would be the cost. Such is the country we have created for ourselves, where it’s acceptable for a partisan audience to cheer for the death of a hypothetical someone who can’t pay for medical care.

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