No Good Deed Goes Unpunished

This is a saying most of us have heard or even used in the past. I recently had a patient who suffered a traumatic brain injury while she was graciously volunteering her time at a festival, face painting the children at this event.

The injury occurred when a large tree limb fell and the patient, leaping forward to protect the child from danger, had the tree limb fall on her head, instead of on the child; who would have most definitely suffered severe injury or death. When I finally saw this patient it was, I believe, about 6 months after the injury.

She presented to my office complaining of profuse watery discharge from her nostrils. Since the trauma from the tree limb had happened months ago, and since the patient never lost consciousness (nor did she go to the ED),; I diagnosed the patient with allergies and prescribed typical anti-allergy medications.

Her profuse discharge persisted.

She finally went to an allergist who, very astutely I might add, checked the fluid which was emanating from her nostrils; discovering that it was not mucous from allergies, but indeed was something called cerebrospinal fluid, or CSF. The only way CSF could flow out of the nostrils would be due to a traumatic brain injury. An MRI ensued and it was found she had suffered a cribriform plate fracture. The cribriform plate seperates the upper part of the nostrils from the outside world.

She saw a neurosurgeon who fixed the fracture and now she is doing well. When she returned to my office for follow-up, we both jokingly made the statement that 'no good deed goes unpunished' and we both laughed.

Then I stopped and thought about the whole sequence of events. Both I and the patient started wondering what would have happened if the patient wasn't at the face painting event. Would this child have been struck by the tree limb? What type of injury or worse would this child have suffered if this patient was not there to protect this child. We both shuddered at the possibilities...

We both came to the conclusion that even with something as tragic as a traumatic brain injury requiring neurosurgical repair; that this was indeed a good deed, as the patient undoubtedly saved a child from serious injury or death; and no, the tree limb falling on her head was not punishment, but just a freak accident.

I now view the statement which started this blog in a whole new light.

Dr Jim

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