Latest Posts

Voices Carry

Wisecracking doc that I work with recently had a little surprise.  He was walking down the hallway and saw a nurse escorting a mother and her overweight young daughter into a room. Daughter was holding her right eye.  When the patient’s registration was completed, he signed up for the patient, took a swig of coffee, and said “OK, looks like it’s time to go see what’s wrong with Honey Boo Boo‘s eye.”  A couple of the nurses chuckled and he ...

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Hurry Home

  First of all, I’m having blog withdrawals. Seriously. I wish I could make a living writing a blog. It would be my dream job to write blog posts and troll the internet. Maybe some day. So a quick story before I go to bed for another long day tomorrow. At one of the hospitals where I moonlight, many nursing homes refer patients to the emergency department for routine medical care. Stuff like “patient has a rash for a week” or ...

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One of many ambulance transfers included a 80-ish year old nursing home patient who was sent by the night staff at the nursing home because they were too busy he had mental status changes. When the patient arrived, he seemed OK to me. Awake, alert, smiling. Held a relatively normal conversation. Watching the news on television. He even grabbed the remote and muted the sound when I came into the room. Unfortunately when a patient gets sent from the nursing ...

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Patient Encounters

What’s the Diagnosis #21?

A patient presented for evaluation of dyspnea. Her trouble breathing had been going on for a few days and kept getting worse. No coughing. No fevers. No other symptoms. No medical history. She smoked a couple packs of cigarettes per week. Her physical exam was entirely normal. Lungs were clear. Heart sounds normal. Labs (including CBC, CMP, d-dimer, and cardiac enzymes) and chest x-ray normal. EKG normal. Intermittently, her pulse oximeter readings would dip down into the low 80s. Then ...

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Hot Blooded

“I’ve had a fever,” said the 50-something year old lady who wasn’t feeling well. “My muscles ache and I don’t feel well.” OK, not much to go on. “Well, how high was your fever?” I asked. “Just under 207 degrees.” “You mean 102.7?” “No, 207.” “As in 2-0-7?” “Yes, as in ‘2-0-7.'” She was starting to get annoyed. “Do you think I don’t know how to take my temperature?” Ummmm. Well, her temperature was 99.7 in triage. Then the backoom ...

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True Love

A nice 89 year old man was brought to the emergency department by ambulance complaining of chest pain. While I was talking to him, he mentioned that he and his wife would be celebrating their 65th wedding anniversary in a few days. So I asked him “What’s the key to your long marriage” He rubbed his chin and I sat back, expecting some profound words. He came up with this: “We don’t communicate much. When I complain, she doesn’t listen. ...

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How to Get Tazed Out of Spite

One of the “regulars” comes into the ED. He has a long rap sheet of pain medication prescriptions on the state database from multiple different providers and is complaining of back pain for which he is requesting a prescription for more pain medications. The 30 Percocet that he filled three days ago have mysteriously vanished. The emergency physician tells him he’s on “The List” and tells him that he’s going to get Naprosyn and like it. The patient tells the ...

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