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Patient Encounters

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 had a smirk on his face as he walked into the room and pulled the curtain. Only the patient and her mother could see his face after that, but his smirk probably faded pretty quickly. The first words out of the mother’s mouth were a stern “Honey Boo Boo, huh?” Oops.  Isn’t it just like a bullshitter to be quick on his feet, though? There was a hesitation and then he began laughing. “Awwww. I’m sorry. I didn’t mean anything bad by saying that. I call EVERYONE that.”  There was another uncomfortable silence and then he doubled down on his faux pas.  “OK, Honey, let’s see if we can get your eye feeling better. What happened?” In the ensuing banter back and forth, it seemed as if the mother’s irritation had waned. Then the moron starts in again. He pokes his head out from the curtain and asks the nurse “Ummm Chelsea, Honey, could you pleeeease grab me some tetracaine eye drops?” Chelsea would have none of it. She promptly gave him a stink eye.  He mouthed the word “Pleeeeease” and put his hands together as if he was praying.  The stink eye remained.  He then mouth the word “Starbucks” and expanded his hands to make a “large” gesture. Of course, he knew Chelsea’s weakness. Mocha latte frappucino deluxe.  She raised an eyebrow. And held up two fingers. He scowled. It was then her turn to smirk as she took a big breath acting as if she was about to say something he didn’t want to hear. He quickly re-thought his predicament. He grimaced momentarily and mouthed the words “OK OK.” “Sure thing, doc, right away.”  By the time they were done, everyone was laughing back and forth in the room. A handful of lollipops and an IOU for two Starbucks later and the crisis was averted.  “Jeez. Does my voice carry that much?” he asked. A chorous of responses from across the department responded “Yeeessss.”  “I hope bald Donald Trump from earlier today had a hearing impediment ….”  ———————– This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on DrWhiteCoat.com, please e-mail me.  

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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 “patient is agitated.” Normally, it doesn’t bother me too much, but one specific nursing home not only sends its patients in for routine medical issues, but it refuses to take the patient back unless we do the testing that their nurses want. If a patient with a history of agitation gets sent in for agitation but arrives calm, we can’t just send them back on the same ambulance. We have to do tests … special “agitation” tests … to rule out excess agitation levels, apparently. Rashes have to have skin scrapings sent. Patients found on the floor must have head and neck CTs. Haven’t had a positive one yet, but try sending a patient back without one and the ambulance will be sent back to the ED. I tried fighting it a couple of times. They’d send the patient back. I’d do another exam while the patient was on the ambulance stretcher, take vital signs, then send the patient back again. Then there would be the call from their medical director to our department chair. Bad doctor. How dare we practice proper medical care? Patient returns by ambulance for third time. Just do the friggin tests, OK? So when patients come with orders … er, um … requests … from this nursing home’s staff, regardless of how stupid the orders er, um requests are, we put the orders in to save time and to save administrative hassles. Harry was the unfortunate soul who was drafted one Sunday morning. It seemed that the nursing home staff felt it was odd that Harry hadn’t had a bowel movement in two days. He probably had an obstruction. Needs an acute abdominal series and some labs. I called BS. Harry had normal bowel sounds, no palpable masses, and no impaction on his rectal exam (sorry about having to do that on an early Sunday morning, Harry). Besides, it’s entirely normal for someone not to have a bowel movement for two days. We called the nursing home and told them Harry was coming back. Nope. Need labs and an abdominal series. Bastards. Needless to say, the labs and the abdominal series were [gasp] normal. So I asked Harry “Would you like me to give you something to help you move your bowels?” Harry replied “Sure, doc. Always nice to have a good BM every day.” We called the ambulance and made arrangements for transfer back to the nursing home … after being forced to fax them the lab and x-ray results. So I’m curious. Would it have been mean for us to give Harry lactulose and Milk of Magnesia as the paramedics were loading him onto the stretcher to take him back to the nursing home?

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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 home with a complaint like this, you’re forced to prove that a problem doesn’t exist. Woe is the doctor who sends a normal patient back to the nursing home without performing testing to prove that the patient really is normal. Then the nursing home administrator calls the hospital administrator and the patient gets sent back to the emergency department for the desperately needed testing. When – and ONLY when – the testing is normal will a patient be accepted back to the nursing home. It’s a stupid game, but one that we’re forced to play. The sooner the normal testing gets done, the sooner the taxi with the big spinning lights can come back to bring the patient back to the nursing home. So we order the standard nursing home lab panel. CBC, chemistries, urinalysis, and drug levels of any medications the patient may be taking. If the patient has dementia, then add a mandatory CT scan of the brain. You see, we can’t really tell if a demented patient has mental status changes, but if the demented patient DID have mental status changes, those mental status changes COULD be due to an acute stroke affecting only the personality centers in the brain. Hey – it happened once, you can’t be too careful. So the lab tech came in to draw the patient’s blood and the nurse gave the patient a urinal for a urine sample. About an hour goes by and the labs are [gasp] normal, but the lab still hasn’t received a urine sample. So I walk back into the room to see if the patient could give us just a little bit of urine in the urinal. Sur-prise! Anyone have some popcorn? “Ummm. Mr. Clinton … why are you drinking your urine out of the urinal?” [giggles, then whispers] “It gives me secret powers.” At that point, I didn’t know whether to puke or to take a sip. “You haven’t been taking your Zyprexa, have you?” “Oh, no. I take it … some-times.” Then he gave me a sheepish wink. Good enough for me. His urinalysis was normal and he levitated got a ride back to the nursing home. Take that, night nurses. ———————– This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on DrWhiteCoat.com, please e-mail me.

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Time To Retire Revisited

Remember the doc from “Time to Retire“? Had a few amusing stories from patients about some of the statements he made while working in the emergency department. Since that post, I became friends with one of the people working in his emergency department. I keep trying to get that person to start a blog … to no avail. Here are a couple of more stories from reported patient encounters. A sick kid comes in. I started an IV. Kid is in and out of consciousness. Doc says “let’s tube him.” The mom is freaking out. I grab the resuscitation bag and hand the doc the Broselow tape. He gives me a blank stare and yells at me. “What the hell is this?” Mom and dad look at him then give me a look of terror. Doc says he’s never heard of a Broselow tape. Fortunately, the rest of the visit went smoothly and the kid was transferred to the peds hospital across town fairly shortly afterwards. I see a patient and then mention to the doc, “Hey just wanted to know that the guy in Room 2 has a glass eye on the left.” Doc says “He isn’t here for a problem with his eye.” I say “I know, I just didn’t want you to look bad by putting ‘PERRLA‘ in your dictation when one eye doesn’t work.” Doc says “What the f*** is the matter with you? I’m not even looking at his eyes. The guy is here for a problem with his leg. Stop worrying about my dictations. ” After the patient was discharged, I look at the dictation. What shows up? You guessed it: PERRLA.

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The Aspirin Technique to Stop Pregnancy

I’m going to preface this post by saying that it isn’t for the faint of heart. You’ve been warned. We’ve all seen them. After a while they become emotionally frustrating. Some patients would rather spend several hours waiting in an emergency department waiting room rather than going to the Dollar Store and buying a test to see if they’re pregnant. No, the hospital tests aren’t more accurate. For all I know the hospitals get them from the same supplier as the Dollar Store. You don’t need to recheck … oh nevermind. Just get five of them. You know that no matter what the test says, if you think you may be pregnant, you’re going to check it over and over again to make sure one way or another. Just buy a handful and be done with it. I’m happy when people are excited about being pregnant, but it gets frustrating when people don’t want to be pregnant and at the same time don’t take any precautions to try to prevent themselves from getting pregnant. Which leads me to my little story… One of said potentially pregnant patients came in for her usual pregnancy test. Her name popping up on the board caused a few people to shake their heads. “C’mon. She was just here like six weeks ago.” “She needs to get a prescription for some birth control.””Or she can just use the aspirin technique.” Suddenly there was a gasp from behind the nurses’ station. One of the older secretaries was coming in for her shift. She was walking behind everyone and had apparently heard the tail end of the conversation. She stood there shocked. This was a four-pack-a-day smoker with a raspy voice who took pride in making others blush with her “colorful” language. Most of the time her breakroom talk could make a truck driver lean back and raise his eyebrows. Yet this time, it was her increasingly reddening face that formed a stark contrast to her white hospital jacket. “What? You know? The aspirin technique? Put an aspirin between your knees and keep it there while you’re having sex to keep from getting pregnant?” She heaved a sigh of relief and smirked. “Oh Hells bells. I thought you said the a**hole technique. Then I’m standing here thinking that you’re all a bunch of sick sons of bitches.” Which made everyone crack up. As she was walking away, she added “Although either way would probably work just as well. Baaaahahaha.” And with that comment the staff decided to skip lunch that afternoon. Got us again. Remember, I *did* warn you … ———————– This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on Dr.WhiteCoat.com, please e-mail me.

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Happy Marriages, Rainbows, Yin and Yang

“She’s a peach,” the nurse quipped as I clicked the link assigning the new patient to my list. “A positive review of systems … if you know what I mean,” she winked. I like getting a head’s up about patients before I go to see them, but sometimes advance notice of a difficult patient gives me anxiety. I took a deep breath and put on a big smile as I pulled back the curtain. “Hi, I’m Dr. WhiteCoat. What brings you here today.” “Didn’t you read the chart? I’m not explaining it again.” “I did read your chart, but it looks like you have a lot of things going on, so I’m going to have to get some more information from you about all of them.” She rolled her eyes, sighed loudly, and gave me a brief end-expiratory “You’ve got to be kidding me.” I listened and took notes as the patient described her chest pain, her chronic dyspnea, the dry socket she had when her wisdom tooth was pulled 6 months ago, and how a tingling sensation sometimes begins in the fingers of one hand, runs up her neck, down her back and into her leg like someone is “ripping the nerves out of her body one at a time.” My “kill them with kindness” tactic seemed to be working … at first. But the more I asked questions about her eight different complaints, the more that the patient became impatient. Finally, she snapped. “You ask too many questions. THIS is why people hate coming to the emergency department.” “Well, I need to find out more about what is bothering you so I can try to figure out how to fix the problems.” “YOU’RE the problem and YOU’RE bothering me. Why don’t you just run some tests?” “But learning more about your problems helps me figure out what test need to be run, though.” “You don’t listen very well, do you?” By this time, I was getting frustrated. “Ma’am …,” I started, but she cut me off. “I bet your wife LOVES it when you leave for work in the morning.” Ooooh. Eeee. Oww. Oww. Poke me with those pointed barbs. I was going to be a smart ass and tell her that I work nights, too, but my inner peace took over and I bit my tongue. “Tell you what. Why don’t I … order some tests … to see if we can get to the bottom of all of these problems you’re having.” Then I left the room. About 15 minutes later, the nurse hunted me down and told me that the patient had pulled off her EKG leads and walked out of the emergency department while yelling at someone on her cell phone. One of the other doctors at the nursing station smiled and shook his head. I briefly explained what had happened. “That’s nothing. Yesterday, I had a lady tell me that men like me were the reason she became a lesbian.” We both got a good laugh out of that one. Later that day, though, I had a patient and her family ask me if I had an office where they could see me as patients outside of the emergency department. Ahhhh. That’s better. The yin and yang of my day has now been re-equilibrated.

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