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Patient Encounters

I Remember You

By Birdstrike M.D.   I walk out of the patient room.  My eyes stare at the computer screen.  I’m behind, way behind.  I roll my head on my neck.  My neck feels tense, and I have a headache.  It’s been a long week.  I need a vacation.  Hurry up, click-click-click this computer, I think to myself.  Dammit, is this EMR really freezing up again? I look up.  A man walks out of a patient room across the hall.  Our eyes lock.  I quickly look away.  Ouch, my neck.   There are patients waiting. I need to get moving, or I’ll never get out of here, I think to myself.  I put my head down and turn to walk away. “Doctor.  Doctor.  Are you Doctor Bird?” he calls to me with urgency. Crap, I think to myself.  I’m never going to get caught up.  He does look familiar.  I hope he’s not mad at me.  Who is this man?  He probably wants to sue me, or maybe he’s angry I didn’t prescribe him those pills he wanted.  Man, my neck. “Yes?” I answer, hesitantly. “Did you work at —– —– Medical Center about 10 years ago?” he asks. He looks so, so familiar, but I can’t place him. “You won’t remember me, but you took care of my son,” he says, with a faint, but warming smile. Right then, it hits me, like a ton of bricks. “My son had cancer,” he says. “Brain cancer,” I answer, and right then my mind goes back 10 years at warp speed, back to room 10, during a chaotic shift at my first job out of residency.  I’m looking at a 12-yr-old boy laying in bed.  His eyes are sunken and gaunt, skin pale, hair blond. He’s dying of cancer and all treatments have failed.  I had never seen a child so sick, so ill appearing, yet still alive.  He looks like he’s in terrible pain.  There’s nothing left to do, but to try to make his last few days, hours and moments as painless as possible. He needs IV fluids, some pain and nausea medicine and needs to be made comfortable.  In a chair next to him is his father, dying inside.  My heart sinks.  “I remember you, and I remember him.  I even remember the room you were in.” “He died shortly after that.  But I still remember you.  You really took the time to ease his suffering, if only for a short time.  That meant a lot to me.  Most of all, you seemed to actually care,” he says. I felt a little dizzy.  I felt like I was having a flash-back of the PTSD sort; so vivid and real. I remember the chaos of the shift.  Walking down the far hallway, walking in the room and closing the door.  As the door closed behind me, the noisy chaos behind disappeared, and it was stark quiet.  I remember feeling the heart-wrenching sadness of this man sitting next to his dying son, so helpless.  I felt equally helpless.  I remember thinking, I don’t care how many patients are waiting.  I don’t care how long the wait is, or what chaos is swirling outside that door.  I need to pause and try to at least listen, if only for a short time.  I need to at least acknowledge what this boy, his father and family are going through.  I need to try to find some way, no matter how small, to make things a little better, or a little less painful for both of them, if I can.  At the very least, I need to ...

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Assault With A Semi-Deadly Weapon

A man comes to the registration window clutching both sides of his head. “Help me … please. My head … it’s killing me.” He is brought straight back to a room and the doctor is called right in to see him. Between moans, the doctor gets the history. “I was fine before the fight. Then my baby’s momma came to my house with her boyfriend. She was nice at first, then she started arguing with me. Then he got all tough and tried to get all in my face. Then out of the blue, she grabs a bowl off the counter and hits me over the head with it.” “Wow. Did you pass out?” “No. But I was damn close.” “Did the bowl break?” “No, it wasn’t open.” “What do you mean it wasn’t open? What kind of bowl was it?” “One of those Ramen Noodle bowls.” “Wait. You mean one of those little plastic bowls with the peel off paper on the top?” “Yeah. But that sh*t HURTS!” “Did you get hit with anything else?” “No. She just slammed me in the head with the Ramen Noodle bowl then they took off running. I think I may have a concussion.” “Pardon me a minute.” The doc walks out into the nurse’s station shaking his head. He regains his composure and walks back into the room. “Well, after examining you, there are no signs of bleeding inside your brain and no concussion. We’ll give you some Tylenol … number three … here and then give you a prescription for a couple of days of Dolobid (pronounced “Da-LAW-bid”). You can follow up with your family physician if you’re not feeling better.” With that, the patient was given three Tylenol tablets, given a prescription for Dolobid, and discharged in stable condition. A couple of hours later, the patient calls the emergency department. “Man, that wasn’t no Dilaudid. That was crap. Can’t y’all just call me in some Oxycontins to last me through the night?” “No. We can’t call Oxycontin into a pharmacy. Try some ice and the Dolobid. You should feel better tomorrow.” So the nurse who took care of the patient overheard the conversation and made a suggestion. “I know something you can call in that would probably help more than pain medications.” “What’s that?” “Testosterone patches?” “Harrr harrr. That’s scheduled, too, you know.” “A football helmet?” “Nonprescription. Not carried in drug stores. Don’t you have patients to see?” “Some plastic bags to store the Ramen Noodles in?” “Stop. I’m getting a concussion.” ———————– 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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Treatment Denied

“I’d like to have someone take out these staples,” said the well-dressed woman who came to the registration window. “OK,” said the registration clerk, “we’ll get you registered and we’ll get you right back to a room.” “Perhaps you didn’t understand,” the woman stated as her voice went up a few decibels, “I want someone to take these staples out now and I’m not going to register to have it done.” The registration desk is on the other side of the wall from the fast track nurse’s station. There was a lull in the action, so I was leaning against the wall talking with a couple of nurses when we heard the woman raise her voice. Everyone stopped talking, looked at each other, and furrowed their brows. One of the nurses went up to the registration area to perform some reconnaissance while pretending to use the copy machine. She came back with a sour look on her face. “It’s Rhonda Jones. Her family owns several restaurants in the area. They’ve got a lot of money and they like trying to push people around.” The registration clerk was already getting flustered. “I’ll have to call my supervisor. Just a minute, ma’am.” “Is Dr. Koop down here today? Maybe you can just call Dr. Koop instead.” Dr. Koop was the head of the medical staff and well-known in the community. Very high-profile doc, but he was a cardiologist and didn’t work in the emergency department. “Just a moment, ma’am. Ummm … Dr. Koop isn’t on call tonight.” Now to put things in perspective, I don’t have any problems doing minor things to help patients. There’s a policy that all patients seen in the emergency department must have a chart made. On one hand, medicine is a business. I get that. On the other hand, morally, I have a hard time justifying a several hundred dollar charge to a patient for doing something that takes two minutes. I’ve gone out to the waiting room or into the triage room and pulled sutures, adjusted a splint that was too tight, and checked people’s blood pressure for them – without registering them to be seen. To me, it’s just the right thing to do and I think it improves the hospital’s reputation with the patients. By this time the woman had raised her voice to the point that people in the waiting room stopped talking to see what was happening. “You call Dr. Koop NOW and tell him that Rhonda Jones is here,” she said firmly. I walked out to the registration desk. “Is there a problem?” “I need to have these staples removed.” “Why are you raising your voice with the registration clerk?” “She wants me to register so that I get another hospital bill and I’m not registering to have it done.” “Unfortunately, the hospital policy is that anyone receiving treatment must be registered to be seen.” “Then you need to call Dr. Koop. He’ll come and remove the staples.” “Again, we don’t call doctors when they’re not on call, and I’ve never seen a doctor come in from home to remove staples, so even if we did call Dr. Koop, I doubt that he’d come to the hospital tonight.” “He’s a family friend of ours. He’d come.” “Have you tried calling him?” [Awkward pause. . . .]  Uh oh. “What is your NAME, doctor?” And so it went from this woman attacking the registration clerk to her attacking me, then calling the administrator on call and telling her I was being rude, then saying the CEO of the hospital would be getting a ...

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Is Bad Medical Care Better Than No Medical Care?

In my past few shifts in the emergency department, I have seen the following patients who were seeking further care after being treated by other providers. One was a child who had been seen twice at an urgent care clinic. He had a fever of 103 degrees and wasn’t eating. The first time he went to the urgent care center, he was diagnosed with an ear infection. He was started on amoxicillin and sent home. He returned to the clinic 8 hours later because he still had the fever and still wasn’t eating. When the clinic provider looked in his mouth, he saw a red rash that appeared to be an allergic reaction. He was therefore changed from amoxicillin to Biaxin and started on Benadryl. The parents were concerned that his allergic reaction may get worse, so they left the urgent care clinic and came directly to the emergency department. When he came to the emergency department, he still had a fever, his ears looked fine, and he had the typical enanthem of herpangina. We stopped the antibiotics, stopped the Benadryl, gave the child some stronger pain medication, and had the parents feed him popsicles and cool liquids. Another patient had been in a bar fight several days prior. He had a cut on his knuckle and his knuckle was starting to hurt. He went to another emergency department and saw a provider who washed out the cut, started the patient on amoxicillin, and then put packing in the wound. When he came to our emergency department, we started IV antibiotics, removed the packing … from the joint … and sent the patient for surgery to clean out the infected joint and to repair the lacerated tendon. A third patient had been to both an urgent care clinic and an emergency department for evaluation of palpitations. The urgent care clinic diagnosed the patient with anxiety and discharged the patient with a prescription for Xanax. When the Xanax didn’t help and the palpitations were causing worsening shortness of breath, the patient went to an emergency department. There the patient was seen by a provider who performed an EKG and did a drug screen. The patient was told not to drink caffeine and given a refill for Xanax. When she came to our emergency department, an EKG showed Wolff Parkinson White syndrome. We got a copy of the EKG from the prior hospital and it showed the same thing. Their EKG even said “Ventricular pre-excitation, WPW pattern” on it. Finally was the patient in his 70s who was seen at another emergency department for evaluation of abdominal pain and no bowel movement for a couple of days. He had some lab tests done and the provider performed a rectal exam which showed that he had a lot of soft stool in his colon. So the patient received an enema and was discharged home with a diagnosis of constipation. He was told to take laxatives and eat more fiber. When he came to our emergency department by ambulance later that evening because he vomited the Milk of Magnesia, his abdomen was swollen and tympanitic. He had low blood pressure, no bowel sounds, and a sigmoid volvulus with an obstruction on x-ray. He also went straight to surgery. I understand that it is considered bad form to question the care of other practitioners. If another provider’s care is criticized, often the criticisms are met with allegations of elitism and hindsight bias followed by a plethora of anecdotes about how those commenting were able to catch some other provider’s mistakes. You don’t know which patients, ...

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Cat Lady

By Birdstrike MD   “She talks to angels, they call her out by her name.” – The Black Crowes. . . The radio crackles alive, “County General…we’ve got a 20-something female……just picked her up…..bagging….we’re at your back door…” Boom! They slam through the double doors, and roll into room 8.  Lying on the stretcher is a young thin woman.  Beneath the mask over her face is a full head of golden wavy hair.  I get to the head of the bed, and get ready to intubate her.  I grab the bag and mask and start bagging her myself.  “What have you given her, so far?  Any narcan?  D50?” I ask. “No,” the paramedic says.  “We just scooped her up and had just enough time to get her here and pop an IV in.  Just lost pulses a few seconds ago.  PEA.” “Okay, give her some narcan and D50, while I get ready to intubate.  Resume compressions!  Etomidate, sux, scope…” roll off my tongue.  I look down at the patient’s face again……blond, so young, hair and face like a movie star, except for the pale-bluish dying hue.  She reminds me of Cat Woman from the old Batman comics.  She’s just about dead and much too young to die.  I don’t think I can handle another young patient death this week.  I’m filling with dread, not from anything that has to do with the medical “case” in front of me, but because somewhere out there is an unsuspecting mother, husband or child that I’m going to have to tell that she is dead.  There’s no way to candy-coat that news, and no matter how many times I do it, it still gives me chills. The nurse has just given narcan.   She starts to move.  Is she trying to breath?  I look at her face, it’s pinking up.  Did we restrain her before the narcan?  Damnit….we didn’t! She VIOLENTLY sits up, blasting upwards towards my head, ripping the mask off her face, ripping out her IV and heaves forward.  I’m looking straight at the back of her head and torso and she’s heaving forward violently grabbing at her own neck, making an awful guttural noise, contracting rhythmically.  That noise, what’s that noise?  I’m hearing my cat, she’s trying to vomit.  Is this lady trying to gag up a hairball?  Cat Lady. “Blahhhhaaaaaacghck…..blaaa…..ughggh!” I look beyond her and the nurses are staring back mortified, at the patient.  “Ahhhhhh!     Ahhhhhhh!    Ahhhhhh!” this Cat Lady is screaming.  “I’m dying here!  Help me!!!  Oh, the pain, s—t, the pain!!!” I step around out from the head of the bed to the front of the patient to see what the nurses are looking at, and on the patient’s lap is a big, gooey, mucous-covered ball of something on her lap.  Whatever it is, this patient was choking on it, it almost killed her and now she’s alive and well, though ready for vengeance. Why the heck is she screaming, now?  This thing, whatever it is, is out of her, and she’s awoken from the dead. I pick up the ball of goo and examine it.  I start picking it apart.  Why do I have to do this, this is disgusting?  I should’ve been an accountant.  Hairball, I think to myself, laughing a little bit inside.  Just like my cat.  It seems like a ball of wadded up plastic.  What the heck is this thing?  There’s writing on the plastic.  What is it? Is that an “F—–, Fe—“? “Fentanyl!  Fentanyl!” yells one of the nurses looking over my shoulder, who can obviously read through bloody mucous much better than me.  Fentanyl ...

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A Tale of Two Patients

One of the things that many emergency physicians enjoy is the variety of patients. You never know what’s coming through the door next, but you can handle it. The variety of patients also brings a variety of attitudes and demeanors. Which can be exemplified by two messages that two different patients recently left in their rooms after being discharged from our emergency department. One patient was having gastrointestinal issues – abdominal pain, bloating, diarrhea. She had numerous normal CT scans and had been to her primary care physician several times for the same problem. The primary care physician would refer her to the emergency department every time she had pain and the emergency department would “lab her up,” do a CT and send her back to the primary care physician. We sat down, figured out that the symptoms tended to coincide with meals and made some suggestions to try to find out what was causing the pain. Perhaps it was  a reaction to food she was eating. Couldn’t be a gall bladder problem because she had already had it removed several years prior. Maybe it was bacterial overgrowth syndrome. Possibly gastritis. She got Bentyl for her pain and felt better.  We suggested that she keep a food diary. Told her to come back in a couple of weeks and we’d recheck her. I gave her the times I’d be in the ED. Even though we didn’t do any labs or x-rays, she was happy to have some direction on how to fix the problem. The other patient was having back issues. Chronic pain. Multiple pain meds. Happened to take his last three Norco pills earlier in the day and needed a refill on Friday night because the pain was worse. We sat down and tried to figure out what was causing his pain. He wasn’t interested in discussing it. He had MRIs that showed bulging discs. So we looked through his old records and found an MRI from a few years ago showing mild disc bulging at two levels. Then we looked through the state database and discovered that the patient had received multiple prescriptions for pain medications from multiple different physicians over the past month – far more than should be prescribed to one person. “I don’t want your Toradol. That stuff doesn’t work. I’m not taking steroids, either. I just need more of my pain medications. “Sorry, I’m not comfortable refilling your prescription.” The note was placed on the pillow of the bed in the room. The glove was taped to the wall behind the door so that when the door was closed, the glove was visible. See if you can match the patients with the messages they left behind.  

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