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Eeew-perman

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.

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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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