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Emergency Diarrhea

Waiting Room Chairs

I simultaneously love and hate nights like this. It’s not just that it seems like patients get off a bus all at the same time and wander over to the registration desk. It’s that almost everyone in the emergency department is actually having an emergency. Full arrest. Stroke. Overdose. Cardiac arrhythmia. Bowel obstruction … with a spike in the cardiac enzymes to boot. What’s that? You can’t reach the  cardiologist or his partner … and the ICU was full so we have to hold critical patients in the emergency department … and we’re short two nurses? Yeah, that’s about right.

While you’re running around, patients and family members stand in the doorways of the rooms giving you the stink eye and watching you dart back and forth from the telephone to a patient room to another patient room back to telephone, then don a gown and disappear into the trauma bay amid a crowd of people.

After what seemed like an eternity, we finally got the serious patient stabilized and were able to take care of some of the less critical patients … like a young patient with diarrhea. He and his family waited 3 1/2 hours to see me. There were lots of snarky comments when I grabbed a couple of charts including his including “there is a new invention called Pepto-Bismol, they should try it” and “since when is diarrhea an emergency?” I kept an open mind as I walked in the room and reflexively apologized for the wait.

The patient was a little boy who was seven years old. He had diarrhea for 2 weeks. Their pediatrician was out of town and besides, they weren’t too happy with him. He never does any testing and just writes a prescription for antibiotics every time the parents bring the patient to see him, anyway. The patient missed two days of school this week because the diarrhea wouldn’t stop. Today was the worst. He was having stomach cramps and couldn’t get off the toilet.
“When’s the last time he had diarrhea?”
The mom scowled. “Right before we got here … like four hours ago.”
That’s patient-speak for “what took you so fricking long, you lazy dickhead?”
That little Jim Carrey character in the back of my head started saying “Oh reeeeeheheeallly? First, it has only been three and a half hours, not four hours — which is incidentally about twice as long as it’s been since I’ve eaten anything or used the bathroom. But that’s beside the point.”
Suddenly my brain’s automatic pilot started saying “Pull up! …. Pull up!” I snapped out of it.

So I started out by making small talk with the patient.
“You’re sure you’re seven? You didn’t turn a year older waiting here all this time?” That got a smirk out of dad and a laugh from the patient.
I did a thorough exam and explained how diarrhea that lasts longer than a week usually has to be evaluated with lab testing. The mother noted that the patient’s grandmother had Clostridium difficile colitis and that they had been to visit her shortly after the symptoms began. We needed to get a stool sample for testing.

With a little extra effort, the child was able to provide a sample. Unfortunately, the wait for the results was going to be another couple of hours. So I got the parents’ phone numbers and told them that I would call them with the results in the morning. That way they didn’t have to wait even longer in the emergency department.
I asked the mother “Do you have any questions? You’ve had over 4 hours to think of them. There has to be something.” They all laughed.
“Nope. You’ve explained everything.”
Overall, the family was understandably annoyed, but were reasonable all things considered. So I told them “Thanks for being patient. I’ve gotten chewed out quite a bit tonight by people angry about waiting, but you have all been very nice considering everything. I appreciate it.”
We all shook hands and I discharged the patient with a prescription for some Tylenol with codeine elixir to help with both the stomach cramps and hopefully some of the diarrhea until the culture results were returned.

The next morning, some of the results were back. WBCs in the stool suggesting an infectious cause of the diarrhea. No Clostridium difficile, thank goodness. Cultures would take another 1-2 days. I called the patient’s mom on her cell phone, told her the results and called in a prescription for a few days of antibiotics until the culture results returned.
“Thank you for calling back. That was nice of you.”
“No problem at all. I hope he’s feeling better soon.”
“By the way, do you have an office to see patients?”

Ha ha. That’s patient-speak for “You’re an OK doctor after all.”

2 comments

  1. I admire your patience, usually when I’m full of work, haven’t eaten and patients start complaining for something it’s not my fault it’s reaaly hard to try and be nice!

  2. No greater compliment than the office question. Having any patient ask it is an honor. Having someone who waited 4 hours ask you speaks volumes!

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