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Tag Archives: Patient Encounters

WTF Moment #998

A 17 year old African American girl comes in by ambulance after being involved in a fight at school. Shortly after the ambulance leaves, her parents arrive. Both of her parents are white. After examining the patient and determining that she isn’t severely injured I walked from the room to go write up her chart. Her mother followed me out of the room. “Um, I’m not sure if this matters, but we’re not her biologic parents.” “No, that shouldn’t be an issue, but thanks for letting me know.” “OK, well just don’t say anything in front of her. She doesn’t know that she’s adopted.” [nodding with a blank stare while simultaneously wondering if the medical library has a genetics book I can borrow] “No problem.” . 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 WhiteCoat’s Call Room, please e-mail me.

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Smurf That!

I have come to grips with the fact that I am a mischievous 11 year old kid trapped in an adult’s body and there is nothing I can do about it. I walk out of a patient’s room and grab the next chart. Eight year old girl. Chemical exposure. Several people are already giggling, but aren’t saying why. One nurse already said that the patient’s parents were pissed off at everyone. The registration clerk says “don’t laugh, now.” I wondered what I was going to see when I opened the door. I walked across the department toward Room 6. I reached for the door and then stopped. I quickly looked back and five sets of eyes were watching me. This is a set-up. I know it. Some practical joke is ahead. I unlatched the handle on the door and slowly pushed the door open without stepping inside. The door creaked ever so slightly as it slowly revealed what was inside the room. No strange smells. That was a good sign. Someone was behind the door waiting to scare me or something, right? The receding door first revealed a man in jeans, a T-shirt, and a baseball cap. His arms were folded. He didn’t look happy. As the door swung further, there was a woman in slacks and a blouse. Her arms were also folded. She didn’t look happy, either. Both were staring at the patient who was sitting on the stretcher behind the door. I pushed the door open the rest of the way. The patient was a pretty young girl with long blonde hair. But there was something different about her. She appeared almost cyanotic. Definitely cyanotic. No, wait. That wasn’t cyanosis. It only involved one arm. It was blue paint. Turns out little sis was hanging out with her 11 year old brother and her brother’s friend when they decided to pound a can of spray paint into the ground with a hammer. Brother hit the can just in the right spot, causing the can to bust open and spray paint all over his sister. Brother and his friend were completely spared the blue spray. They thought the outcome was hilarious. Mom and dad weren’t amused. The whole front of the patient’s face was royal blue – except for her eyes and her teeth. The paint got on the front of her hair, also, making her bangs stick up in the air. The blue color also extended down onto her neck, to her left arm and the palm of her left hand. The parents changed her shirt before bringing her to the emergency department, so someone looking at her from the left would literally think she had blue skin. Fortunately, none of the paint got into her eyes and only a little bit of paint got up her nose. Then the 11-year-old inside of me started giggling. “She’s starting a new show called the ‘Blue GIRL Group!'” I was able to keep a straight face while I looked around the room. “Hi!” No answer. Tough crowd. “Guess I don’t need to ask what happened.” [crickets] “OK, so are your eyes bothering you?” The glance to the folded-arm statues showed the stark contrast between her white sclera and her blue face. Her mom yelled “Well … answer him!” The patient shook her head. The remainder of her exam was normal. “You can try using some baby oil or mayonnaise to get the paint off. Can’t promise that it will work, but avoid using any chemical solvents – especially around the face.” I had a flashback to college when a ...

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A Good Bet

A patient comes in from the nursing home for evaluation of a choking episode … that occurred 6 hours prior to his arrival while he was drinking water. Because the patient was sent in by a staff attending, I usually call the staff docs to let them know that there is nothing wrong with the patient before I send the patients back to the nursing home – just to make sure there are no other concerns the attending docs have.  In this case, the nurse ordered a CXR when the patient arrived to look for aspiration (or a tooth in the right mainstem bronchus), and the CXR was abnormal, but the changes were no different from a previous CXR done the month before. Pulse oximeter was fine. There were also some chronic abnormalities on blood testing done the week prior. No acute changes. The patient felt fine and had no complaints. He wanted to go “home.” So I asked the unit clerk to call the patient’s attending. One of the nurses rolled her eyes. “Good luck with that. It’s Dr. NoReturnaCall” “Great” Certain docs on the hospital staff have a tendency not to return phone calls from the emergency department on a timely basis. Once it gets to be mid-afternoon, some of the docs just don’t return the calls at all. You page them for a couple of hours and call their office, but they never call back. If you catch the nurse at the office, the standard line is “He’s in with a patient. He’ll call you back as soon as he’s finished.” Well, either the patient has a 2 hour appointment, the nurse doesn’t give the doctor the message, or the doctor is passive aggressive because often we just don’t get that call back. Then, after 5PM the on-call doctor gets stuck dealing with the problem. If you call the on-call doctor before 5PM, you get an earful because it isn’t 5PM yet. Then if you call some of the on-call docs just after 5PM, they’ll tell you to call the doctor who was on call before 5PM because the patients were ready to be admitted before 5PM. Sometimes patients just can’t win. As the unit clerk started dialing the office number, I blurted out “I’ve got ten bucks that says he doesn’t call back before he leaves for the day.” His usual departure time was about 4:30 PM which was about 45 minutes away. The unit clerk whipped out her purse and pulled out a crisp new $10 bill. “You’re on.” Then I felt bad. I didn’t want to take her money. “How about we bet a soda instead?” “Hell no. You said $10. Now get your money out.” OK, you asked for it. “Here. I’ll be in Room 5 if … er, um, when … he calls back.” I was in the room for 10 minutes, came back to the desk, entered some orders and headed toward the next patient’s room. “I’ll be in Room 8 when he calls back.” After another 5-10 minutes … “I’ll be in Room 2 when he calls back.” By that time I didn’t really care if Dr. NoReturnaCall did call back before 4:30. The looks I was getting from our unit clerk were worth $10 regardless of the bet. She’d squint her eyes, curl her upper lip, shake her head back and forth, and repeatedly look at the clock. She muttered to one of the nurses “If he doesn’t call back in 10 more minutes. I’m going to kick his ballsack so hard it inverts.” “Looking at the clock isn’t ...

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The Minion

There are some times where you can’t help messing around with patients … just a little. A patient got brought into the emergency department by police in a “hog tied” position. According to police and to the patient’s brother, the patient had smoked some “K2” and then began drinking. He then listened to some unidentified rock music on the radio and decided that it was time for him to “spill his blood for Satan.” So he ran screaming through the house, stopped in the kitchen to grab a Ginsu knife, and then ran staggered out the door toward the woods yelling unintelligible chants in order to find a suitable place to perform his sacrifice. The patient’s brother then ran out of the house after him. When the patient realized that he could not outrun his brother, he turned around and held the knife to his neck and yelled “Don’t deny me!” His brother was unfazed and proceeded to knock the knife out of the patient’s hand. The patient then took off running staggering again and his brother tackled him to the ground before he made it to the woods. In a feat of unparalleled strength, his brother then withstood the onslaught of countless demons that the patient summoned to whisk his brother away to the fires of Hell. By the time the patient made it to the emergency department, he was writhing back and forth on the ambulance stretcher, contorting his neck, and putting on a pretty good show. The police let his legs loose so that we could sit him on the stretcher. “Stay away from me, mortal. Or I will summon Satan himself to destroy you.” “Yeah, OK. Did you use any drugs tonight?” “I WILL SUMMON SATAN!” “Satan isn’t his real name, is it? What’s his real name?” “Satan is his real name!” “I think that’s his stage name. Kind of like how she’s ‘Lady Gaga’ in public, but how she’s Stefani Germanotta in real life. So what’s his real name? After all, he was the spirit of a live person, right? They used two names back then. Even Jesus went by ‘Jesus of Nazareth.’ Was he like ‘Satan of Paris’ or what? Who were his parents?” “He is one of seven spirits. The other six are going to come to get you. They’re GOING TO COME AND GET YOOOUUUUUUUU!” “Well, this is a religious hospital, so there’s no way for them to get inside. Won’t happen.” “They’re GOING TO COME AND GET YOOOUUUUUUUU!” “That’s it. Nurse. Can you go get me the restraints? Make sure that you dip them in holy water over in the chapel, too.” “NOOOOOOOOOOoooooooooo.” Fortunately, his close ties to the underworld did not make him impervious to the effects of Haldol and Ativan. Soon, Satan’s minion was snoring soundly on the bed. And I checked his wrists, too — there were no burn marks from the holy water. Phew. 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 WhiteCoat’s Call Room, please e-mail me.

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The Angry Mime

An older gentleman comes in because he has a “sinus infection” for the past couple of days. As soon as the triage nurse brings him back, she’s already whispering to the other nurses. Later, I learned that she told them to make sure that I get the patient. She’ll get her paybacks later. The man was upset because the ZeePack he got from his primary care physician wasn’t working after he had taken a couple of doses. He wanted some stronger antibiotics “like Augmentin or some Levaquin 750s” to make sure that his sinus infections went away. Triage nurse is really going to get her paybacks. I examined him. He had no sinus infection. He had sinus congestion at best, but even that was questionable. I dutifully explained that even if he did have sinusitis, studies show that antibiotics confer little or no benefit on patients with uncomplicated sinusitis. In fact, the best things for sinus congestion/sinusitis are topical decongestants and nasal irrigation. I even printed out a copy of the JAMA study and handed it to him. Then I gave him a couple of squirts of Neo-Synephrine in each nostril. Ten minutes later, he was much less congested and felt much better. He thanked me and promised to go home and use the nasal rinses. That was about 7PM. At 2AM, he shows up again and he is hot under the collar. I walked into the room and asked him what happened. “That Neo-Synephrine makes my blood pressure go too high and I read that those nasal washes can give you brain infections, so I’m not taking them. I haven’t slept yet tonight and I want some Levaquin NOW!” Whoa. I told him that Levaquin wouldn’t help and that I wasn’t going to prescribe it for him. I started to mention that he could use sterile water in the nasal irrigation and try some Benadryl for his congestion/sleep problems, but he interrupted me. “Well then, this was a complete waste of time.” And with that he got up and walked out of the door. Or at least he tried to walk out the door. Only problem is that the doors are locked and patients have to be buzzed in and out of the department. When you’re angry, there isn’t an exception to that rule. He went to the regular exit, tried to open the door, pounded it a couple of times and walked back in the department toward the ambulance bay. People ran after him calling “Sir! Sir! This way, sir! Wait!” He would have none of it. He got to the ambulance bay doors and tried to pull them open with his bare hands. Nope. You have to use a button to open those, too. Then he started shaking the doors. Nope. They still won’t open. We have cameras all over the place, so while he’s freaking out and people are trying to help him, everyone else is watching his antics in the camera and admiring his technique. It’s like a new reality TV series. Then the patient makes one final mighty effort to pull the ambulance bay doors apart. And in the camera he looks just like an angry mime straining against an immovable object. His body shakes ever so slightly. His face gets red. Then … the doors open. Waaait a minute. We looked across the nurse’s station to the control panel. The respiratory tech stood there smiling. “Hey, he was going to break the door if he kept it up.” And with a one-finger salute, the patient stormed out of the emergency department and into ...

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You Know You've Been Admitted Too Many Times When …

… your conversation with the admitting clerk goes like this: “You’re going to be admitted to Room 201B.” “I don’t want to go to 201B.” “Why?” “The faucet in the bathroom drips and cold air leaks around the window. Can’t I have like 216 or 217 instead?” “Those are private rooms. There’s an extra charge for those.” “How about telemetry? Those rooms are OK.” “Those are also private rooms. You have stomach pain. There is no medical need for telemetry. We can’t just send you to that floor if you don’t need telemetry.” “Fine. Now I’m having chest pain.” [patient’s nurse, who needs to be partially restrained and injected with Ativan upon hearing what transpired] “WHAT!?!?!? She’s going to need a trauma bed if she keeps THAT up.”   This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

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