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Tag Archives: Patient Encounters

Lucky in More Ways Than he Knows

Hey all, I this is ERP from ERstories doing a guest post on Whitecoat’s Blog. I want to give him and the EP Monthly staff my thanks for accepting some of my occasional ramblings. Drunk people are often victims of their own stupidity. However, just as often they manage to avoid disaster by some miracle. For example, intoxicated persons have a tendency to end up face down in the street and often manage to avoid getting run over. Sometimes they are even luckier. Of course they never really realise this since after all, they are drunk. Hopefully when they sober up they count their blessings but often they simply can’t remember enough! Anyway, we had a guy who was brought in by police intoxicated outside someone’s house. Apparently he was visiting the area and was staying with someone in the neighbourhood. Unfortunately, when he stumbled home from the local watering hole, he went up to the front door of the wrong house. Frustrated by the fact that his key did not work and upset that no one answered his knocking, he preceded to kick the door in. He flopped partially into the doorway and nearly passed out. This of course triggered the house alarm and the police were notified. The responding officer sped rapidly to the scene for more than one reason. The door that had been kicked in belonged to the chief of police’s house! Expecting the worst, the cops showed up with Glocks drawn. Knowing the chief’s love of firearms and the fact that he was not afraid to use them, I imagine they thought they might encounter some OK Corral– type scenario. Fortunately for the guy, the police chief was not at home at the time. Otherwise, he would have likely been brought to the morgue instead of the ER! One more of his nine lives used up I guess….

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You're DEAD!

This wasn’t my patient, because if it was my patient I would have spent the whole shift looking for people videotaping me to catch the looks on my face and the phrases coming out of my mouth. A pediatric patient is brought in by ambulance for evaluation of suicidal and homicidal ideations. Great. The kid is already seeing a psychiatrist and is taking Strattera and Clonidine. Fine. I have issues with kids being started on psych meds, but what do I know? I’m just a dumb emergency physician. The social worker met the ambulance at the hospital and called the children’s psych facility immediately upon her arrival. She kept saying “He’s gotta go. This is it. This time he’s really gotta go.” The parents had the patient brought in by ambulance and wanted him transferred to the children’s psych facility by ambulance because they didn’t know if they could control him in the car. Did I mention that the child was THREE YEARS OLD? The parents and social worker became concerned when he bit his sister on the leg and punched her a couple of times. In the ED, he was drinking his bottle, then intermittently holding the bottle between his teeth while climbing on and off the bed. One of the nurses called me at home to tell me about the patient. I had to talk to the other nurse, the secretary, and the EMT that was there to do the transport just to confirm that they weren’t BS’ing me. I still have my doubts. The kid can’t even put together a sentence and the parents and social worker are saying he has suicidal ideations. Maybe it’s me. Maybe he’s half Tasmanian Devil and can kick his parents’ collective asses with nary more than the sharp edges of the buckles from his car seat. Maybe was told that he’s got multidrug resistant peptostreptococcus on the six teeth that have managed to rupture through his gums and, with that knowledge, told his sister in baby language “Now you DIE!” before he bit her.  Right after that he told his parents in some variant of non-Mandarin Chinese baby talk that his Similac was really insecticide and that he was going to drink it so he could die of a cholinergic toxidrome. The parents must have called the AT&T Language Line to confirm before calling the social worker and 911, but by that time the child was faking as if he couldn’t really speak. Oh yeah, and to finish the plan, after he would drink the hidden insecticide but before he vomited, salivated, urinated, and defecated all over himself, he ga-ga goo-gooed his intent to beat the family chihuahua to death with his sister’s Hannah Montana microphone. Back when I was a kid, punishment for hitting your sibling used to be a butt-whoopin from your parents. If you got in trouble at school, it was nothing compared to the trouble you got in when you got home. These days, school teachers are afraid to discipline kids because of lawsuits. Now proper punishment when kids get home is a time out – maybe some dish soap or Tabasco sauce in the mouth for biting or swearing. Apparently now the paradigm is changing yet again. Soon we’ll be seeing papers on how the most effective form of punishment is a three day stint in the children’s psych ward. BYOD – bring your own diapers. Maybe they’ll start him on some kiddie Haldol just for good measure. That’ll teach ’em. Picture credit here UPDATE: Because I have already received several comments questioning my abilities as ...

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Smiles

Every once in a while you run across a patient that just makes you smile for no particular reason. For me, usually it’s a little kid. This time, it was someone at the other end of the age spectrum. A 98-year-old grandmother was brought by ambulance because she was found in a nursing home laying on the floor beside her bed. She didn’t complain of any pain. She was just laying next to her bed … singing. Because she was suffering from Alzheimer’s Disease, the nursing home sent her to the emergency department for evaluation because they couldn’t determine whether or not grandma had hurt herself. When grandma arrived in the hospital, she was smiling and calm. She was a little hard of hearing, so we had to raise our voices to talk to her. As she was being transferred from the ambulance cart to the bed, I introduced myself and told her that I was going to check things out to make sure that she was okay. “Oh, how nice … thank you.” Right away that made me smile. As we were examining her, we discovered that poetry must have been a pastime of hers. The nurse asked her “Did you fall out of bed?” She replied “No, I am not dead” as if she were reciting a Dr. Seuss poem. Everyone in the room giggled. As I was listening to her heart, she said “Your hands are too cold … And I am too old.” Everyone giggled again. Then she started singing and stopped making sense Hey, hey, this is the room In the lagoon Hey, hey, what you cooking How about something good to eat? Through the river and down the stream Everything moving to make everything clean Tomorrow we got a grain Tomorrow the mountain will strain Keep your head up and keep your things down Then all will be up off of the ground Hey good lookin’ [obviously she was completely lucid and talking to me at this point] What cha got cookin’? Everything is beautiful Everything is fine This little old grandma serenaded the staff, the x-ray technician, and the lab technician with her soft little voice. We all stood around mesmerized for a few minutes – smiling and listening to her. The more that we looked at each other, the more that we all smiled. I went and grabbed a sheet of scrap paper to write down some of the stanzas in the songs that she was singing – just so I wouldn’t forget them. We did an x-ray of her hip and pelvis and everything was fine. “Everything looks just fine. You’re going to be able to go home so you can have some dinner now.” “Oh, thank you so much!” “I am so hap-py … as you can see me.” We’re happy now too, grandma. Thanks for the smiles.

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You Talkin' to ME?

A young lady who has logged nearly 90 visits to our emergency department over the years was having pain all over the right side of her body. Just out of the blue, she developed sharp stabbing pains in the right side of her head, neck, chest, abdomen and her outer right leg. No other symptoms, just pain. Her vital signs were normal. Her physical exam had no abnormalities – except for being a little anxious. I did an EKG that was unchanged from several other EKGs that were in her old records. We even did a trial of controlled hyperventilation and her symptoms got worse. So I gave her a shot of Toradol and told her about my plans to discharge her. “You’re not going to do any lab tests?” “I hadn’t planned to. What is it that you want to be tested for?” “How about gall bladder or low potassium or something like that?” “Gallbladder pain typically doesn’t involve the head or leg and it uncommonly involves the chest. Besides your pain isn’t over your gallbladder. ” “The last two times I have been here my symptoms were due to low potassium.” “I’ll go review your records.” Her records showed multiple EKGs, chest x-rays, and lab sets since the end of 2007. I pulled up seven sets of lab tests just from the ED that time and printed them out. Every test was normal. I went back into the room and this time a large gentleman with a cowboy hat was standing next to her bed. “Here are copies of tests from 2007, several tests from 2008, some from January and some from June of this year. They are all, without fail, normal. Your potassium levels have always been normal. Your EKG was normal this time. No signs of low potassium on it. So I’m not going to do any more testing right now. Let’s just see how the Toradol works.” I walked out of the room and over to the desk to finish writing up her chart. Her husband followed me out of the room, came over to desk, pulled a business card out of his pocket, held it up between his fingers, and placed it on the desk, holding his index finger over it. Then he used his index finger to push it over on the desk next to me. He held his index finger on the card and stared me down while he talked. “I have to leave. My number is on here. Please contact me when you find something.” I was initially going to post a scan of his card, but decided not to. The card had a bunch of Chinese writing on the top. Underneath was his name “Master [Jean Claude VanDamme]”. After that, it said “expert in Judo, Karate, Taekwondo, Hapkido, Kung Fu” and some other martial art that I had never heard of before. Then it had an e-mail address and a cell phone number. No street address. No company. Just him and all his martial arts expertise. The card looked like it was sitting on a workbench while he was changing the oil in his car. There were a bunch of grease spots on it. On the back were a bunch of handwritten numbers. They didn’t add up to anything. Maybe they were geo-coordinates to his office or something. “Cool. You compete?” He looked at me with a blank stare. “I was in nationals a couple years ago … knocked my opponent unconscious in the semifinals. Won a silver medal in sparring in an international tourney a few years back.” He ...

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Be Careful What You Wish For

Ever hear the story about the man who caught a leprechaun and then wished his woo hoo was so long it would touch the ground? The leprechaun didn’t like him very much, so he shrunk the man’s woo hoo and made both the man’s legs fall off. Just like Mr. No-legs, a new tech in our ED should have been more careful about what he wished for. The tech was eager and wanted to see some action that night. Apparently he was aware of the Candyman Phenomenon, so he kept saying “I want to run a code tonight. I really want to run a code tonight.” He got to five requests in about the first half hour. Then he tempted fate and kept saying it. “I really want a code to come in.” We told him to stop it, but he persisted. Wouldn’t you know it. A gentleman got brought in by ambulance after having a syncopal event at home. He was semi-conscious and confused. His vital signs were stable in the field, but he looked out of it as the paramedics wheeled him into the room. The nurse followed them into the room, pulled the curtains, and hooked the patient up to the monitor. Heart rate in the 40s. Blood pressure 120s systolic. The tech was entering the patient’s information onto the computer when the nurse walked out of the room and told him “Hey. You got your wish. There’s a code.” I looked up from the admission orders I was writing. The tech got an excited look in his eye and says “Really?” The nurse tossed him a washcloth and said “Yeah, really. Code Brown. Get wiping.”

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The Cavalry

A young girl was brought in by ambulance after being involved in an argument with her boyfriend and attempting to cut her throat with a knife. Yet another of the many suicidal patients we have seen lately. When her father arrived, he told her to get her things together because they were leaving. “Ummmm … sir … you can’t do that. She’s going to require admission for psychiatric evaluation.” “The hell she is. Not in this place.” “She needs to be hospitalized.” “Listen. You waited on my wife last year. You diagnosed her with a throat infection and gave her antibiotics. Two days later the side of her face swolled up like this (cupping his hand against the side of his face as if holding a softball against his cheek). We went to the chiropractor and he said that you damn near killed her. He had to give her a stronger antibiotic to cure her [I know, chiropractors can’t prescribe medications – it didn’t make sense to me, either]. So you’ll have to excuse me if I just don’t trust your judgment.” “Sir, it is beyond me what this has to do with a determination as to whether your homicidal daughter requires hospitalization for psychiatric evaluation when she has Exacto knife lacerations mere millimeters from her internal carotid arteries.” “You just don’t get it, do you?” [Silence] I was going to answer him, but I was hitting the rewind and play buttons in my brain to see if I missed something. I wanted to “get it.” I just must have missed something. What did I miss? “We are never coming to this hospital again. You hear me? Never.” “Oh come now. I wish you’d reconsider.” “Honey, call the lawyer … now.” [Silence] Dammit. My logic circuits – they appear to be jammed. Now I’m going to get a patient complaint and get sued? What did I do? Ah, nevermind. “Sue, can you call the police and have them come down here?” “Fine … she’ll stay. But we’re still calling the lawyer. We have rights, you know.” Two minutes later a couple of officers walk into the room. The patient’s father sat in a chair and got a short lecture from the po po. “He shouldn’t give you any more problems, doc,” said one of the officers as they walked back out of the ED. “If he does, just give us a call.” Did I mention how much easier the police make things for us in our department? Those packages of Christmas cookies are worth every penny. Our police force rocks.

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