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Tag Archives: Patient Encounters

The Nectar of Life

A patient with a penchant for telling me what sexual acts to perform on myself and what kind of sexual acts my mother performs in a place that rhymes with “smell” was brought in for suicidal ideation associated with … of all things … alcohol intoxication. She got into it with the nurse. “Ma’am, you can’t keep taking your clothes off and walking around naked. There are other patients in the department. “[Perform a sexual act on yourself]!” “OK. But you’ll still need to keep your gown on to avoid public indecency.” “Oooh. Who are you? Mr. Big Shot? What’d you take a test and get an ‘A’?” Then a patient gets brought in by ambulance after he was witnessed staggering out of a bar, into an alley, and, without provocation, walking directly into a telephone pole. The pole pushed back and the patient fell flat to his back unconscious. Then another patient gets brought in for trying to ride a bike home from the bar, losing control, and doing a face plant in the asphalt. No family pictures for you for a while. Then another drunk patient gets an ambulance ride to the hospital after trying to pull a Ringling Bros/Barnum and Bailey stunt by riding a tricycle down a slide. He did a face plant in the grass. Did I mention how much easier my life becomes after the bars have closed and alcohol is tougher to obtain?

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A Broken Heart

A stoic man in his early 60s walked up to the registration window and even the registration clerk could tell that something wasn’t right. He looked sallow and was a little sweaty. The clerk asked him what was wrong and he calmly said “chest pain.” He was whisked back to a treatment room to begin the standard chest pain protocols. We could still smell the remnants of that last drag he took off his cigarette before walking in the hospital doors and flicking the cigarette butt onto the parking lot. A pack of Pall Malls abutted his heart in his left front shirt pocket. As we questioned him, we learned that he had been having the pain on and off for more than a week. Only that morning did the pain become constant. He sat at home for 9 hours going about his business and hoping that the pain would go away. It didn’t. He didn’t like going to doctors. In fact, he hadn’t seen a doctor in more than 20 years. Wouldn’t have come that day had his daughter not nagged him so much about it. He came to the hospital more to stop her from nagging than he did because of the pain. The pains actually felt like “gas” and he was burping a lot. His physical exam didn’t tell us much. I told him I needed to check a rectal exam for bleeding. His daughter stood up to excuse herself. “Ain’t no doctor done that in more than 60 years, and you ain’t going to be the first. There’s no blood there.” “But if it’s an ulcer or intestinal bleeding, I may have difficulty diagnosing it.” “There’s no blood there,” he repeated. Our hopes that the pain was just some indigestion were short-lived. The EKG showed that he was having the “big one.” Significant ST elevation in all the anterior leads. As I walked into the room to inform them about the diagnosis, the patient was leaning back on the bed with his eyes closed and his daughter was chomping on her thumb nail. “It looks like you’re having a heart attack,” I said calmly. His daughter immediately started crying. “I told you that you should have come in sooner.” “Don’t worry about me,” he replied. “Only the good die young.” “We’re the only ones left. We have to take care of each other.” I interrupted. “We don’t have the ability to do a cardiac catheterization here, so we’ll need to fly you to the closest cardiology center.” Tears streamed down the daughter’s face. The patient just laid his head back and closed his eyes. I spoke with the cardiologist on call at the referral center. Normally the arrival time for the helicopter is about 30 minutes. This time, the helicopter was out on another run, so it wouldn’t even get to our hospital for another 60 minutes. Sixty long minutes. The cardiologist suggested that we give thrombolytics. “You realize that the pain has been stuttering all week and that it has been constant for the past 9+ hours, right?” “Thrombolytics are OK. They will save some muscle even if they are given a little late.” Nothing else we were doing was helping the pain. The patient just sat there with his eyes closed. I couldn’t tell whether the beads of sweat on his forehead were because of his pain or because he was scared. We gave him morphine several times, but the pain didn’t improve. We gave him beta blockers. Still no improvement. Nitroglycerin … nothing. OK, we’ll give the thrombolytics. What can they hurt? I ...

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You're Kidding

It was busy in the emergency department (isn’t it always?) when the secretary picked up a phone call. On the other end, a male voice started screaming at her. “You better have a cart at the back door when my daughter gets there. She was eating lunch with us and all of a sudden she started hemorrhaging from down below!” “Sir, it is very busy now and we don’t stop seeing patients in order to wait for people to arrive. We will take care of her when she gets here.” Click. He hung up. A minute later the nursing supervisor calls and asks us what’s going on with the woman hemorrhaging to death. Apparently, the man then called her to tell her to go wait for his daughter at the back door. He was told that only ambulances can go to the back door and that she should go to the front door. Too late. Click. He hung up again. A few minutes later we could see a car screech up to the back ambulance bay in the surveillance camera. The driver got out and started beating on the glass door. A mime argument ensued. The driver stood at the glass, pointed at the door and mouthed the words “OPEN THE DOOR!” Staff started mouthing the words “go around” and gesturing around an imaginary corner, trying to get the man to drive the car around to the main entrance. The driver stomped his foot, motioning louder “OPEN THE DAMN DOOR!” Fine. The nurse walked to the back to open the door and tell the guy to move his vehicle. We could hear the man yell at her, then we saw the nurse look in the back of the car. She came rushing back in. “We need a stretcher out here NOW!” Several people pushed a stretcher out to the ambulance bay and rushed the patient back into the gyne room. Blood was dripping off the stretcher onto the floor as she whisked by. A blood clot the size of a football was left on the seat of the car. Pulse 140. Blood pressure 90 over palp. Not good. Went into the room and there was already blood all over the stretcher. Pulled out enough clots to fill up an emesis basin and the blood was freely flowing. I inserted a speculum to see inside the vagina. Blood just gushed out over the speculum and onto the pad underneath her. The pad was already saturated. Blood pressure 80 over palp. Two IV lines were flowing wide in each arm. Blood bank was on the way. The patient was sweating and looking pale. The patient’s family physician had arrived and was helping me out, but there wasn’t much she could do at that point. I asked for a roll of kling wrap. The nurse had a puzzled look on her face, but tossed me a roll anyway. I unrolled the kling wrap and began packing it into the patient’s vagina through the speculum. Got about 2/3 of the roll packed inside and the blood stopped flowing. Slowly pulled out the speculum and pushed a little more packing in just to be sure. The Kling remained white. It appeared that the bleeding had stopped. Ultrasound came over to get a look at the source of the bleeding. To our surprise, we could see a definite fetal heart beat. Mom’s vital signs stabilized, baby was OK. I left to see more patients. About 15 minutes later, an ultrasound report was faxed to the ED: “Live 13 week intrauterine pregnancy with small subchorionic hemorrhage.” Small. ...

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Quote of the Day #106

A patient came in because she had a yeast infection that wasn’t responding to over the counter medications. She had significant itching and burning down below, so I did a gyne exam to make sure that it wasn’t anything else but a candida infection going on. The exam showed a significant yeast infection with a lot of irritation. As I was removing the speculum, the patient says: “You’ll probably find it ironic that I work in a bakery.” Actually, I found it funny that she worked in a bakery. The timing of her comment … that was a little strange.

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True Love

When your boyfriend gets the smackdown after talking tough in a bar and is later found to have bleeding inside of his brain, it is wonderful that you are at his bedside providing him comfort. I have to draw the line at jamming your finger up his nose to dig for gold while he’s laying on a backboard, though. Tissues still work even if someone’s wearing a cervical collar. They were in that box marked “Kleenex” on the counter behind you. If you get up to greet me, I’m not shaking your hand. No, not even a fist bump.

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Kid-ding

It was busy in the ED and all the nurses were tied up with patients. An ambulance call came in and I was near the radio, so I took the call. “Yeah, Metro General, be advised we’re bringing in a 97 year old female from the nursing home with a chief complaint of weakness for the past 6-7 days.” The ED secretary cringed. “Why would a nursing home call an ambulance for a patient with weakness of all things – and for a whole week, yet?” I have to admit that “weakness” isn’t my favorite chief complaint, either, but I have also found some wild pathology in little old ladies whose only symptom is feeling weak. So I don’t like the complaint, but I also have a healthy respect for the complaint. “Be advised that this patient’s blood pressure is 130/70, her pulse is 80 and her respirations are 20. We have about a six minute ETA. Any questions?” The ED secretary had turned back around, but was still shaking her head. So I acted like I was talking on the radio, but didn’t push the “talk” button. I asked loudly “Metro 27, did you have this patient do any push ups?” The secretary’s head snapped around and she stared at me with wide eyes. I winked at her and nodded. Again, without pressing the talk button, I said loudly “If you didn’t have her do pushups in the nursing home and she’s on the stretcher, can you just have her do some sit-ups to assess her weakness for me? Let me know how many she can do.” By this time, the secretary’s jaw had dropped. “You know that’s a recorded line, don’t you? You’re going to get in trouble!” “Yeah, but it only records when you press the ‘talk’ button.” “You jerk.” Weakness just became my favorite complaint for the day.

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