Home / Tag Archives: Patient Encounters (page 5)

Tag Archives: Patient Encounters

Oddest Patient Complaints of the Night

Daughter brings in elderly parent saying “her voice doesn’t sound as strong when she talks.” Patient then proceeds to scream at daughter telling her that there’s nothing wrong with her voice. Daughter says “Well, I guess she’s better now, but how do you know she didn’t have a TIA?” Simple answer was that I don’t know she doesn’t have filariasis, but I’m not testing her for that, either. Bottom line was the patient’s caregiver was gone for the weekend and the daughter didn’t know how to take care of mom. Then there’s the patient who came in by ambulance with the following complaint: “I’m melting.” No one threw water on her and she wasn’t wearing a pointy black hat, either, Dorothy. Translation: All this red blood was going in the toilet every time I have a bowel movement, my skin is getting pale, and my hemoglobin is 6.2. Never underestimate the power of a good history and physical exam. ———————– 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.

Read More »

The Not-So-Free Lunch

A report comes from a nurse on the general medical floor about a patient who is being wheeled down to the emergency department in a wheelchair: The patient was visiting her mother in the hospital when her mother was served lunch. The visitor asked if she could have a tray as well and asked to have the tray charged to the mother’s account. The nurse told the visitor that there were only enough trays for the patients but that the cafeteria was open until 1:30 PM for lunch. The visitor said that she didn’t have money for the cafeteria and asked the nurse to order her a tray as previously requested. The nurse said that she couldn’t do that. Ten minutes later, there was a yell and the mother’s call light started ringing. When the nurses went into the room, the visitor was sprawled out over the floor, moaning and tossing her head back and forth. The mother said “She must have had a diabetic reaction. She’s diabetic, you know.” No, we didn’t know. But that is a right fine piece of floor throwing, though. So the patient is wheeled down to the emergency department in a wheelchair for evaluation of a “diabetic reaction” … when her glucose level was 147. She reportedly got dizzy and passed out, so she was monitored and labs were done. She hit her head when she fell and was complaining of a severe headache, so she received a CT scan of her head. And she got a lunch tray. After a full medical evaluation, telemetry monitoring, several thousand dollars in tests, a liter of IV fluid, and a lunch tray, the patient felt better and was deemed fit for discharge. Rather than going home, the patient expressed a desire to return to her mother’s room. And so she left the emergency department in a wheelchair, content with the knowledge that her diabetic reaction did not result in any long-lasting effects … until at least dinnertime. ———————– 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.

Read More »

WTF Moment #1012

A patient and his wife wait patiently in the room for evaluation of the patient’s bilateral leg pain … which has been present for two weeks. Mostly in the back of his calves. Could it be a blood clot? I go in the room and took a look at the patient’s legs. There are two circular two-inch bruises — one in the middle of each calf. I pressed on them to make sure they were the source of his pain. His yell and his wife’s reverse hiss confirmed my suspicions. “It looks like your pain is from these two bruises.” “I know that. I want to know what caused the bruises.” “I’m not sure how I’m supposed to determine what happened to your legs two weeks ago.” “Are you serious?” I looked at him quizzically. Was he kidding? “Yes I’m serious. How would I be able to tell what happened to you two weeks ago?” “You can’t do some kind of blood test or something? He wasn’t kidding. It was the end of the shift, so I wasn’t quick enough on my feet to come up with a good comeback. “You mean like whether you hit your legs on a chair versus whether you were bitten by a dog? No. There’s no blood test to tell what caused a bruise.” Then the wife chimes in. “I suppose you’re not going to be able to tell us what the mark on his back is, either.” “Probably another bruise,” I thought to myself. I looked at his back and there was nothing there. “Where?” “It was on the left, there. It looked like those things on his legs, but it went away.” She wants me to tell her what caused a nonexistent mark on her husband’s back. “If it looked like what was on his legs, then it was probably a bruise, too.” “NAAAAH. It wasn’t a bruise.” “Sorry then. It’s kind of tough to diagnose a mark that isn’t there any more.” “Come on, Honey. Let’s go to Crosstown Hospital. They’ll be able to figure it out.” Doubtful. ———————– 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.    

Read More »

The Sneaky “Drunk”

A man is brought in by police for blood draw after being arrested for suspicion of DUI. It was very busy, so the patient and officer waited in the waiting room for an hour or so before being brought back to a room. Typically a serum alcohol level decreases by 20-25 mg/dl (.20 to .25) per hour. Already if the patient’s alcohol level was borderline high, it is now below the legal limit. Upon arrival, the patient refused to submit to the DUI kit. He did allow the nurse to draw blood, though. So the police officer loudly commented “What a dope. Now all we have to do is subpoena the hospital records to get his alcohol level.” The nurse drew the patient’s blood, put the tubes in a biohazard bag, and set the tubes on the tray table next to the bed. The lab tech came into the room to get the blood tubes. When she couldn’t find them, the patient told her that the nurse came back in and took the tubes with her. “Oh, OK.” So she left to go back to the lab to run the blood. The nurse came back into the room, filled out the paperwork for the officer, and discharged the patient to police custody. About 45 minutes later, we get a call from the police officer. While the patient was being searched at the police station, the police officer made an interesting find in the patient’s coat pocket: A bag with multiple tubes of blood. What? Checked the computer. No results. No blood received. The patient grabbed his blood when the officer wasn’t looking. I’m not a criminal lawyer, but I’m betting that DUI case will be thrown out. ———————– 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.

Read More »

Spidey Senses

This was one of the patients I submitted for Nurse K’s Dr. No BS contest. By my calculations, I was the unofficial winner in said contest, but I don’t want to brag. The case involves what one of my old mentors used to call his “Spidey Senses“. Something just doesn’t seem quite right. You can’t figure it out, but something tells you that you need to dig deeper. Most of the time, the Spidey Senses are just a false alarm and you end up performing what some people deem an “unnecessary” test. Hey, even Spiderman wasn’t always right. But in a select few cases, listening to your Spidey Senses (and sometimes ordering “unnecessary” tests), can help to make an important diagnosis. Psych wonks may use the term “cognitive dissonance” to describe the Spidey Senses. I’m leaving the post title as “Spidey Senses” because prolly no one would read a post about cognitive dissonance and because I couldn’t find a cognitive dissonance picture. A 50-year-old man came in with R shoulder pain for about a week. He was already going to a pain clinic for low back pain, and that day he went to the pain clinic for a re-check of his shoulder pain. The doctor at the clinic prescribed him Neurontin for his shoulder pain and the patient came to the emergency department because “that stuff doesn’t work.” He said that his shoulder pain was bothering him so much that now his right side was killing him, too. In fact, he wouldn’t lay back on the bed because of the pain. His wife sat next to him helping to support him while he was sitting as he slumped over to the right side and didn’t answer many questions because he was in too much pain. The patient’s wife did most of the talking. I have to admit that my initial impression of this gent was tainted by the whole pain clinic story. Maybe he was coughing from his pack-and-a-half day smoking habit and strained a muscle in his chest wall. Pain from a gallbladder attack can cause referred pain to the right shoulder when the inflamed gallbladder irritates the diaphragm. Maybe he’s having biliary colic. Maybe he had a pneumothorax. Maybe he was doing something he shouldn’t have been doing and injured his shoulder, but he didn’t want to tell me. But come on, now. Pain so bad you can’t even talk to the person trying to help you? Call me skeptical.

Read More »

Double Bad Idea

Throwing gasoline on a lit barbecue is never a good idea. It is an especially bad idea when wearing baggy clothing upon which the gasoline may splash because when the gasoline suddenly explodes, your clothes may catch on fire as well, causing significant burns to your chest, arms, hands, and face. Strange, though, usually when gasoline is involved in a fire, there is at least a little bit of a gasoline smell on the patients when they are in an enclosed room in the ED. Assume that if your friends bring you in by car after having been involved in such a fire, either police or the fire department will go to the scene to investigate and make sure that everything is safe. If you have a meth lab in the kitchen of the house you are renting and it explodes causing significant burns to your chest, arms, hands, and face and you plan to tell the emergency department personnel that your barbecue exploded, at least put away all of the drug paraphernalia before you go to the hospital. Failing to do so may just make you skin-grafted, arrested, and homeless. ———————– 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.

Read More »