Things I Learn From My Patients

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
I just got back from Latin America. Here are some of the chief complaints I saw this week:

I have gotten some choice chief complaints in Latin America, though often, as mentioned, it is a result of poor education and/or cultural belief. In Nicaragua I got a lot of temperature contrast related complaints, such as "When I have a cool beverage when it is hot out I get X. Y. and Z." or "I knew I shouldnt have hot coffee on a cool night, but I did, and thats how I got my cold."

I also encountered lots of people who had "Asma [Asthma]." Further history gave me any of the following symptoms: difficulty breathing, cough, wheeze, palpatations, congestion, sore throat, headaches or chest pain. With durations usually in the days to weeks. It seemed about 1/3 of cases were consistent with Asthma, 1/3 with a viral URI, and 1/3 with nothing. So don't always trust the PMHx of Asthma.

The cc of anemia was much more varied. Reasons for suspected anemia included pallor, lethary, constipation, yellow eyes, photophobia, headaches, and strange eating habits in children. Some hits; some misses. I always asked about the strange eating habits; almost always it involved a kid who didnt like rice and beans, and wanted to eat ice cream, soda or candy instead. Shocker. Twice I got good pica: once with a child who snuck outside to eat dirt [classic] and once with an adorable little girl who snuck into the street to eat the cigarette butts that collected in the gutters [sad]. Both of those got flinstons vitamins, the others got tooth brushes.

Members don't see this ad.
 
  • Like
Reactions: 1 user
Remember a couple other good ones:

In Haiti (via translator):
Female Patient who looks a bit pregnant: "i'm pregnant :) "
Me: "congratulations! how far along are you?"
FPWLABP: "13 months!"
Me, to translator: "I think we misunderstood, try that again..."
FPWLABP: "No, no, 13 months! I am sure!"
Me: "Ok then. Moving on."

Turns out it was a classic case of arrested pregnancy syndrome-- aka perdicion, pedisyon, or perdition. Basically a cultural constract in which an outside force (like the evil eye) can place the fetus in suspended animation inside the womb for a period of time, afterwhich the infant continues normal development. Thus a single pregnancy can last from 9 to 24 to ++++ months! Fascinating, eh?

This page describes it as "a common culture-bound illness in which a woman is thought to be pregnant, but the flow of blood to the uterus is diverted to menstrual blood and the pregnancy is thus arrested. The belief is that this state (characterized by menstruation) may last for years until a cure is obtained and the pregnancy then resumes."

One translator explained it as a nice social safety valve to explain away some adultery, such as if a woman becomes pregnant while her husband has been away for 10 months. Regardless, it made taking a gyn history nigh-impossible.
 
Both of those got flinstons vitamins, the others got tooth brushes.

On our first day of clinic, we had hundreds of patients show up. We eventually ran out of time with 50+ people still left in line. The easiest solution was to give everyone Tylenol and vitamins. That's what they were going to get anyway after seeing our doctors.
 
Members don't see this ad :)
CC: "Someone put lithium in my vagina".. 8 months ago. While she was sleeping.. ALONE in her house. :smuggrin:
 
If you want to put some chlorine tablets in your pool but they have been sitting in your garage for so long that they have all sort of melted together do not put the big chunk of solid chlorine in your microwave to "soften it up." You will wind up causing a pretty intense Hazmat incident, developing a rapidly worsening ARDS type picture and chewing plastic for a long time.

It was really incredible. This guy wound up gassing himself. His chest Xray lookes like Hell. It's like he walked off a WWI French battlefield.
HOLY $***! He actually lived?
I probably should have added that if you are a schizophrenic you really shouldn't be handling chemicals and that if you run a group home for the mentally ill you shouldn't be letting the residents take care of the pool.
At first I said 'what a *****' but then I read the above, I guess it's not really his fault then eh? I guess the supervisor was the mo-ron in this case

We used to practice the haz-mat type stuff when I was lifeguard instructing in undergrad. Mostly to get our guards to check the lights and alarms before entering the enclosure-our protocol basically stated "Once you see the green gas, it's too late-you're dead"

Why not just get a hammer and chip a piece off? *shakes head in wonder*
 
He should have gone for Draino. The district next to ours just had a suicide by drinking the stuff last night. It still amazes me the ways people decide to use in attempts to kill themselves.


Yeah, just buy a gun or find a tall building/bridge.
 
A REALLY GOOD way to get high is to inconspicuously steal the drugs from the cardiac crash cart in the ED, then later try to inject them into your veins...hmm wonder why he ended up back there again later with no pulse?


Wow. What a jacka**.
 
  • Like
Reactions: 1 user
He should have gone for Draino. The district next to ours just had a suicide by drinking the stuff last night. It still amazes me the ways people decide to use in attempts to kill themselves.



Maybe he was actually a smart fellar who figure out he had an intestinal blockage. You don't know. :rolleyes:

:D


I learned to question every single thing the doctor wishes to do to you (labs, x-rays, etc) as if you're very concerned about your health, but when asked about your medical history, draw a blank. It makes the doctor happy.

Pt: "I had a liver needle done."
Doc: "Biopsy?"
Pt: "Yeah, maybe that was it."
Doc: "Why?"
Pt: "I dunno. I had a blood tranfusion six months ago..."
Doc: "Why?"
Pt: :shrug: "I went to this doctor my other doctor sent me to. It turns out it was an oncologist."
Doc: "Do you have cancer or something that...
Pt: "I dunno. Oh, I had a surgery," [pt rubs stomach]
Doc: "What was done?"
Pt: "Oh, I dunno. I can't pee."
Doc: "Today or because of your surgery? [pt nods] You're having trouble urinating today? Does it burn? Do you feel like you need to urinate?"
Pt: "Uh..."
Doc: "When do you urinate last?"
Pt: "Um...oh...about two hours ago."

The doc wanted to scream by the time he left the exam room. :laugh:


Also, drive 8 hours to your nearest not so close ER because you say the metal in your leg broke. Doctors don't suspect a thing when you tell them about your surgeon "wiping his hands of you" and all of the ER's that have turned you away because you're an "African American...[dramatic pause]...Wo-man".
 
I liked the woman the other day who, upon receiving some Tylenol from the nurse, asked "this isn't an overdose, is it? Because I took some Tyleol about three hours ago." Yes, ma'am, we are total *****s. True, acetominophen is easier to OD than many OTC medications, but sheesh.

This was the same patient who declined the Maalox/lido shooter for her heartburn because, quote, "it's nasty." It's medicine, lady, not candy. If you'd rather just keep the heartburn, that's absolutely cool. Yet somehow I can't help think the story will be more like "...and they didn't so anything for me."
 
I once did a history on a patient that went something like this:

ME: Have you had any surgeriess?
PT: No
ME: Have you ever been hospitalized?
PT: No
ME: Do you have any past medical problems that caused you to see a doctor?
PT: Yes
ME: What did you go in for?
PT: Chest pain
ME: What did they do for it?
PT: Triple bypass

His computerized record showed that he had been admitted for strokes on multiple occasions.

ME: Have you ever had a stroke?
PT: Oh yeah, I've had a few of those.
 
  • Like
Reactions: 1 user
Not a doctor, this is my own personal stupidity.

If you've been feeling this way for a while, it's really not a good idea to ignore the dizziness, the headaches, and the sore throat that just won't clear up. Never mind the fact that you haven't got a car... for god's sake, ask a family member to drive you to your doctor!

Ignoring it for two months (and during this time, not getting much sleep, drinking lots of coke, and working in the middle of the hottest summer on record in a bakery with a broken air conditioner) will result in you feeling much, much worse. Calling in a locum doctor is the only thing you can do because your entire family is interstate for the weekend, and you need a medical certificate to verify your absence from work.

The doctor will arrive at your house, take one look down your throat, look shocked and say "you need to go to the hospital right away!"

Result: very very bad glandular fever... and quinsy! My tonsils were so swollen that I could barely breathe, let alone talk. (Oh, and to make things even better... I'd had my tongue pierced two days prior to being hospitalised!) The doctors were all amazed that I hadn't collapsed!
 
Not a doctor, this is my own personal stupidity.

Welcome! Thanks for sharing! I, as a practicing EM physician, right now am looking at my index finger on my right hand (thank heavens I'm left-handed) with the laceration from the serrated knife that I should have had closed some way, but is now closing by secondary intention. It will leave a lovely scar!
 
Welcome! Thanks for sharing! I, as a practicing EM physician, right now am looking at my index finger on my right hand (thank heavens I'm left-handed) with the laceration from the serrated knife that I should have had closed some way, but is now closing by secondary intention. It will leave a lovely scar!

Well, you know...they say that medical personnel make the worst patients...
 
Members don't see this ad :)
Don't try to quit your methadone and alcohol on the same day.

In his defense his plan was to quit the methadone and drink his way through it. It worked for a while until the vomiting from the opiate withdrawals kicked in and he kept vomiking up the booze. With no booze he started to shake and by the time I saw him he was hallucinating and had a BP of 200/110 and HR of 145. Benzos to the rescue!
 
  • Like
Reactions: 1 user
Why are you here?


CC... I just had a large bowel movement and it looked exactly like Spiro Agnew.
 
I wouldn't take that to the ED. I'd post it on the Internet. :smuggrin:
 
I had a guy who knocks back about a liter of vodka a day come in for detox. He'd quit drinking the day before.

Except for the beer he drank in the ER parking lot immediately before coming in.

Me: If you want to stop drinking, why'd you do that?

Him: I've been through both DTs and your waiting room before.

Me: Oh. Pause.....

Me: OK, then. You clearly have a pretty good understanding of how this works. I'll just go call psych now. Anything else I can get you?

Sometimes our patients really can teach us something. Dude had this figured out.

Take care,
Jeff
 
I learned that no longer how long you have been doing this, some things will still make you say, "Holy ****"

If you need a vasectomy you can ask your buddy from the Navy to do it on your kitchen table. I'm still not clear exactly what his buddy's medical training was mostly because I'm not sure the patient knew. When the wound breaks down a few days later and your "surgeon" is nowhere to be found you can sew it up yourself. Come see me a few days later with fevers, chills, and a giant swollen scrotum. The weirdest part is that the guy had great insurance and could have had it done for free by any urologist in town.


Later I learned that you are never too old for chemo. I saw a 98 year old demented lady with metastatic breast cancer with no PO intake for a week secondary to nausea from her chemo. I swear if they found a tumor on King Tut's mummy you could find an oncologist to give him chemo. Later when his kidney's were found to be non-functional you could find someone to dialyze him too.
 
  • Like
Reactions: 1 user
Well hey, points for knowing who Spiro Agnew was. Must've paid attention in history class :)


Why are you here?


CC... I just had a large bowel movement and it looked exactly like Spiro Agnew.
 
Whoa, cool... that goes under "Things I Learned from the EM Forum."

As to patients, today I learned that if your liver is failing badly enough, you can actually be the same color as folks on The Simpsons.
 
I'm not sure how I found this site, but kudos, folks. I myself am a bartender, and could tell you plenty of stories that most likely continued into many an ED. My mother was an RN all her life though, and she told me this once after a long shift:
"If you're going to accidentally fall onto your cell phone and it somehow makes it's way into your rectum, please have the foresight to tell your friends beforehand to not keep calling you every five minutes."
(this was a few years ago when cell phones we a bit bigger.. I didn't ask the particulars).
 
I'm not sure how I found this site, but kudos, folks. I myself am a bartender, and could tell you plenty of stories that most likely continued into many an ED. My mother was an RN all her life though, and she told me this once after a long shift:
"If you're going to accidentally fall onto your cell phone and it somehow makes it's way into your rectum, please have the foresight to tell your friends beforehand to not keep calling you every five minutes."
(this was a few years ago when cell phones we a bit bigger.. I didn't ask the particulars).

Zach Morris phone?
zackmorrisphone-10128.jpg
 
Something I learned from a patient was that if the first push pin disappears into your testicle as you attempt to pierce your scrotum, you'd better try it 4 more times before giving up. I have to admire this guy's perseverance. Unfortunately for him, he's half the man he used to be since I saw the testicle in question in the anat path lab. Yep, that's right, he had 4 push pins in there. :eek:
 
Something I learned from a patient was that if the first push pin disappears into your testicle as you attempt to pierce your scrotum, you'd better try it 4 more times before giving up. I have to admire this guy's perseverance. Unfortunately for him, he's half the man he used to be since I saw the testicle in question in the anat path lab. Yep, that's right, he had 4 push pins in there. :eek:
You gotta wonder what he rated his pain. If it was anything less than 8/10 we may have finally found the mythical patient with a high pain tolerance who we hear so much about.
 
I have a calendar that has a joke or funny saying or something related to medicine for each day.

So far there have been three days of jokes or sayings from this thread. Today's was: "Just because the hired help outside your room isnt a "real cop" doesnt make it hurt any less when youre trying to escape and they tackle you, resulting in you taking a header through a sliding glass door." It was posted back on March 26, 2005 by cubsrule4e.
 
If you want to put some chlorine tablets in your pool but they have been sitting in your garage for so long that they have all sort of melted together do not put the big chunk of solid chlorine in your microwave to “soften it up.” You will wind up causing a pretty intense Hazmat incident, developing a rapidly worsening ARDS type picture and chewing plastic for a long time.

It was really incredible. This guy wound up gassing himself. His chest Xray lookes like Hell. It's like he walked off a WWI French battlefield.
If you haven't called dibs on writing that up, I request to be allowed to do so. :laugh:
 
I have a calendar that has a joke or funny saying or something related to medicine for each day.

So far there have been three days of jokes or sayings from this thread. Today's was: "Just because the hired help outside your room isnt a "real cop" doesnt make it hurt any less when youre trying to escape and they tackle you, resulting in you taking a header through a sliding glass door." It was posted back on March 26, 2005 by cubsrule4e.

Last year, I had a doctor joke calendar. There were multiple instances of copying from this thread. The calendar at least referenced SDN. I don't know if yours does, or if either bothered to get permission to copy.
 
In reference to the calendars, if the frustrated chicken bone guy isn't in there, then your calendar is lacking.
IMO, the guy who put the bolt, pencil and chicken bone into his arm is still the best to date. :laugh:
 
This happened to the co-worker of a friend of mine. Reposted with permission.

If you are a young man looking to get laid, you shouldn't be drunk out of your mind when it happens. In your drunken state, you and the girl will mistake a bottle of self-tanning lotion for lube and apply it liberally.

When you wake up and see the results, you will freak out and think "holy crap, my DICK'S GONE RUSTY", leap out of bed and into the shower and scrub your manhood for TWO HOURS in an attempt to remove what "that diseased *****" must have given you. If you fail to remove it all (and you will) by all means, use rubbing alcohol on a towel to try and remove what remains.

When this method fails (and your manhood is burning like whoa) feel free to wake up the girl and start screaming at her. She will also start screaming as she is covered in the same orange stuff. When you both finally track the source of the problem down, don't just laugh it off and go to work; go to the ED! They'll be happy to give you anti-inflammatory cream to keep the swelling, the scratching and the welts down.

Your boss won't be happy about giving you the day off work (she has to - you have a MEDICAL CERTIFICATE) but rest assured she won't be able to look at you ever again without laughing her head off. She will also post it to Livejournal so all her friends can laugh at you and your "rusty dick". :laugh:
 
This happened to the co-worker of a friend of mine. Reposted with permission.

If you are a young man looking to get laid, you shouldn't be drunk out of your mind when it happens. In your drunken state, you and the girl will mistake a bottle of self-tanning lotion for lube and apply it liberally.

When you wake up and see the results, you will freak out and think "holy crap, my DICK'S GONE RUSTY", leap out of bed and into the shower and scrub your manhood for TWO HOURS in an attempt to remove what "that diseased *****" must have given you. If you fail to remove it all (and you will) by all means, use rubbing alcohol on a towel to try and remove what remains.

When this method fails (and your manhood is burning like whoa) feel free to wake up the girl and start screaming at her. She will also start screaming as she is covered in the same orange stuff. When you both finally track the source of the problem down, don't just laugh it off and go to work; go to the ED! They'll be happy to give you anti-inflammatory cream to keep the swelling, the scratching and the welts down.

Your boss won't be happy about giving you the day off work (she has to - you have a MEDICAL CERTIFICATE) but rest assured she won't be able to look at you ever again without laughing her head off. She will also post it to Livejournal so all her friends can laugh at you and your "rusty dick". :laugh:

One of the funniest things I've heard in a long time.
 
Okay that was some funny $#!%.

LM
 
This happened to the co-worker of a friend of mine. Reposted with permission.

If you are a young man looking to get laid, you shouldn't be drunk out of your mind when it happens. In your drunken state, you and the girl will mistake a bottle of self-tanning lotion for lube and apply it liberally.

When you wake up and see the results, you will freak out and think "holy crap, my DICK'S GONE RUSTY", leap out of bed and into the shower and scrub your manhood for TWO HOURS in an attempt to remove what "that diseased *****" must have given you. If you fail to remove it all (and you will) by all means, use rubbing alcohol on a towel to try and remove what remains.

When this method fails (and your manhood is burning like whoa) feel free to wake up the girl and start screaming at her. She will also start screaming as she is covered in the same orange stuff. When you both finally track the source of the problem down, don't just laugh it off and go to work; go to the ED! They'll be happy to give you anti-inflammatory cream to keep the swelling, the scratching and the welts down.

Your boss won't be happy about giving you the day off work (she has to - you have a MEDICAL CERTIFICATE) but rest assured she won't be able to look at you ever again without laughing her head off. She will also post it to Livejournal so all her friends can laugh at you and your "rusty dick". :laugh:

Brilliant!!!:laugh: :laugh:
 
In reference to the calendars, if the frustrated chicken bone guy isn't in there, then your calendar is lacking.
IMO, the guy who put the bolt, pencil and chicken bone into his arm is still the best to date. :laugh:

Do you know where I can find this story? I can't seem to find it with any searches. Thanks!
 
Your wife will have no sympathy for you when you complained that you missed your bike race after you crash your motorcycle because you were drunk and stoned (+hep c, 'natch), and broke your previously rodded femoral neck (clean break in a titanium rod!). The orthos will still scratching their heads on how to fix this last I heard.
 
if you can't score any meth follow these instructions like my pt today:
1. steal your friends adderall
2.grind up and snort multiple tablets
3. have a hypertensive crisis
4. stroke out.....
 
Speaking of meth, here's a great plan I learned of last night.

Do your usual meth.
Get in your car with your kids.
Crash your car.
Kill your oldest kid.
Badly injury the other kid.
Buy a cric for yourself.


Take care,
Jeff
 
I learned from a patient today that it's possible to fit 13 golfballs into one's rectum and lower colon. I also learned that they are sort of radio-opaque (they have a hazy look to them)- one of those things I always wondered but was never bored enough to actually find out for sure. One of the rad techs is getting me a copy of the film.
 
I learned from a patient today that it's possible to fit 13 golfballs into one's rectum and lower colon. I also learned that they are sort of radio-opaque (they have a hazy look to them)- one of those things I always wondered but was never bored enough to actually find out for sure. One of the rad techs is getting me a copy of the film.

Now that's the sort of thing I wonder... will they teach me that in med school? Glad I have SDN so I don't have to worry.
 
Now that's the sort of thing I wonder... will they teach me that in med school? Glad I have SDN so I don't have to worry.
Ah, yes....the crap you would never find in a book.....actually a bunch of us should write a book called "The Things They Had to Leave Out of Rosen's" :smuggrin:
 
When you are brought in for ETOH and the nurse will not give you a sandwich becuase you haven't stopped vomiting since you got here, don't curse her out and tell her " Bitch I'm gonna f**kin kill you like I killed that mothaf**ka in 'such and such park' last night!"

Why should you not do this? Well because a police officer that is there escorting a prisoner just might hear you and realize that the murder you are talking about happened in his district and that you fit the description of the suspect, so they get your name, run it, find out you have a warrant for your arrest, when you are discharged take you to the police station to question you about the murder, and after a very short investigation (DNA evidence and ballistics tests I am guessing) you will be charged with first degree murder.

The reason I know all this is because it happened a little while back and I just happen to see that same cop here the other night and I asked him what happened to the guy. Apparantly he has a very long and distinguished criminal record, so he might be going in for life this time.
 
When you are brought in for ETOH and the nurse will not give you a sandwich becuase you haven't stopped vomiting since you got here, don't curse her out and tell her " Bitch I'm gonna f**kin kill you like I killed that mothaf**ka in 'such and such park' last night!"

Why should you not do this? Well because a police officer that is there escorting a prisoner just might hear you and realize that the murder you are talking about happened in his district and that you fit the description of the suspect, so they get your name, run it, find out you have a warrant for your arrest, when you are discharged take you to the police station to question you about the murder, and after a very short investigation (DNA evidence and ballistics tests I am guessing) you will be charged with first degree murder.

Wow, lucky break!
 
The emergency department is a fantastic place to go at 7pm for writer's cramp in your hand. It is an even better idea to yell at the ED staff when they tell you that it might be hours before you're looked after. Your chart might just keep getting bumped back further in the Fast Track system.
 
CC: "I took too much vicodin"

Pt states she was prescribed vicodin for a toothache, took one tablet when she woke up and is NOT SURE if she took a second tablet an hour later when she still had pain. In total she was only sure that she took ONE. She called poison control and they told her liver failure was a side effect so she rushed to the ER to have her liver checked. needless to say she wasted a bed for about an hour while we waited for her useless LFTs, that she insisted on having.
 
Not sure if it made the national news but we recently had a suburban cop call 911 and told that dispatcher that he and his girlfriend had overdosed on marijuana. Apparently he had pinched a bit from the evidence room and used them to cook up a "special" pan of brownies. I'm not sure if EMS made the run or not but it's still a great story.

The real news was that apparently he was allowed to simply resign without facing any real discipline or charges.
 
Top