Things I Learn From My Patients

If you were just discharged from the hospital after having a TIA (with L sided numbness/weakness), and later on that evening fall to the floor because you can't move the entire L side of your body, by all means drag yourself into bed and "try to sleep it off." Be sure to call your sister and make sure that this is an appropriate course of action. Then, when you aren't magically cured the next morning, have your sister drive you to the ED a full 12 hrs after the fact. Who needs tPA, when "sleeping it off" is just as effective? After all, both you and your sister are nurses.

The other day I discovered one of the quickest ways to receive a death stare from the patient and to feel like a huge jackass is to:

Make a seemingly innocuous comment about, "starting off on the right foot," to the guy sitting there with amputations just above the knee on both legs.

I've learned that setting an LP tray and approaching the patient with a spinal needle more often than not will miraculously cure someone's new onset paraplegia.

An offered ride by the Police Department can also miraculously cure full-body parsthesia if the only other alternative is "or walk out the door now".

Though your way is more fun. :]

1. A size 10 ring may fit on a penis, a secondary erection will cause problems though.

2. Definition of ex-boyfriend: you let go of the 15" dildo, losing it into your girlfriend's large intestine...and then finish up with your fun. THEN you search the couch with her for about 10 or 15 minutes before finally admitting you might know where it is. You then drop her off at the door to the ER, leaving only your kind donation to the fun of the pelvic/rectal exam to represent your noted absence from her stay with us.

3. When giving your wife of 30 years oral sex for the 1st time in about 7 years, feeling tightness in your throat afterwords does not, in fact, mean you are allergic to her. Nor does it necessitate a trip to the ER. Nor does it excuse you medically from future marital duties.

Things I've learned from my patients recently:

-Delerium tremens and opioid withdrawal can be resolved with a quick trip outside for a cigarette.

-If you were found to be PPD+ in the days before antibiotic treatment for TB, making a large incision in your forearm and pouring holy water in it does the trick.

I have just run smack into what's broken about healthcare here.


Pt presents to ER with cc of wanting his jaw wired shut. Pt seen by private oral surgeon and told he had fx but pt (or rather, mom; pt is 21 and ignoring all this while fiddling with phone) does not want to pay associated fee and in the hospital, all treatment is free, right? When told that no fx apparent on Mn series and therefore should be D/C and F/U at oral surgeon's offfice, pt's mom goes ballistic - she "knows an attorney" and "will sue". Is convinced greedy oral surgeon just wants money and she shouldn't have to pay because in the hospital it's free. Doesn't mind being admitted and waiting because son not working or doing anything anyway buts insists must be treated in hospital. D/Ced fuming and muttering about lawyers.

And I'm in no mood to humor her because, even though I'm just a lowly resident, I do not appreciate being treated as an errand boy and called by my first name. I payed for that degree with sleepless nights and student loans, which is why I can't afford those fancy phones that she and son are flashing around.

This was NOT an appropriate use of the ER
It is not a basic right to receive medical care free of charge
I have found what is broken in the healthcare system, and it's the patients.
/rant

Just because your PCO2 is 97 does not give you the liberty to verbally assault and berate myself or my nurses because you want to lie flat and sleep.

The fact that you apparently don't care to live, yet still come to the ER so frequently is a mystery. We all know you're a jerk. Especially considering you smoke while on oxygen, refuse medications, and left AMA just last week for the same COPD exacerbation. That you refuse to cooperate in your own (lifesaving) medical care, with your RA sat of 80%, is a brilliant strategy. In fact, that Bipap you just tore off was your last chance. Cursing and screaming at the nurse was an bonus, and even though it made your bluish face turn red, it really didn't help your situation much. I'd love to just throw you out, but you do technically have a lifethreatening emergency.

Therefore, it gives me the right to declare you an idiot, "incapable of understanding the seriousness of your medical situation due to hypoxia and hypercapnia," and go ninja on your airway.

(Fearing he'd get violent, we all massed outside the room while a different nurse pushed the etomidate. Then rushed, tubed, tied down, propofoled, and suggested strongly to the admitting doc that they keep him intubated as long as they planned to keep him in the hospital.)

That would be my tax dollars saving you, buddy. Groan.

I think recognized a new syndrome in one of my patients today and I'm going to try to write it up.

Much like white coat hypertension (where patients experience anxiety in the doctors office and their blood pressure goes up), I think my patient today had white coat pain syndrome. I enter her room to interview her, she's speaking on the phone with her laptop on her lap in no acute distress. She sees me and suddenly her 10/10 pain refractory to everything but dilaudid returns and is writhing in pain through the interview and exam.

Think I have a shot at a publication?

I have one from my early days in the Medical field.
I was a young Medic working ICU not long after school. We frequently were pulled to whatever unit was short, I guess we ICU types were thought to be able to work anywhere. One night I was in the ER, asked to chaperone an ER Doc doing a pelvic on a female GI with "pelvic pain". There weren't any Female nurses or Medics available. The procedure was that we men would stand behind a small curtain, so we could see the Dr., but not much of the patient, to observe all the laws of propriety.
Anyway, the female GI is up in the stirrups, the Doc explaining the whos and whys and whatnots of the procedure, as was normal. After warming the speculum in warm water( nice guy!), he proceded to insert it. Upon reaching operational depth, his face lit up: Literally! Both of us excused ourselves to "find your medical records", which were on the mayo stand in the room, and raced to a broom closet, where we laughed ourselves until the MPs opened the door to find out what was going on!
Not very professional, but still makes me smile 30+ years later!

Really sad...
When your dog has mauled your toddler so badly she only has half a face, don't accompany the poor screaming child to the hospital because you have 'errands'.

If you bring a very floppy baby with a giant cranial hematoma and subsequently discovered skull fx to the ER and your explanation is he fell over, don't be surprised when we don't believe you...who knew 3 month olds could walk?

If you are mother to a 12 year old child who has an extensive stage IV osteosarcoma and is crying in pain, by all means ask us to withhold pain relief and tell her to 'just grow up' or 'get over it'. I am not a violent person but that pushed my buttons so well I could have hit her.


WHY are people not screened before being allowed to become parents....

DarwinsDefeat said:

An offered ride by the Police Department can also miraculously cure full-body parsthesia if the only other alternative is "or walk out the door now".

Though your way is more fun. :]

Click to expand...

During my trauma rotation I also learned both a foley and the words "finger in your bottom, sir" can both instantly cure full body paralysis incurred by falling while running from police. Isn't the US health care system wonderful?

I've learned that patients would rather wait in the ED for 4-6 hours for free bottles of chlorpheneramine and guaifenesin rather than go to a local store and pay $8.00 out of their own pocket.

Socialized medicine at its best, courtesy of the US military.

I'm just a lowly MS1 but I got one.

55 y.o. woman comes into the ED with a severe rectal bleed. We go in and the attending does a DRE which leaves his glove bright red. Occult blood exam is done and comes up negative. After the third negative occult blood, we look at her and ask what she ate. She says she had white castle, which gave her diarrhea, and then had red velvet cake. The attending and I are now trying not to laugh as he explains to her that she is simply crapping out the food coloring.

If you are a scrawny white 15 yr old boy and have been drinking vodka all day with your low life friends (who all happen to be solid Samoan guys), don't play rugby with them. And when you do and it results in a compound fx of your ankle, you really really shouldn't let one of your drunk mates 'click it back in'. Reduction is best left to trained, preferably sober adults.
What a mess.


Also, if your husband takes a really smelly crap and neglects to use air freshener, feel free to call an ambulance.
That's right, if your bathroom smells offensive this is considered a medical emergency and your life is in immediate danger. :-D

If you are an 18 y.o. female who claims to be an assault victim, having a total lack of visible bruises or injuries, claiming 8/10 pain while calmly talking to us, and telling us about how the OTHER party is the one filing charges is very convincing.

Once the doctor does a thorough physical and finds a total lack of bruises, crepitus, or anything indicating injury to the chest (where the 8/10 pain is), and tells you that you don't need a CXR b/c you don't need the extra radiation, feel free to throw a fit and call your mom so she can tell the doctor that she KNOWS that an Xray is required.

Once it comes back negative, feel free to find someone else's room to wander into and fall asleep. When we wake you up to discharge you, definitely gain points with us by asking for a note to excuse you from school. Then, ask for one for you sister too, who apparently dropped you off and bolted.

If you go to the ED and you're diagnosed with pacreatitis, don't go home and drink a fifth of vodka...

Furthermore, don't come back via EMS and ask why you're hurting.

^awesome!

I got another one:

When the peds ER is so busy that there is a 17 person waitlist, please make sure to get in with your daughter who is having severe lower right quadrant pain and make sure to call the doctor a nurse. When the doctor tells you she is not a nurse and is, in fact, a doctor, tell her that you meant ME, because "that one there is in training, so he must be a nurse". I completely forgot that med students have to be nurses before they are doctors...my fault.

Once the doctor corrects you again, definitely get all huffy and start yelling loudly about how you are being disrespected and insult the doctor at every turn ("if you dont get the IV right on the first try, we're leaving!"). Threaten us with going to another hospital every time we pass your room....not with a white count of 17 you're not!

Oh, and while we're at it, please remember proper ER etiquette, which would be to sneak around the security guards with your child to come to the peds ER and ask me how many people there are in front of you. When I say 17, definitely badger me about it for the next 10 minutes. Reminds me of a restaurant sometimes....

And to top it off, here's one more: During rounds, the attending gets to the isolation room and the resident coming on asks why a 15 y.o. male is sitting there. The attending tells us that he put him there because this guy wouldn't stop verbally assaulting him because he thought the attending was gay. All this time, the patient is glaring at him through the window. The attending sees this and, clearly fed up with him, blows him a kiss. Needless to say the patient was irate and we were laughing hysterically.

Here's a piece of information that I honestly didn't know, learned from a patient, and will absolutely hang on to (all the people having spent any time in Killadelphia will immediately recognize):

If you're on any sort of public mass transit vehicle that gets into an accident, going to the ED (usually a very VERY busy one in North Philly) will net you a $500 check* from said mass transit authority. This applies to anyone involved in said accident (either riding in or being struck by the vehicle).

We were in the ED on an unusually slow Tuesday morning when we were SLAMMED with 40 patients at once... No one could figure out what was going on until a nurse goes outside for a smoke, comes back inside cursing, and screams "IT'S A SEPTA BUS, Y'ALL!". The upside (and downside for the pt in question) was that, upon taking a history, the resident and I found a molar pregnancy on a woman that was being examined for knee pain... Cool finding (because of the presentation), but really sad, especially because it was such a nice lady (in a city full of venom-spitters).


* in exchange for not suing... obviously

If you are an experienced EM physician, you can still slice your hand open when cutting a steak. Then, go to work, trying to stop the bleeding, and be blasé about the soaked Band-Aid, then the bleeding around the steri-strips, and other failing attempts at hemostasis. Finally, 13 hours after the injury, pushing the limits for primary closure, Dermabond the whole damn wound up.

It's not a good idea to take four ecstasy tablets. When your fiancee brings you into the stand-alone ER and you are A & O X 4, but then deteriorate rapidly, while urinating all over yourself and shaking wildly (I was pretty proud of myself for getting the IV on the first stick), don't be surprised if your "fiancee" gradually turns into your "girlfriend" and then starts ignoring you completely while texting, and upon transfer to the main hospital, informs the ambulance crew, "I ain't signin' nothin'!!! I ain't payin' no more of his bills!"

I wonder how that relationship is doing now?

When you tell the ER staff that you are allergic to all NSAIDs and Tylenol, while claiming that you and your boyfriend rear-ended a car twelve hours ago at 35 mph, but both cars were drivable so no one called the police, and now your neck hurts even though all tests are negative, and the computer takes several minutes to scroll through your extensive visit history, don't be surprised if you leave without any fun IV medications.

Also, saying that you are allergic to Toradol, but when asked about ketorolac, saying that's okay, is only going to raise our already-very-elevated level of suspicion that you are a seeker.

When you and your husband are the nicest people on the planet, and are having your first baby, and you are petite, and you are nice enough to allow a student on clinicals to be in the room, that is a guarantee that you will push for four hours, need a forceps delivery, and incur a grade IV tear ("I haven't seen anyone tear like that in 15 years!", both the OB and the RN tell the student later).

The student will be glad that she is almost past her child-bearing years, since seeing that at a younger age would have horrified her forever.

Also, if you are the OB, the mom is an RN, and the dad has no medical background, telling the mom that the baby will be a conehead for a few days will not bother the mom, but the dad may have visions of old SNL skits.

When asked by an RN, "Do you want to put in a Flexi-Seal?", saying "Sure! What's a Flexi-Seal?" will cause much snickering. Further snickering will ensue when another RN attempts to point out the black insertion-level line on the device, when it is covered in something else that is dark in color since the patient just dislodged it.

Putting a Flexi-Seal into a HepC-ESLD, ESKD, intubated patient with severe pneumonia is not nearly as difficult as palpating a cow. And if your patient lets fly during the procedure (the human patient did not, but many cows have), you are far less likely to be hit in the face if you are only knuckle-deep as opposed to shoulder-deep.

Also, when the patient does let fly a few hours later, the RN will confirm your suspicion that the patient's sphincter was probably too loose to hold the Flexi-Seal in under...ahem...pressure. Patient was an inmate. Huh. Imagine that.

A patient of mine yesterday taught me to keep watching the local news; no matter how terrible it is.

This guy came in complaining of right frontal/retro-orbital headache for two weeks straight. He said he dad died of a brain tumor, his grandfather died of a brain tumor and his father before that died of a brain tumor.

I got the CT scan because he is saying all the buzzwords, but I knew this guy was full of crap. I sent him home with motrin 800 mg. Two days later I saw him and his mom on the news busted by the cops for selling narcs out of there hair boutique.

I've learned that if you get a work-up for your chronic abdominal pain that would take a month to coordinate as an outpatient, its still ok to complain that during your 5 hour stay you only saw the doctor for 10 minutes. I mean what part of EMS wheeling an women pouring blood from her dialysis fistula while she screams "Help me I'm going to die" do they not understand? Oh yeah, the part were I'm not paying attention to them right at that second.

I discovered tonight that if your crazy patients go around talking to the rest of the ED population, all of the rest of the patients are a lot nicer when they see you.

deuist said:

I discovered tonight that if your crazy patients go around talking to the rest of the ED population, all of the rest of the patients are a lot nicer when they see you.

Click to expand...

Our psych emergency room doc learned her lesson last night too...

When you see a patient brought up to your floor in a four point restraint Hannibal Lecter style wheelchair there is usually a reason. To question why she is in restraints and then decline to put your own means your in for a suprise. When the ER techs release the patient don't look shocked when the patient strips naked and starts pleasuring herself all in the blink of an eye.

I have never seen a psychiatrist turn as bright red, let alone blush until last night.

Put the lotion in your hand when you feel a need to jerk off, don't plug yourself into the source, aka the bottle, because you will find yourself trying to stuff the whole apparatus into a pair of shorts for that embarassing trip to the ER.

Not an ER doc, but I'm one of your very patient secretaries, sorry for the intrusion

I learned this morning that when a corrections officer tells you no, he has to stay with the inmate who is your patient, especially if he is unshackled? He really does mean it, and he's no more thrilled about it than you are, especially in the cath lab.

He's even less thrilled when he's wearing a lead-lined protective suit, and still has to make sure he can get to his pepper spray, Taser, and cuffs.

Trust me on this one.

If a very irrational psych patient approaches you at the desk and screams "I AM DISABLED-LOOKING" - do not, under any circumstances, say "I know."

These are great! Loved every minute of it. I'd prefer the whackos we see to the whackos you guys see any day...

Still, I learned one thing from a (human) "patient" of mine...

Apparently the type of hidden microchip that the aliens and/or government conspiracy implant in you are not the right frequency to show up on the scanner that we scan pets with. Thank you for showing me your extensive notes on where these chips are in your body, and telling me all about how you know where they are and what they are for. I especially thank you for only asking me to scan the one in your foot and NOT the one in your testicle.

Actually, the guy was very polite and paid me twenty bucks to scan his foot. I offered to buy the staff pizza with it but they told me to keep it. They were amazed I even talked to the guy. What can I say... it was a slow day and I have a bad problem with morbid curiosity.

The sad thing was that the guy had clearly seen his regular doc about this, and obviously was not taking his meds or was not on the right meds. Poor guy.

Something I learned today:

If you lose your glucometer, you can just guess for sliding-scale insulin.

I learned that it takes two prison guards and one foot shackle to make sure a man with catastrophic brain damage (no brainstem reflexes and was declared brain dead 24 hours later) doesn't make a run for it.

If you're want to kill yourself by taking a bunch of your mother's pills, make sure they're not the multivitamins...

I learned that it's perfectly fine to stick your hand into an industrial trash compactor. Rather I should say, it's perfectly fine to stick your hand into an industrial trash compactor as long as you don't mind completely mutilating said hand.

Also, I learned that mouthwash will get you just as drunk as any liquor store alcohol, or maybe even drunker, yet it has the added benefit of making life more pleasant smelling for the ER staff who will be attending to you after you become comatose from drinking said mouthwash.

Here's another thing I learned. Apparently the ER is a full service restaurant and hotel catering to the exclusive class known as the homeless, because immediately after arriving in the ER it is not uncommon for said homeless person to immediately start shouting that he wants food right now and he wants a better room.

I just finished reading this entire thread! And I have one to share. It was a discharge instead of anything dealing with the ED.

If you live in an octagonal house with a cemetery on three sides and give your at the time husband a pentagon necklace that you put a magic spell on for him to love you.

This doesn't mean you're a witch, even if the neighborhood children think different.

Insane thread.

I learned that when you break your ankle, it's a good idea to never go to the hospital and just keep walking on it for 6 months. When the foot forms a 45 degree sideways ankle with the leg, keep on walking on it. When you're literally walking on the side of your ankle, keep on walking on it. When the ankle wears down to the point that the bone is both visible and CLEARLY infected, keep walking on it. And when your husband finally forces you to go to the hospital, rip off all the bandages and refuse to take antibiotics even when the MRI shows clear deep bone infection.

Today, I learned that if you are a true pill head, it is perfectly acceptable to call the pharmacy that is refusing your refills because your doctor said no, and tell the pharmacist that you're going to keep the delivery driver at your house until you get your pills. And that when the delivery driver lets you know, in no uncertain terms, that attempting to hold her against her will is going to result in you getting a face full of pepper spray, it's perfectly acceptable to threaten to get her fired.

Some people need to be fed to banthas.

Today I learned that if you come into our ED complaining of a headache for the week since you fell over and seem really confused and uncoordinated, with a nice bruise behind your left ear, and the doc is worried enough about you to CT you even though you are a known drug seeker and have pinpoint pupils (because said doc really needs her head examined, and is relatively new to the game) after the CT radiologists calls because he's concerned about your recent infarct and thinks neuro really needs to see you.......
it's ok to leave AMA because Tylenol 3 will fix your headache and your family doc will dispense those (but I won't).
And, you don't really need the ramipril or the atorvastatin the family doc prescribed you last year. You don't like pills, after all, except for the ones that contain narcotics, and the other pills don't make you feel any different so they can't be working. That would explain her BP of 170/110 in triage, I guess. Glad we didn't run her lipids.
In her giant shopping bag of pills the only ones she appeared to be taking regularly were:
a) clonazepam
2) tramadol
3) t-3's and
4) trazadone
I am sooo glad I am not this woman's primary care provider (although going through her ED notes, it appears we really act as such most weeks).CHeers,
M

Add another one to the list of "needs to be eaten by banthas."

Apparently, when my boss calls one of your doctors, who has prescribed you trazodone, and asks him if he knows that another doctor has prescribed you Lortabs? It's perfectly acceptable to have a complete meltdown because YOU lied to your doctors, and they're BOTH refusing to prescribe anything further for you by way of pain pills.

Seriously, I wanted to be able to speak Huttese for a moment, so I could say the WHOLE line, instead of just, "ho ho ho ho, Bantha pudu..."

I learned that the part of a medication that's helpful is not the chemical contained within the pill, instead it turns out that the part of the medication that's helpful is the look of the pill and the look of the container it comes in. I learned this because a patient who came into the ED complaining of severe heartburn was demanding, absolutely demanding, that he be prescribed Nexium instead of the generic pill of the exact same medication. When we absolutely would only offer him the generic form of the pill, he simply walked out and didn't take the script for the generic.

But seriously, from this incident I learned that there is a street-sale black market for EVERY well-known prescription medication - truly *every* one, even simple heartburn pills.

If you're going to insist on making sausages from bear and wild boar, you should definitely taste the sausages before cooking to make sure you got the seasoning right.

Drink plenty of gin to dull the pain before you attempt to circumcise yourself with a pizza cutter.

Do not attempt surgical procedures as you've seen on ER, House, ect. especially when you might have the diagnosis wrong. A concussion does not require a tracheotomy nor should you attempt to put in a chest tube when your roommate passes out after a night of drinking.

It is possible to remove your own tonsils with an exacto knife and soldering iron.

If you have no medical training and suspect appendicitis, do not go to the hospital four blocks away, make an incision yourself and rummage around four two hours before calling 911, the hospital staff will be happy to close for you "doctor."

Last night I learned that your friends will let a few weeks of hallucinations slide, but they will draw the line and seek medical help when you try to cook eggs in the toilet.

Insulting someone for their love of the music of Journey can get you stabbed on a Sunday morning.

Distracting the nurse who is slowly giving you IV morphine and slamming the meds in yourself is a good way to get thrown out of the ED; and no I'm not giving you any pain meds to go.

Ripping off your EKG leads in order to get a nurse or tech to come into your room and touch your chest while putting the leads back so you can pleasure yourself is not appropriate behavior in the Emergency Department.