Favorite Chief Complaint
Started by kugel
"I tried to kill myself by eating sesame noodles." Fun times last week.
Not a cc: but one of our residents reported today that:
"Today a patient got confused between the brand name "Ambien" and the generic name "Zolpidem" and called it "Zombien." I think that's what I'll call it from now on."
🤣
EXCELLENT! It just works on SO many levels!
"Today a patient got confused between the brand name "Ambien" and the generic name "Zolpidem" and called it "Zombien." I think that's what I'll call it from now on."
🤣
EXCELLENT! It just works on SO many levels!
Most memorable, non-humorous cc:
"My father is also my grandfather."
"My father is also my grandfather."
7 yo boy inpatient psych today:
"Why did you come to the hospital last night?"
"Because people are trying to kill me." Deadpan.
Poor kid.
16 yo boy with hf autism and depression +/- psychosis:
"So the aliens have chosen to contact you because you share half your DNA with their species? And what is it the aliens are telling you?"
Pause.
Pause.
Looks down. Pause.
Looks up all creepy, making eye contact for the first time since arriving:
"Be prepared..."
Goosebumps from hell right there.
"Why did you come to the hospital last night?"
"Because people are trying to kill me." Deadpan.
Poor kid.
16 yo boy with hf autism and depression +/- psychosis:
"So the aliens have chosen to contact you because you share half your DNA with their species? And what is it the aliens are telling you?"
Pause.
Pause.
Looks down. Pause.
Looks up all creepy, making eye contact for the first time since arriving:
"Be prepared..."
Goosebumps from hell right there.
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Haha that's like a movie trailer
wow. how do you keep from laughing your asses of? i feel im way to immature for psych though its a specialty i have considered.
Very frightened 60 year old lady: "Honey don't worry grab my hand, your drowning! Look at all that water swirling around we are both going to drown grab my hand." She was pretty hysterical at that point, was probably really hallucinating and told me later she actually thought I had drowned in the ER.
So when patients intitially say stuff like this to you whats your responce?
like you just nod tell them everything is going to be ok or do you actually confront the statements?
like you just nod tell them everything is going to be ok or do you actually confront the statements?
In this case I made sure I and the patient were safe. In this case the patient had a severe impairment in reality testing, which isn't the case in all hallucinating patients. I did speak to her for about twenty minutes and I tried to convey to her that I was not in fact drowning and that there was no water in the ER. Even so, she continued to hallucinate and we medicated and admitted her to the inpatient unit.
From one of my very favorite and friendly bipolar patients, to my close friend on-call at the PES:
"You're as bad as that a----ole (my name)! Are you related?"
My friend was careful to completely and accurately record this CC into the admission H&P. Ahhhh, immortality at last.
"You're as bad as that a----ole (my name)! Are you related?"
My friend was careful to completely and accurately record this CC into the admission H&P. Ahhhh, immortality at last.
Patient: Acutely manic middle aged man.
Me: Having been around patients for way too long, extremely tired. 😴
When he isn't flat out ignoring my questions, he is blasting me with the most intricate details of his entire life history.
My supervisor walks by, hands him another set of admission forms plus some spare paper to write on and says to me "just file that".
I did, and it made my day! Though it did ruin it for the desk clerk.
(He has been around previously, so they already had some history...)
Me: Having been around patients for way too long, extremely tired. 😴
When he isn't flat out ignoring my questions, he is blasting me with the most intricate details of his entire life history.
My supervisor walks by, hands him another set of admission forms plus some spare paper to write on and says to me "just file that".
I did, and it made my day! Though it did ruin it for the desk clerk.
(He has been around previously, so they already had some history...)
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(from a man):
"A vagina started growing in my stomach last weekend. Now I'm a eunuch, right?"
"A vagina started growing in my stomach last weekend. Now I'm a eunuch, right?"
Hey! In Montana, it frequently snows in May. And sometimes June. And occassionally August.
We had snow last week
Yes. Folks from Wisconsin tell they only have 3 seasons:
last winter, this winter, and next winter
Chief Complaint in the Psyche emergency center: "Suicidal" -written by the ER doctor or nurse on the chart.
Patient: I never said I was suicidal (nor does he show any objective symptoms of mental illness). I came to the ER because a box fell on my leg and it hurts like hell!
Me-did they do anything to your leg like an X-ray?
Patient: no.
I look at the patient's physical exam done by the ER doctor showing all of it is normal. I look at the patient's leg--its throbbing, showing all the classic dulor, calor etc, its larger than the other one, and he's saying he's in pain.
Yep--another dump job.
Me: Do you know the ER doctor wrote down you were suicidal?
Patient: He what? That idiot kept asking me if I was depressed and I said no. He kept asking me if I was suicidal and I said no. He kept pushing it, so I finally said that one time about 5 years ago I felt bad, thought maybe life wasn't worth it for a second, but that was it. Next thing you know, I'm transferred to this room with you.
I made it a habit in residency to let the patients who were dumped on us know exactly what the previous doctor had written, and give them that doctor's name. After all, doesn't the patient have the right to have full access to their medical records?
Patient: I never said I was suicidal (nor does he show any objective symptoms of mental illness). I came to the ER because a box fell on my leg and it hurts like hell!
Me-did they do anything to your leg like an X-ray?
Patient: no.
I look at the patient's physical exam done by the ER doctor showing all of it is normal. I look at the patient's leg--its throbbing, showing all the classic dulor, calor etc, its larger than the other one, and he's saying he's in pain.
Yep--another dump job.
Me: Do you know the ER doctor wrote down you were suicidal?
Patient: He what? That idiot kept asking me if I was depressed and I said no. He kept asking me if I was suicidal and I said no. He kept pushing it, so I finally said that one time about 5 years ago I felt bad, thought maybe life wasn't worth it for a second, but that was it. Next thing you know, I'm transferred to this room with you.
I made it a habit in residency to let the patients who were dumped on us know exactly what the previous doctor had written, and give them that doctor's name. After all, doesn't the patient have the right to have full access to their medical records?
LOL, I got a consult at the VA in residency: "Patient shed tears." Turns out he lost his leg per that amputation they hadn't planned for before he went under anesthesia and yet had bone cancer that would kill him soon. They wanted me to medicate him so he didn't cry, as it bothered the nurses.
This reminded me of a patient I saw in the psych ER.
Me: So what brings you here today?
Pt: I hurt my leg.
Me: What happened?
Pt: Well my leg's been hurting for a week so this morning I hit it with a hammer.
Me: Did that make it better or worse?
Pt: Worse.
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That's a wee bit depressing.
It was, but we got to be ok with each other. I followed him for the next about 4 mths untill he died. And he got to handle it OK.
Me: "so what's going on tonight? what brings you into the hospital?"
Lady: "MY EX-HUSBAND IS INFECTING ME WITH INSECTS!!" (this comes up fairly often actually)
Lady continues: "HE IS PUTTING INSECT EGGS IN MY LIP BALM! LOOK!"
-lady pulls out small tin of lip balm and opens it, extracts a tiny piece of lint from the lid as would collect in any old tin of lip balm carried around in a dirty purse-
Lady again: "SEE! SEE! IT'S RIGHT THERE! IT'S AN INSECT! LOOK AT ITS LEGS!! OH IT IS SO DISGUSTING"
Me: "That looks like lint to me..."
Lady: "ARE YOU SURE?!! IT LOOKS LIKE A BUG!! HOW CAN YOU EVEN SEE THAT! IT'S SO SMALL! LOOK AT ITS LITTLE LEGS!"
Me: "I have good eyesight. That's just a piece of lint. The things that look like legs are just little fibers in the lint."
Lady closely examining the tiny piece of lint: "I DON'T KNOW...IT SURE LOOKS LIKE A BUG TO ME..."
Me: "so have you been using meth recently?"
Lady: "-long pause-...UH...I DON'T DO METH"
Me: "Oh you don't?"
Lady: "...WELL...NOT USUALLY..."
Me: "Ah, I see. So when was the last time you used meth?"
Lady: "...I'VE BEEN SMOKING IT FOR A COUPLE MONTHS NOW WITH MY BOYFRIEND"
Lady: "MY EX-HUSBAND IS INFECTING ME WITH INSECTS!!" (this comes up fairly often actually)
Lady continues: "HE IS PUTTING INSECT EGGS IN MY LIP BALM! LOOK!"
-lady pulls out small tin of lip balm and opens it, extracts a tiny piece of lint from the lid as would collect in any old tin of lip balm carried around in a dirty purse-
Lady again: "SEE! SEE! IT'S RIGHT THERE! IT'S AN INSECT! LOOK AT ITS LEGS!! OH IT IS SO DISGUSTING"
Me: "That looks like lint to me..."
Lady: "ARE YOU SURE?!! IT LOOKS LIKE A BUG!! HOW CAN YOU EVEN SEE THAT! IT'S SO SMALL! LOOK AT ITS LITTLE LEGS!"
Me: "I have good eyesight. That's just a piece of lint. The things that look like legs are just little fibers in the lint."
Lady closely examining the tiny piece of lint: "I DON'T KNOW...IT SURE LOOKS LIKE A BUG TO ME..."
Me: "so have you been using meth recently?"
Lady: "-long pause-...UH...I DON'T DO METH"
Me: "Oh you don't?"
Lady: "...WELL...NOT USUALLY..."
Me: "Ah, I see. So when was the last time you used meth?"
Lady: "...I'VE BEEN SMOKING IT FOR A COUPLE MONTHS NOW WITH MY BOYFRIEND"
I had one a while back ago that went like this, between me and a giant muscly dude in handcuffs after the hospital police brought him to the psych ER after they found him running through the medical ER shouting "I need help, I don't want to hurt nobody no more"
Me: Are you allergic to any medications?
Giant: No
Me: Are you taking any medications?
Giant: Yes ma'am I take PCP I take it every day it helps me CALM DOWN!
(I don't think it was having the desired effect)
Me: Are you allergic to any medications?
Giant: No
Me: Are you taking any medications?
Giant: Yes ma'am I take PCP I take it every day it helps me CALM DOWN!
(I don't think it was having the desired effect)
Pt: " My lawyer advised me to sign up with psychiatry and get some follow up? "
Me: "What are the charges against you?"
Pt : "Aghh.. nothing major, child molestation, but it is not true, you know."
My attending: "Sir, I think you need a better lawyer, not a psychiatrist"
Me: "What are the charges against you?"
Pt : "Aghh.. nothing major, child molestation, but it is not true, you know."
My attending: "Sir, I think you need a better lawyer, not a psychiatrist"
Bull****. I don't believe you.
Nope, really did happen. The ER xrayed her leg and nothing was broken so they sent her over.
Her explanation was that putting pressure on it seemed to help, and then hitting it with her fist seemed to help, and obviously the next step was...a hammer.
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A man with schizoaffective DO befriended a young guy with disorganized schizophrenia on the inpatient ward. The schizoaffective DO guy felt himself to be a space ship captain. Somehow he managed to convince the younger guy to become his first mate. Interestingly, the hebephrenic remained convinced in the validity of this delusion long after the schizoaffective DO pt improved and was discharged from the ward...
I have had headaches so bad that I've fantasized that a hammer would work...
I don't get it. Why was it so hard just to take care of that guy's leg? I mean say he actually was suicidal, wouldn't they still need to take care of his leg?
That's the point. It was a dump job. The ER doctor found just 1 psychiatric symptom (and it really wasn't even a symptom) and turfed the patient off to psychiatry, when in fact the patient had a nonpsychiatric problem, while the ER doc erroneously writing up a physical exam that presented the patient as if the patient had no physical problem. It just demonstrates the willingness to dump the patient without examining what was really going on.
I did residency in Atlantic City. Once a year, the Wednesday before the summer tourism season starts, the police go through the boardwalk, haul off all the homeless people to the hospital or the rescue mission--which is literally dozens to hundreds of people--no kidding. Its not that the people needed to go the hospital--just that the police needed to dump them somewhere other than back to the boardwalk.
So if you're the unfortunate resident on call that night, you'll have about 30 or more people in the psyche emergency center that usually (at that point) only carried about 3-6---and none of them really in need of a psychiatrist. The ER doctor pretty much labelled all of them as suicidal because he didn't want to deal with their disposition, and the psyche emergency center had better communication with the rescue mission. So the ER docs figure they can just dump this all to psychiatry. So if you're on call that night--you'll get almost all of them with a "suicidal" on their chart and the person denied they were suicidal.
Or the Edinburgh Depression Scale which in NJ became law that it be given to women who had just delivered a baby. If the woman didn't speak English, the nurse didn't want to deal with the inconvenience of getting a translator, so they direct the woman to check off the choices indicating depression--forcing the psychiatry CL resident to have to deal with the mess. Trust me--sitting there with a translator on that scale can take 20 minutes to half an hour. Having the woman just check off the wrong boxes takes about 30 seconds.
(My solution was to write down on the consult--"will return when the the NJ Patient Bill of Rights is followed--giving the patient a translator for the scale. Please consult only after staff have provided a translator" which always ticked off the nursing staff at the Ob-Gyn ward because it made them have to do their work for real. The attendings didn't seem to care because it was not their time wasted, but I was the Chief, I'm supposed to be a resident advocate & I figured I'd actually take a stand on that position, and if they complained it'd only reveal that they weren't doing their jobs.)
I got a million more turf stories, but I'll spare you the rants.
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A lady comes up to the nurses station while I'm dialing the phone for another patient, interrupts and loudly states, "Mister doctor, sir, they told me that if I want to kill myself, that you can give me a shot and it'll be over in about 10 minutes. I'd like that, please."
"No, ma'am. No one here is going to kill you."
"Oh, PLEASE mister doctor. I just CAN'T...."
"Please have a seat and we'll talk with you in just a few minutes."
Very pleasantly, "Oh, okay. Thank you, mister doctor sir," and sits down quietly.
"No, ma'am. No one here is going to kill you."
"Oh, PLEASE mister doctor. I just CAN'T...."
"Please have a seat and we'll talk with you in just a few minutes."
Very pleasantly, "Oh, okay. Thank you, mister doctor sir," and sits down quietly.
I had a woman on my caseload whose constant refrain was "I have to make sure all the children in all the schools in the United States say the Lord's Prayer at 8:00 p.m. on Halloween, or all the trials and tribulations of Revelations will come true."
She calmed down some after Halloween but quickly renewed her campaign for the following year. I was often tempted to ask her how she was going to get the kids in school at 8 p.m. in the first place, let alone on Halloween.
She calmed down some after Halloween but quickly renewed her campaign for the following year. I was often tempted to ask her how she was going to get the kids in school at 8 p.m. in the first place, let alone on Halloween.
"I was raped three hours ago by Hugh Hefner with a power drill and a blue construction hat."
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