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Discussion in 'Clinical Rotations' started by Dr JPH, May 13, 2007.
lmfao (*convulses in amazement*)
Me: Tell me more about it
Pt: I think I'm allergic to my tramadol
Me: What makes you think that?
Pt: It's causing me a lot of pain
Me: Um... are you sure it's the tramadol? Usually people take that to relieve pain.
Pt: Yeah, well, today I took it and later I got pain.
On exam the patient has an acute abdomen and is rushed to the OR. Perforated ulcer I think.
66 y/o male presents to ER with left knee pain.
Me: So what brings you here today?
pt: My knee hurts.
Me: How long has this been going on?
pt: Since before high school.
Me: So what made you decide to come to the ER today???
pt: Gettin' old, I guess.
A variation of this I have heard is "fireballs in my eucharist," i.e. vaginal bleeding.
"i have electric panty-lines" - from a pregnant pt who's gravid uterus is expanding and stretching things out...
"i'm volume-overloaded" - this one is my all-time favorite, from a CHF/dialysis pt who skipped several days at the dialysis center in favor of partying it up with a long weekend of chips, soda & chocolate cake. it's sad when your pts have the jargon down....
Med student: What brings you to the E.R. tonight?
Patient #1: My Ford Truck
Patient #2: Came to see a pretty young thang like yourself (He's a 70y/o male).
In the ER at the VA:
48 y/o male
CC: Pt is loud and abusive to staff, police are accompanying to waiting room, pt states he thinks "orange soda is making me sterile" and he's afraid that he "won't be able to get my bitches knocked up".
Turns out he wanted to be admitted to the Psych floor for substance abuse issues on inpatient basis despite the fact that he hadn't used illicit drugs in over 3 years, no history of tobacco use, and only minimal EtOH...
Was actually a really nice guy and even for a vet (who tend to be pretty grateful to begin with), was extremely thankful for my rather cursory H&P.
If the psych floor at our VA has an open bed, it's not that hard to get admitted. Your guy is trying too hard.
I was tempted to tell him that being sterile might be a good thing...that his life would be easier without a lot of "baby mama's drama" going on.
this is one from my paramedic days.....
at 3 am a 65 yro lady calls 911
her complaint... "my finger nails have hurt"
i ask... how long has that been going on
she says... "3 years"
needless to say i would like a refund for the half hour i wasted
a guy in his 20's decides to kill himself.
his choice, a samurai sword.
somehow he managed to stab himself in the abdomen with the 2 to 3 foot sword. but it shockingly, it hurt "a lot" so he stopped after two inches and pulled it out.
fear not, he was grossly obese and didn't get throught the adipose tissue. spent the night and was refered to psych.
Two separate patients present to the ER with a deep laceration on one of their hands on the same night. Cause of both their lacerations: grass. Both had been gardening that day and cut themselves to the point of stitches trying to pull out wild grass or something like that.
Not the craziest story, but who'd a thought grass was that dangerous?
Here's another random one: Individual calls the ER to ask the number for 911. Apparently couldn't find the "11" button on the phone. The nurses tell me calls like this are commonplace.
"nuts not in sac"
These were the Chief complaints according to the admit registrar.
I'm pretty sure whoever decided the CC should be in the pt's own words really just wanted a good laugh.
This is from a Urology rotation:
Pt: I'm here because I have a hydrocele.
Me: When did you first notice this?
Me: Ok. Has it changed recently?
Me. Ok. Has it changed at all since 1981?
Me: Are you having any other concerns - problems with urinary? sexual function [insert all the questions you can think of here]?
Pt: No, not at all.
Me: So what made you decide you needed to be seen about this today?
Pt: My new primary doc told me to come here when she noticed the hydrocele.
Me: Did you tell you primary care doc that you have had this has not changed since 1981?
Pt: No. Do you think I should have?
I then had to tell the urologist 4 times that this is completely unchanged - nothing, nada, zip - for the last 27 years and that the patient had no complaints - nothing, nada, zip - before he would begin to believe me. Still, his first question to the patient was "I understand you came here today for this hydrocele that hasn't given you any problems since 1981", and the patient replied, "Yep, it only worries my primary care doc".
Medical Student: What brings you to the ER today?
Pt: To have my blood pressure measured
M.S.: ohh ok
R3 interrupts: why, do you have any heart conditions?
R3: Well are you feeling sick or have any symptoms?
Pt.: No, I just came to have my blood pressure measured
R3: Sir this is the emergency room people who have emergencies come here, if you want to have a cardiac consult go to the cardiology office right across the hall.
Pt.: but why, I just want my blood pressure measured
R3 is about to explode...
M.S. interrupts: doc thats ok I'll measure his blood pressure...
LOL!!!!! thats hilarious, I've gotten a bunch of those wacky names they put to whatever they have, but they're in Spanish and possibly have no translation to the English language...its not enough to learn the medical terms one has to learn the patient terms too!
Printed on triage sheet in clinic:
What is the problem that brings you in?
Answer: "***** eyes"
From the ED:
CC: Pt swallowed crack pipe 3 days ago. Wants to know if he will digest it.
CC: Pt is victim of a complex conspiracy involving the Catholic Church, the communist party and Jesus Christ. Pt has psych history.
HAHAHAHAHAHAHAH! So true...
"i'm pregnant! Deliver me!"
I work on the Labor and Delivery unit at my hospital. At 4am we get a call from a nurse at another hospital's ER. She's giving report on a 25wk G3P1 that will be coming to us because their hospital doesn't have an OB department. Her CC? "I'm upset because my husband is cheating on me and doesn't care about me and the kids," so she decided to go to the hospital to make him feel bad.
The other hospital has ordered a UA, CBC, and started her on antibiotics in case she has a UTI. She drives herself over to our hospital to be seen. Arrives, crying hysterically, and the docs order a SSE, we put her on the monitor, and then fight with her about who's going to call her husband and tell her she's in the hospital. Ugh.
9 year old brought into clinic by father.
Father is asleep and drooling in chair. 9 year old states: "My leg is swollen. It itches too. I think I have a serious infection."
Me: "Sweetheart...that's a mosquito bite........"
Trauma CC: "F*** you doc! You're a f***ing ***hole!"
I was putting pt's ear back together--it had been filleted into three separate parts by something moderately sharp.
Another trauma situation:
Me: "Hey man, who shot ya?" (this is my favorite interview question)
Pt: "Gimme a dolla, mane."
Me: "So you don't know who shot you?"
Pt: "I need a dolla. Gimme a dolla."
Me: "I can't give you any money."
Pt: "I got to buy me some rock."
patient with AKA, I am here to get my other leg cut off
i dont know if this is sad or funny?
One of my ER patients was here for schizophrenia:
Me: So, what brought you in today?
Him: I am hearing voices.
Me: What are the voices telling you to do?
Him: They are telling me to go breakdancing in the black neighborhoods...
I wasnt sure whether that counted as self-endangerment... I told this to my attending and she laughed for a good 10 minutes.
A now legendary CC at my school's OB/GYN department was from a couple of years ago when a patient who came in with abnormal uterine bleeding who claimed to have a history of "Fireballs of the Eucharist"...
Translation - Fibroids of the Uterus...
We should introduce her to my mother-in-law, who suffers from immaculate degeneration.
Edited because I evidently still haven't mastered tags.
LOL Man I am dying over here.
This is one I had today while doing the H&P up on the floor after the ER had admitted the pt for chest pain:
MS: what brings you in today?
Patient: "I'm homeless and it's raining outside. So whenever the weather is bad I just go to an ER and tell them I'm having severe chest pain so I get somewhere to sleep and free food."
...i have to give the guy credit for honesty though, plus we thankfully didn't have to waste time and money giving him the whole chest pain workup. My ER kills me though with how lenient they are in regards to admitting patients to the floors.
Part of the ROS:
"Patient denies dick fungus"
This is freakin hilarious! Ok, I have some from the ER
CC: "I just got a bad head ache"
I then walked around the shock room bed and found blood pouring out of this woman's head because her boyfriend literally ripped her scalp off. Talk about high threshold for pain!
CC: "I don't know what happened! I used a condom!"
The guy got an STD and decided to put prescription strength corticosteroid cream on his balls causing massive scrotal skin peeling and horrible secondary bacterial infection. His balls were glued to his thighs with pus. It was lovely.
This isn't really a chief complaint, but I did have to interview one of our community hospital's infamous patients. She has an esophageal ostomy bag because she drank drain cleaner in a suicide attempt. Anyway through out the interview she drank soda which drained into the ostomy bag, emptied the bag, and then drank it again. Charming woman.
That is pretty squicky. I mean, I love Diet Pepsi, but come on!
we get all kinds of ridiculous stuff working for the local EMS. One call in particular was for a woman who called because "there is an old lady stuck behind my sink. We keep reaching for one another, but I can't seem to grab her hand." Turns out she was demented and didn't recognize her own reflection in the mirror.
on another note, had a great call where a woman told me her medical history included her "intestings" that "fell out through my vagina"
Cerebellar dysfunction, unexplained syncope, mental retardation....
On an "I've fallen and I can't get up" call once...a nice elderly lady who explained to us this was her second time with this particular problem. She proceeds to tell us she's grateful this time because the last time it had happened, she fell on her cat and the cat never got back up.
Yeah. I don't think that one's particularly funny, because if I'd fallen and inadvertently caused one of my cats to die, you'd probably have to put me in restraints to stop me killing myself.
Label me crazy if you like, but consider this: would you label someone who'd inadvertently caused the death of his/her human child crazy if they wanted to kill themselves afterwards?
Hmmm....anyone see the My Name is Earl episode with the crazy cat lady?
I happily admit to being a Crazy Cat Lady. I don't hurt anyone, and Kittendaddy's grandkids will grow up respecting/loving animals. I think that's a win/win situation!
One of my favorites happened when I was an undergrad keeping a friend company late one night when she was an ED patient.
At about 2 am, a guy gets brought back to the bed next to my friend's. A nurse came in to ask what was wrong, and the guy replied "my veins are leaking." Of course, he kept insisting that his veins were leaking and denying that he had taken any drugs or alcohol.
My friend and I nearly died trying to contain our laughter.
My psyche resident actually told me about this one from a homeless guy who really wanted an admission that night into the psyche wards for a place to sleep.
CC: I am hearing voices and I want to kill everyone and myself.
Resident concludes that the patient is malingering and tells him to leave... so the patient changes his chief complaint.
CC: If you don't let me in I will run my car into this hospital.
A/P: 50 yo male with HI, admit to floor.
Not so much a CC..but in comp care yesterday a patient listed "Band-Aids" as one of her allergies. I would have liked to have been the one to see her to get the scoop on that.
That's actually a legitimate allergy, although I've only seen it as "tape." Some people get a pretty impressive rip-roaring skin reaction (including sloughing) to the tape we use to secure IVs, bandages, etc.
Not to burst your bubble, but this is probably a pretty legitimate allergy. I've seen many people develop allergies to various adhesives such as those found on commonly used medical tape or "Band-Aids." Some bandages contain latex as well, which can be a very serious allergy.
oops, you beat me to it! lol
There are whole wards devoted to Psyche? Wow, you guys really take your Greek myths seriously!
You both beat me to it. I knew someone who had a latex allergy, which she discovered when she had sex for the first time. Yeah, you can imagine how that turned out!
He was homeless yet he had a car? I'd call his bluff on this one
If homeless person has a car, where do they park it?
I've just read every single post. Love it.