Discussion in 'Clinical Rotations' started by Dr JPH, May 13, 2007.
I am guessing in the street like everyone else. Perhaps covered by some card board though.
Dudez and Duddettes. I gotta say man I agree with a lotta the above. Psych patients are Fing hilarious! Hahaha. Well not the ones that like want to hurt people or kill themselves immediately but just the off the wwall funky ones. Its so fun trying to conduct an interview and half the time you're just trying so hard not to burst out in laughter. I've had a few of those and I gotta say it sure makes the time fly by. Sure beats standing in on a long ass surgery or smelling the disgustings smells of OB or seeing the myriad numbers of internal med patients who are just literally so god damn obese and disgusting looking it makes me want to vomit on them.
My dad is a retina guy and calls me today with a new one he got from a referred patient.
CC: My eye doc says I have masculine degeneration.
The ophtho stuff is always great! My wife works with a cornea specialist and sees old people with 'Cadillacs' in their eyes all the time.
This morning in the ER (CC not so funny as the final diagnosis): forehead laceration secondary to patient's wife throwing a pressure cooker at his head during a fight.
I was on scene once for a piggy bank versus forehead. The baby mama smashed her son's piggy bank on the dad's head with some nice lacs. It was somewhat hilarious seeing the porcelain strewn about.
A patient last week had allergies listed as iceburg lettuce and mango flavoring.
This one's for Kittenmommy
I don't have blonde hair and I wear glasses... and I have more cats. Other than that, I'd say it's pretty accurate!
County Psych Hospital Admit.
CC: F--- You!
Elderly nursing home patient transferred to ER because she took a slightly longer nap than usual.
CC: "I smoked some pot and now I feel funny"
CC: "Pain unda mah titties!"
not a cc, but I love it when my pt says no, I've never had any surgeries and I do not have any health conditions, and then I see a vertical scar on exam and sternotomy closure wires on the CXR.
What? CABG? That doesn't count
(Fellow GP complaining to Fellow Ophthalmologist)
GP: I feel my lacrimal duct valve is dysfunctional because it bubbles up when I say "mmmmmmmmmmmmmmmmmmmmmmmmmm"! Does that make any sense?
Ophthalmologist: (down on his knees laughing)
I've had that one. He had chest palpitations a few minutes after smoking some weed. I should've asked if he had recently changed dealers and/or did he trust what his dealer might be putting in the MJ?
CC: I hads the shakes.
Head CT request history: "Patient is less belligerent than usual."
"My pu$$y stinks and my husband won't have sex with me anymore."
Oh the things you miss out on when you AREN'T in the ED waiting room:
The woman with COPD who rants about how she has COPD and needs Albuterol/oxygen for 2 HOURS without (obviously) the aid of Albuterol or oxygen.
HER rant makes it so the woman sitting beside her's (admittedly in for anxiety/depression) CC ends up as "being in the hospital" by the time she's taken back.
Or the woman comes in carrying a 3-year-old saying "my baby has an auto-immune disease!" I'm like, what am I supposed to do about it? Oh well...
Oooh, I've seen 2 Cornelia de Lange myself, one of them as my patient on the peds wards....ended up expiring in the end.
Not sure if its funny, but the most interesting CCs I had (psych of course):
Pt - I see vampires with guns in the hallways
Me - Oh......do you see anything else
Pt - The floor is shaking and they don't leave me alone
Me - Whose making the floor shake?
Pt - The aliens that are coming to take me away to their planet with spider man
Other pt - The devil lives in your shoe
Other pt - Yeah....and the paintings on the wall are telling me that white people want to control your life
This one got me.
I'm currently rotating on a treatment-resistant schizophrenia unit. We have regular conversations like this. Sometimes during group therapy I wonder if they realize that their topics of conversation aren't even remotely on the same planet. It doesn't seem to faze them, and they keep merrily/suspiciously/haughtily chatting away until I finally say, "OK guys, that about wraps it up for the day..."
23 yo male at the free clinic, written CC:
"My back is all f**ked up and I think I have herpes."
I go in the room and he's playing a videogame on his laptop
"What brings you in today?"
"Hold on, I can't save my game here...."
From my internal medicine inpatient experience. Not exactly CCs, but during rounds:
Med Student: "Do you know where you are?"
Patient: "I'm not certain, but I'm pretty sure I'm in a machine."
Intern: "Do you know what year it is?"
*about 15 seconds elapse*
Intern: "OK, good...and the last 3 digits?"
Attending: "Mr. X, your cardiac enzymes and stress test have come back normal, for the 5th time in the past year. We're pretty sure your chest pain is due to your cocaine use. Cocaine can cause the blood vessels in your heart to..."
Pt X: "But doc, I told you, I haven't used cocaine in over a year!"
Attending: "But your urine tox screen came back positive for cocaine."
Pt X: "It's wrong. The test is wrong."
Attending: "Well, it got in to your urine somehow."
Pt X: "I know what it could be. I live with a bunch of guys who do that stuff. I must've caught it from one of them."
MALE attending on rounds: "Hello Ms. X. I'm Dr. Y, the head doctor on your medicine team. How are you feeling today?"
Pt w/ h/o schizophrenia in for medical problem: "You're SO pretty!"
*snickers all around from med students and residents*
...later during same exam...
Patient to intern: "Your teeth are big."
Patient to me: "You're very white."
By the time we left the room, even the attending was wiping his eyes from laughter.
I had a demented patient last week ask me, "Are you your mother's son?" after saying "You're so pretty."
Picture a gentleman who looks AND sounds EXACTLY like Cleveland from Family Guy.
Me: Hello Sir.
Him(with Cleveland voice): Hi there.
Me(trying not to laugh at the uncanny resemblance): What seems to be the problem today?
Him: My right side is bigger than my left side.
Me(trying as hard as I can not to laugh):Hold on, I'll get my supervisor.
I then leave the room, walk to the doctor's lounge, and laugh my face off.
Great stories, keep em coming guys.
Again, not so much a chief complaint but a call on one of my patients the other night at 2:30 am.
Nurse: Ms. So-and-so [84 y.o. woman in for UTI] in bed 58-2 is not responsive. Her vitals signs are good, but we've done everything and can't arouse her. We've done sternal rubs, painful stimuli, everything - please come and check on her.
I walk in...
Me: [gently] Ms. So-and-so ?
No response. I gently touch her shoulder. She shrieks.
Me: Ms. So-and-so, sorry to wake you. The nurses said that they were having a hard time waking you up.
Ms. So-and-so: [turns to the clock and soundly says in the most lucid voice I've ever heard her use] It's 2:30 in the morning.
(at that point, I figure she passed my MMSE so I left)
My Bajigo is on fire.
Am I missing something? Why is that funny?
Fistulas make a noise that you can auscultate with a stethoscope/palpate called a "thrill". It is a play on words.
I know - I assumed that the patient meant they couldn't feel the thrill, which meant that it was somehow occluded, which would be a perfectly reasonable CC...
Of course, if he just meant the initial excitement had worn off...
excuse me for posting on an old thread, but hey it's D-day plus 1 (first day post step 1) and I am enjoying wasting time!
From my other life in nursing:
CC: "went to get another beer and fell over a wall."
Patient admitted for etOH withdrawl. This was actually dictated in the H&P!
Change in mental status:
Me: What day is it?
Pt: about the 16th (fair enough coming from a carehome)
Me: Where are you?
Me: do you live with your son?
Pt: no, he lives with me
Everything he knew the answer to, he decided to joke around with, but never gave correct answers. If he didn't know the answer, he would still make up an answer and smile like he was joking. Who knows.
cc: "my jaw hurts bro"
CC: Excuse me but I really feel like I need to dance to the rhythm of the heart monitor because my mom is a crazy psycho bitch who doesn't understand that I need Dippin Dots - OMG! - Dippin dots are like asian people except that when you take off both of your shoes at the same time the birds don't know where to go when it rains so I always skip art school when it rains because no one can understand my medication so I flushed it down the toilet. (obviously, this was loud, fast, and pressured)
Another patient, in response to "mood": I'm taking lots of cat naps. I feel grrrrrrrrreat! I'm chillaxin like a tiger.
Another CC: I was driving in the truck with my dad when fifteen tiny Mexicans tried to get out the back. So I made my dad stop the truck and I got out and a rod from heaven shot down into the ground, which I grabbed and used it to beat the Mexicans.
Turns out this floridly psychotic patient exited his father's Ford Explorer while in motion, then caused thousands of dollars in damage to the stopped vehicle with a discarded fence post from the roadside.
The psych ward is definitely the place to pick up interesting stories.
i don't think that one patient was even altered... if i took catnaps i'd feel great and would strongly consider chillaxin. it was astute of her to note that tigers do, in fact, chillax regularly.
"I passed out after opening my phone bill."
Patient: I lost "something" in my butt.
Over 2 hours (30 of which were using the speculum in the wrong hole...), and 2 trips to the OR for tools later, a 4 inch wide, 1 and a half foot penis shaped dildo was pulled (or birthed rather...) from the rectum. Extended the sigmoid so far that it was at the level of the splenic flexure on Xray.
The big risk was perfing the colon because he had left it in for 24 hours and the rectum was really inflammed. He did this because he was to embarressed and thought he could get it out on his own...
He was so thankful afterwards because he was a farmer and if he had needed surgery, wouldn't have been able to sit on his tractor... To be honest this was a good feeling.
Anyway this is why I support overnight call.
I had a lot of weird psych patients... but the three conversations I remember best went like this:
I've been told that I have bipolar or borderline or something, but I don't believe them. I'm only here to complain about my ex-ex-husband, who found out I was cheating on him and tried to push me down the stairs. That's why my arm's in a sling. The police officer is here because then I beat him up with an iron and he called them. He's so overdramatic! Anyways, I've got to go soon, because my skydiving instructor said I could go again, even with a hurt arm. You know, sometimes I think about not pulling the cord, just to see what it would be like, but I always do. I'm only 20 jumps from being an instructor!
Me: Insight-- poor, Judgement-- poor.
Well, I guess I came in because I have two living sprites living in my ears, and they whisper to me.
Me: Oh, what do they whisper?
Patient B: Oh, you know.... *shyly* the usual.
Me: Do they tell you to do anything?
Patient B: Oh yes. They tell me all the time. Its awful. They try and make me do things I don't want to. They're ruining my life.
Me: Do they ever tell you to hurt yourself or anyone else?
Patient: Oh no... no...
Me: What do they tell you?
Patient: Well, they tell me to drink Pepsi, but I like Coke.
Patient C, who was in an ED isolation room, and whom I was sent to interview alone:
I'm hearing voices.
Me: What are the voices saying?
Patient C: Well, they're telling me to kill you. Its pretty distracting, seeing as I'd really rather not.
Me: I'll be right back.
:: Umm... the speculum was used in what wrong hole? I feel like anatomy is failing me. Where else did you put the speculum in this dude?
Fabulous story. Did he accidentally fall on it in the shower? I hear that happens a lot. Showers are tricky.
we had to use a speculum to visualize....it was very far in. Believe me this thing dwarfed the size of the speculum. After we got a grip on the thing, we were able to get it out, and had to take out the speculum prior to removal because the diameter of the speculum was probably about 1/3 the diameter of the object.
He was in the process of doing "naughty things" when this got sucked up. he had it on a chair, sat, and before he knew it, that sucker was gone. My guess is he had created a vacuum between the object and his bum hole. It had such a strong vacuum on it that anytime we got a good grip, it would eventually rip a piece of the rubber off, and the unclamped dong would get sucked in. You could actually feel the beast in his abdomen on palpation. I was pushing on the abdomen while the intern was pulling....not one of my proudest moments....
Haha. Nice way to put it.
My thought exactly. Maybe the pie hole? Or the patient was really masculine female?
After reading it several times, I realized that the poster meant a hole other than where you'd normally place a speculum...not as though they put the speculum someplace where they couldn't visualize the object.
To overcome the vacuum effect, use an NGT (through the rectum) and place it up past the object. Letting air in/out through the NGT breaks the suction, making the object easier to retrieve.
ah, the things I learn on SDN...
I'm filing that away for just the right moment.
If the object is THAT big, how do you get the NGT past it in the first place?
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