Things I Learn From My Patients

[deleted109597]

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Ok, I think I forgot to post this one (although if I did, shoot me).

We had severe overflow issues one night, so we were taking waiting room patients into the quiet room to draw labs on them so that they would be dispo'ed by the time the got back.

So I get this 18 year old kid with "flu-like illness" and bring him into the QR. Get the vacutainer needle in him (I'm a tech at this time), start drawing the rainbow. Get to tube 3, and kid makes a noise. I look up to see him turn green and go limp. So limp that he becomes incontinent. In his clothes, on a cloth chair, on a carpeted floor, with a needle in his arm. The doors are shut, and there aren't any call lights in the QR. I get the last tubes (I'm sure as hell not sticking him again), tape him up, and basically prop him so I can get a nurse.

Kid wakes up, and ends up having to go home in a gown. I think environmental had to burn the chair.

 

[Febrifuge]

I get the last tubes (I'm sure as hell not sticking him again), tape him up, and basically prop him so I can get a nurse.

Damn right. That's my kind of tech!

Shoot, I've been a tech now longer than I'll be in PA school. I've probably cleaned my body weight in poo by now.

I recently learned something that's not funny, just interesting (to me). I encountered the meanest, grumpiest, most disrespectful patient ever... who later became the sweetest.

When newly roomed, her tooth pain made the patient demanding and surly; nothing anybody said convinced her we were not hateful incompetents bent on making her feel worse instead of better. Nobody, from me to the RNs to the docs, came back to the nurses' station after an interaction without remarking on this patient's beee-yotchiness. The patient hit the "CALL" button at three-minute intervals, to see how those pain meds were coming along. Then she discovered the "CODE" button. Total nightmare.

Later, with a Cipro drip going and two doses of Dilaudid on top of 6mg MS, waiting for her admission to go through, she was apologetic and repeatedly thanked me for being patient with and good to her.

So I learned not to be too hasty. Pain makes people weird. Sometimes they literally cannot perceive, in the moment, that things are really under control and will soon be okay. Or maybe they can, but they are only able to respond as though they're being threatened or abused.

This ain't a funny one, but I really feel like this was a step in my education, and my cruddy paycheck will be worth it this week.

 

[sphincter tone]

If you have a total BS MVA in the middle of no where with your car jam packed full of family members, the appropriate course of action is

1) get out of the car and running around the scene screaming

2) call 911 and inform the dispatcher that all of your (talking, walking, crawling in the mud looking for any spilled narcotics from the vehicle) family members are critical

3) whip out your cell phones and call EVERYBODY in your phonebook so that we magically get 30+ of your hysterical family/ friends/ neighbors/ dry cleaner/ kindergarten teacher/ and of course dog walker on scene ALL screaming about how horribly the fire department/ police department and EMS are treating you

4) crying, screaming, moaning, and swearing are perfectly acceptable alternatives to answering the paramedics' pesky questions

5) Later call and complain that EMS stole your pain meds

 

[DropkickMurphy]

If you're having a panic attack, and you have been drinking, it's probably not a good idea to take a Xanax. It's even a worse idea to try to keep yourself from going into a coma by taking Ritalin.

 

[USAF MD '05]

If your flank pain diagnosed as a 5 mm stone in your proximal ureter 2 days ago becomes unbearable as the rock makes it's way towards your pelvis, and the measly percs aren't working, by all means, have your wife pull over on the way to the hospital ( about 15 minutes away) and call 911. Wait 15 minutes for the ambulance and the complete your 15 minute ride. Pain really does make people nuts.... Steve

 

[Annette]

I learned that it won't really matter if I tell you no IV narcs for your chronic daily headache when you already have a half used stash of po diluadid in your purse. Especially if you've taken your stashed xanax as well.

 

[sphincter tone]

If your flank pain diagnosed as a 5 mm stone in your proximal ureter 2 days ago becomes unbearable as the rock makes it's way towards your pelvis, and the measly percs aren't working, by all means, have your wife pull over on the way to the hospital ( about 15 minutes away) and call 911. Wait 15 minutes for the ambulance and the complete your 15 minute ride. Pain really does make people nuts.... Steve

Or even better...

2 miles away from the hospital, have your wife u-turn on the feeder and drive 5 miles back up the freeway the OTHER WAY to the ambulance station so that they can take you to the same hospital.... bonus points if you weigh 400+ lbs and don't fit on the stretcher 🙄

 

[ForbiddenComma]

Incidentally, some ED nurses have a similar thread going in their forum 🙂

http://allnurses.com/forums/f18/phone-calls-no-outsider-would-believe-183939.html

 

[gujuDoc]

The real tragedy is that she thinks she can get it by coming to the ER and saying she has vaginal bleeding.


Take care,
Jeff

Sounds like the Montel Show or one of those day time talk shows!!! I remember seeing one of those type of shows where this lady had like 5 people tested as possible fathers and not one of them turned out to be the dad. Then she had come on the show at a later date and had another 5 men tested to be her baby's daddy and it turned out none of them were the father either.

 

[Kittenmommy]

Kittenmommy, what were the ABx for? Did he get a pneumonia from not breathing deeply?

Kittendaddy has asthma and the ER doc said that he didn't want to take a chance that maybe there was a bit of internal bleeding from the fracture... or some kind of fluid leak. Something like that. This was in July, so I can't remember the details. I know that the antibiotic was prescribed to prevent pneumonia.

Do you think that's crazy, like maybe the guy didn't know what he was doing? 😱

I know for a fact that he didn't give Kittendaddy enough Vicodin, because he was in serious pain. His meds ran out long before his pain ran out. Good thing my uncle is an MD. 😛


ETA: Just curious - as a soon-to-be ER doc, what do you think about the kitten story I posted? Am I right that anyone with any sense would've realized she should've been admitted when we first brought her in?

Edited again because: I just realized from your sig you're not an MD (yet!). 😀

 

[Kittenmommy]

So I learned not to be too hasty. Pain makes people weird. Sometimes they literally cannot perceive, in the moment, that things are really under control and will soon be okay. Or maybe they can, but they are only able to respond as though they're being threatened or abused.

My mom died of cancer in January.

She told me that the pain is so incredible, there's nothing you wouldn't do to stop it.

She was a very, very religious person who believed that suicide is a sin that would condemn one to eternal damnation. Yet, only two days before she died, she begged one of her nurses to kill her. In fact, that was the last lucid thing she said.

And she had all the pain meds one could ever want - as I said in an earlier post, my uncle (her brother) is an MD. Some kinds of pain just can't be controlled, and it's literally Hell on Earth.

And now, back to your regularly scheduled thread.

 

[deleted92121]

On my third day of my first week working as an EMT, we got a call of a 33 y/o male complaining of hand and shoulder pain.

We get there and he is sitting in a chair watching tv. We ask him when did the shoulder start hurting and he says about three days ago. We assess the shoulder and ask if he hurt it in anyway. He says no and we move on to his hand. Assess his hand and ask him if he hurt it or anything made it better or worse. He replies with loud moans and tears, thrashing about wildly.

We are en-route to the ER and he looks over and says "I wonder if I hurt my shoulder when I fell off the roof a few days ago"...WTF?!

We now have that MOI and now what about the hand? We ask what he was doing before his hand started hurting. He says it started hurting while he was playing his video games. Of course, the logical question is to ask how long he had been playing. His answer: 2 DAYS STRAIGHT!!!

I'm loving this job...

dxu

 

[El Cheba]

If you are seen for a abcessed tooth, please get your prescription filled promptly. Otherwise you might have to return to the ED a few days later to have an awake tracheostomy, due to the abcess deviating your trachea, so they can then put you to sleep to drain the abcess.

This has happened twice here lately and the first one died. Havent heard an update on the latest one

 

[DrBuckNasty]

Exactly, especialy if you give a fake name, address and SSN. Not that I've ever done that for a broken hand.

seriously now.. I went to an ED some 5 years ago, and I'm still making payments for the 950$ they charged me for the amoxacillin.. I always wondered what would have happened if...

 

[NKMU]

I learned that if you eat chlorine-tainted tacos (that never existed), it will make you want to kill your parents and blow stuff up. The only thing that can save them is the "angel of death" that is going to make you jump from an airplane WITH a chute, but won't let you pull the ripcord.

Psych patients are the best. The only reason I can keep a straight face while getting a history is because I feel bad for them.

 

[Jeff698]

seriously now.. I went to an ED some 5 years ago, and I'm still making payments for the 950$ they charged me for the amoxacillin.. I always wondered what would have happened if...

Not to pick nits or anything but the $950 wasn't just for the Rx. You utilized the facility, the technical and nursing staffs as well as a (presumably) appropriate physcian evaluation with the resulting decision making based on years of education and experience.

Lots more than an Rx.

Take care,
Jeff

 

[acrunchyfrog]

Hmmm.... what have I learned from several years working in an ED?

1. A blood alcohol of 2.3 will NOT prevent the rattlesnake you're messing with from biting you.

2. Sometimes when Mom and Dad bring the kid in a 2 am w/ an earache, you're really treating the parents more than the kid.

3. If your scrotum has been swelling up to the size of a cantaloupe for the last two months, please by all means present to the ED at 4 am because you can't sleep. (actually this was a fun one. The biggest I/D I've seen in quite a while.)

4. There are some great sounding drugs out there, like Urispaz (a bladder antispasmodic) that make me think we ought to have drugs like Gedagrip and Godahell.

5. When being brought in by the cops after eating two 8-balls of meth, don't cuss and spit at the nursing staff. Because they get to select what size catheters they will be using to procure that urine spec and whether to use lido jelly. (I didn't know foleys could get much worse till that night)

 

[emtp6811]

4. There are some great sounding drugs out there, like Urispaz (a bladder antispasmodic) that make me think we ought to have drugs like Gedagrip and Godahell.

Brings a whole new meaning to "Take a chill pill"

 

[DropkickMurphy]

4. There are some great sounding drugs out there, like Urispaz (a bladder antispasmodic) that make me think we ought to have drugs like Gedagrip and Godahell.

I would like to give my grandfather some Godahell.....hopefully it comes in the form of a boot shaped suppository.

I've learned, just tonight, that he can call me at 3:00am from his hospital room and demand that I come help him "Get up to go piss". When all else fails, I can get up, go down there (it's 5 minutes away thankfully) and tell him in person that I can not and will not do that but I however can and will move his phone out of his reach. The nurse (a former coworker of mine) stood and laughed from the doorway. As I was leaving (slightly cranky from having been awoken from a sound sleep for this bull****), I told her that she could chart "Pt is A/Ox3 -to person, place and ability to piss off his family". She was still laughing when I turned the corner at the end of the hall.

 

[racerx]

hopefully it comes in the form of a boot shaped suppository.

Then he'll be calling you to help him 'go take a dump,' what, with the suppository and all.😉

 

[DropkickMurphy]

Then he'll be calling you to help him 'go take a dump,' what, with the suppository and all.😉

You get the idea though

 

[docB]

If you go to your urologist and they inject your penis with something to give you an erection so they can do some ultrasound doppler flow study do not go home and take a Levitra. 20 hours later when you come to the ER with the little soldier at full and painful attention I'll be explaining this rule to you as I inject the phenylephrine.

 

[ISR]

Selling copper wire can be a lucrative business, especially if you "aquired" it from a "friend" in the first place. However, precaution should be taken to make sure that the transformer you are "aquiring" the wire out of is not live when you stick your hand in there. Unless of course you want a good reason to change your name to "Bob" or "Mat"

85.5% TBSA FT burns resulting in bilateral AEA, right BKA, and left AKA

 

[Dr. Dukes]

Selling copper wire can be a lucrative business, especially if you "aquired" it from a "friend" in the first place. However, precaution should be taken to make sure that the transformer you are "aquiring" the wire out of is not live when you stick your hand in there. Unless of course you want a good reason to change your name to "Bob" or "Mat"

85.5% TBSA FT burns resulting in bilateral AEA, right BKA, and left AKA

This happened in greater Boston, except it resulted in 2X DRT when found by the security guards.

 

[Flopotomist]

I would like to give my grandfather some Godahell.....hopefully it comes in the form of a boot shaped suppository.

I've learned, just tonight, that he can call me at 3:00am from his hospital room and demand that I come help him "Get up to go piss". When all else fails, I can get up, go down there (it's 5 minutes away thankfully) and tell him in person that I can not and will not do that but I however can and will move his phone out of his reach. The nurse (a former coworker of mine) stood and laughed from the doorway. As I was leaving (slightly cranky from having been awoken from a sound sleep for this bull****), I told her that she could chart "Pt is A/Ox3 -to person, place and ability to piss off his family". She was still laughing when I turned the corner at the end of the hall.

Wait - did I read this correctly? Your bedridden grandfather needs help to get out of bed to urinate, and you drive over to tell him that you won't help him? Then you are so proud of yourself for being so "noble, selfless, and kind" that you brag about leaving your family member to suffer to a nurse (who hopefully doesn't share your attitude)??

And you want to go into medicine why exactly?

 

[racerx]

Wait - did I read this correctly? Your bedridden grandfather needs help to get out of bed to urinate, and you drive over to tell him that you won't help him? Then you are so proud of yourself for being so "noble, selfless, and kind" that you brag about leaving your family member to suffer to a nurse (who hopefully doesn't share your attitude)??

And you want to go into medicine why exactly?

You might want to read his post a little closer. His grandfather was in the hospital. There were nurses there whose job it is to help with that. Why would DKM be a bad person for getting peeved at his grandfather for calling him at home, across town, at 3AM, to come take him the the bathroom when there are people a call button away?

 

[Flopotomist]

You might want to read his post a little closer. His grandfather was in the hospital. There were nurses there whose job it is to help with that. Why would DKM be a bad person for getting peeved at his grandfather for calling him at home, across town, to come take him the the bathroom when there are people a call button away?

Don't be so quick to judge and pull out the "you are going to be a sucky doctor because you aren't a totally agape person" card.

I would hope that if an ailing family member calls you needing help going to the bathroom, and you are a short 5 minutes away, you would either go help (maybe he was uncomfortable with having a female nurse help him?) or would call the nurses station and make sure somebody ELSE was going to help him.

I would CERTAINLY not drive all the way over to my ailing family member, move the phone out of the way so that he could no longer use it, NOT help him go to the bathroom, and then mock him.

To respond to your final quote - is the type of person that would treat their own family like this the type of person you would want caring for you or your family?

 

[racerx]

I would hope that if an ailing family member calls you needing help going to the bathroom, and you are a short 5 minutes away, you would either go help (maybe he was uncomfortable with having a female nurse help him?) or would call the nurses station and make sure somebody ELSE was going to help him.

I would CERTAINLY not drive all the way over to my ailing family member, move the phone out of the way so that he could no longer use it, NOT help him go to the bathroom, and then mock him.

To respond to your final quote - is the type of person that would treat their own family like this the type of person you would want caring for you or your family?

If he is technically competent, I could give a rat's behind whether he was there to sooth my humanistic "needs". I'd rather have a technically excellent physician that knew what he was doing than a marginally competent boob that was good at holding hands and feeling my pain. I can be there for my own family and vice versa -- I don't need my physician to become a proxy for family. So, I don't care if he's not there for his own family...as long as he shows up and knows his stuff when it's time for an appointment.

Even doctors are allowed a private life, free from the scrutiny of the holier-than-thou brigade.

 

[Flopotomist]

If he is technically competent, I could give a rat's behind whether he was there to sooth my humanistic "needs". I'd rather have a technically excellent physician that knew what he was doing than a marginally competent boob that was good at holding hands and feeling my pain. I can be there for my own family and vice versa -- I don't need my physician to become a proxy for family. So, I don't care if he's not there for his own family...as long as he shows up and knows his stuff when it's time for an appointment.

Even doctors are allowed a private life, free from the scrutiny of the holier-than-thou brigade.

Let me put it another way - if I were ill and in pain at 3 in the morning, I would prefer to have a physician who was compassionate enough to wake up and write a pain med order instead of just disconnecting my call light and mocking me to the nurse. That is analogous to what DKM in essence did to his OWN FAMILY, and for that reason would predict that I would prefer to have somebody else as my provider.

I have said about all I have to say on this, so if you would like to have the last word feel free - I am not going to hijack this thread any further.

 

[gujuDoc]

Let me put it another way - if I were ill and in pain at 3 in the morning, I would prefer to have a physician who was compassionate enough to wake up and write a pain med order instead of just disconnecting my call light and mocking me to the nurse. That is analogous to what DKM in essence did to his OWN FAMILY, and for that reason would predict that I would prefer to have somebody else as my provider.

I have said about all I have to say on this, so if you would like to have the last word feel free - I am not going to hijack this thread any further.

And let me put it another way......

He is DKM's grandpa NOT HIS PATIENT!!!! He may be family but why does that mean he's the one who has to be obliged to go there at 3AM?? There are probably other family members who could have come and even possibly the nurses on duty and other people. He's not the freaking doctor and I'm sure he'd know how to treat his patients.

I know several physicians who may be arrogant as people with other indians at parties and all. But when it comes down to it and you go to them as a patient, they treat you with the utmost respect that a patient deserves and give excellent care. Get off the holier than thou attitude.

 

[FoughtFyr]

ENOUGH!

Flop - Quit calling people out in a personal way. Yes, I know DKM put the story out there and it apparently inspired strong feelings in you, but attacking him is not the answer. Let it go or I'll have to yellow card you.

Guju - You too - let it go. I realize you are only defending DKM but in doing so you are encouraging Flop.

I now return you to your regularly scheduled thread...

- H

 

[roja]

I learned it is perfectly acceptable for a woman's boyfriend to call EMS because 'she smells down there' and for her to get in the ambulance, drive to the hospital and then refuse to be seen because she don't have nothing wrong wit her.

 

[ISR]

I learned that the best way to dispose of a 55gallon drum half filled with gasoline is to weld the lid on so it won't spill when you put it in your truck. Without dumping out the gasoline first.

 

[O2 Jockey]

If you are a 17 year old male who decides to runaway from home taking both your 16 year old best friend “Paul” and his 14 year girlfriend in tow, by all means drink to excess as you speed down I-70 resulting in an MVC that kills the girl and seriously injures both you and your friend. While strapped down in full C-Spine immobilization in the ED, scream at the top of your lungs that this is “All Paul’s fault.” When we log roll you to perform a digital exam of your rectum to check for internal bleeding, we will be pleased when you begin screaming, “Rape! Rape! Someone’s raping my butt!” Again, blame Paul for all of this as you have done nothing to contribute to your own traumatic condition. When the nurse preps the meatus of your penis with warm betadine for foley insertion, we realize that you can only see lights and ceiling tiles, but we will giggle, nonetheless, when you clear your throat and sheepishly say, “That’s really sick Paul.” ​

 

[rescuedog]

Here are a couple of my favorites:

If you have a roofing nail through your thumb, it makes perfect sense to whine about getting a shot before we pull it out.

The best time to take a swing at your wife is when she is holding an aluminum baseball bat.

When you call because your husband is acting strange, don't tell the crew about the large dose of Vicodin he took 45 minutes beforehand.

 

[dmunorse]

Saw this in the OR but the pt came through the ED...apparently PVC pipe can be used as a sex toy. The male pt I saw must have preferred the 8" long by 3/4" diameter size. And he and his girlfriend must have been new at it, 'cause they had no way of retrieving it once it slipped in the rectum and couldn't be seen, despite their own attempts. By the time he came in, it was probably 10-12 hrs after insertion.

Lucky for him, the surgeon with the smallest hands of the group was on call to lube up, reach in, and pull it out. A couple fairly minor partial thickness mucosal tears had to be repaired, too.

 

[deuist]

I just got back from Latin America. Here are some of the chief complaints I saw this week:

1. My son gets hot when he stands in the sun for an hour.

2. My baby has parasites. I can tell because he sleeps with his eyes open.

3. I have a kidney infection... I know because my urine is dark yellow... Of course I don't drink water throughout the day.

 

[gujuDoc]

I learned it is perfectly acceptable for a woman's boyfriend to call EMS because 'she smells down there' and for her to get in the ambulance, drive to the hospital and then refuse to be seen because she don't have nothing wrong wit her.

This has got to be one of my favorite ones. Too funny!!! 😆

 

[Miami_med]

I just got back from Latin America. Here are some of the chief complaints I saw this week:

1. My son gets hot when he stands in the sun for an hour.

2. My baby has parasites. I can tell because he sleeps with his eyes open.

3. I have a kidney infection... I know because my urine is dark yellow... Of course I don't drink water throughout the day.

Hey Deuist,

Fun Trip 🙂

 

[docB]

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.

 

[gujuDoc]

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.

Wow that's real sad. That guy should have just gotten new chlorine tablets from the pool store and found out how to dispose of the old ones because they weren't good. When we had a pool, we used to use the liquid clorine stuff because it was much easier.

 

[docB]

Wow that's real sad. That guy should have just gotten new chlorine tablets from the pool store and found out how to dispose of the old ones because they weren't good. When we had a pool, we used to use the liquid clorine stuff because it was much easier.

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.

 

[gujuDoc]

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.

God some people lack common sense. I swear!!!

 

[dmunorse]

I just got back from Latin America. Here are some of the chief complaints I saw this week:

1. My son gets hot when he stands in the sun for an hour.

2. My baby has parasites. I can tell because he sleeps with his eyes open.

3. I have a kidney infection... I know because my urine is dark yellow... Of course I don't drink water throughout the day.

Sounds familiar (been in Central America four times for medical mission trips). The level of education of most people in rural areas down there is quite poor, though, so I have a hard time finding fault. I feel especially bad for the young moms down there, oftentimes they don't have anyone to really show/teach them how to handle/take care of their babies.
Another thing is that you see much more attribution of illness to spiritual causes down there than in the US.

 

[wrested]

Even having a pool at a group home for the mentally ill seems like a profoundly bad idea from the outset.

 

[gujuDoc]

Sounds familiar (been in Central America four times for medical mission trips). The level of education of most people in rural areas down there is quite poor, though, so I have a hard time finding fault. I feel especially bad for the young moms down there, oftentimes they don't have anyone to really show/teach them how to handle/take care of their babies.
Another thing is that you see much more attribution of illness to spiritual causes down there than in the US.

You think spiritual causes are emphasized in Central America?? Just wait til you go to India!!!! There are many places in India that don't even believe in mental illness and think its some religious reason why there relatives with mental illnesses are suffering.

 

[docB]

Even having a pool at a group home for the mentally ill seems like a profoundly bad idea from the outset.

Yeah, that's what I thought too but then who am I to judge? I'm just the guy who cleans up the mess. I do think that the thought process must have been fascinating: "How can I entertain the unstable mentally ill boarders? Hmmmm. I know! A pool. That way they can fall and drown and otherwise just generally endanger themselves. That's the ticket. And I'll have the residents take care of the pool, measure out the chemicals and so on. Great.

I can only assume that the residents of this particular group home also use the kitchen to cook everything, tend the grounds with mowers and power tools and repair the roof when need be and so on. It sounds like some horrendous Adam Sandler movie.

 

[SuziQ]

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?

 

[Chronic Student]

Just so this unknown menace can be brought out in the open.

Do not skateboard behind a 4-wheeler going at full blast when you are under the influence of EToH, pot and meth. The asphalt may be a bit hard when you lose control and land on your head and you may get a pretty bad CHI.

Even if you do eventually recover, relearning how to speak, walk and eat is not nearly as fun as it sounds.

-Mike

 

[Janders]

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.