Themes
The themes were well-defined that week. One night it was the head injury theme. Three come to mind, if only because they all were equally doubtful in their mechanisms. But who am I to cast aspersions on a carefully constructed history?
Can a softball really break so many bones in the face? I suppose it can, but yuck. That one took calls to three different surgeons before I found one who sounded confident about fixing it. While I was dealing with that conundrum, my nurse said "OMG, the one in the waiting room is even worse than him!" Worse how, I asked. "Well, her eye is sticking out and stuff." Her eye? "Well her eyelid, I guess. But it's gross." That's what happens when you wait until the next day to seek attention. The eyelids can swell grotesquely. She reportedly broke up a barfight and got hit in the face with a chair. You always have to wonder about left facial injuries, because most people punch with the right hand only. Then there was the frying pan that mysteriously fell off a high shelf at work, striking the dude without obvious sign of injury. Yes, you can have a work note.
The next night it was the viral upper respiratory theme. I had that bug myself, so I know that it can't be treated. But I treated most of them anyway, because I'm not an antibiotic Nazi. If I tell you that it's viral and that antibiotics won't help, but you still want antibiotics anyway, then go for it little mama. I hope you have enough money left to pay my bill. Honestly, I'd rather overtreat a thousand snotty nose kids than get one complaint letter that says "that doctor told me it was a virus, but the next day my pediatrician said it was pneumonia." Did he do an X-ray? Probably not, he just wanted to be the "good cop." Thanks a bunch, oh master of small adults.
Finally, the theme I hate most of all: the young woman with left arm numbness. Early 30s, employed, worried, insured. At least you'd better hope you are insured, honey, because you won't believe how expensive the workup is for that complaint. Is it a stroke? A "mini-stroke?" A heart attack? A "warning of a heart attack?" Pinched nerve in the neck? Stress? "Gas?" For some cultural reason I don't understand, many nonwhites often presume that the cause of every symptom from the rectum to the fingertips is "gas." Which is fine with me, because that answer is probably as reasonable as anything I am going to be able to figure out, even after 10K worth of tests. Your mama is usually right about gas, I must admit.
The elderly lady who "just isn't eating" "just isn't herself" or is "weak and dizzy" is much easier, because she'll probably have something abnormal on one of her tests, even if it's just a UTI or chronic microvascular disease on her CT. But the 30 year old chick with no sign of anything on her exam, CT, ECG, or megalab workup? She's a harder sell, but if she wants to be admitted, I'll try to spin it. Then she can be discharged by someone smarter than me, with a diagnosis of GERD.
Otherwise known as gas.
Can a softball really break so many bones in the face? I suppose it can, but yuck. That one took calls to three different surgeons before I found one who sounded confident about fixing it. While I was dealing with that conundrum, my nurse said "OMG, the one in the waiting room is even worse than him!" Worse how, I asked. "Well, her eye is sticking out and stuff." Her eye? "Well her eyelid, I guess. But it's gross." That's what happens when you wait until the next day to seek attention. The eyelids can swell grotesquely. She reportedly broke up a barfight and got hit in the face with a chair. You always have to wonder about left facial injuries, because most people punch with the right hand only. Then there was the frying pan that mysteriously fell off a high shelf at work, striking the dude without obvious sign of injury. Yes, you can have a work note.
The next night it was the viral upper respiratory theme. I had that bug myself, so I know that it can't be treated. But I treated most of them anyway, because I'm not an antibiotic Nazi. If I tell you that it's viral and that antibiotics won't help, but you still want antibiotics anyway, then go for it little mama. I hope you have enough money left to pay my bill. Honestly, I'd rather overtreat a thousand snotty nose kids than get one complaint letter that says "that doctor told me it was a virus, but the next day my pediatrician said it was pneumonia." Did he do an X-ray? Probably not, he just wanted to be the "good cop." Thanks a bunch, oh master of small adults.
Finally, the theme I hate most of all: the young woman with left arm numbness. Early 30s, employed, worried, insured. At least you'd better hope you are insured, honey, because you won't believe how expensive the workup is for that complaint. Is it a stroke? A "mini-stroke?" A heart attack? A "warning of a heart attack?" Pinched nerve in the neck? Stress? "Gas?" For some cultural reason I don't understand, many nonwhites often presume that the cause of every symptom from the rectum to the fingertips is "gas." Which is fine with me, because that answer is probably as reasonable as anything I am going to be able to figure out, even after 10K worth of tests. Your mama is usually right about gas, I must admit.
The elderly lady who "just isn't eating" "just isn't herself" or is "weak and dizzy" is much easier, because she'll probably have something abnormal on one of her tests, even if it's just a UTI or chronic microvascular disease on her CT. But the 30 year old chick with no sign of anything on her exam, CT, ECG, or megalab workup? She's a harder sell, but if she wants to be admitted, I'll try to spin it. Then she can be discharged by someone smarter than me, with a diagnosis of GERD.
Otherwise known as gas.
Labels: patients
posted by scalpel at 10:52 AM
14 Comments:
Playing Little League, my son took a grounder in his mouth. His braces cut the insides of his lips pretty badly, but probably enabled him to keep all his teeth. Looks bad when it happens, especially to moms. His mom, anyway. Not that I was much calmer.
I don't know how old I was, but as a kid, I ran into a tree on my bike. It didn't hurt at all. Honest. Of course, a tree branch did cut my head, and as soon as my little brother saw the bleeding (we were probably 8 and 6 years old at the time?), he started jumping around in circles screaming. My dad ripped off his shirt and pressed it to my head, but when we got back to the minivan and my mom saw me, I'll never forget her jumping to the otherside of the van, backing into the wall in terror. All my blonde curls turned red that day, and my mom joked, "You always wanted to be a redhead!" Oh dear... It didn't need any stitches or anything as it was a tiny scrape to the scalp, but darn those head wounds can bleed!
I can attest to the eyelid swelling thing. When I had surgery to my face, the left eye swelled completely shut and the right eye was about 90% there. I was 16 at the time....16 yo female with face looking like it was hit by rather large object...not pretty!
Funny to read about the 30 yo female thing... The other night, my dad took me to the ER after I had tried every single thing I could think of to treat my severe shoulder pain with spasms. I did not want to go and as he said he was leaving right now to take me as I couldn't stop crying, I finally convinced him to let me give it one last try by taking a hot shower, too. By the time I got to the back and the nurse got my entire history, she said, "You're going to scare off the interns with this one!" Hehh.....wouldn't be the first time - and part of the reason I didn't want to go!! They did get it to stop spasming and decreased the pain enough so I could get through the night and call ortho myself the next day - everybody was really great. (And I don't think that was just because I'm a neonatal nurse in the same hospital and worked in that very same ER or anything!)
You're giving me flashbacks to my ER days. (And I STILL think trampolenes and skateboards should be outlawed.)
I had a patient who broke his mandible playing cricket - quite unlucky too, since he was wearing one of those helmets with the cage in front. My (Indian) colleague drove me mad by wittering on for ages about exactly how you'd have to bowl the ball to get it to do that. I felt that, as a Scottish bird, I should have a special cultural dispensation to get out of hearing such a boring conversation, but it was not to be.
Where are your archives? I wanted to read more but couldn't.
The insight of what goes on in the ER. And I thought Scrubs made most of that crap up. Nice stuff, I'll have to keep checking back.
Hi Scalpel:
I admire anyone who works in an er. It's a tough place to work.
I worked this weekend, and I'm trying to catch up with my blog duties. Thanks for coming by and saying hello on my blog.
MJ
whoa. I knew life in the ER was tough, but I alse know it provides endless material for humour. wouldn't be surprised if the guy who came up with Scrubs was an ER doc :)
P.S. the locum: thank yer stars he wasn't pakistani. you'd never hear the end o' it, laddie.
You're gonna catch hell from Flea for referring to kids as "small adults."
You're gonna catch hell from Flea for referring to kids as "small adults."
You're right. They aren't really small adults. More like small Democrats.
refarding the 30 y.o. female with left arm pain.I am a female mid 30's and I work on a cardiac floor and after 2 weeks of having chest pain when climbing stairs, I told my boss and the cardiac P.A. what was going on. the P.A. thought it was my gallbladder and my boss was concerned and got me in to see the cardiologist.
A week later,saw the cardiologist and went for a heart cath 2 days later and wound up needing a triple bypass! I avoided the emergency room because I was worried that they wouldn't take me seriously!
cat
We take chest pain seriously even in 30 year old women....heck, I admitted one tonight. But the incidence of atherosclerotic heart disease is somewhere in the 1/1,000 to 1/10,000 range in that population, I would guess.
Gas...I laughed till I cried.
Re: girl with numb arm - I say MS. Unexplained numbness from a 30 y.o. female - fits it to a tee. I am sure the MRI with contrast solution showed the lesions...
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