Why Bother?

Why do people bother to go to see the doctor?

It's not like most of them actually listen to what the docs and nurses tell them.  Some do.  That's great.  But this post isn't about them.

So many people come in to the ER or to their primary care provider (PCP) for problems, but don't seem to give a crap enough to do what we tell them to.

Case in point:
18 year old female with abdominal pain, nausea, vomiting in the ER.  Turns out the girl has a UTI.  We give her discharge instructions, along with a prescription for some antibiotics and set her up with our low cost clinic for follow up care by the PCP.

One month later, same girl shows back up with the exact same symptoms.  I happen to be her nurse again.

NurseHubba: Oh, no!  Sorry to see you back again (sympathetic tone, not irritated).  

Repeat Offender: Yeah, I didn't get better after last time you people (you people was said in a derogatory tone) saw me.

NurseHubba: The antibiotics didn't help?

Repeat Offender: Nope.

NurseHubba: Well, did you follow up with the clinic to get something else?

Repeat Offender: No.

NurseHubba: Did you take the whole bottle of antibiotics like we talked about?

Repeat Offender: No.  I didn't get them.  I can't afford to buy antibiotics! 

Let me make sure this is clear for everyone.  It was a $4 prescription.  She smokes.  She reeks of it.  She's playing with an iPhone.  Foregoing one pack of cigarettes for her prescription would have been relatively easy.  Hell, she could have panhandled outside the pharmacy to get enough for the script.  She can afford an iPhone and cigarettes, but not her prescription.  Then she bitches at us for not taking care of her properly.

People always want a magic pill for their problems.  In this case, we were able to get her one, but she still didn't take it.

I FEEL LIKE I'M TAKING CRAZY PILLS!!!!!!!!

Discharge Instruction Of The Day

Young lady came in today because she had a pretty violent seizure at the local grocery store.  

She has no history of seizures or any other medical problems, but she does like smoking pot.  

She bought some synthetic marijuana from "some guy," smoked it, went to the store, and had a seizure.

She was ok and was discharged with the had-written instructions from Dr. Discharge:

"Stop smoking synthetic marijuana."

That was a fun discharge to do. . .

Can You Please Hurry?

*4:30am:  Thirty minutes after arrival for chest pain.  EKG unremarkable.  Initial Troponin slightly elevated.  Still waiting on other cardiac enzymes and blood tests.*

Impatient Wife: Ummm. . . excuse me?!?! 

Nurse V: Yes, ma'am?  How can I help you? 

Impatient Wife: I'm not impatient, but when are we going to get to go home?

*Nurse V explains [again] what the plan is, including the meaning of additional tests we are waiting for.

NOT Impatient Wife: Oh. . . well, we both have to be at work at 7am.  Do you think you could hurry it up?

Seriously, lady?  You brought your husband, who has multiple risk factors for ACS, in for chest pain and you just can't wait to get him out of there?  You came in screaming about him having a heart attack and crying.

How about if you just leave and let us take care of your husband, since you don't really seem to care now that the dramatic entrance is over?

Why Can't You Fix Her?

*Family of a 99 year old woman with slightly more altered mental status than usual is bedside*

Dr. Discharge: Well, all her labs look good.  Urine is clean.  She has a history of Alzheimer's that's been getting worse over the years.  I can't find anything acute going on.  We're going to go ahead and send her back to the nursing home now.

*The nursing home, for once, didn't think she needed to come in but the family insisted*

Family: What about her confusion? 

Dr. Discharge: She's been confused for years and, I hate to break it to you, but she's only going to continue to get worse. 

Family: What about her shaky hands? 

Dr. Discharge: She's had Parkinson's for years. . . 

Family: What about her high blood pressure? 

Dr. Discharge: She's had that for years too and is on medication. 

Family: But it's too high!

Dr. Discharge: It's 140/90.  It's a little elevated, but the doc at the home can take care of a med adjustment.

Family: What about --

Dr. Discharge (giving me the look that he's about to lose patience): Look, there isn't anything going on that hasn't been going on for years.  There's no emergency.  There's no acute illness.  This is an EMERGENCY room.  We can't fix or test for every little thing that is going on.  Unfortunately, there's no magic pill or procedure that's going to fix everything she's got going on.  She's ninety-nine.  She's got to see her primary doc at the home.

*Dr. Discharge walks out*

Family (Great, now their attention is on me): Well, where did he go to medical school?!?!  He's the worst doctor I've ever seen!

Some people have no idea. . .

Thank You, Dr. WhiteCoat

I read this post on Dr. WhiteCoat's blog.

He links to a couple of videos that he and his colleagues were watching a lot at the time.  Well, one of those videos stood out to me.  The first time I watched it, I thought, "What the hell?"

But, for some reason, I had to watch it again. . . and again. . . and again.

I then shared it with my colleagues.  On slow nights, goofy videos help pass the time.  

WARNING:  Strong and offensive language.  Watch it and suck it up.  Or don't and don't bitch at me.

Here is the video

Soon, I hope, you'll be quoting along as we are.  The lines from the video have become a staple of our night shift conversations.

Whether The Weather Is Nice

It's interesting to me how much the weather impacts people's "emergencies."

You'd think that an emergency is an emergency, and that, no matter what the weather is, it needs to be treated.  I'm not talking about snow storms, tornadoes, or hurricanes here.  I'm talking about temperature.  People will actually stay home if it is "too cold."

I say "too cold" rather than too cold because I live in a part of the country where it doesn't really get that cold.  If it's below fifty or sixty out, people don't want to come.  Well, ok, fine.  I'm not complaining because that usually means we get patients in who actually need emergency services.

But it's funny that the same person who won't come in because it's cold out will come in on a nice day with the sniffles and tell me how they just had to come because it's an emergency to them.

I've got news for those folks.  If the temperature influences whether or not you come in to the emergency room, it isn't an emergency!

Bond. . . James Bond

*With a dude complaining of chest pain (in English accent) who is definitely schizophrenic and possibly manic*

This was not my patient

NurseHubba: Sir, your name is not James Bond.  Please tell me your real name.

Not James Bond: Bond. . . James Bond.

NurseHubba: Sir, stop that.  Remember that conversation with the cops you had just now?  This is real life.  What's your name?

Not James Bond: Eric Jones (pt gave real name, but obviously, this isn't it)

NurseHubba: Thank you.  Mr. Jones, what brings you in today?

Not James Bond: I'm 91 years old and I'm having chest pains.

*Dammit.  I need to get him back on track!*

NurseHubba: Ok, you're having chest pains.  But you are not 91 years old.

Not James Bond: No. . . no, I'm not.

Finally got him triaged, settled in, and evaluated.  Not sure if he ever really was having chest pains, but he was in his 50s. . . not 90s.  Ended up discharged by the awesome Dr. Discharge.  Also, we had to continuously corral him back into his room.  Every time we had to go help another patient and we'd disappear from his view, he'd start yelling, "NurseHubba!  NurseHubba!  I can't see you, NurseHubba!"

It took about a 20 minute stand off with police in the lobby to get this guy calmed down enough to come to the back.  The guy originally came in with an empty bottle of wine and a hand held work light that he was waving at people like a metal detector wand.  Also, he tried to pull the fire alarm and steal an O2 tank and a fire extinguisher.

Did I mention that the only thing he was wearing was a knee length skirt?

I love my job.  Never know what the hell is gonna walk through that door. . .