Best Chief Complaint of the Night

Patient “A” is brought in by EMS, and a friend accompanies A.

EMS reports they were called for a seizure, and on arriving they found A to be having a lot of flailing behavior but not having a seizure.

A query of the friend elicits the following: A had ‘only’ had 5 or 6 mixed drinks and had three lines of cocaine, but friend was concerned because A does that a lot and doesn’t act oddly, and “I think someone put something in A’s drink”.

It’s sometimes difficult not to roll your eyes during the history and physical, but I tried.


  1. At least they admitted it. I racently had a patient with “stroke-like symptoms” (slurred speech, confusion, right sided weakness) brought in by his wife. My nurse said “he smells like crack!” He was tachycardic, hypertensive, and fidgety. He denied any drug use. His concerned family filled the room.

    Two hours later, we finally get the drug screen showing cocaine, marijuana, and benzos. He then admitted to smoking some weed, but he just didn’t know how the other stuff got in there. “You aren’t going to tell my wife, are you?”

    Sigh. Expensive habit you got there, fella.

  2. scalpel-
    As n potential future ED nurse, can I seriously expect to come to recognize the scent of crack? That honestly scares me.

  3. An effective nurse uses all of the senses, including the “sixth sense.” I’m personally more scared of the smell of poop.

  4. LOL Scalpel, the smell of ulcerative colitis is perhaps the one that struck me as the worst. As a student nurse in the ER, one of the nurses I was working with decided that I needed to get the scut work type job experience and made me empty a bedside commode for a patient with ulcerative colitis. I almost threw up, myself! I really didn’t appreciate her giving me the jobs she didn’t want to do, but I guess that’s just another part of the learning experience! ha…

    People really do say the wackiest things sometimes. One night while in the ER (again while I was a student), I was taking care of a patient with abdominal pain, a history of abdominal surgery, and a seriously distended, tense abdomen that didn’t look all that great… She was moaning and told me that she had taken vicodin and something else that I can’t remember. I thought this was prescribed for her because she very obviously had received some sort of medical care recently and appeared to have a good bit of pain. She said she had been prescribed it. Then later on, she grabbed my arm and told me that she had bought it on the street because she couldn’t afford the prescription. She kept telling me about the drugs she bought on the street… I’m not sure if she was saying all this because she was worried that maybe what she bought wasn’t what she thought or what exactly! Her honesty was a little surprising!

    Then another one that really got me was I was taking care of an infant on the NICU one night when the baby’s mother called in to see how he was doing. The infant was being treated for neonatal abstinence syndrome and the mother had been positive (by UDS) for benzos, methadone, opiates, and crack… The mom was very obviously concerned about her infant’s condition, and the baby was not exhibiting any signs of withdrawal and we had stopped scoring him since it had been some time (he was fairly premature, so somehow skipped major withdrawal)….the mom then went on to ask me about how crack affects the baby. She actually put it as, “What about the crack?” I then picked my jaw up off the desk and asked if she had been doing it all the time during the pregnancy. She went on to say, “No…just once in awhile, you know. I just got really lucky I guess.” Oh my… (Pertinent details all changed for privacy, but she really did ask this…)

    I remember all the patients in the ER brought in unresponsive (cognitively) due to drugs and alcohol. We also had a ton that were there for seizures, and many were drug related. One night (during the time when I used to work ER patient registration) a patient was brought in and labelled John Doe. His family happened to call and ask about him by name, and I said we didn’t have a patient there by that name but we did have a patient that we could not identify. The family (wife, I presume) went on to describe him and said he’d been doing all these drugs…very brutally blunt. She did positively ID her husband – and she sounded quite pissed by the whole thing. It certainly wasn’t his first visit there for this, either. Sad sometimes…

  5. TheNewGuy says:

    Unfortunately, that’s the lot of many ER personnel… nursing drug cripples back form the edge of death over and over again.

    And people wonder why I’m against drug legalization…

  6. The chief complaints, and explanations, for certain foreign bodies are quite special as well.

  7. Frequent exchange:

    doctor: “do you use any drugs?”
    patient: “no”
    doctor: “well, do you smoke weed?”
    patient: “yes, sometimes”
    doctor: “when did you last smoke meth?” (repeat the question for every drug you can think of)
    patient: “two days ago”
    doctor: “I thought you said you didn’t use drugs?”
    patient: “I thought you meant today”


    I think you are confusing ulcerative colitis with pseudomembranous colitis. A good case of pseudomembraneous colitis will exterminate a whole wing of the hospital.

  8. “I slipped and fell on the shampoo bottle, and now it’s stuck in my…”

  9. Good story and somewhat analogous to the morbidly obese patient who comes in complaining of knee pain and when I suggest that his/her weight might be contributing they answer “no, I’ve been this heavy all my life and my knees have never hurt before…”

  10. One of my colleagues told me about a demonstration he claimed that he showed one of his overweight patients with knee pain. He took a styrofoam coffee cup and placed it upside down on the desk. “This is your knee joint,” he said. He then put his fist on top of the cup. “This is you.” He crunched the cup.

    I think he was an engineering major in college.

  11. Jerry – no he was definitely diagnosed with ulcerative colitis. I’ve never run into a patient with pseudomembranous colitis, although these are both topics that will be covered on Saturday’s pathophysiology exam (for my masters)… I saw a slide of pseudomembranous while reviewing with the prof yesterday and said, “Eww….”

    I have relived the smell on some small level with the few infants we’ve had with grossly bloody diarrhea… It’s just the mix of blood and…well…I don’t need to be graphic. Those that have smelled it know exactly what I mean!