The Patient of the Year

(This is not meant in any way to disparage my patient.  I post this so you get an inkling of the challenges facing the terrifically good-looking but otherwise ordinary Emergency Physician during a shift).

A patient presents to the ED, from an assisted living center.  The Chief Complaint on the triage form says ” ? ”  I’m game.  Into the cubicle we go.

“Tell me the story”, I say.  Blank look.  Look again at the triage form.  ‘Patient is deaf’ it says.  Also, ‘history of schizophrenia, and CHF’.  Ooh.  No medication list. 

Great.

So, a good PE is completed, and a lot of pantomime is done.  The interpreter is called.  And, a wait ensues for said interpreter, though the lab workup continues.

The interpreter comes, sleepy but competent.  After a while signing with the patient, I get something unexpected: ‘this isn’t making any sense’.  What do you mean?  ‘I mean the answers have nothing to do with the questions, and there’s a lot of things that make no sense’.

Ask if the voices are louder than normal.  ‘Yes’, and the interpreter is relieved, as now it’s all making sense, at least for them, if not for the patient.  Does patient think their voices are out of control?  ‘Yes’ says interpreter, clearly relieved that things make sense now.

Labs are returning, and it’s not good news.  Elevated troponin could (probably does) indicate cardiac injury.  ?Chest pain? is asked, and there is no answer that makes sense, per the interpreter.  The EKG looks like the chest xray: wide and abnormal, but nothing that makes the clinician panic.

To say the consultants were thrilled with this admission would be an understatement, but not one griped. Amazing.

Patients Say the Darndest Things

This is from a colleague.  This is real Emergency Medicine:

I was dismissing a 70 year old lady with abd pain that my night doc had left for me.  Her lab work, x-rays and CAT scan were normal. When I told her this, she said  “I just want you to tell me why my butthole won’t open up and let my shit out.”

Direct and to the point.  Nice.