Some weird stories

First of all, I was hit by a patient on my last shift. I'd never been hit before. Spit on- yes. Groped- yes. Cursed at- daily. But no patient has ever intentionally raised a hand to me. This woman was bipolar and out of control. We try our best not to sedate or restrain patients in the Emergency Department if we can redirect them verbally. This woman tried to escape, but did not have the capacity to make decisions for herself. I stopped her and put a hand on her shoulder to try to guide her back to her stretcher. She raised her hand a smacked me. It was only on the arm and it only stung for a few minutes, but I was shaken. For her safety and the safety of the staff (me included!), we gave her some powerful sedative medication. I went to check on her later and she looked at me and said, "I'm sorry." I don't think she knew what she was apologizing for, but she did know that she had done something inappropriate. The mind does amazing things.

Next, the goofiest statement of the week. From a woman who had complaints from her head to her toes. When I asked which thing specifically brought her to the Emergency Department, she of course replied, "all of them". In any case, I was asking my usual list of questions, which includes an allergy history. "Well, I used to be allergic to ketchup, but since they took out my fibroids, I can eat it." What?!?! Is this one of those scientology things?

Last is my "I can't believe the lives that people lead" moment of the week. I attended to a young man, about 25 years old, who was brought by the police to be examined before going to jail. He was in handcuffs and had some dried blood in his mouth. He said that the police had beaten his head against the ground nine times and that he had lost consciousness. He seemed a little out of it, so I decided that he needed a CT scan of his head. During my questioning, he revealed that although he is on a powerful heroin-antagonist, he still used IV heroin, his last use being that morning. "Doc, while I'm here, can you look at my arms? I think I have some infections." He sure did. "Do you skin pop?" I asked. "No, I just have bad aim." He asked for a drink of water and I told him that I didn't want him to drink anything until he had his head scan. He was furious. "You could have blood in your brain, which could kill you," I said. He looked at me and said, "Maam, I use heroin every day. I could die at any minute. A little bit of blood in my head doesn't scare me. If I die, I die." There was no answer to that. Before I could get him some water, he agreed to have the scan. It looked fine.

It's not a tumor

Unfortunately, it was. Today I had to tell two patients and their families that they had brain tumors. It is so uncommon to even have one patient with a brain tumor that two kind of overwhelmed me. Both patients were stoic, but their spouses started to cry. It's not necessarily a death sentence, but there is just no good way to tell someone that he/she has cancer in the brain. One patient presented with 2 weeks of worsening memory loss and difficulty word-finding. The other had a change in her mental status. We thought she was on drugs. She wasn't. She had two tumors in her head that were pushing against the other side of her brain. It had been going on for a few weeks and her family doctor told her she had a "complicated migraine". I don't have the benefit of knowing these people. This is the first time I'm meeting them and I have to give them life-changing news. I used to cry with them, but have developed some coping skills in order to keep my sanity. But coping skills aren't enough for these two patients.

0 for 6

It was one of those weeks- I couldn't figure out what was wrong with anybody, it seemed! In one shift, I had four different patients with abdominal pain and none of them had any objective signs of disease. Normal blood tests, CT scans, urinalysis. Even their exams and stories were inconsistent. One of the things I like most about medicine is the search for the right answer. The clues are often hidden, poorly expressed or both. I get such a sense of satisfaction when I figure something out. But not figuring it out is so annoying. One young man had right lower quadrant pain, which made me suspicious for appendicitis. His pain had been there for four days. He had told the triage nurse that his pain was in his left upper quadrant, diagonal from where he told me it was. I treated his pain and ordered some tests. They were all normal and his pain kept coming back. I sent him home. I still don't know what was wrong with him. A teenaged girl came in with right sided chest pain that brought her to tears. Her mother insisted that her right neck was swollen. Her exam was essentially normal. She had no risk factors for a pulmonary embolus (blood clot in the lungs), but I did a CT scan of her neck and chest to make sure. Needless to say, they were negative. When I went back to tell her, the pain had completely resolved and her breathing was unlabored. What was it? I have no idea.