We pretty much went paperless in our ER several years ago. In paper's place, I now have a computer that lists all of the patients in the ER, their complaints, their vital signs, and their medical histories.
All at my disposal with the click of a mouse. Yes, mine is a powerful finger!
The nurses enter most of this medical information in triage or at a bedside computer in the patient's room. Occasionally, they will enter little tidbits of information that are quite funny. I live for these innocent commentaries.
"Patient's toupee keeps shifting on his head."
"Patient had smelly flatus during interview." (Is there any other kind?)
"Patient refused to put on gown but did adjust her halter top."
"Patient getting long lingering hugs from her 'brother'."
"Patient did not wash his hands after showing me his hernia."
"Patient used to smoke but quit three hours ago."
"Patient is constipated and tried to disimpact himself in our bathroom."
Yes, it's these little subtle comments that sometime tell me the most about a patient. And sometime warn me to shake the patient's hand with a glove on when I introduce myself!
So, after clicking to treat the patient in Room 29, directly across the hall from the nurses' station, I scanned the computer screen for the patient's information.
She was 24, complaining of abdominal pain for three days, and had no entertaining nursing comments charted. Another serious, legitimate patient.
As I walked into the room, I was surprised to find a young woman sitting comfortably on the bed, just finishing a small bag of Cheetos. In the corner of the room, accompanying her, was her husband, his hands dipped into a small bag of Doritos. Both had orange fingers. They must have been snacking for a while.
Now, if you had significant enough abdominal pain that brought you to the ER, don't you think you would pass on the Cheetos? I know I would. And trust me--nothing comes between me and my Cheetos!
I introduced myself to the patient and her husband but skipped my customary handshake. I didn't want orange fingers, too.
"What brings you here today, maam?"
The patient mumbled something that I couldn't understand.
"I'm sorry, can you say that again?"
The patient held up her finger to me, her way of telling me to wait. She nimbly jumped from the bed, went to the counter in the room, picked up a 20 oz. Pepsi that was nearly full, and proceeded to chug it down to within an inch of the bottom. As she put the Pepsi back down, I noticed that there was a second, though empty, bag of Cheetos sitting on the counter.
She spoke a little more clearly now, thanks to the Pepsi washout, although I could still see the orange crumbs clinging to her chin and orange saliva building up in the creases of her lips.
"You're the doctor, right?" I nodded yes to her question. She grabbed her left abdomen. "Oh," she started moaning, "oh my God! Help me, Doctor! My stomach hurts so bad." I think I actually saw her suppress a smile.
She was serious. Seriously a bad actress. She could have at least practiced in front of a mirror.
And maam, I'm so sorry, but Julia Roberts just called. She wants her Oscar back.
I asked this patient some specific, in-depth questions and got only the sketchiest of responses.
"Well," I said, after finishing my interview and performing a stone-cold normal physical exam, "I'm happy to say that you have a good exam. And your blood and urine work that the nurse ordered in triage came back normal, too."
"What?" she shrieked. "You mean to tell me I just waited four hours to have you tell me I'm okay?"
"Maam," I gently pointed out, "your vital signs are good, your exam is unremarkable, and frankly, you ate two bags of Cheetos and chugged a 20 oz. Pepsi. I think whatever was hurting your belly is already passing you by."
She looked very unhappy while she nervously glanced over to the corner at her husband.
"Umm," she said, "I need some pain pills."
"Pardon me?" I asked.
Now, I am a very compassionate doctor and rarely hesitate to provide pain relief with strong medications when needed. In fact, I sometimes get teased by our nurses for being a "candy man." So I promise you, I was not taking this patient's complaints lightly. It's just that between her complaints, her actions, her exam and her test results, my suspicions of her having a serious illness were so low that all she was going to get from me was Tylenol.
"Tried that. It doesn't work."
"Well, I'm sorry. You won't be getting any pain medication with your visit today."
She eyed me, I eyed her, she eyed her husband, he eyed me, I eyed him.
I was eyed out.
"You sure I can't have any pain pills? Just a couple. I'm hurting so bad." She was now holding the other side of her belly, not remembering it was the left side that was hurting before.
And then, in the midst of her drama, she did something unexpected and glorious.
A big, nasty, bullfrog burp.
I think after that, she knew it was over. I shook my head no to her request, wished her good luck, and advised her to return if she got a fever or her symptoms worsened or changed.
"Yeah, whatever," she mumbled as she easily jumped up from the bed to get dressed.
I went back to my computer screen to get her discharge instructions ready and noticed that she had another page that I hadn't scrolled down on.
There, on page two, sat my warning from her nurse.
"Patient's 19th visit this year."
Maybe she just likes the Cheetos from our waiting room vending machine.
I hope everyone had a great Thanksgiving weekend. Thanks for reading. Next post will be Wednesday, December 2. See you then.