Monday, November 30, 2009

Cheetos and Painkillers

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.

She burped.

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.


Rositta said...

I'm pretty sure I saw someone just like her at the ER last Thursday night as I waited patiently to be examined for a suspected retinal detachment. In fact there were five hours of patients just like her and I was never seen. I left in frustration after 6 hours risking possible blindness rather than wait some more, sadly...ciao

tracy said...

Ewwwww, "Cheeto Burp"....the worst! i loved it when you said you were "...eyed out"! Too funny! i mean, really, who sits in an Emergency room, munching om snacks? i would be embarrassed to be seen eating, by anyone!

SeaSpray said...

Aww c'mon StorytellERdoc .. it was the power of the CHEETOS ..she just couldn't help herself! ;)

Eyed out funny! The whole post was hilarious! :)

I can't drink 2 gulps of soda fast. it's too fizzy. No wonder she burped. Too bad you can't send them a video of her behavior.

Great post!

Classof65 said...

It's so unusual for a blogger to let me know when they're going to blog again -- thanks! It save me from accessing your site only to be disappointed that there's nothing new...

Danny said...


Anonymous said...

Funny but sad that there are people that will do anything for pain killers.19 times!! Some may say cheeto addiction..I say drug addict.

Bongi said...

this is a bit of a side note so sorry.

rositta, you risked possible blindness rather than wait 6 hours??

6 hours of patience vs lifetime of blindness?

fortunately, it seems, there was nothing wrong wioth you and you shouldn't have even been in the er, just like the patient in the story.

Rositta said...

Bongi, yes I left and risked blindness. You had to have been there to understand. I have two bad hips, degenerative spine and have recently had foot surgery. The chair provided to wait in was so bad that every time I stood up I almost fell over from a locked up hip. All I needed was a place to lie down which was not provided and I would have waited. This had nothing to do with patience, I saw people examined and on their way home who arrived way after I did with nothing more than the sniffles. Having said all that, the eye in question had retinal surgery in the same hospital in March and yes there was a reason for my vision issues which after seeing my Ophthalmologist today will be solved. Fortunately it was not a retinal detachment. Sorry for this long reply, I simply could not let that remark stand. For the record, I rarely to to an ER...ciao

StorytellERdoc said...

Hey All

Bongi and Rositta--I appreciated your specific exchange. In fact, I encourage more comments from anyone reading--just continue keeping them respectful and kind-hearted (and concise! LOL). Thanks.

From a doc standpoint, any visual change or disturbance could be serious. So I appreciate your shared experience and POV, Rositta, and your visit to your ER.

I appreciate your comment, too, Bongi. It hints of a wicked sense of humor (which I love) in comparing Cheetos girl to Rositta. Both symptoms could have serious consequences, so seeing a physician, ER or otherwise, is the wise thing to do if you are unsure. I think it's plain to see, though, that Rositta's motives and Cheetos girl's motives are completely different!

I am gaining some very cool and intelligent readers. Thanks for all the input and making this fun.


Rositta said...

I guess I'll come to the defense of Bongi (a little bit), he had no way of knowing that I'd had a Vitrectomy/Sceral Buckle back in March, without reading my blog and that the symptoms were exactly what I'd been told to watch out for. As it turns out it's a cataract grew so quickly that it's blinding me. What he also doesn't know is that I HATE Cheetos and if I wanted drugs my own doctor wouldn't hesitate to give them to me. Always respectful...ciao

SeaSpray said...

I'll work on concise ..(okay fellow bloggers can stop laughing now ;), but I make no promises. :)

EDNurseasauras said...

That is known around these parts as the "Cheetos Challange"; usually it is specific for adolescent girls complaining of abdominal pain who,as you know,travel in groups of no less than 5 at any given time. This is called the Teen Pack Rule.

SeaSpray said...

ED Nurse ..I never heard the Teen pack rule. That's funny. :)

Hey, You said...

Bongi, your comments are a bit offensive.

Rositta didn't leave rather than wait 6 hours. She had ALREADY waited 6 hours, then left when it was clear the ER didn't find her problem to be a particularly high priority.

If you think she didn't belong in the ER, perhaps you, being a doctor, can tell us how a patient would know that they did not have a detached retina. Or are you just saying that if any patient comes to the ER with a problem that eventually resolves itself, the patient didn't belong there in the first place?

This is one of the things I find so frustrating about medical blogs. Somehow they won't tell us over the phone whether our problem is serious enough to need emergency treatment, we need to come down to find out. But if we get there and it turns out to be nothing, I'm an idiot for coming in. We're supposed to know? Really? In your thinking, are there no cases where it might be serious or it might be nothing, but there is no way a patient could tell without seeing a doctor?

Out of curosity, what is the timeframe a potential retina detachment should be seen before it would be "too late"?

Also, why couldn't a patient like this get a quick check by the doctor and then either be sent home or have an ophthalmologist called?

I see no reason for the patient not to assume the timeframe is fairly large if they sit there for 6 hours while sniffles are coming in, being seen, and discharged. It makes sense to me that it's probably quicker at that point to go home and then to an ophthalmologist's office as soon as they open.

Bongi, as a doctor you need to have a little more understanding of what patients are dealing with. We don't know all of the things you know. I'm pretty sure I've let some potentially serious problems slide because I worry that the doctor will think I'm being overly concerned with a minor issue. You need to understand that what may be obviously nothing to you may be a big concern to us because WE DON'T KNOW IT'S NOTHING. Sorry for shouting, but I am very frustrated with this kind of attitude from some (though not all) medical "professionals." I think it would be appropriate to cut lay people a little slack when they make a triage mistake. Maybe Rositta made a triage mistake--why do you find the need to put her down for that?

Mad Jack said...

Nice blog. My own experiences in ER are few and far between, but I have one series of visits that enlightened me.

Around 1986 or so, I suffered a bout of kidney stones. My first attack came just as Main Lady and I were being served dinner at a local rib joint. I didn't know just what was wrong with me, but something sure wasn't right. Main Lady took me to the closest ER, the (then) Medical Collete of Ohio (MCO) in Toledo, Ohio where I was taken into the back room and examined. I got an IV and a pain shot that didn't work. I got several more shots over the course of four hours and was finally discharged, higher and happier.

Three days later I was back, but now I knew what was wrong. The ER refused to give me a pain shot and told me to wait, that it would be several hours before anyone could see me. I left, and Main Lady drove me to the ER at Flower Hospital in Sylvania. I was taken into the back room and medicated, which didn't work. Between bouts of absolute agony I demanded that the staff do something to alleviate the pain. The staff was long on promise and short on delivery. Finally the ER doctor came clean and told me that they suspected I was a drug user looking for a fix. They were keeping me under observation to see if I was faking symptoms or not. The doctor determined I wasn't practicing for the leading role in A Visit to the Dentist and treated me to another pain shot or three, none of which actually worked. In fact, the shots didn't seem to have much effect at all.

The pain finally stopped (I must have passed the stone) and I am now careful to keep myself well hydrated.

I have reason to believe that my tolerance for pain is average, but my self-control is far above average, meaning that I can sit and take it without much complaint. My question is: How do I convince the ER staff that I actually am in a lot of pain and I want some very serious medicine to help me over this rough spot?

Maha said...

StorytellERdoc you really should read up the newest evidence that shows cheetos and pepsi cure ALL abdo pain :P

Keep the stories coming!

DrJohnM said...

Hey Doc, Nice story.

I am envious of your comments. 16 comments and you have only been blogging for month. Nice.

I am also a new blogger and based on your about me statement we are about the same age.

NorthEast? I was raised in Hartford, CT but now am a solid Kentuckian.

Good Luck, I am a follower.

t. said...

I'm a sign language interpreter at a university hospital--a friend of mine introduced me to your blog. I tell all of my friends at work that they really need to read your posts! You have a gift for sharing your stories. Thanks for the laughter and tears.

Ambrosia Bierce (2014 AD) said...

Costochondritis - now THERE'S the ultimate diagnosis that makes every ER doc think a patient is a drug-seeking or attention-seeking whining cry-baby. I was suffering such severe chest pain that I could scarcely breathe. Coughing or sneezing or hiccups would have meant the end of me. I thought, naturally, that my overweightness and lack of exercise were finally catching up to me & I was having a heart attack. D-dimer and EKG & something something something or other and I was sent home with nothing. No diagnosis, no advice, no Tylenol. The doc didn't say it outright but it was clear that I was a suspected seeker. Sure I had been there before - with severe asthma, flu (despite immunization), vertigo. A nebulizer treatment or two, some meclizine.... And suddenly severe chest pain makes me a drug seeker? Saw my PCP doc the next business day. I think PCP had a word or two for disdainful ER doc. Sorry for not being concise. CheetoGirl & the comments pushed a hot button I guess.