Monday, January 4, 2010

ER Tupperware

I am only going to warn you once, so please pay attention. Beware of any patient carrying Tupperware or Gladware in the ER. Chances are slim at best that they are carrying food in those containers. What is in them, then? Oh, my friend, I could write a book on what people have brought us using those containers.

It happened again to me last night in the middle of my overnight shift. I should have known better, but I must have been tired.

A very nice elderly woman, a retired government worker, presented to the ER for complaints of two days of coughing with phlegm production. She had no fever, no difficulty breathing, no difficulty speaking, stable vital signs, and no change in her daily routine. She just thought that she needed "checked out" at 5 a.m. while a snowstorm raged outside our ER doors. She came by ambulance.

"I've had the cough for a few days, doctor, and wanted to make sure it wasn't pneumonia. I never had it but heard it can get pretty bad."

"Well, maam, do you feel bad?" I asked, trying to get to the root of her buried complaint. Sometimes you have to dig and dig and dig to find that complaint and, still, all you're left with is an empty hole.

"Oh no, not at all. I feel great." Her words were followed by a sweet, innocent, old lady smile.

Hmmm, I thought, scratching my chin after performing a perfect exam. 5 a.m. Raging snowstorm. Feels great. What oh what should I do.

I sent her to x-ray for a quick two-view of her chest that, of course, came back negative.

After she returned from radiology, I repeated a brief exam, still stable, and explained the results of her negative chest x-ray to her. She nodded her head in agreement with my words and after I was done speaking, she stood up, went to her room's counter, and pulled her Samsonite purse from it. She carried the purse back to her cot and sat back down, opening it. She pulled out her wallet, two books, a rosary, a red Jolly Rancher, and a paper-clipped bundle of papers before finding what she was looking for.

"Oh, yes dear, here it is."

I watched her with excitement, wondering what she was going to pull out to show me.

Slowly, she began pulling her hand from her bag. Was she going to show me a winning lottery ticket, a rare signature from Abraham Lincoln, or heck, maybe even some banana-flavored Laffy Taffy?

I held my breath. As her hand lingered in the purse, teasing me, my tension mounted. Finally, she pulled out the object.

Nooooooooooooooo! I wanted to scream. And run fast.

She held up a blue-tinted disposable plastic Tupperware container for me.

The best defense is a good offense, of course, so I didn't waste any time. "Is that a snack, maam? Did you bring some leftovers to eat in our ER tonight while you were waiting?"

"Oh no, doctor, I think you really need to see what I've been coughing up." She tapped the lid as she spoke. How could I refuse this little old lady's request? I couldn't.

I stepped forward as she peeled the lid off the container. There better be a gold nugget in there, I thought to myself. But no, not even close.

"See," she said, "isn't that just awful?"

I peered hard into the container to see what she was seeing. I couldn't see anything awful, just a string of clear spittle beautifully draping the inside walls of the container, like garland around the front door. Her partial upper plate sat smack on the bottom, a small puddle dispersed around its edges.

"Oh, there you are," the woman said, snatching up the wet partial and plopping it into her mouth. I made a silent plea with God. Please, dear God who is all kind and good, if you can get me out of this room in the next minute, I will shovel my neighbor's driveway. Or shave my head. Or never make another bowel movement joke again.

Now the woman held her breath in anticipation of my exam of her spittle.

"Oh yes, maam," I spoke, choosing my words carefully, "I see what you mean. That's some mighty clear phlegm you got there. Isn't that something how it sticks to the sides like that?"

"Yeah," she nodded, somewhat panicked, "tell me about it. Does that mean something? Is it bad when it sticks to the sides? Am I going to be alright?"

I answered her. "Yes, maam, you are going to be alright. Spittle clinging to the side doesn't mean anything more to us than usual spittle. And more good news. Everything about your visit looks okay--nothing we need to worry about or treat with antibiotics. Just work hard to keep bringing up that extra spit and if you get a fever or worsening symptoms, you can always come back for a recheck."

She seemed happy enough with that. But I knew one more question was coming my way.

"Um, doctor," she spoke, holding out her container, "do you want to keep this and send it to lab or something?"

Well, heck yeah, I thought to myself. I would like to keep your container and send it to lab, maam--if it were April Fool's Day. But otherwise, no, I don't feel any overwhelming urge to keep your container.

"Do you want me to throw it out?" I asked, reaching for it.

She pulled the container back towards her. "Oh no," she said, emphatically, "I'll take this home and reuse it."

I may have swallowed back a little phlegm of my own, thinking of what she would store in there next. A piece of lasagna? Leftover baked beans? Pennies from 1982? Jelly packets from a restaurant? Tomorrow morning's bowel movement? You know, the constipated one that she could slice like a stick of pepperoni?

I wonder if this is what Tupperware and Gladware had in mind when they marketed these useful containers.

The kind woman packed up her container and put it back in her Samsonite. She repacked her other things, too, which made me kind of sad. I had been eyeing up that Jolly Rancher.

"Well then, maam. You take care of yourself, okay? And again, always feel free to come back or visit your family doctor if you need to."

She reached out and shook my hand. "God Bless You, Doctor."

What a sweetie-pie, yes? After helping her out of her room, I looked down at my watch. More than five minutes had passed since my plea-bargain with God. There would be no extra shoveling for me when I got home that morning.

As always, thank you for reading. Next post will be Wednesday, January 6. Stay warm...

18 comments:

AtYourCervix said...

That was really gross. ::shiver::

I'll take amniotic fluid and meconium ANY day over sputum!!

Chrysalis Angel said...

I didn't know whether to laugh or grab a bucket. I'm glad I wasn't sipping on my tea while reading.

Jacqueline said...

I was ok until you got to the wet partial..sputum I can do...but a wet, sticky partial in that sputum, pulled out and replaced in one's mouth? I nearly retched. Ugh...sends chills down my spine. I could never be a dentist.

Katie said...

I like to think this is why Ziploc began manufacturing semi-permanent containers: washable but also easy to pitch. Sounds perfert for bizarre specimens that no one really wants to see.

Enjoy the snow.
<>< Katie

BubbleGirl said...

How can you make it to that age without knowing that CLEAR mucous is a GOOD thing. If it was a nasty brown color, or bright red, I could understand being worried. Or if it was coming out by the bucket.

SeaSpray said...

Hi Jim - Awww ..what a sweet elderly lady. :) You're so good with your patients. I'm sure that's not always easy at 5am when you know they don't need to be there. I had to laugh out loud when you bargained with God. I always prayed whenever a patient came in with lice or scabies and then itched all night too. :)

You just couldn't resist the pepperoni comment could you? ;)

I worked with a doc who told us he was friends with a a pulmonary doc who named his dog phlegm. :)

I was pretty relaxed reading it because I figured it couldn't top having a gross foreign body in your mouth.

I LOVE ziploc bags *organizing*. You can even use a punch hole thingy and then snap into a loose leaf binder for the purpose of holding pertinent receipts or smaller objects you want included with the rest of the paperwork. Then just flip to or past them while working in that binder.

Your posts are so well written, moving, entertaining, etc. that you should consider writing a book.
***********************
I have to say..I wasn't worried about what you would say ..because unless it was in your mouth ..it wouldn't effect me too badly.

I hope you don't mind Jim, but I thought you might be interested in reading a set of posts I wrote as a newbie blogger. It's a true story and maybe I overreacted..but you had to have it in your mouth to know how panicked I was really feeling. I put the links down in order- pt I, II and III. It tied in with the gross aspect of your story. If you prefer I not do this then please feel free to delete. :)

http://seaspray-itsawonderfullife.blogspot.com/2007/01/what-is-in-my-mouth.html

http://seaspray-itsawonderfullife.blogspot.com/2007/01/whatis-in-my-mouth-part-ii.html

http://seaspray-itsawonderfullife.blogspot.com/2007/01/what-is-in-my-mouth-partiii.html

Dr. Mongo Lloyd said...

Clear spittle and feeling fine...what is wrong with people?

torontoemerg said...

I actually couldn't read the post...seen too many at triage. My personal faves are the baby food jars filled with poo samples, and the aluminum pots used as ad hoc emesis basins --- which I guess will be used to cook the macaroni the next day.

It's all too ugly.

MLee said...

ROFLMAO... The dreaded tupperware containers, down hear most bring things in mason jars, at least than we have some advance warning of what is in them.

MLee said...

opps... meant to say "here" not hear

artdoctor said...

Scary indeed. Not to burst your bubble, but I think what you're experiencing is a re-living of childhood, watching your mom and her lady friends at the monthly tupperware party? Joking...

ER would be fun- sounds like there's a good balance of everyday human craziness and actual medical practice!?

mommy-medic said...

Once upon a time I worked for a urologists office. You don't even want to begin to imagine the post-vasectomy "samples" we got delivered to us. In various tupperware. One still steamy on the inside. And one- in a PAPER bag. and nothing else. Puke away.

t. said...

I started to chuckle at the first italicized sentence. Laughter only became more diphragmatic from then on.

Completely, totally, utterly gross. And just equally as funny!

Again, Doc, your colorful knack for storytelling hits the mark!

Maha said...

LOL the dreaded tupperware sign! If positive, prepare for + + emotional support.

I'm with torontoemerg - I haven't been doing triage very long but the time that I have been doing it has left me queasy on many an occasion. I had the misfortune of seeing the same tupperware container as the one that I carry my lunch in (walmart was having a sale - i guess i wasn't the only one who knew about it) with a whole bunch of foul, cloudy pee from a nephrostomy along with a few pebbles of poop in it.

I had to replace all of my plastic containers with glass ones after that.

Great story as always! Looking forward to the next post.

IrishPoet said...

oh come on doc, I'm a little surprised at your 'squeamish' reaction to an old lady's pleghm...I've seen MUCH worse in my time for sure, and I'm always amazed at how freaked out people get over bodily fluids. And what's the big deal about taking her Tupperware home to clean and re-use? it's not like she had some hazardous material in there, and it was HER spittle? (that's all we do NOT need is one more piece of plastic in the garbage dump!)

aow0526 said...

Usually it is bats, snakes, or spiders in the container. Pooh is captured on the digital camera for review.

OHN said...

OH MY GOD.

Please, please, convince me it wasn't my 93 year old aunt that INSISTS on sending leftovers with everyone when they stop by.

We finally bought her a bunch of disposable containers and as we exit the apartment, our "gifts" get tossed into the dumpster, as we have seen her kitchen and are well aware of her inability to really see any of the gross things that are happening there).

(Don't worry....she has gobs of money and these little tidbits of disposable leftover potatoes aren't sending her to the poor house)

italianfashion said...

I brought one of these tupperwares in the er . I just got so frustrated. I came in to er so sick and in level 10 pain in gallbladder area. Just had Gallbladder surgery 2 months ago. Morphine shot they gave me made it worse. Doc had no clue and said we are going to send you home . I told him no something is wrong but it was useless. Get home and start throwing again even worse. This time it was dark green thick bile and attack was making me feel like I was dying. I went back to er brought my container in with the green stuff so they could see I am really in pain and sick and wanted help. That did the trick. haha! Was sent right back. Liver levels were taken 380 alt and 370 ast and elevated tbili. Admitted me. Turns out I have been diagnosed with sphincter of oddi dysfunction and was having an attack. Thankfully no more attacks that bad and have not had to use the container :)