I believe this could be a new protocol for cardiac stress testing.
Recently on the late shift, the nurses on the telemetry unit were alerted to an elderly female patient who was having tachycardia. Her heart rate had been steady at around 80, but for no clear reason it accelerated to about 150 beats per minute. The charge nurse walked quickly over to investigate.
The patient noted that she had been having some insomnia, so she decided to read her romance novel. Suddenly, she had a very realistic hallucination.
“What did you see dear?” asked the nurse.
“Well, it was a very good looking man, who just walked into my room and asked where the grocery store was. And, he was . . . completely naked.” She admitted.
The nurse reassured the patient that it was nothing, and tucked her back into bed, and then chuckled her way back to the nurses station. A few minutes later while doing some charting, she was surprised to see another patient standing in front of the counter. It was a 40 year old man admitted for gallstones. He had been given a dose of Ambien for sleep about an hour before.
“Excuse me, can you show me where the grocery store is?” asked the man.
“I certainly can,” said the nurse, who then gently walked the sleepwalking (and completely naked) patient back to his room.
A middle aged man recently drove to the ER looking to get some medical attention for a rash that he had for over a year. It was a bit unusual to come to the ER for a chronic rash, but I’ve seen stranger things for sure. The timing was stranger still, since it was about 2am. But let’s give him the benefit of the doubt, and assume he was just trying to come in when the ER wasn’t too crowded.
It wasn’t though–pretty much packed and full of cops who were there for a car crash and an assault. This turned out to be bad news for the man with the rash since he was completely drunk. He knew it was bad mojo when he pulled into the parking lot and saw all the squad cars. If his plan was to be inconspicuous, that didn’t work too well, because he drove in the wrong way on a one-way driveway. As calmly as possible, he tried to perform a casual 3-point U-turn. Unfortunately, he ended up on the curb, and nearly hit the ambulance entrance doors. This did not go unnoticed by our boys in blue, and the man was quickly arrested for DUI, his car was impounded, and he was given a notice to appear before the court. At that point, he should have just been glad he wasn’t going to spend the night at county jail, but he was pretty mad. He stomped over to register in the ER and demanded a blood alcohol level, since he “wasn’t even drunk!”
1 hour later and a measured blood alcohol level of 0.25, the man was ready for discharge.
“Well what’s my diagnosis?!” he demanded.
“Looks like you’re drunk, sir.”
I think one of the fundamental desires of humans is to be appreciated. They want to do things that are important, they want to make an impact on other people, and they want acknowledgement for their efforts. I suspect ER doctors are no different, and many of them (including me) probably went into medicine to satisfy this desire.
Sometimes however, you don’t want to be thanked.
One such time was a few years ago, when I had a man in his early 60′s present to the ER with fevers, rash, and feeling crummy for a couple weeks. His symptoms were not adding up to a typical infection, so I ran some tests. Turns out he had acute leukemia. This was obviously terrible news, and I had to deliver it. The man was typically upset, but took the news with great composure. He then asked if he could go home.
I said, “No, you’ve got to be admitted for treatment, and you’ll probably be in the hospital for quite a while.” He needed induction chemotherapy, and he was going to have a tough time. He really didn’t want to be admitted to the hospital, because it turns out, he had cancelled his health insurance last year. He couldn’t afford the premiums anymore. He was hoping to make it to age 65, and get Medicare benefits, before he had any serious health problems. As the wheels were turning in his head, I came to realize that I had given him several pieces of bad news all at once. He was very ill, he could die, he was going to have a long and difficult hospital course, and he was going to lose all his money.
I checked on him several more times before he was admitted, and each time, he expressed his sincere appreciation and gratitude to me.
I wanted to say “For what? So I could give you the worst news of your life?”
Sometimes feeling appreciated is a shallow goal.
One of our more commonly seen fractures is the appropriately named “Boxer’s fracture.” This results from punching objects, usually a wall, sometimes another person’s face. The hand is broken at the neck of the pinky metacarpal bone, just before the big knuckle. One recent sufferer from this injury is a young man who I know well. However, he did not punch a wall, or a person’s face. No, he punched his friend’s butt. Yes, that’s right. I thought I’d seen it all. All I know is, I wish my butt was firm enough to cause hand fractures, but sadly, punching it would barely result in a sprain.
Perhaps my least favorite thing about my job is night shifts. As I get older, they get more and more painful. If I don’t get a nap before going in at 11pm, my brain gradually turns to oatmeal. Come 4am, and I’m hoping I don’t have to think very much. A sore throat or ear infection is about all I want to tackle.
One surprising side effect of night shifts is that the nurses start getting chatty, and all kinds of intense conversations spring up. Last night, I was working with some of my favorite nurses and we somehow started talking about religion. My usual rule is not to get into any debates about religion, because it never ends well. Unfortunately at 4 in the morning, it seems like you can really get to the bottom of these issues and solve them. You can’t. We spent a good hour sifting through all kinds of intense religious theory, wasting valuable charting (or napping) time. Huge waste. Luckily, I don’t think anyone was mad or offended by the end of shift.
