Monday, April 30, 2007

Lady With Sheets and Other Stuff

Had a good one the other day. This lady came in with her husband with symptoms of something which turned out to be nothing. He was sort of an over bearing type and, although she had genuine medical problems, was also a card carrying hypochondriac. I saw the card.

But the point of the story is the sheets she brought in with medical history, meds, allergies. I realize 911 had a previous post on this, but the information on these was incredible. She was allergic to 32 medications, musk scent, every single food dye (even green), potatoes, carrots, tomatoes, fruit packed in its own juice, and gravy (yes, gravy). She also had had 22 surgical procedures performed, and was taking 16 medications. I honestly could not stop looking at these sheets. How could someone have been exposed to 32 medications, much less be allergic to them? Now, she did have medical problems, namely diabetes and heart disease, but 32! And what is it with being allergic to gravy. God gave us gravy to enjoy and to slop biscuits in, not to be allergic to it. The sheets showed a tremendous exposure to the medical world, probably 1/2 our fault for throwing meds at her and 1/2 hers for demanding them and then not liking or tolerating them. And then again she could be just unlucky.


Anxiety or just being stressed out is not an emergency. Granted, the feeling may be disconcerting, but out of the 45,000 or so patients I have seen, I haven't had an anxiety death. Maybe I have just been lucky. But I did have a 25ish year old female type run up to the nurses station while I was finishing orders on a respiratory distress patient who I had just intubated and was getting her ready for the unit. The MI patient had just gone to the cath lab and I was about to get to another chart, when she informed me that if someone didn't give her friend something quick, she was going to have a FULL BLOWN PANIC ATTACK. I mean with the carpo-pedal spasms and rapid breathing and everything. "Oh, my gosh" I said and ran from the critically ill patients room to help this poor lass. No, I'm just kidding. I didn't do that. But I did tell her friend to just stop talking, that all her talking was starting to bother me, and I gave her friend the required vitamin X. She lived, and we didn't even have to put a brown paper bag over her face. Ain't medicine a beautiful thing.


  1. I don't know doc... I had a patient once who almost had a heart attack in the middle of a full blown panic attack and was near syncopal at the time. We nearly made her well and she almost got better in the ED. Unfortunately for her, she was nearly killed later that day by an almost drunk driver who had near anaphylaxis from red dye number two and almost required surgery for a nearly broken arm. Where is your compassion?

  2. You nearly almost had me concerned for that almost sick patient.

  3. Perhaps if you knew that she had pseudoseizures with acute chronic fatigue syndrome and traumatic fibromyalgia you would not be so nearly-concerned?

  4. When I read ACUTE chronic fatigue, my brain completely fried trying to unify the inherently blatant dichotomous duplicity of it all. I must instigate, propogate, and flatulate the injustice, inscrupatiousness, and shear constufabulinity of that statement.(O.K., I borrowed that last line from Jesse Jackson, but the rest was mine).

  5. P.S.

    Didn't you like the "God given gravy" alliteration.

  6. Some people live for drama and would love to have an actual medical reason for feeling not so good. Sometimes things are hard. There doesn't need to be a medical reason for that. I would gladly trade my real medical problems with them and we would both be much happier. Too bad that just isn't possible...I think my mother in law would probably take me up on my trade. She has those sheets of paper listing all her "problems" that you speak of.

  7. 'cat,
    forgive me for not giving props on the gravy comment. it was, as is so often the case with you, un-toppable. i got all exited writing about the nearly-sick. my sincere apologies.

    rad girl,
    you have made a true observation about those who are sick and those who wish to be. it is indeed sad that we can't all exchange it on ebay. thyroid cancer would bring a pretty penny. i'm sure and you could trade it out for fibromyalgia or chronic fatigue syndrome at a steal.

  8. So an acute panic attack doesnt count as an emergency? But you would treat them though, wouldnt you?
    Thought you wanted to end the suffering not ignore it.

  9. actually no, ben, an acute panic attack is not an emergency. the trick is to make sure it's not something else. also, if you will take the time to read the original post you will see that schrodinger's cat was deeply involved with two different patients who were ACTUALLY DYING and was being distracted by the friend of someone who THOUGHT THEY WERE DYING. and we do truly want to end suffering, and death, and war, and hunger, and we are for the children and against bad people, but to quit being a smart ass what we want is to do the best we can for all our patients and not screw up and go home at the end of the shift without having to crawl inside a bottle of jack daniels to go to sleep.

  10. Well said, 911. As to Ben's comment, to someone who has them I guess they are distressing, but if confronted with a list of medical emergencies, like bleeding from the mouth and anus, a heart attack, stroke, gunshot wound to chest or abdomen, etc, etc, ( I really could go on and on) a panic attack is WAY down on the list. And in our business, worst comes first. Just because you got to the ED before the HIV patient with a stiff neck and headache does not mean you get your ativan or xanax before they get a CT, tap, antibiotics, diflucan, and acyclovir. SORRY.

  11. Hey, don't make fun of anxiety. If you had the "serious kind", you'd understand. There, but for the Grace of God, go you. I've lived with free-floating, "no-reason for it" anxiety since practically birth and it is like living in terror all day long.

    Let me just give you an example and you might understand a little better:

    For me, it was always the thought of "infinity". When I was young, I had a very inquiring mind and wanted to know things like "what happened BEFORE the chapter of Genesis" or what happened AFTER we died and went to the afterlife. I wanted to know what happened when "Heaven ended". What happened in "the infinity of time"? What happened to our souls when time ended? How could there be infinity?

    Thinking about these issues would invariably produce a panic attack in me at age 10 and upwards to where my blood would run cold and I would want to run screaming down the street in stark terror.

    These days, after shrinks, anti-depressants, a history of ETOH abuse, recovery from ETOH, and the current membership in AA, I have learned to discipline my thoughts to simply not allow myself to think of panic-inducing thoughts---but the free-floating anxiety is still there.

    Anxiety is real in a lot of people, doc. Be merciful...

  12. No one ever said it wasn't real. It is obviously real. It usually requires investigation, therapy, counselling, and too many times drug and alcohol treatment, services not only not available, but not even appropriate in an ED setting. (I leave my therapist hat at home on a busy Saturday night shift, when I can barely stay afloat as it is.)Nearly every time all we can do is give anxiolytic drugs. But again, death is the ultimate endpoint, and if you are not near it in my ED, even if you feel like you are, you will get in line to be treated behind the people who are closer to the reaper than you.
    Focker out, and this horse if officially beaten to death.

  13. Please BHR! You of all folks should know that we suck at treating chronic conditions in the ED. Sure we can dole out the benzos but that's a band-aid at best. Congratulations on beating your anxiety by the way, along with it's attendant problems.

  14. Last line of last post should read:

    and this horse IS officially beaten to death.

  15. i don't know, seems more like that prize cow in "me, myself, and irene".

  16. No, the correct comment should be Yul Bryner's:

    "And so it is written, and so it shall be done...."

  17. I thought I was the only one whose ED has a "frequent flyer" who is allergic to gravy. And every painkiller on the face of the earth except for dilaudid.

    Considering the fact that said patient weighs 450 lbs, I would like to posit the idea that this patient is not allergic ENOUGH to gravy.

  18. Perhaps the allergy to said gravy manifests as uncontrolled swelling up to 450 lbs. Which, of course, is accompanied by unimaginable pain, that can only be controlled by Dilaudid. I'll bet he has anxiety attacks, too. I'd be anxious if I had to worry about my gravy/narcotic allergy. What if somebody slips you some morphine-laced gravy on your biscuits? Come to think of it, I think they serve that in our cafeteria for breakfast....

  19. i'm sure and you could trade it out for fibromyalgia or chronic fatigue syndrome at a steal.

    i'm sure this person would agree to trade.

  20. I've never presented to the ED with a panic attack, but I can understand someone doing so when they have the FIRST ever attack (or one of the early ones before the patient has been dx'd with panic attacks, and understands what the heck is happening.) They are very frightening and unpleasant, and even when you learn how to prevent some of them and how to shut them down more quickly, the initial moments are truly awful.

    Once you know about your anxiety disorder and your panic attacks, there is NO excuse for heading to the ED when you have one. A person who anticipates "a full blown panic attack" surely knows that (1) they aren't really dying, and (2) EDs are not set up to handle mental health problems short of the type of crisis that gets you admitted to a psych ward.

    So go ahead and be gentle with the "first timers," one you've ruled out a real life-threatening problem, but repeat trips to the ED for panic attacks is not a lot different than using the ED for other non-emergency services. In that case, long waits are appropriate and may, occasionally, deter that sort of behavior in the future.


  21. Anonymous I don't appreciate your implication by listing my blog in your comment.

    Since you don't know me I don't think you should be posting referring to me.

    I agree that some people "want" to be sick and use CFS & Fibro for attention. I assure that I have never gone to an ED for anything that had anything to do with Fibromyalgia. Things I have gone to the ED for - bowel obstruction, ruptured appendix, closed head trauma.