Saturday, December 15, 2007

My Favorite Patient

A few weeks ago, I had a 50ish year old lady brought to the ED by her daughter. The chief complaint was "confusion". Mom had been confused for days. Significant medical history was denied, no medications.

History was not helpful, exam revealed a very confused somnolent patient, but was otherwise unhelpful.

The standard workup including CT scan was negative, but there was one interesting lab test. The Urine Drug Screen was almost pan-positive.

Amphetamines: POS
Benzodiazepines: POS
Opiates: POS
Barbiturates: POS
Cannabis: NEG

I went back to the room to ask more questions and talk to the daughter. I handed the multiply positive drug screen to the daughter and said "maybe this explains her confusion" Turns out that drug abuse had been a significant history with the patient, but they didn't tell me that part.

She woke her mother up and said "Mama, have you been doing drugs again (or "druds" if you're pretending to be a doctor...see other posts)?" The mother woke up and said......(this is my favorite part)...... "not unless they've been putting it in my weed"!

For the non-medical folks....of course the only negative part of her drug screen was the weed...the only part she admitted to! I thought it was hysterical! That case made my night all worthwhile.

17 comments:

  1. Well, I guess this counts as a really good story...hehe, I'm kidding.

    It's a great story! Brightened my mood after this last call I had, freaking frequent flying itchy nipple guy!

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  2. Nice story, but you haven't lived until you get two of our frequent flyers. 1. Jesus Christ's mistress (who happens to be a male). 2. The Virgin Mary, who signs all her consents just like that.

    Hey, maybe the 50 year old is sharing her medications with the Mistres and the Virgin Mary.

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  3. i plan on living long enough to become an embarrassment to my kids and my profession. i will be the most inveterate abuser of the ER, and have every allergy in the book. the only thing that will work for me will be dilaudid. i also plan on starting to smoke pot the day my youngest heads off to college. when the ER doc asks me if i drink or use drugs i will say, "as much as i can whenever i am awake, ouch, my ding-dong hurts again, oh me! it's fixin' to making my head explode! help! help!"

    there will be payback, the sins of our population will be visited upon the next generation of people silly enough to go into emergency medicine by ME. obtw, erdoc85, at that time i will hope you are still practicing. i will come and visit a lot... by ambulance every time.

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  4. 911

    I'm only going to use the ED for disimpactions and "funny" looking moles. One of each per week. I'll get the nickname the shit- filled mole guy. I like it already.

    The family of this lady probably said..."momma ain't never been this out of it." Then a quick search of her last visit shows that it was for an accidental overdose.

    CAT

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  5. emergencyem: one time as a medicine intern, I got a 4am call from one of the Sri Lankan night nurses. The patient's scrotum was "very itching". Upon further questioning this was a 2 week old problem, and "nothing worked".

    I gave her the same verbal order I'd give you "scratch 'em prn"!

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  6. Just heard from current patient...

    Me: "Have you had any blood in your diarhea."

    Patient: "No, it's solid water."

    Until today, I have never seen a patient poop ice, but this guy evidently did.

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  7. Okay, now I get it. You goofballs created this blog to satisfy your need to see who is funnier. Me? I'm just enjoying the ride.

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  8. erdoc,

    This dude calls us AT LEAST twice a week...I finally got fed up one night and asked him, "just what do you want us to do about this?" He looked at me blankly then said, "scratch it?" I replied, "I dont think so, get in the ambulance."

    The next time I said, "well hell, why don't you scratch it?" He flipped me off. Yea.

    He doesn't have heating in his house...so I suspect when it gets really cold we'll be picking him up every night...is there a law against abusing 911?

    On a different note, I agree with Lynn. I love this damn blog.

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  9. i think we are one of the few doc blogs, scalpel included of course, that rants a bit about our insane patients. other than that we would be the guys snapping towels at your ass in the locker room.

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  10. "other than that we would be the guys snapping towels at your ass in the locker room."

    i always liked that.

    hahaha

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  11. bwahaha. apparently it was all spike and no weed....

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  12. She was fucked-up because 'kind' mellows the buzz of all the other shit. Rx: two bong hits, STAT!

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  13. Etotheipi: Be very careful dude...you just made a clinically significant remark! That was my recommendations too...that someone add some weed to her crank and she'd be all better!

    Emergencyem: no laws. It's not about abuse of the EMS, it's about lawyers. Imagine one time if you fail to transport this dude and he suffers acute spontaneous bilateral nippoplosions. He'd be all over 20/20 and the "uncaring" medical establishment would again be blamed for societies' ills. Hillary would surely be interviewed. Seriously, though,if your medical director had any balls (in my experience, few do), he could arrange a protocol by where you don't have to transport this guy every time.

    Lynn: I expect to read about nippoplisions in your next book.

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  14. "Acute spontaneous bilateral nippoplosions."

    +20 for that comment. +5 for saying Hillary would be involved. Very funny!

    Yea...our director won't write refusing transports into our protocols...he's a pussy...of course the gig with the itchy nipple guy is waaaay backwoods ems...at my other job we have a protocol in place to where we wouldn't have to transport his sorry ass...sorry I'm angry. I just got back from picking him up. Again.

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  15. other than that we would be the guys snapping towels at your ass in the locker room.
    911, I have to admit that whenever a guy saw my ass, snapping it never entered into the conversation.

    Lynn: I expect to read about nippoplisions in your next book.
    Since my writing is based on reality, I'm going to search far and wide to find such a case. I'm depending on you guys to help me out. Oh. Wait. Then I gotta dedicate the book to you. Yeah...I can do that.

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  16. All this talk about weed reminds of the old days when PCP was still a big player on the street and people came in all "wacked out". (Now U know how old I really am!)
    Never understood why they wanted to ruin the buzz and mellow of their pot!

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  17. ever see that scare tactic school movie with the dude who drowns while on PCP and the other junkie is standing by the pool droning: "wow, why are you swimming on the bottom of the pool?"

    Classic. It's like the Citizen Kane of school anti-drug movies.

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