Can we strangle patients?

Have you ever had one of those days where your stupid patients have stupid problems that the poor nurses have to page you for? Here's two dandies from today:

Patient 1- 30's female with a personal and family history of DVT, now at 15 weeks gestation with a DVT in her thigh. Should be simple enough, hypercoaguability work-up, heparinize and discharge on lovenox. Yeah, right...
  • "Where was your lovenox made"- New Jersey...perhaps the one place on earth scarier than China.
  • "Are there any preservatives in lovenox"- not in the single dose form that you'll be getting...but that room-temperature, unpasteurized, farm-fresh, organic kefir you're chugging might contain some brucella or mycobacteria bovis...I hear those are bad for babies.
  • "I've read there are all sorts of side effects of that nasty drug lovenox"- Most of them are bleeding related...it beats a PE that could kill you and your baby! We could always try rat poison.
  • "Can I eat an avocado? I read all about the food interactions of heparin and avocado was on there"- you read about warfarin, avocados and many foods interact with warfarin. Lovenox works by a completely different mechanism. Bon Apetite and I question your sources.
  • "I've read that people who inject their skin with insulin loose fat at the injection site. Will that happen with lovenox?" No lovenox is not a good way to lose that pesky baby fat.
  • "Why is the hematologist so interested in all of those tests...what if I don't want to know?"- Wait...you just asked me what preservatives are in lovenox and you don't want to know if you have a clotting disoder? Either be OCD or non-chalant about it...don't flip-flop.
  • "What are the potential side effects of ultrasound on my baby? I've read studies about them damaging the ears and eyes and I know it hasn't been studied because there isn't a big enough group of un-ultrasounded women out there." Um...no. Actually due to your advanced maternal age, you may want to consider an ultrasound to screen for potential birth defects since women of your age are at an increased risk. The benefits would probably outweigh the risks. I bet you take your immunization advice from a porn star too!
  • "What percentage of EMLA cream is absorbed by the skin into the body?" Um...adults don't generally use EMLA cream...no idea.
  • "My homeopathic doctor...blah blah blah"...not that I'm skeptical or anything, but crystals and accupuncture aren't going to fix your DVT or genetically based hypercoaguability.
  • "With my first baby, my membranes ruptured on Sunday and I delivered on Thursday...my midwife got a little worried on Wednesday"...Um ever hear of chorioamnionitis or GBSS? Oh, you never saw an OB or had an ultrasound?...no wonder your dates were a month off.
  • How'd that lovenox shot go? ::dramatically:: "Oh it was so horrible!"
Patient 2: 25 yo guy admitted for a CF tune-up, ended up having an exlap for an intussiception, on a PCA for pain control. POD#3, just got the NG tube out and starting to eat. Still has PCA (Patient Controlled Analgesia) pump with dilaudid.
  • He pounds down his liquid breakfast tray in under 10 minutes, and has belly pain shortly there after. Covering SubI (who witnessed the first episode of belly pain leading to surgery 4 days ago) was paged. Explains that the bowel "goes to sleep" after surgery and while taking opiates. Downing his tray so fast was probably a bad idea...take it easy on the food for now.
  • SubI paged for worsening abdominal pain. Now rolling on the floor, howling in pain, patient is still able to text and talk about his wife and make a few jokes. Benign exam...I'll reassess in an hour
  • SubI paged for worsening abdominal pain. "This feels like right before the surgery"...patient not texting any longer but still a benign exam. SubI orders STAT labs and imaging and pages surgery, discusses with medicine attending who agrees to examine the patient and is not very impressed either but agrees that labs should be sent anyway. SubI calls his resident to cosign STAT orders. Writes progress note re: plan.
  • SubI reassesses patient after ordering labs. Patient eating dinner tray, talking on phone to wife, pain well controlled with PCA pump. "Yeah, I just decided to start using my PCA pump again. I feel ok now man! Hey do you play Dungeons and Dragons?" SubI explains the finer points of the PCA machine (Push the green button until the pain is tolerable...if you're unconscious, you're gonna get a rude awakening). And no, but I do play fantasy baseball and football...no you're not getting a draft invite.
  • "I get lonely in here...thanks for talking to me man" SubI checks his not-ringing pager, excuses himself to answer his phantom page, calls resident to cancel STAT orders because the patient is a fucking idiot, writes a progress note that the patient is a fucking idiot, bangs head on desk and questions so many of his poor decisions in life...like going to medical school.
It was a long day...and I only covered 12 patients...I felt bad for the interns who had to cover dozens of them and the resident getting killed in the ED with admissions...more fun tomorrow

1 comment:

Albinoblackbear said...

Is it wrong to strangle the mother with the umbilical cord?

Oops. That was my inside voice.


Glad you're back!