Have You Ever Thought A Patient Was Lying Only To Find Out Their Condition Was Serious And Fatal?

This question was originally posted on Quora.com and was answered by Marcela Ruano, studied at Universidad Nacional De Colombia



Yes. I had this patient who regularly came to the ER with some complain or other, usually minor like a headache or rash. Since he lived in a remote area I would always treat him on the spot and send him on his way when he felt better, but I couldn't help but rolling my eyes internally, because we were always overwhelmed with actual emergencies. One day he comes with a “weird plugged sensation in the ear”. I didn't think he was lying, but I did think this was far from urgent and felt some irritation. I was the only one on service, so I give him a pill and don't even examine him until a good 3 hours later. He says it's been a few days and has intermittent fever. Now he says it hurts. He labors informally in various fields and sleeps in barns and such. I take him to examine his ear almost as an afterthought and almost fainted seeing what looks like a large insect stuck in the ear canal, surrounded by pus and inflammation. I think it's a roach and I start to have palpitations and cold sweats because I'm fucking terrified of roaches. This was in my country, so we're not talking about little German roaches, but South American ones (look up palmetto bug). I tremble while I try to fish out the damn thing without breaking it with a forceps that looks like a little bayonet. I get ahold of it with a sickening crunchy sensation and start pulling ever so slightly…it had been there for days so of course it breaks in 2,so I'm holding half a giant roach which is leaking guts and that's when I have to sit down looking as sweaty and pale as the poor guy. Good thing I pulled the rest almost out and the LPN is able to get the rest, followed by a gush of pus. I am blinking back tears thinking the poor guy must have been in agony. Once I get up on wobbly legs we clean him up as best as we can and admit him for a couple of days of antibiotics and pain control. The thing is, I was on the verge of just give him a script and send him home. In the hours between him coming in and me seeing him I delivered a baby and sutured a few wounds and admitted 2 people with pneumonia and every time I passed him he was calm and just sitting there patiently. Every time I felt the temptation of not really paying attention I remembered a teacher who used to say “you have the right to not know but you have no right to not look”. Rural dwellers are incredibly stoic. To this day I have no idea how such a large beast crawled in there.

Another one was this morbidly obese woman who would always come with unspecific nausea and upset stomach. Very difficult to examine, not only because of her size, she also was very shy and reluctant to even lift her gown a bit. It was always a long process to just try and touch her belly and I found it annoying and overdramatic. We could not find anything with our very limited resources (not even an ultrasound without sending them a couple of hours away) and she seemed to get better with a bit of fluids and lying down. One night she comes howling about earlier “cramps” but seems okay. There are 3 of us and no one can come up with anything good. We leave the overnight guy with the patient and head home. On my way out I went to ask her if she would let me examine her before I leave, because my colleagues are male and she was even more resistant to let them examine her. She agrees and I think oh, great. I am trying to get her to unfurl and to please let me get a damn hand on properly when she says ‘I feel pain now'. I take advantage of the distraction and quickly sink my hand on her belly…feels firm and round and… BABY??!!! She hadn't had her period in years due to contraceptive implant. Not for a second did we consider pregnancy in the previous visits, since she said she wasn't sexually active and had the implant. Now, imagine the conversation after that, the trying to listen to a heartbeat with a bell, let alone a gynecological exam. She was in abject denial so we found ourselves in the ridiculous situation of doing a pregnancy test in the early stages of labor to convince her. We sent her away in the ambulance, because we figured this delivery may be a nightmare, we knew nothing about the baby (babies?) and a gynecologist at least could do a C-section if necessary. We only did raw delivery, epidural anesthesia was never a thing. We were glad to see the back of her tbh. Lo and behold, we were recalled to the hospital some 4 hours later by our harried overnight colleague. The gyno returned the patient because there was “nothing risky” about the pregnancy and surely we lazy bums could manage to deliver a baby, yes? … At least he told us the head was down! well it took all 3 of us to man this WrestleMania delivery of a thankfully healthy surprise baby boy whose first outfit was just a diaper and a brand new t shirt intended for a 5 year old. We were in the tropics so no big deal, but boy…her condition was serious!

As an aside, I think she lied. I really don't believe these “I didn't know I was pregnant” stories, even if they have a reality show about it. I think powerful psychological factors are at play, but the body changes are so extreme they are impossible to ignore.…anyway despite the good faith principle, after that we tested every woman every time, no matter if it was an 80 year old lesbian nun.

TL/DR: about to dismiss frequent flyer guy with earache only to find massive foreign body and raging infection. 2. Vague digestive upset turns out to be labor in an obese patient.

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