Body Parts Just Move Around All Willy Nilly Sometimes "I have an albatross of a patient who's been causing me heartburn for about a year now. I had to operate on him back then to save his life, otherwise, I'd have never willingly touched him. He smokes a ridiculous amount and is morbidly obese. He lives on his couch (as in, he keeps a pee jug next to it instead of getting up to go to the bathroom), etc. Any surgeon's worst nightmare. Naturally he had a ton of complications, was in the hospital forever, and has never really done well since. However, that alone isn't the reason that my staff and I all want to make like Disney lemmings and leap from the nearest high structure every time he calls or shows up. The man is also paranoid, delusional, and this horrible combination of stupid and stubborn. He doesn't really have the smarts to fully understand what his many doctors tell him but also doesn't have the self-awareness to realize that. Instead, he pretty much takes anything anyone tells him, mashes it up, and turns it into some kind of crazy medical fanfiction from which he cannot be dissuaded. For example, he has a colostomy. This means he still has a rectum but poops in a bag instead of the usual way. The rectum is still functional, though, and the lining makes mucous the way it always does. It is completely normal for people with colostomies to have 'bowel movements' consisting of mucous. Nothing and no one can convince my Mr. Albatross that this is okay. He takes pictures of it every time it happens and collects it in jelly jars to show me. He calls and demands tests and antibiotics or something to 'fix it,' and becomes enraged when we tell him there's nothing to fix. He is simultaneously convinced it's related to a butt abscess he once had (it's not) or that it's a fistula between his rectum and other areas because now he's SURE it's his own manly juices. At our last visit, I think I finally really angered him off. He came in to tell me how he visited the ER in the next town over because the skin on his back was itchy. According to him, some doc there (can't remember the guy's name, of course) took an X-ray of his chest and showed him 'something white' up by his shoulder. This white spot was - per Mr. Albatross - his stomach acid escaping from his stomach and building up in his shoulder, thereby causing the itching. I stared at him dumbfounded, asked if he had a copy of the record from the other ER (or his permission to get it from them), and that I seriously doubted that the doctor had actually told him that because it was completely nonsensical. I thought he meant he had aspiration pneumonia, as in if he had been throwing up and maybe inhaled some vomit. Nope. Mr. Albatross has had pneumonia a million times and that wasn't it. The stomach acid was in his SKIN and it was WHITE on the X-ray, and he was totally not getting why I wasn't believing what this alleged ER doctor had told him. I looked at his back, saw garden-variety dry skin, and he told me, yeah, it was way better when he had his wife just put lotion on it. Haven't gotten a call from him in a good month or so now, which is definitely our longest pause. Fingers crossed he may decide I'm not competent to handle him and his migrating stomach acid anymore." Feeding Time Was Always Exciting With Him Around "We had this schizophrenic guy on one of the units I used to work on. Unfortunately, the disease can be characterized by delusional thinking - organs being replaced with yarn, bugs living inside the body, etc. This wasn't really one of those cases, though. Those can be funny in the 'my heart is breaking for you and I have to laugh because no one should live that way and so I've developed a really dark, inappropriate sense of humor to cope, otherwise I would cry all the time' kind of way (like the elderly demented woman that grew out a righteous beard because she thought David Hasselhoff snuck through her window at night for 'discreet relations' and liked the beard. Sad but you have to find the humor in it). Anyway, we had this issue with this poor guy where literally he would fly out of his room every night and try and punch someone in the face because we were 'poisoning him.' The guy was always a risk to others but it was particularly bad after meals. We'd bring him his food and literally minutes after he would finish, he would fly down the hall at full speed and punch the first staff member he could find, screaming, 'It's poison! You're poisoning me!' So okay, we thought. Maybe changing the food would help? Poor guy had some terrible dentition. Every time we tried to get him to dental (or literally have any medical doctor examine him) or look at his mouth, he'd try to bite or hit. Which is rough because patients have the right to self-determination. It's really, really hard to force people to get care if they do not want it. So we tried all the least invasive interventions we could: Change to soft food? 'Poison!' Change to Bland food? 'Poison!' Literally asking him what he wanted and having a staff member leave the hospital to bring him his requested McDonald's? 'Poison!' Asking him what staff member he trusted the most and then having only that staff bring him his food? 'Poison. Poison, poison.' Medicating him right before a meal? He'd somehow spite away the effects of medications at dosages that would drop most bodybuilders and still do a sprint, flying jump leaps and pound the crap out of your head before getting carted away in restraints yelling, 'Poison!' We did every single non-invasive thing we could do to prevent him from hurting us and going into restraints. He literally had half of my staff out at one point because of injuries received from him. Finally, we were just like, we need to get this guy to dental...it has to be the teeth. Luckily, I had the absolute best nursing assistants in the world and one, in particular, had managed to build as good of a relationship as possible with this guy. She spent a lot of time working with him, just trying to talk to him. She managed to convince him that he should go to the dentist because the dentist would give him beautiful teeth like hers. So, 'Go to the dentist. Have good teeth,' it was. We had to go through a lot of channels to get everything approved and that it was in his absolute best interest to have the work done etc. He gets to the dentist and basically, his teeth had rotted up to the root - the poor guy must have been in excruciating pain. Which we figured the schizophrenia and pain with eating had him interpreting the food as being 'poison' and that the staff was 'poisoning him.' We got the rotten teeth removed and fitted the guy with a beautiful pair of dentures, which he called his, 'good teeth.' That cut his assault rate way down. I mean dude would still hit us, but the nightly rush down the hall after eating to go punch a staff pretty much went from every night to once a week. When it happened, it was no longer because 'poison' but because 'You're the devil.' Which I consider an improvement?" The Family Who Cried Wolf "I used to volunteer at a hospital and there was this one family who were always in there exaggerating symptoms. One week you would see the father, another week the mother, sometimes they'd bring the kids in. They always came in through the emergency room to be told they have a cold or a bruise is just a bruise or sometimes urine just smells funny. They were always loud enough to make sure everyone knew they were there. My favorite, though, was the time I was put down there to help with transport. I wore a big tan jacket that says 'VOLUNTEER' in bold letters. I was restocking something I was told to and the mother pointed to her kid on the chair and yelled in my face, while she was standing next to me so it was right in my ear, 'WHERE IS A DOCTOR? MY CHILD MIGHT HAVE A FLESH EATING DISEASE!' Now, I wasn't facing them and didn't recognize the voice, so I braced myself for what I was about to see when I explained I was just there to bring things the staff need. I took a deep breath as I'm not good with blood and turned and looked. The kid had three inches of road rash. I just said, 'They'll be here soon,' and left. I laughed the whole way back to the office." Everything Can Change In A Blink Of an Eye "The best story I have is definitely the girl who came to the ER on a busy Friday night because of problems with her eye. She told me she had these weird spasms in both her eyes. I looked at her and she blinked. There wasn't an excessive amount of blinking or anything. Just regular blinking. Like we all do all the time. But she had for the first time become aware of the fact that she was blinking and it freaked her out. Every time she blinked, she would go, 'See, there it is again! I swear I never had that before.' (I bet you're now all aware of your blinking). Another one was when I was in private practice. I had a patient come in to discuss her lab results, a routine lab screening she had requested. She had also requested the lab report be sent to her directly. Now when she came in to discuss the results, she had her husband and two kids with her. I could tell they're all dressed well for the occasion and I was a little confused as there's this weird air of fearful anticipation. I started discussing the lab results -which are all normal- and they become visibly more nervous. The woman was almost in tears, now. When I finished telling them the good news, they're very confused and asked me about a liver value that wass slightly elevated. I explained that that value alone meant nothing as it's just like two or three units above the limit. A real elevation would be like 80 - 300 units above the limit. I was sure if we repeated the test in a few months, nothing would come of it, we saw it all the time. Turns out, she had googled the lab value and decided that it must be liver cancer. She and her whole family had braced themselves for the bad news. In their eyes, this was going to be the day their lives would change forever. And that's why I don't like patients looking at their lab reports without me present to explain." That's Not How Any Of That Works "We frequently treated this girl in the emergency department who was lacking in brain cells. She was about 20 and of course, she had already reproduced with a gentleman who also lacked brain cells. Anyway, I had many talks with them about stupid behavior in general. For example, we had a 'bay' that had rooms that were only separated by curtains. We put things like small fractures, colds, back pain, and anything that really didn't need to be in the department in there. One day this couple was back there and I had to request they turn down the loud adult video they were watching on their phone. The first time I encountered her was about three weeks after she had her baby. She was concerned about the bleeding she was experiencing. When asked why she was concerned, she told us she just had a baby (three weeks ago) and was afraid she was miscarrying. She couldn't really explain why she didn't think it was just her PERIOD. So, an exam was done which she giggled through the entire time. Turns out, she was having a normal period. A few months later, I saw her because she was sure she was dying as she drank expired Metamucil. She was not dying." Hypochondria Being One Of His Most Out Of Control Conditions "I had this patient when I was a resident who actually had a bunch of real medical conditions, but they were all very well controlled because he monitored them so obsessively. He went to the emergency department for some reason and had a brain MRI that was totally normal except that the report said something like 'ventricles are slightly larger than expected for age,' meaning the central places in the brain where the CSF is -the 'butterfly' shape on a regular head CT- were slightly bigger than expected for someone his age. The ventricles get bigger with age because the brain shrinks. So a year later, he asked for a follow-up MRI to monitor the size. He had zero neurological symptoms, so I'm reluctant to do this because there is basically no action we would take, but after arguing back and forth for a while I figured it's not ridiculous to appease him and make sure there hasn't been a rapid enlargement. Unsurprisingly, the follow-up imaging is completely unchanged. A year later, he came back and asks for another MRI to monitor his ventricles again and this time I just said no, there was absolutely no reason to do it and I wouldn't order it. So he shrugged, said okay, and left. I was feeling pleased with myself because normally there would be a big argument and maybe I'd finally had a breakthrough with this guy. I was in the middle of seeing my next patient when I got an automatic notification from the hospital that he was in the waiting room of the emergency department complaining of a terrible headache. They did a CT scan. It was normal." Don't Do Illegal Substances "The worst case I've ever seen was when I was a fresh third-year med student. I saw a former substance abuser whose health was extremely frail. She was only 24 but looked 80. She was so malnourished her hemoglobin (red iron compound in blood that carries oxygen and gives your blood its color) was half of normal. She was as cold and white as a porcelain doll. Unfortunately, the illegal substance use had already affected her brain too, and her mother had become her caretaker and was tending to her needs and bringing her to her appointments. Anyways, the day I met her, she was meeting the doctor to go over some important labs, including her dangerous low hemoglobin. The goal of the visit was originally to explain she needed a blood transfusion, but she came in with jars of watery red material with clumps of tissue, claiming she had worms in her facial bones and that she had procured samples of these worms from her last nosebleed. It was then that her mother revealed to the doctor and to the patient that she knew the patient was still sneaking away to use illegal substances. Then the doctor revealed to the patient the worms aren't real, that her diagnosis was 'delusional parasitosis,' and that she needed a psych referral. It would be funny if it weren't for the look on the patient's face. She was scared. She was absolutely certain she had deadly brain-eating worms and no one believed her. I could see in her expression her hopelessness and anger. She yelled and left. The doctor and mom were mortified, as the patient still really needed a blood transfusion still. Her oxygen carrying capacity was so low that at any time she could drop dead of a stroke or heart attack. Unfortunately, that was the last I saw of her. I don't know if she ever got better." Do You Want To Be The One To Tell Her Or Should I? "I work in Anaesthetics and it drives me mad the number of patients that want to have allergies, e.g, antibiotics give them the trots, er no that's a side effect. Anyway, the anesthetist comes into the anesthetic room one morning and asks me not to ask the patient about allergies. I'm puzzled at this and ask her why. The patient said she was allergic to oxygen. Yes, oxygen. She was a fun patient." The Miracle Of Modern Medicine "Skin is always fascinating. I had a patient come in with a spot on his side. He said his wife had just noticed it last week and it was noticeably growing. He wanted an instant referral to the dermatologist. Certainly, it must be melanoma! I grabbed tweezers and removed a tick. Hallelujah, it's a miracle." A Doctor Has To Be Thorough "I'm a 3rd-year medical student. A guy comes into the ER and is talking a big game. He is writhing about on the bed, saying he is in terrible pain. The physician asks him about any other symptoms and this guy says he had bloody stools. I wasn't aware of it yet, but this guy is a known illegal substance seeker. As soon as this guy mentioned bloody stools, the attending got an evil grin on his face and turned to me saying, 'Med student! This man needs a rectal exam.' He sure changed his tune, but too late. Rectal exam it is." One Symptom Leads To Another "I used to work for a company that provided in-home care to people with disabilities. One of my guys was a pretty serious hypochondriac, among other intellectual/mental health issues. One time, he hadn't used the washroom for two days so we took him to urgent care. We are encouraged to let them speak for themselves, as they are actual people with thoughts, ideas, and opinions. We just sort of fill in the blanks, or maybe guide the thought along. We tiptoe around these 'corrections' in the doctor's office to avoid the appearance of an attempt to cover up abuse/misconduct. Anyway, this guy complained about the abdominal pain, which led to one symptom, which led to another, which led to another. After a while, we weren't certain about which ones were legitimate and which ones were not. Finally, at the end, he said, 'And some of the people sneak in and put bugs in my nose 'cause my nose hurts. And in my ears 'cause my ears hurt. And up my butt 'cause my butt hurts.' The doctor coughed, but he was clearly trying to cover up a snicker. This physician knew this guy tended to have violent outbursts if his complaints weren't attended to. Crisis averted. He just had a bowel obstruction. Suppositories for three days." The School System Fails Another One "I am an ER doctor. I once had a 20-year-old and his girlfriend come into the emergency room at 2 am freaking out because 'Something had torn his throat open.' He seemed fine. No blood. Breathing fine. I had him open his mouth, saw nothing. So didn't want him to lose confidence in me, clearly, something had happened. So I'm looking and looking. There is nothing wrong with this kids throat. Finally, I say 'Look, it seems okay. What do you feel or see?' 'I don't feel it, but LOOK ITS RIGHT THERE.' WHERE? It was his uvula. Somehow this kid had gotten to the age of 20 without ever noticing his uvula. His girlfriend was also horrified. I told them it was normal. They did not believe me. So I told them I was about to blow their minds and showed him his girlfriend's uvula. Minds were blown. Another life saved in the ER." These Mosquitos Are A Sign Of An Epidemic! "My first year I was a doctor, I had the same guy come in somewhere between 10-15 times during a summer with bug bites. Just regular mosquito bites. He was always worried it was an infection, some rare manifestation of hepatitis, possibly HIV related Kaposi's sarcoma (he did not have HIV. I know. We tested him at his request), skin cancer, etc. Nope, just mosquito bites." The Emergency Room - Performing Small Miracles Every Day "I saw a girl with a small cut in triage. She had been digging in the dirt. She shoved the cut in my face and started talking about how she had gangrene because the finger was off colored (keep in mind, this is the ADULT emergency department). I asked if she had washed her hands and she said she had not. I had her wash her hands. Low and behold her finger was no longer off colored. I put a band-aid on her and told her it would be a while before a doctor could assess her (triaged her as a 5 which is basically saying this is complete bull). The woman waited 5 hours so the doctor could look under my handy dandy band-aid and say yep that is a normal cut, good news you are also up to date on your tetanus. SEE YA! Another time, I had a woman who couldn't breathe through her left nostril. She swore she was dying. We weren't busy that day so she actually made it back to the fast track in an hour or so where I was working. The physician assistant came in, handed her a Kleenex, and told her to blow. A big booger came out, and by GOD'S GRACE she could breathe again. She was discharged." The Things People Go Through Life Not Knowing "I had a guy in his 40's come into his primary care office. He says, 'So I have this problem with my hands.' I ask what kind of problem he was having and he says, 'Well, my hands have been going numb.' I say, 'I see. Does it happen all the time?' 'Well, no. It only happens when I hold my hands over my head for a long time,' he answers. I then say, 'Okay, and if you lower your hands back down, do they go back to feeling normal?' He says, 'Yeah. I'm worried that it's happening because I have tiny clots traveling through my whole body.' That's quite a jump. I had to explain to the guy that everyone's hands/arms feel tired if you put them over your head too long." Source
