So a lady comes into the room with neck and hand pain. Because the pain is in the thumb and the first finger and the pain was worsened with Spurling’s maneuver, my tentative diagnosis was a C6 cervical radiculopathy. I say that ahead of time so I can look smart …
Unfortunately, the ED was busy (when isn’t it lately?), so the patient was waiting in the room for a little while. About 10 minutes after she had arrived, the patient’s husband called the nurse into room. She was concerned because she believed that her hand had “ballooned up to three times its size.”
The nurse pissed the patient off by asking “Ummmm. Exactly which hand is the swollen one?”
About 15 minutes later, I went into the room, expecting to have to force the door open because of the exponentially growing hand. Fortunately, the patient’s hand was normal again. Good. One less thing to try to explain.
Not so fast.
The patient and her husband both demanded to know why her hand became so swollen while they were waiting.
How am I supposed to answer that?
How about “Unless you’re related to that stretchy lady on the Incredibles, skin doesn’t expand and contract that quickly. It has collagen fibers, not rubber bands in it.”
No, I’m too chicken.
“Well I didn’t really get a chance to examine it when it was swollen, so it’s tough for me to say.”
They wouldn’t drop it, though.
“Well could a pinched nerve in the neck cause someone’s hand to swell up like that?”
My eyes darted around a second. I couldn’t think of anything else better to say and I could feel my neck getting red. They were already pissed at the nurse because she didn’t see the “swelling.” If I tell them that radiculopathy can’t cause swelling they’ll ask me what did cause it. Then I’ll have to tell them they didn’t see what they really think they saw and they’ll think I don’t know what I’m talking about. If I tell them that radiculopathy does cause swelling, the neurosurgeon who they see will think I’m a quack.
“Oh yes, ab-solutely.”
I really am a chicken shit sometimes.