A young lady who has logged nearly 90 visits to our emergency department over the years was having pain all over the right side of her body. Just out of the blue, she developed sharp stabbing pains in the right side of her head, neck, chest, abdomen and her outer right leg. No other symptoms, just pain.
Her vital signs were normal. Her physical exam had no abnormalities – except for being a little anxious. I did an EKG that was unchanged from several other EKGs that were in her old records. We even did a trial of controlled hyperventilation and her symptoms got worse. So I gave her a shot of Toradol and told her about my plans to discharge her.
“You’re not going to do any lab tests?”
“I hadn’t planned to. What is it that you want to be tested for?”
“How about gall bladder or low potassium or something like that?”
“Gallbladder pain typically doesn’t involve the head or leg and it uncommonly involves the chest. Besides your pain isn’t over your gallbladder. ”
“The last two times I have been here my symptoms were due to low potassium.”
“I’ll go review your records.”
Her records showed multiple EKGs, chest x-rays, and lab sets since the end of 2007. I pulled up seven sets of lab tests just from the ED that time and printed them out. Every test was normal.
I went back into the room and this time a large gentleman with a cowboy hat was standing next to her bed.
“Here are copies of tests from 2007, several tests from 2008, some from January and some from June of this year. They are all, without fail, normal. Your potassium levels have always been normal. Your EKG was normal this time. No signs of low potassium on it. So I’m not going to do any more testing right now. Let’s just see how the Toradol works.”
I walked out of the room and over to the desk to finish writing up her chart. Her husband followed me out of the room, came over to desk, pulled a business card out of his pocket, held it up between his fingers, and placed it on the desk, holding his index finger over it. Then he used his index finger to push it over on the desk next to me. He held his index finger on the card and stared me down while he talked.
“I have to leave. My number is on here. Please contact me when you find something.”
I was initially going to post a scan of his card, but decided not to.
The card had a bunch of Chinese writing on the top. Underneath was his name “Master [Jean Claude VanDamme]“. After that, it said “expert in Judo, Karate, Taekwondo, Hapkido, Kung Fu” and some other martial art that I had never heard of before. Then it had an e-mail address and a cell phone number. No street address. No company. Just him and all his martial arts expertise.
The card looked like it was sitting on a workbench while he was changing the oil in his car. There were a bunch of grease spots on it. On the back were a bunch of handwritten numbers. They didn’t add up to anything. Maybe they were geo-coordinates to his office or something.
“Cool. You compete?”
He looked at me with a blank stare.
“I was in nationals a couple years ago … knocked my opponent unconscious in the semifinals. Won a silver medal in sparring in an international tourney a few years back.”
He still didn’t say anything. He just turned and walked away.
I did a potassium level on the patient just so that she couldn’t complain that I “didn’t do anything.” Not surprisingly, it was normal.
I discharged her without calling her MMA hubby.
The patient came back a couple of days later. This time all her pain had localized to her right flank. She happened to arrive during a busy time and ended up waiting several hours. Her evaluation was still benign.
Before I even discussed my plan with her, she said “I think I’ll just follow up with my primary care physician.”
“I think that’s a good idea,” I told her.
“Oh, and say hello to your husband for me.”
I had the same happen to me (except he handed me a card that described himself as an “independent MMA instructor”). I handed him a copy of my “other” business card – the one identifying be as a Sheriff’s Deputy and member of the tactical team (I am the medical director). I told him he could call me at my office there if he had any follow-up questions regarding his wife. I was met with the same silence.
Could she be in pain because he was practicing his martial arts on her?
[...] You talkin’ to ME? (WhiteCoat’s Call Room) [...]
the grease spots were probably from fighting off an army of robot aliens. seriously- defending the planet with your kung-fu is very messy work!
Kung fu, hell! Doc fu!
I feel for the woman if she really believes she has the pain. Why the emergency room vs her private physician?
I hate saying this… because sometimes things are really wrong..but staff blows them off as anxious.. but maybe a psych evaluation would be a good idea.
I had a friend who saw about 9 doctors before the last one figured out it was lyme disease. (early days of disease and not known by many physicians at that time) She got better after the anti-biotics.
I have an insurance story about this. She had to had to get the antibiotics intravenously foe one month.Her insurance company would only pay for it… *if she was an in-patient at the hospital for TWO WEEKS!* Can you believe that?! What did that cost them??? Then she got the other 2 weeks at home. A visiting nurse gave her the meds every day. I think some insurance rep screwed up there.
So…were you supposed to be intimidated by this oaf? How rude of him for not answering you!
I can outdo that one in terms of sheer insurance company absurdity:
On my second stay in the hospital, I somehow contracted MRSA in my wound due to open fracture of the right tibia. (Sometimes, if the open fracture wound is large enough and low enough on the leg, there’s not enough skin and tissue to close it properly- 4×6 cm in the beginning)
This was discovered at a follow-up visit to the plastic surgeon who was monitoring healing of this wound.
The regimen for this manifestation of MRSA is six weeks of IV Vancomycin twice a day. The infusion nurse got us started but– and this is the crux of the biscuit– **my wife and I did the IV infusions.**
**Outside of the cost of the nurse’s weekly visits and the drug costs**, the insurance company paid the hospital around $1600 per week for us to do said infusions.
This is analogous to purchasing a Coke at McDonalds and having to fill the cup yourself, but a couple of orders of magnitude larger.
I complained to the insurance company about this, but, as you’d expect, my complaint fell on deaf ears.
I think the Chinese characters could be translated as “Phu-kin tyul”
You should have ordered a serum porcelain level.
Wow, her husband’s a d***
Her docs have probably investigated this, but I was just wondering if she’s ever had an EEG or seen a neuro? (if you genuinely think she’s in pain and not a seeker) The only reason I ask is because my partner has visited GPs and urgent care clinics for acute pain, for which the causes were never found, despite complete workups.
Now he’s undergoing tests for Epilepsy (simple/complex partials). He has a whole bunch of (sometimes uncommon)signs of seizures, but never told them to the docs when he went in for the pain, because he didn’t think they were related in any way.
He often has low potassium as well, anxiety-like symptoms, and hyperventilation makes him worse.