A guy in his mid-60′s came in thinking that he had a stroke. He “felt funny” but wasn’t having any other symptoms. The initial part of his exam was normal, so I started doing a neuro exam.
I break a cotton swab in half and use it to lightly poke his arms and legs to test his sensation from side to side.
“Ow, Goddammit! Cut that out!”
I thought he was kidding at first, but when I looked up at him, he furled his brow at me.
“I’m just checking your sensory nerves, sir.”
Then I tell him I’m going to use a reflex hammer to test his reflexes. [Tap tap] I hit his patellar tendon.
“Stop hitting me with that damn thing.”
“OK, fine, but it’s going to be hard for me to see whether you’ve had a stroke if I can’t test to see how your nerves are functioning.”
I hesitated for a few seconds, still half expecting him to crack a smile. All I got was a scowl.
“I need to check to see if you have any muscle weakness. Can you pull up with your arm?”
He pulled up with his left arm but it didn’t go anywhere against my resistance. Good strength.
“Good. Now try it with your other arm.”
He began pulling against my resistance again, then he suddenly grabbed my arm with his free hand and said
“Listen, you better quit f**king with me or I’m going to kick your ass, and if I can’t do it, I have two sons who look like King Kong.”
What I was thinking: “OK, whackball. You don’t have a stroke, it’s just that the lone synapse in your skull is being overworked. And if you don’t let go of my arm in the next 10 milliseconds, people are going to read about you twice on my blog – once to hear me tell the story and a second time when I link to the newspaper article about how some crazed emergency physician slapped the snot out of one of his patients.”
What I said: “Well, sir, it doesn’t appear that you have any signs of a stroke. Be sure to follow up with your doctor tomorrow for a re-check. Have a nice day.”
I didn’t have any bananas for him to take home to his sons, so I’m sure this is just going to be another one of those bad Press Ganey days.
And dang it, I only get one post out of the incident, too.