A man in his 5os drives himself to the emergency department with 10/10 crushing chest pain, nausea, and shortness of breath. He was clearly uncomfortable when he arrived. Why did he drive himself there? Well, he was going to call an ambulance, but he happened to be only a couple of blocks from the hospital and thought driving would be quicker.

Heart attack, right?
Well, the EKG showed LVH with minor repolarization abnormalities and the POC troponin was negative. No acute MI.

The patient got some nitroglycerin. The chest pain didn’t improve, but the patient became hypotensive. He got IV fluids.

ECHO tech comes in and does an ECHO. No wall motion abnormalities. Normal ejection fraction. Mild LVH. An essentially normal exam.

Labs returned and CBC and chem panel are normal. D dimer is significantly elevated. His blood pressure comes up so he gets IV morphine.

Pulmonary embolus, right?
Well, the CT scan showed no PE. And there wasn’t a dissection, either. But the CT scan did show some abnormality coming off the aorta that wasn’t present on ECHO. Different density than blood, so it wasn’t a dissection. We decided to admit the patient and do further testing.

Not so fast. The patient has an HMO and our hospital isn’t in network. His chest pain is better after receiving the medications, so he gets transferred 30 miles away to another hospital.

What was his final diagnosis?

We don’t know. Never got a follow up call.

That’s one of the downsides to emergency medicine. You don’t get to finalize workups as often as you’d like. Was it esophageal spasms, a cardiac tumor, or a sneaky circumflex lesion?

Most of the time you don’t get follow up until one of your colleagues comes up to you and says …

“Hey, remember that guy with the chest pain you saw last week?”

And you think to yourself “why didn’t I become a plumber?”

This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

An 89 year old little old lady is brought in because she is weak and doesn’t want to eat. She hasn’t eaten in about a week and she hasn’t been out of her home in longer than that. Finally a friend visiting her convinces her to come to the hospital for some IV fluids.

When she arrives, her tongue is dry, she’s tachycardic, and she has no urine output. We begin fluids and obtain labs that show she is moderately dehydrated. Otherwise, the labs and EKG look surprisingly good.

We make arrangements to admit her to the on-call physician since she has no primary care physician. We’re holding patients in the emergency department because the floor is full. The on-call physician has several patients being held in the ED. The patient gets taken over to x-ray department for a chest x-ray. She returns and about a half hour later I get a phone call from the radiologist.

“Your little lady with the shortness of breath has bilateral pulmonary emboli on her chest CT.”
“What little old lady with shortness of breath?”
“Mrs. Doroshow in Bed 4.”
“She’s not short of breath and I didn’t order a chest CT on her.”
[10 seconds of silence]
“Ooops. We did the scan on the wrong person. Well, she still has bilateral pulmonary emboli.”
“Nurse, can we get a heparin drip going on Mrs. Doroshow and hook her up to a monitor?”
“Whaaaat? Why?”
“You’re not going to believe this.”

There but for the grace of God go I.

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This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

A patient comes in for evaluation of left flank pain. In her urine sample, the nurse finds a small brown pebble.

Nurse, holding small plastic cup with stone inside: “Looks like I found what was causing your pain! That looks like a kidney stone!”
Patient: “Well, maybe … but I do have a cat, you know.”

Sometimes I wish that there were cameras in the rooms so that I could see my own confused looks.

When you come limping into the emergency department bent over and moaning because your back pain is “definitely 10 out of 10″ and is “so bad you can barely move your arms,” then 20 minutes later when the doctor comes to see you in the room, you are sitting on the bed laughing with your visitor and using a fork and plate to eat a piece of a nurse’s birthday cake that you somehow managed to pilfer from our staff break room … it’s a good bet that you are not going to get your Oxycontin prescription refilled.

Nope, you aren’t getting another piece of cake, either.

Now give me back that fork.

This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.