WhiteCoat

The Angry Mime

An older gentleman comes in because he has a “sinus infection” for the past couple of days.

As soon as the triage nurse brings him back, she’s already whispering to the other nurses. Later, I learned that she told them to make sure that I get the patient. She’ll get her paybacks later.

The man was upset because the ZeePack he got from his primary care physician wasn’t working after he had taken a couple of doses. He wanted some stronger antibiotics “like Augmentin or some Levaquin 750s” to make sure that his sinus infections went away. Triage nurse is really going to get her paybacks.

I examined him. He had no sinus infection. He had sinus congestion at best, but even that was questionable.

I dutifully explained that even if he did have sinusitis, studies show that antibiotics confer little or no benefit on patients with uncomplicated sinusitis. In fact, the best things for sinus congestion/sinusitis are topical decongestants and nasal irrigation. I even printed out a copy of the JAMA study and handed it to him. Then I gave him a couple of squirts of Neo-Synephrine in each nostril. Ten minutes later, he was much less congested and felt much better. He thanked me and promised to go home and use the nasal rinses.

That was about 7PM.

At 2AM, he shows up again and he is hot under the collar. I walked into the room and asked him what happened.
“That Neo-Synephrine makes my blood pressure go too high and I read that those nasal washes can give you brain infections, so I’m not taking them. I haven’t slept yet tonight and I want some Levaquin NOW!”
Whoa.
I told him that Levaquin wouldn’t help and that I wasn’t going to prescribe it for him. I started to mention that he could use sterile water in the nasal irrigation and try some Benadryl for his congestion/sleep problems, but he interrupted me.
“Well then, this was a complete waste of time.”
And with that he got up and walked out of the door.
Or at least he tried to walk out the door.

Only problem is that the doors are locked and patients have to be buzzed in and out of the department. When you’re angry, there isn’t an exception to that rule. He went to the regular exit, tried to open the door, pounded it a couple of times and walked back in the department toward the ambulance bay. People ran after him calling “Sir! Sir! This way, sir! Wait!”

He would have none of it.

He got to the ambulance bay doors and tried to pull them open with his bare hands. Nope. You have to use a button to open those, too. Then he started shaking the doors. Nope. They still won’t open.

We have cameras all over the place, so while he’s freaking out and people are trying to help him, everyone else is watching his antics in the camera and admiring his technique. It’s like a new reality TV series.

Then the patient makes one final mighty effort to pull the ambulance bay doors apart. And in the camera he looks just like an angry mime straining against an immovable object. His body shakes ever so slightly. His face gets red. Then … the doors open.

Waaait a minute. We looked across the nurse’s station to the control panel. The respiratory tech stood there smiling.
“Hey, he was going to break the door if he kept it up.”

And with a one-finger salute, the patient stormed out of the emergency department and into the ambulance bay, in further search of the holy grail of mucous sterilants: Levaquin 750s.

Doesn’t it figure that now he’s twice as likely to get a Press Ganey survey.

This and all posts about patients may be my experiences or may be submitted by readers for publication here. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

By the way, completely unrelated, but any time I think of mimes, this video comes to mind. Don’t know why.
Just like any time I think of pipe fitters, this story comes to mind.

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