WhiteCoat

Soon To Be Unemployed

It is with a heavy heart that I tell you all that someone else is going to be taking over my duties in the emergency department and on this blog from this point forward. Below is the story why.

———

Something didn’t look right when the very large patient was wheeled into the emergency department. He was moaning in pain and had his hands over his face. Usually the people who have their hands over their faces have something to hide.

When he got into the room, he was moaning how his chest hurt. He had an aneurysm in his chest that he thought was bursting. In the past, the aneurysm had dissected into his coronary arteries, giving him a heart attack. His pain was “20″ on a 1-10 scale. But he laid there comfortably, still with his hands over his face and peeking out through his fingers at what was going on in the room. His vital signs were rock solid stable. As I started to examine him, I noticed that he had sticky residue from EKG leads on his legs — making me think that he had been to another hospital in the recent past. When he took his hands down from his face, he wasn’t sweating at all. His front four teeth were missing. His heart sounds were okay, but he yelled when I put my stethoscope on his chest.
“That HURTS!”
“Oh. I’m sorry.”
The pulses in his arms were equal which is a good sign when considering whether or not there is a dissecting aneurysm. I also noted that he had tape residue on his wrists which appeared to be from a recent IV site. His abdomen was quite large which prevented me from palpating any of his organs.

I got a little more history.

The patient started having “crushing” chest pain early in the morning. The pain went into his neck and into his left arm. He was also having a large amount of blood coming from his rectum. He wasn’t sure why, but he was feeling dizzy.

I moved out of the way so the tech could hook up EKG leads.

He’d been neglecting his health. He stated that the last time he had received any medical care was about five weeks ago. At that time, he was told by the doctor in our emergency department that he needed to have an angiogram, but he had other issues to take care of, so he left against medical advice and never did get to follow-up with the cardiologist as was recommended. He had just moved to the area from Montana and did not have a primary care physician. His doctors in Montana had done an extensive workup and found that he had an aneurysm in his chest that was unable to be surgically repaired. In fact, he remembered some nurse in the emergency department out there whose name began with a “K” who would never give him the medications he wanted. I got the contact information for the hospital where the patient had been worked up in Montana.

Then I went to look in his old records. He was right. The last time that he was in our emergency department was about five weeks ago. We recommend that he stay for a cardiac workup, but he had to leave against medical advice. But that wasn’t all. We also got records from his Montana hospital during that visit. They showed that the patient had been extensively evaluated for multiple complaints and no etiology for any of the complaints had ever been found. Those record suggested that he had a “somatization disorder” and on the patient’s last admission, he had been referred to a neuropsychiatrist. Hmmmm.

On a hunch, I asked the nurse to call around to some of the other hospitals in our area to see if the patient had been anywhere else recently. The first hospital that we called was across town. The emergency department nurse knew the patient by name.
“You mean the heavyset guy with no front teeth? Yeah he was here a few days ago. He got admitted.”
“Oh reeeheeheeheeaaallly?”
We requested records and lab results from their medical record department.

When we received the 14 page fax, it showed that the patient had been discharged from the hospital four hours prior to his visit to our emergency department. That would have been just about enough time for him to get home and then call the ambulance again. The patient was complaining of abdominal pain in that hospital. He had CT scans of his chest, abdomen, and pelvis performed the day prior. All were completely normal. There was no aneurysm. He also had an ultrasound of his gallbladder performed which was also negative. The morning of his discharge, he had a normal cardiac stress test.
By this time, some of the laboratory tests we performed our emergency department were coming back. They were all normal. His EKG was normal as well.

I gathered up the results of the testing that had been performed at the other hospital and brought them in to the room with me. One of the nurses tagged along behind me. “I don’t want to miss this.”

“So, you told me before that you haven’t had any medical care in five weeks. Is that right?”
“Yeah, I really need to take better care of myself.”
“That’s funny, because we got a fax from Metro General Hospital just now showing that you were just discharged from their hospital this morning.”
“No I wasn’t.”
“The fax also shows that you had normal CAT scans, a normal ultrasound of your abdomen, and a normal cardiac stress test in the past two days.”
“I haven’t had any testing done since I was here five weeks ago.”
“That’s strange. The nurse that we spoke to over there knew you by name, confirmed your birthdate, and described you as being heavyset and having ‘no front teeth.’ I have a hard time believing that they are getting you confused with another patient who is having all of this testing done.”
“Are you calling me a liar?”
“Let’s just say that I am doubting your story. By the way, why is it that you have residue from an IV and from EKG leads on your arms and legs?”
“The ambulance put those on there when they brought me here.”
“The ambulance put the IV in your other arm where it is still located and the ambulance does not put EKG leads on people’s legs. I think we need to call the police to get a positive identification on you and to sort this whole matter out.”

That was it.
“You motherf***er! You have invaded my privacy and violated the law!”
“You can file a police report on me, then. Can someone call the police, please?”

With that, the patient ripped off his EKG leads, ripped out his IV, and demanded a phone so he could call his attorney.

“But wait. We need to do some other testing to make sure that you’re not bleeding from your colon. We need to do something called an NG tube and perform a rectal exam to check for blood.”
“You’re not f***ing touching me, you QUACK.”

He pulled on his pants, and grabbed the rest of his clothing, and walked out of the room. Then, he pointed his finger at me and began yelling.

“Your job is MINE, you hear me? Your f***ing job is MINE. MIIINE!” He reminded me of this outburst by Newman on one of the Seinfeld episodes. All he needed was the faux evil laugh.

I haven’t received the official word from his lawyer yet, but, in planning ahead. So I’ll write a few more blog posts before this chap takes over.

Gosh, I’ll miss you all.

[sniff]

———————–

This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. 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.

18 Responses to “Soon To Be Unemployed”

  1. THS says:

    You scared me so much!!! When I saw your first lines, I turned off my Pandora and focused in on what I thought was your final post. My mind was racing trying to guess what could cause this…maybe the trial you’ve been hinting at? But you wouldn’t leave us without a full multiple-post story after the amazing job you did before. Maybe you were made a hospital administrator because they think your ideas on this blog are so amazing? But you’re anonymous. Maybe…maybe… You fooled me! Great post!!

  2. Felix Kasza says:

    > Soon To Be Unemployed

    Don’t do such things, I was scared about missing my future Whitecoat-fix!!

    Also, you are clearly cruel. Instead of assisting the patient in verbalising his complaints, you brushed him off. Would it have been so hard to listen, with a friendly nod now and then, until the pt gets to saying “that D-medicine”? At that point, you politely excuse yourself to prepare the injection, go to the Pyxis, and pull a dose of Toradol. After all, with four missing front teeth, producing those “T” sounds correctly is difficult!

  3. throckmorton says:

    Four hours between admissions. Just long enough for him to fill out those Press Gainey forms.

  4. Brian says:

    Bravo!

  5. Dan says:

    Thanks for making me almost blow an aneurism, YOU MOTHERF***ER!!!!!

  6. landlockedtxn says:

    Dude,

    NOT funny! well, the story is funny…I enjoyed it! unfortunately, I know people like that…but don’t mess with us! gotta have the white coat fix everyday!

  7. SeaSpray says:

    WC! Ha ha ..no heh heh ..no ..suffice it to know I am laughing like one does when they think …”You son of a gun! Funny – you GOT me good!” And if you were in range right now I would’ve already LOBBED something at you and NOT missed! (Nothing that would hurt you though ..not too much anyway ;)

    Gee …you scared me. And every follower that enjoys your writing. I was tired and just about to shut the computer off and thought let me just visit and see if anything new here. Adrenaline must’ve kicked in because I am wide awake now.

    Actually, I couldn’t even read the rest of the post because I had to reread the first paragraph 3 times (last two times slowly)as if I’d find the answer there ..and also I didn’t want to face the loss of one of my favorite bloggers…but look away ..I could not.

    Then with laser focus I honed in on the rest of the post.

    BUT …first I wondered if you were ill,if there was a family concern, if you were leaving medicine, pursuing another career, Legal problem with other blog affecting this one,in trouble for blogging, bored blogging, too busy too blog, and then as I began reading about the patient’s crazy claims and angry threats as I was reading ..I was also wondering if you were in danger…would he stalk you and you had to leave where you are. Those were all the random thoughts flying through my brain.

    Gotta give it to you – very funny. Cruel ..but, funny. :)

    I LOVED the Newman character. I like him on the new TV land show too.

    That patient must be racking up some medical bills. What a waste of time. Can the police be called on HIM?

    That post is so you.

    You’d be missed.

    I’m just sayin.

  8. defendUSA says:

    Uh, gee WC…maybe he needs a great manic-depressive cocktail(I’ve got the perfect one) and you can give him the pen and paper to facilitate! :)

  9. Ray says:

    Such a great post, but the icing is that you’re not actually leaving! Major sigh of relief!!

  10. Guiac says:

    I remain amazed at how many of my indigent patients maintain lawyers on retainer. I don’t personally have such a lawyer to call and would have to resort to contacting a firm in the event that I need legal services. I suppose like with Iphones I am simply behind the times.

  11. Brighid says:

    (throwing rotten vegetables) You SCARED us!

    But it was a good story.

  12. JT says:

    With HIE coming, this will be easy information to obtain for patients thus decreasing costs of redundant testing and work ups. You can opt out however and I suspect all the patients like this guy will opt out for “privacy reasons”. BTW, I was excited by the thought of your leaving–I was going to offer you a job here! LOL. Offer still stands anyway.

  13. DL says:

    This story exemplifies what is exactly wrong with health care in this country. Patients are held to no standard so their behavior remains unchecked (except by worsening morbidity or death). The scenario is VERY realistic and likely plays out in many ED’s across the country on a daily basis. It’s the sort of thing that stares us in the face reminding us we’re not empowered to help these types of people because the system actually rewards irresponsible, self destructive behavior.

  14. totalfailure says:

    you scared and scarred me! i almost bought it hook line and sinker.

  15. Siby Sebastian says:

    I am an ER dcc at a couple of rural hospitals…needless to say we see similar scenarios all the time…My own reaction is…it is not worth wasting your energy on confronting them…ignore them…it is an equally powerful weapon…obviously another case illustrating the need for tort reform

  16. RuthieH says:

    This blog was pure GREATNESS! After I got over the shock, I almost fell out of my chair from laughing.

    We see patients like this so often. Sad but true. Physician, pharmacy and hospital hopping are the “norm” for so many that our society has come to accept it and just turn their heads. Not to mention the costs rolled over to all of us. I applaud you doc for stepping up and following through. BRAVO!!!

Leave a Reply


8 − = one

Popular Authors

  • Greg Henry
  • Rick Bukata
  • Mark Plaster
  • Kevin Klauer
  • Jesse Pines
  • David Newman
  • Rich Levitan
  • Ghazala Sharieff
  • Nicholas Genes
  • Jeannette Wolfe
  • William Sullivan
  • Michael Silverman

Subscribe to EPM