A patient comes in with dyspnea. He has a history of CHF and a history of COPD, so determining the etiology of his shortness of breath would prove to be a little tricky.
His wife, trying to be helpful, repeatedly interrupts the patient during his history.
“How long have you been having trouble breathing, sir?”
“About three …”
“It all started when my son’s nurse came to visit. My son has multiple ulcers from diabetes and is getting wound care at our home. They’re not sure if he has MRSA yet.”
“I’m sorry to hear that. Now how long have the symptoms been going on for, sir?”
“About three or four hours.”
“You’re going to check him for pneumonia, right? The home health nurse said that he should definitely be checked for pneumonia.”
“Yes, ma’am. We’ll check him for pneumonia. Now does anything make your breathing get better or worse?”
“You’re going to check his pro-time, too, right? You did know that he was on coumadin, right? He hasn’t had his pro-time checked in over a month.”
“Yes, ma’am. We’ll check his pro-time. Now is there anything that makes your breathing better or worse?”
“He was last admitted in this hospital about 3 months ago. He had heart failure then.”
“That’s good to know. I’ll …”
“Oh and I don’t know if this makes any difference, but he had two bowls of Mini-Wheats for breakfast this morning. He usually only eats one.”
Back in the old days, when a woman was ready to deliver her baby and a father was getting in the way of preparations to deliver the baby, the doctor or midwife might tell the husband to go boil some water. In reality, there wasn’t much of a use for boiling water when delivering a baby. But in order to boil the water, the father had to go out and build a fire, collect the water from the well, heat up the stove, and then put the kettle on the stove to boil. By the time that the father returned with the boiling water, the baby had already been delivered and the father hadn’t managed to get in the way of the delivery.
Our helpful but counterproductive young lady needed to “boil some water,” but telling to do so wouldn’t help matters much. Then an idea sprouted up.
“Wait, did you say he was on coumadin?”
“I don’t know. We left his medications at home when we rushed to get here.”
“I need you to go home and get those medications for me.”
“It’s a JCAHO regulation that we have accurate medication reconciliations on every patient that comes into this emergency department. It would be very helpful to see the medications your husband is taking so that we can make sure that they aren’t causing his difficulty breathing.”
“OK. I’ll be back as soon as I can.”
“No hurry. Please drive safely.”
“Now about your shortness of breath, sir ….”
He didn’t have pneumonia. And he was admitted and waiting for a bed before his wife returned with the medications.
“Go get the medications” may just become the modern day equivalent of “go boil some water.”
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.