Tuesday, April 26, 2005

A typical night patient in the EC

Her chief complaint was "a cold." She presented to the triage nurse at midnight and waited in the lobby until 2 am when she was shown to a room. Another 45 minutes later, enter the physician.

Doc: How can I help you this morning? Oh, My God! This woman waited 3 hours to be seen for a cold! I can't believe it.

She: Doc, I've had a cold for several weeks. It's just not getting better.

Doc: What symptoms are you having? What was so freaking emergent that you had to be seen at 3 AM for a problem you have had for several weeks?

She: I told the nurse already. Isn't it all on my chart?

Doc: This isn't going to be easy. Well, I always like to ask again, sometimes people remember extra stuff. Have you had a stuffy nose, fever, runny nose, cough, shortness of breath?

She: Well, my legs quit working all the time.

Doc: Oh, that's not good. Tell me what happens. You think THAT is due to a cold? What on earth are you talking about?

She: I have so much trouble walking. My legs just give out and I fall to the ground.

Doc: How often does that happen?

She: It has happened at least a hundred times.

Doc: Yes, but how many times a day/week/month? Jeez, don't you know what "how often" means? You answered "How many times?" See the difference?

She: Oh, all the time.

Doc: Ok, in the last week, how many times has it happened? Maybe she can't answer a two variable questions (numerator and denominator, such as 2times/week) Maybe if I define the denominator, she might accidently answer the question.

She: Every day.

Doc: So that didn't work. Try again. How many times a day does it happen?

She: All the time.

Doc: OK, I freakin' give up. Are you saying that your legs are weak all the time and that you can never walk?

She: No, doctor. You're not listening. I said that when I am walking, sometimes my legs give out on me and I fall.

Doc: I'm tired. I'm tired. I'm tired. I'm busy. I have 13 more patients waiting to be seen. OK, be nice. Don't get another patient complaint. Maybe there is actually something wrong with her. Be patient. I'm just trying to understand so I can help you. What I hear you saying Wow, I'm reflecting, just like that guy in med school told me to do. is that you are able to walk, but that, occasionally, and at least once a day, your legs suddenly become weak and you fall. Is that right?

She: That's what I've been saying. I've been waiting 6 hours and you are just repeating what I'm saying!

Doc: I'm not repeating, I'm reflecting. Anyway, you've only been here 3 hours! I'm just trying to make sure I get everything clearly. Thank you for your patience. I'm always sorry when anyone has to wait. So how long do these spells of weakness last?

She: Every day.

Doc: Wait, where's the camera? This can't be for real. Am I on ER Candid Camera? Yes, maam. It happens every day, but how long does it last when it does happen?

She: Oh, about as long as it takes my mother to drive from her house to mine.

Doc: Here in the real world we use a standardized units of time such as minutes and hours. HEY!! I DON'T KNOW WHAT WHERE YOUR MOTHER LIVES OR HOW LONG IT TAKES HER TO GET TO YOUR HOUSE!! Would you say it was just a few minutes or more, like several hours?

She: Usually just a few minutes.

Doc: OK, thank you. Finally, an answer. Have you ever been hurt as a result of any of these falls?

She: No. I just fall onto the couch.

Doc: So, do these spells only happen when you are getting up from the couch? Maybe orthostatis.

She: No, when I am walking about my house.

Doc: I don't understand. If the spells happen anywhere in your house, how come you only fall on your couch? You've never fallen on the floor?

She: No, I can make it to my couch before I fall.

Doc: No way this is real. Are the nurses playing a joke on me?

She: What?

Doc: Uh Oh. Did I say that out loud? No, it's in purple, I just thought it. You said this has been going on for several months. Have you had an opportunity to talk to your doctor about this? What does he think it is?

She: Oh, he doesn't know. He sent me to a neurologist.

Doc: And what did the neurologist say?

She: My appointment with him is at 8 this morning.

Doc: So why are you here!? And how can I help you this morning? Wait, am I repeating myself?

She: I was hoping to get a CAT scan so I wouldn't have to see the neurologist.