I am in the middle of 36 hours off before I have to go back for my last 3 nights at ECMC. After the pain of the prior shift, I had a day off to transition back to night shift. Like I said before, that first night back was a killer. I was falling asleep during our morning meeting and doing everything I could to stay awake while driving back home. Now I am just staying awake to the keep the whole night/day rhythm going so I can work the next set of nights.
But I digress... let's talk about the themes and patients from the last several nights shall we...?
Of Gomeres and LOLNADs: In the "House of God," a GOMER is defined as "Get Out of My Emergency Room" usually referring to a nursing home patient. A female gomer was affectionately called a gomere. Also, when we write our physical exams, we describe a patient's state which is usually NAD = no apparent distress. In the "House of God," they refer to a LOLNAD which is a "Little Old Lady in No Apparent Distress." I had a night of gomeres and LOLNADs.
You've read my diatribes on the local nursing homes, so enough said there. I had several patients who came in, and when I asked what brought them to the E.D. they had no idea. Smiling LOLNADs. No idea why they were there. Nope, didn't hurt anywhere, didn't remember having a pain anywhere, just told they needed to come to the E.D., packed onto an ambulance and sent over.
Twenty pages into the photocopied stack of papers sent with them from the nursing home I was finally able to figure out that they'd had some abnormal (lab, vital sign, cough, episode of throwing up, etc.) and had been sent over for evaluation. Most likely because some doctor was called multiple times and finally said, "Just send them to be evaluated."
Unfortunately, ambulances just deliver, they don't pick up. AND, the van to the nursing homes doesn't start until, oh, 07:30. So, my gomeres that show up around 9 p.m. and get worked up and are ready for discharge around midnight have to spend the night at the hospital because unless a family member comes to get them (been hung up on several times at that suggestionso I don't even bother any more), they are going to be spending the night.
Primary care medicine night: I always ask patients if they have a primary care doctor who follows them for their general medical management. Most of the time it's because a patient is going to need to be admitted, and I need to know which service to admit them to. The other night it was because almost all of my patients, and those of my fellow residents were coming in for primary care issues.
I knew as soon as I walked into the room, heard the presenting complaint and asked, "How long has this been going on?" that if the patient answered greater than two months it was going to be tedious, very tedious. And, unsatisfactory. I would do the complete work-up, probably not come up with a diagnosis, and end up referring them to who...? A primary care doctor: their own or a referral to the medicine clinic who will eventually sort things out and manage the patients care. As they should. Not me. Them.
Musta been a full moon: Last night was crazy night. Crazy patient night. We all had them. We're used to the drunks, the druggies, the confused gomers and gomeres. But, last night it was the schizos, the psychos, and everything in between.
There's a medical condition called Munchausen's where patients make themselves sick so that they'll get attention. And, there's a condition, pseudocyesis, where patients want to be pregnant so badly that they'll actually be able to stop their periods, gain weight, start making milk, etc. I had a patient last night that seemed to have both.
A police officer brought in a woman who had been found at a bar drunk after her family reported her missing. The report stated that she was 8 1/2 months' pregnant and had missed going to her ob-gyn appointment. No one knew where she was. When she was found by police just a few blocks from her home, she stated that she had gone to her ob's that morning, had been told that her baby died, delivered the baby and had left. There was concern that she may have done something to the baby, or had delivered out of the hospital.
I asked the officer if he was sure there actually was a baby. Supposedly her sister and several other family members were under the impression that she was. The baby was presumed to be due next week. They were all worried about her mental state since she had previously lost another baby close to term. She even had a tattoo on her left breast in honor of it.
Well, long story short. Pregnancy test was negative. No baby for at least a month. The more we investigated (I even put an ultrasound probe on her) the more upset she got. She was the victim. Feel sorry for her. Lost another baby and didn't go home. No, she went to a bar to drink and figure out what she was going to do because she didn't want to disappoint her husband and family.
When I told the police officer, he was dumbfounded. He stayed around to help escort her over to our psychiatric intake center because she was not going easily. He was still shaking his head as he was leaving. He was even more amazed that the husband was still under the delusion that his wife had been pregnant. When I asked if the husband hadn't found out, I was told no. Telling him would be in violation of HIPAA rights which if you didn't know are the protection of patient privacy laws which you're informed of whenever you see a doctor.
So he's in oblivion, and she's in the looney bin. My attending is still snickering because I was concerned about a baby that never was. No wonder House is so cynical. "Everybody lies."
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