Saturday, December 19, 2009

Vitum's Field Guide to Hospital Grunts - Patient Edition


ID: Reproductus cornicopious, the common multip (i.e. multiparous woman, who has delivered a few babies already)
HABITAT: Maternity Ward

BACKGROUND: There is a saying on the maternity ward: “Never turn your back on a multip.” It is a known medical phenomenon these women, who have already had a few babies, have shorter and shorter labour for subsequent pregnancies, to the point where you better not ever be too far away or you’ll be picking baby up off the floor.

I have actually been trained that these multips often make a loud, primal, guttural grown the moment before the serious pushing begins. If you’re not in the room, and you hear this, hustle.


ID: Narcoticus demandilus, the drug seeker
HABITAT: Emergency Department
ACTION REQUIRED: Holistic support up to and not including writing an opioid prescription

BACKGROUND: The loudest patients demanding pain medication tend to be the ones for whom Tylenol just doesn’t work, they’re allergic to the stronger anti-inflammatories, and gosh darn it your only option is to prescribe the good stuff. The ones who are bad at it are the ones who only seem to be in pain when the doctor walks by, and are easily fooled (i.e. “Let me examine your back.” “Ow ow ow! Even the slightest touch on my back hurts!” “Funny, when I felt your back earlier and didn’t warn you that I was examining you, you didn’t seem to notice…”
A good rule of thumb is the more convincing the patient, the more you should look for signs they’re trying to fool you.

Be careful, though. Every so often you’ll get someone who you are convinced just wants drugs, and then you are later corrected and find out with convincing evidence they are in legitimate pain. Looking back and realizing you denied a cancer patient some form of relief makes you feel really bad.

The hard part is, there is a legitimate argument that drug seekers need treatment too, just not the drugs they’re looking for. This is something I wish modern medicine could treat way better than it does.


ID: Constipationaticus fecalis, the bunged-up ones
HABITAT: Old folk’s wards
ACTION REQUIRED: Grab a diaper. Just in case.

BACKGROUND: I was called one night to see an ornery elderly woman, and recognized her from seeing her in the emergency department, shouting at the nurse. “Closer, I’m deaf! Closer! Louder! I can’t hear you! Closer! WHY ARE YOU SHOUTING AT ME? *smacks the nurse*” I thought she was hysterical.

I’m not even sure what the original call was about, probably needing a sleeping pill or something basic like that. All I do remember is walking in the room, and she was moaning, as above. “MMGGGGNNNNHHH!”

“Why are you groaning?” I asked of the woman laying in the bed, gripping the siderail for dear life. “I’m POOPING!” she shouted at me. “I’m POOping in my DIAper!”

I was only a third-year medical student at the time, so not an expert in things medical. But I did know a few things, and took haste to correct her.
“Ma’am, you’re not wearing a diaper.”

The ruckus stopped. She looked down, and stopped to think for a minute.

“MMGGGGNNNNHHH!” I went and got someone who knew where the diapers were.


ID: Cardiovascularis joltishockus, or defibrillating a semi-sedated patient
HABITAT: Emergency department, cardiology ward
ACTION REQUIRED: Increase sedation!

BACKGROUND: Some patients who have a heart arrhythmia need to be shocked with the defibrillator, or cardioverted, to get their hearts back in normal rhythm. They are given sedation, then, under strangely close supervision, the medical student is often allowed to push the button with the little lightning bolt on it. One or two, sometimes three, shocks, and their hearts are back to happy beat (Yes, that’s what we call it when the patients are sedated and can’t hear us).

There was one patient who didn’t seem to have very much sedation. He had just barely fallen asleep, and the doctor turned to me and said, “Vitum, push the button!” “Uh, does he need some more propofol?” I asked. “No! Push the button!” So I pushed it, wincing a bit as I did, sending 100 joules of electricity through this young, muscular man’s heart.

The machine clicked, the patient jolted just like on TV, uttering a HUUNFGH, and his eyes went COMPLETELY wide open. And he turned his head, and stared directly at me. And stared. And stared. His eyes were bugging out of his head, and he was clearly sending the first silent death threat I had ever received, probably trying to kill me with his mind.

And then the doctor said the words I didn’t want to hear: “Hmm, he needs another one. Shock him again, Vitum.”

I asked the patient later if he remembered. Fortunately, the doc was right – he’d had enough sedation, which made me breathe a huge sigh of relief. I swore he’d be waiting in the parking lot for me after work.


mollyw said...

Awesome post. Can't wait to get into medical school to enjoy the musings of rotations.

Xiaonangua said...

Yay! you posted again! (no pressure). Your stories are always so well written and ever so amusing. Keep up the good work.

Paramed said...

The first person I cardioverted screamed "Aaaaaaaa I'm gonna kill you." I took it to heart. Now I make sure I give at least 5 of versed and wait a couple of minutes just to make sure they don't remember me.

Zac said...

Vitum, where'd you go? I miss your posts!

Anonymous said...

You are so jaded and disrespectful. You went into medicine for the paycheck didnt you? Are you even capable of expressing empathy? I really think you would benefit from spending a few months with some nurse on the internal med floors with 20+years exp. THEY still have compassion and could teach you a think or two about what it means to be human. I hope you become an excellent surgeon because otherwise no patient would want a prick like you.

dr. pathologue

fan_of_vitum said...

To me it looks like he's got plenty of empathy:

- realizing you denied a cancer patient some form of relief makes you feel really bad

- This is something I wish modern medicine could treat way better than it does.

- “Uh, does he need some more propofol?” I asked.

- he’d had enough sedation, which made me breathe a huge sigh of relief.

It's a shame you have to resort to foul language to get your point across; why are you so bitter?

amara said...

so funny vitum! :) love the one about the diaper.. or lack thereof..

beatnbustem said...

How do you wish that our medical system deals with drug addicts/drunks/etc?

Anonymous said...

Have you abandoned ship Vitum? :( I enjoyed reading your posts

Anonymous said...

Dude you have to give us an update

Mihai said...

ohh God ..the worlds is changing so fast article