jmj11 Posted September 25, 2009 Share Posted September 25, 2009 Okay, I was just thinking about how oddly some people behave in my book. Not that I'm so sane myself:rolleyes:. But I wanted to share a couple of snippets from the last couple of days. Case 1: A man with episodic migraine comes in for a new appointment. He has about two headaches a week. As I read his outside clinical notes, I see that his wife has just been diagnosed with metastatic breast cancer which looks terminal (with mets to her brain). The wife is with the patient, wearing a scarf (from chemo-fallout) and looking bad (she is only in her 40s). I didn't say anything about her cancer until I got to her husband's ROS. I always ask about stress. As I asked him about stress in his life, I looked up at his wife and said, "I read about your story. I'm so sorry. This must be tough." She started to cry and then her husband quickly interrupted us, "Hey . . . this is MY appointment! We are here to talk about me!" Case 2: 10 year old kid with seizures. Trying to titrate meds. As I was explaining the long story of how to take his meds, when to get his labs etc. I noticed that his mother never looked up at me and never said a word. The poor kid was trying to understand what I was saying. Then I noticed that the mom was looking down, text messaging (with her phone behind her pocketbook where I wouldn't see it) the entire time. I asked her to repeat what I had said and she didn't have a clue. Any others? Is the world nuts are is this normal behavior these days?:confused: Link to comment Share on other sites More sharing options...
aprillh Posted October 2, 2009 Share Posted October 2, 2009 Oh my gosh, how horrifying and sad. Both cases. How did you respond? Unfortunately (or fortunately) the most I get in derm is the sullen, overdramatic teenager who needs their acne cured yesterday. Link to comment Share on other sites More sharing options...
Tom Scoufalos Posted June 18, 2011 Share Posted June 18, 2011 I had a guy with chronic diarrhea, hitherto perfectly reasonable on several encounters, (FWIW probable autonomic diabetic diarrhea and therefore difficult to manage), come in for a follow-up bearing photographs if each bowel movement he'd had for the prior three months on his digital camera. And printed. AND ON HIS LAPTOP. It was all I could do to keep a straight face, try and make the "data" seem valuable, and not say something on the order of "what...in the name of G-d...makes you think I have ANY INTEREST IN THIS AT ALL?!?" Link to comment Share on other sites More sharing options...
COTA for now Posted June 18, 2011 Share Posted June 18, 2011 The poor guy is probably stressed out, and on some level, resentful of his wife. I can imagine who he is probably expending so much energy on helping her, and trying to cope, that he feels like he is always 2nd rate. Ironically, asking about her, and seeing his reaction shows that this is definitely an issue for him, and probably making his health worse overall. Link to comment Share on other sites More sharing options...
JFarnsworth Posted June 18, 2011 Share Posted June 18, 2011 I always wonder what people are thinking when they bring in a sample of their feces so we can see what it looks like. And I also wonder if they will be using the tupperware container again for food... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 18, 2011 Moderator Share Posted June 18, 2011 had a guy last night for "uncontrolled htn for yrs" on 3 agents and still with a bp of 160/110. lots of coffee/soda? nope decongestants? nope daily IV meth? yup...now maybe, just maybe, this might play a role in your "uncontrolled bp" Link to comment Share on other sites More sharing options...
jdenning Posted June 19, 2011 Share Posted June 19, 2011 The thing I find interesting is how much of this "odd" behavior is something within conscious control or not. Case in point: 17 year old male with long history of absence seizures, now with 2 generalized episodes in the past year. Our epilepsy specialist added a second drug and gave him a titration schedule; I am seeing him for follow up to see how he is doing. His mom comes to the appointment with him, but stays in the waiting room, consumed by something on her phone. (What is it with the phone stuff??) In our practice, your office is also your exam room. All of our offices are full with a new physician starting, so I am relegated to using other offices on various days that the docs aren't here. (this is what you get when you are the only PA in the practice - but that's another story.) So I am using another office, and that physician has 2 computers and 3 monitors, so here I am peering at the patient from behind the monitors. He tells me he started the second drug, but stopped it fairly quickly after it upset his stomach. He didn't call to report this and apparently didn't tell his mom either. Thinks he has had a "few" seizures and has "passed out" at school a few times - oh by the way he needs a note for school - I of course am a bit alarmed by this, since his other drug isn't going to control generalized seizures and he could fall down and hit his head just about anywhere....And he stopped the drug almost 3 months ago and didn't call. So we discuss some options, and he agrees to try another drug. I leave the room momentarily to get some samples for him of the new drug, when I hear a bunch of noise that sounds like things crashing. I return to the other physician's office to find my patient mid generalized seizure and he has not only fallen out of the chair, but he is now wedged between the 2 chairs in the room and is rhythmically kicking the desk. All of the contents of the desk drawers are spewing everywhere, and 2 monitors are rocking on the top of the desk threatening to fall and land on the patient. Fortunately, my SP hears what is going on and rushes in - he goes for the patient and I get the monitors before they fall. The convulsion stops after 45 seconds or so and patient comes to. We get him back in the chair and he seems to come back to baseline fairly quickly - which seems a bit odd to me given the severity of what we've just seen. We get his Mom from the waiting room and decide that he doesn't need to go to the ER, but he definitely needs to start the new drug ASAP and I go over everything with his Mom, all the while thinking that the physician whose office I am in is going to kill me because his desk is destroyed and the room is an absolute mess. He's one of those people who has every single thing in his desk drawers organized and knows where absolutely everything is.... After we get the patient out and on his way, SP asks me if I'm ok and I say yes, of course, but I'm worried sick about the physician's desk and office. We can't get his desk fixed before his return, and he is not too happy when he comes in the next day, but has a sense of humor about it and even now still sends me e mails that I am not to go anywhere near his desk if he is not around.... A few months later, our epilepsy specialist winds up admitting him for inpatient monitoring (which is what we do when we're trying to figure out whether seizures are "real" or not or if monitoring can help us localize the seizures better to determine if they might be a surgical candidate). It turns out that our patient had a similar "episode" at his PCPs office and the PCP was suspicious whether the seizure was "real" or faked. Sooo....inpatient monitoring reveals that he indeed has brief absence episodes but no evidence of generalization. And he was monitored for several days OFF meds. !!!! So it turns out that the episode in our office was probably faked, and we have a destroyed desk and a near miss of 2 monitors nearly landing on this kid's head, and a Mom who was texting in the waiting room the whole time. Just another day in the neuro office..... Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 19, 2011 Moderator Share Posted June 19, 2011 I always wonder what people are thinking when they bring in a sample of their feces so we can see what it looks like. And I also wonder if they will be using the tupperware container again for food... patient just did this to me last week - problem is that he saw two of my SP's once each in the previous two weeks C/O fatigue WITH a hx of GI bleed - they never did a rectal or gave him stool cards - so when he saw me he brought in a stool sample - low and behold and is was GROSSLY positive for blood....... so very wrong that an 88 yr old previous hx of GI bleed did not get a rectal or stool cards in the previous 2 visits that I actually thanked him for bringing in the sample.... saved me doing the rectal but answered my question..... nice to have a patient smarter then me!! Link to comment Share on other sites More sharing options...
Just Steve Posted June 19, 2011 Share Posted June 19, 2011 It's 2 a.m., called the residence for report of "one having a stroke" Me: "how can I help you tonight?" Pt, while playing video game, not looking at me or the other three responders in room: "I can't sleep" Me: "how about we turn off the game and talk about why you called 911" Pt: "after I clear this level" The conversation doesn't improve much after that. The contract we have as an ems company contracted in to provide ems for the county doesn't allow us to simply walk away without a refusal. They call, we haul, that's all. That is just one tiny example in the insanity that is the world of ems. Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted June 20, 2011 Share Posted June 20, 2011 Called to apartment (the complex is like a vertical trailer park) for 23 y/o/m OD, possible non-breather. Pt. cyanotic, resps of 2/min, paraphenalia all over. Mom says, "My son doesn't do drugs." Pt's pupils pinpoint. 1 min after IV narcan, pt. breathing, 2 min later alert & talking. Transport. Call dispatch for times. They say, "Yep, mom told us he doesn't do drugs - we ran him, he's got felony possession warrants." Go figure. Or, as the saying goes, what do we in the fire service call stupid people: job security. Link to comment Share on other sites More sharing options...
Evan Posted June 20, 2011 Share Posted June 20, 2011 The poor guy is probably stressed out, and on some level, resentful of his wife. I can imagine who he is probably expending so much energy on helping her, and trying to cope, that he feels like he is always 2nd rate. Ironically, asking about her, and seeing his reaction shows that this is definitely an issue for him, and probably making his health worse overall. I had an encounter that was quite similar a few months back. The pt with cancer came in with her husband. She was quite ill, on chemo, cancer progressing. Husband kept trying to move our discussion over to his extensive history of low back pain and how hard it was for him to take care of his wife. After a few minutes his wife just got quiet and was letting him do all the talking. It was all I could do NOT to tell him to shut up and let her speak/answer a question or 2... Some family members just feel left out when they aren't the sick one... Link to comment Share on other sites More sharing options...
cs278405 Posted June 20, 2011 Share Posted June 20, 2011 I've had Link to comment Share on other sites More sharing options...
nightrt Posted June 21, 2011 Share Posted June 21, 2011 Had an ER patient (16 y.o) once when I was a practicing RT that came in for what looked like tonic clonic seizures, but pupils were equal and reactive. The doc obtaining the history from the mother had to stop what he was doing several times due to patient having seizures that would continue for several minutes with no other signs of seizure other than the jerking and thrashing. At the 4th "seizure", doc opened the curtain to his room in the ER, completely uncovered the patient and pulled his pants and underwear to his ankles, and called for a few female nurses, then resumed his interview of mom. Wouldn't you know it, the seizure stopped just in time to get the pants pulled back up by the patient. Kiddo had a project due the next day, and had seen a brother of a friend who suffered from seizures, so he thought he could fake seizures and get admitted to the hospital. Also had another case recently where a 16 year old with a known seizure disorder was admitted for seizures to the PICU due to status state. He was having 30-45 seconds seizures several times an hour. My SP on evaluation in the unit was suspicious, because his vitals remained within normal limits and pupils were reactive. During an episode, she raised his arm up over his head several times and never did his arm fall onto his head, it always landed at his side. Turned out, he was suspected of theft and the police were looking for him, so he figured he could fake his seizures to not be home when they came a knocking. Link to comment Share on other sites More sharing options...
bgdog Posted June 21, 2011 Share Posted June 21, 2011 Pt airlifted to trauma center, crashed while texting. Everything broken, lots of surgery, admitted to the ICU. The next day the trauma surgeon is in the room explaining all the different procedures that he did and what his tx goals are to the nurses and family. What is the pt doing? Texting Link to comment Share on other sites More sharing options...
Joelseff Posted June 22, 2011 Share Posted June 22, 2011 Pt today wanted to get off opiates because he states he is feeling better post ESI injection. As I began writing his taper RX, pt says "Oh yeah can you write that for an early fill, I ran out early..." I ask, "Why'd you run out early?" Pt: "I took more than prescribed because I had more pain" I rip up the script.... Oh and another one: Pt calls to get a vacation/emergency override because her "Father just died, and I have to fly out for the funeral" I tell her sorry for her loss but procedurally we need a copy of her itinerary for a vacation override. She says "Oh, my flight is in August..." *Sigh* 14 days and a wake up!!!! Link to comment Share on other sites More sharing options...
Joelseff Posted June 22, 2011 Share Posted June 22, 2011 patient just did this to me last week - problem is that he saw two of my SP's once each in the previous two weeks C/O fatigue WITH a hx of GI bleed - they never did a rectal or gave him stool cards - so when he saw me he brought in a stool sample - low and behold and is was GROSSLY positive for blood....... so very wrong that an 88 yr old previous hx of GI bleed did not get a rectal or stool cards in the previous 2 visits that I actually thanked him for bringing in the sample.... saved me doing the rectal but answered my question..... nice to have a patient smarter then me!! LOL I had a pt bring in urine in a pill bottle. I ask her what it's for, she says "for my urine tox screen." I LOL and tell her I cant accept it and she says "Why, it's sterile, I washed it out myself." Pain Medicine-FML Link to comment Share on other sites More sharing options...
hrjames Posted June 22, 2011 Share Posted June 22, 2011 20-something who texted during the entire visit. Including during the pelvic exam. I wanted to ask what she was sending and wondered if there are any abbreviations for this kind of event - OMG! I notice a lot of friends and even family members will often interrupt with "yeah, I had this exact same thing..." and launch into their own story, when they are not going to be seen. They just can't seem to let the patient have the attention. Link to comment Share on other sites More sharing options...
EMSArtist Posted June 22, 2011 Share Posted June 22, 2011 I notice a lot of friends and even family members will often interrupt with "yeah, I had this exact same thing..." and launch into their own story, when they are not going to be seen. They just can't seem to let the patient have the attention. I think a lot of people just want attention. They can be 3 or 93 and that is one of the major things people both want and need. I think a lot of people have trouble accepting that sometimes other people get attention. It's a little pathetic, but so common... Link to comment Share on other sites More sharing options...
anels111685 Posted June 23, 2011 Share Posted June 23, 2011 Just yesterday I had an elderly lady bring in a Cool Whip container of her stools. We did a DRE so we didn't need the sample she brought with her. So she took the Cool Whip container back home and I was also wondering if she would be re-using it! Gross! Link to comment Share on other sites More sharing options...
unewillow Posted June 24, 2011 Share Posted June 24, 2011 I don't really have fun stories like those above, but I do get asked A LOT of stupid questions. My 2 recent favorites are: "How far back will the babies head go if you don't hold it when you pick them up?" ...uh, all the way back, in fact it might fall off. "Can a woman on her period hold the baby? I mean will it give the baby cramps?" I had no words...in fact, I had to walk away and let the nurse doing the discharge field that one because I couldn't not laugh at them. Link to comment Share on other sites More sharing options...
JFarnsworth Posted June 25, 2011 Share Posted June 25, 2011 I had a 17 year old come in with his adopted mother, who is in her 60's. When I asked him a question he'd look at his mother and she'd answer for him. I asked him which ear was bothering him and he pointed to his left ear. It took about 10 minutes before he finally opened his mouth and actually spoke to me. This was right as I was about to ask if he talked at all. It was a weird dynamic and then suddenly he bursts out that his mother had 5150'd him recently because he took 2 Ambien one night. And it seemed like it was her way of punishing him for something... made me wonder what was going on in that house. Link to comment Share on other sites More sharing options...
polarbears11 Posted June 25, 2011 Share Posted June 25, 2011 This is from when I shadowed in the PT field but I think its just too funny not to share. This woman came in with her 18 year old son to see her PT. She stated that she hadnt done any of her exercises from the previous visit because she was too sore from that visit and didn't leave her bed the past two days. This woman is 5'3'' and 250lbs. She claims shes never been this tired in her entire life and she hates that she cant get out of bed. She asked the PT in all seriousness, and I quote, "Could my tiredness and lazyness come from the fact that I haven't had sex in 18 years?" I literally had to turn around and pretend to grab some equiptment to keep my face straight for when I turned back around. TOO FUNNY! Link to comment Share on other sites More sharing options...
mytopeka Posted July 1, 2011 Share Posted July 1, 2011 Guy with a 20 cm screwdriver in his rectum came in. During our conversation I asked why he chose that particular item. "Well, it's my favorite screwdriver." He liked it a little too much, in my opinion. Link to comment Share on other sites More sharing options...
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