There are typified patients that we all dread taking care of and sometimes forget that they are people as well and not just illnesses. Yesterday I had three such encounters, each with a humorous twist that made me laugh.
1) The elderly patient with abdominal pain.
We tend to loathe this presentation because old people can get sick fast and have a pretty benign examination. Perforated diverticula can present as a simple stomach ache, Ischemic bowel may get masked with a little pain medicine and you send home a septic patient that dies from shock at home. This patient was 91 and had survived major complications from gall bladder surgery, and actually carried around with him his case presentation for the family practice morbidity and mortality (M&M) weekly conference from 1986. (You don’t ever want to be a case report at M&M!) After rectalizing him, knowing that we’d probably have to scan him and he’d be there till 3 AM, he rolled back over onto his back and said to me, “Don’t ever get old…b’ut don’t die either.” I found it refreshing that he could be objective about his own mortality after coming so close back in 86.
2) The aphasic patient with a worried spouse.
This lady came in with stacks of lab reports, diaries, notebooks and a binder about her husband’s health. He had suffered a stroke and was left aphasic…he could barely speak…and could not use his left arm at all. He was scheduled for a CT scan of his belly in the morning (it was about 11pm). She became worried because he began peeing frequently and was walking around at home holding his penis. She brought in some pee from home in a rinsed out vitamin pill bottle. The only words he could form were “Amen” said enthusiasticallly for a yes, and less enthusiastically for a ‘well, ok’. His urine was normal. “Sir, I have to examine your penis, OK?” A less than enthusiastic “Amen” came from his lips. His wife was out of the room and I had a nurse with me. I looked for any trauma or infection, the foreskin getting stuck or injured. It looked normal. I told him, “I can’t find anything wrong with you, you can go home.” “AMEN” he said, and smiled a lopsided grin. When I returned, his wife was flustered, “I couldn’t keep him from getting out of bed, someone must have told him he was going home.” He smiled at me while standing in his boxers, trying with one hand to get his shirt on.
3) The 27 year old female with pseudo siezures
These patients always get labeled as crazy, psych cases, drug seekers, etc… This lady was having a pseudo post ictal period and her speech was slow and slurred. She sounded like she was mentally retarded. She kept saying to me in her slow, slurred voice, “Aym a noorm all peer sun.” I had no way to tell if she was telling the truth or not. She had driven up from the south to visit family, so I said to her, you might want to consider having a family member drive back home with you to be sure you get there safely. She retorted, “I have to teach that dog of mine to drive.”
An hour later, she was fine, a ‘normal person’ walking and talking. She asked me for my name and a comment card so she could say how kind we were to her. It sounds like she’s been treated like crap before because they have assumed she was a druggie, a psych case, etc… and was pleased at how nice we were to her.