Mix and match meds

So this guy comes in, covered in a rash. An allergic reaction to his antibiotics. Now he’s got a fever. He’s a nervous nelly to boot, trying to convince me that he had “chemical poisoning” in the 70s due to his former profession as a chemistry teacher. Being a scientist, I knew that he would appreciate my explanation of why I chose a new antibiotic for him and why he should continue it for another week. (I was afraid he had prostatitis). I carefully explained how the scientific principle of changing only one variable at a time applied to the medicine changes I was making for him. He nodded his approval and smiled. I prepared his discharge instructions after spending about 15 minutes talking with him, reassuring him and answering all of their questions. I moved on to other things assuming he had left.

20 minutes later, the nurse says to me, “Do you know what happened in room 6?” “When Mr. Brubank got up to leave, he became hypotensive with a pressure of 70/40. So we put him in trendelenburg and are giving him a fluid bolus.” Crap. WHat was going on? Was he getting septic? Was his skin rash really steven-johnson’s syndrome? I went to check on him. His pressure was up to 100. He looked concerned and I tried to be reassurning without knowing what was going on. But he was stable.

Another 20 minutes pass. The nurse says to me this time. “Doc Shazam, do you know what happened to Mr. Brubank? When he was getting dressed to leave, he felt anxious and thought he had chest pain, so he took a nitroglycerin tablet. That’s why his blood pressure dropped to 70.”

What scientist doesn’t understand the concept of changing only one variable at a time? Here he is, in a hospital, getting ready to leave and he’s having chest pain. There are doctors and nurses everywhere. Don’t you think he or his wife would have thought to tell somone about it? I had to spend another 15 minutes with him reassuring him that he wasn’t having a heart attack (or angina for that matter). He may be the first patient I’ve had that takes nitro for anxiety!

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