24 July 2007

Best Chief Complaint ever?

I love nurses. Specifically, I live our triage nurses. At our facility, they only let the best nurses, with the most experience and the best bullshit meter (and best ability to spot the one "sick" patient amidst the worried well) to work at triage. It's a little bit of a controversial policy, since the better nurses don't all like to work triage, and some of them feel punished having to work out there more often. But it works well, operationally.

We have a computerized patient tracking system which incorporates all the nursing notes, including triage. The patient's chief complaint is chosen from a preformatted list, and if the complaint just doesn't fit any of the options, our triage nurses default to "PAIN - MULTIPLE" and explain in the narrative portion of the triage note. Sometimes they have a little fun with the story-telling, in an understated, "you need to read between the lines" sort of way. Because it's the medical record, you can't write anything that will get you in trouble. But they still want to say "Holy Shit!" at some of the things that come through triage.

Picking up a patient described as "PAIN - MULTIPLE" is something like unwrapping a present from a schizophrenic gift-giver. It could be something as simple as a MVA on a backboard or it could as easily be an anxious patient with multiple somatic complaints. So it is always with a sense of curiosity and utter dread that I open up the triage note to see whether I have unwrapped a nice little gift or a proverbial lump of coal.

So today, I saw my obligatory "PAIN - MULTIPLE" patient, and with a mixture of horror and delight read the following narrative (which I swear is reproduced verbatim, in its entirety):

22 y/o male, reports that 2 years ago, during foreplay, allowed GF (girlfriend) to squirt douche up his penis. Ever since then, complains of: excessive sweating.

7 comments:

  1. Wow! Where does one start with this?

    First of all "douche up his penis"?
    Oh the fun, the romance the WTH (heck)? Well maybe fun for her - who knows? Maybe him too?

    2 years ago? What's the rush? He couldn't give it another year?

    Sweating - excessive sweating requires an ER visit?

    The only thing to make this even richer is if you said he came in at 2 am!

    Did he become afraid all of a sudden? Something must've concerned him.

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  2. I swear, people like this are just lonely for human companionship at 2AM. Otherwise he was in the grips of substance-induced paranoia.

    We had a lady with poison ivy that came in at about 1AM with her kids...and she waited until about 4AM to be seen, discharged at 5AM.

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  3. craziness.

    My favorite part of our computerized system is the "no accident" button.

    Short of breath/no accident

    MVA/no accident (yeah, I've seen it)

    possible UTI/no accident.

    Our greeters are the ones putting the complaints in, which explains:

    trombonin test positive (I don't know about his trombonin, but he had elevated cardiac enzymes)

    autoimmune enema (yes, really)

    r/o Lime disease

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  4. Sounds like he'd need a really big foley to fix him.

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  5. *gape* *ungape* *gape again*

    Well. That he felt comfortable enough to share that at all says something about the nursing staff. I'm not sure what. But it's good. I think.

    Wow.

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  6. Don't you wonder how the triage nurse manages to keep a straight face?

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  7. I have had a few patients like this - some times I subtly go downt the "ever have unusual experiences route" had one guy 21 yrs, with a complaint of a smelly scrotum - checked ok on exam - asked what he was worriend about - delusional about the smell - thought it would have to be surgically removed - he was very releived to here that that would not be the case - turffed for psyc to review (new dx of schizophrenia).

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