19 July 2007

This is gonna take a while...

The Triage Chief Complaint: Weak and dizzy

"Hi, I'm Dr Shadowfax. What brings you to the ER today?"
"Well it started two years ago, when my doctor gave me some skin cream and it caused me to start having heart palpitations. He said it wasn't from the skin cream but I stopped the cream and the palpitations continued so what did he know anyway? So I had the palpitations for two years every morning at 7 or 8 o'clock but then they stopped, and I hasn't having the palpitations any more but I would still get sort of sick-ee like I was having them only there was no thumping in my chest like my heart had stopped and then in October I had this headache..."

I put down my pen and affix a smile and a look of keen interest on my face. I wonder if the Cubs won today? Have I let her talk for long enough that I can interrupt her and redirect this? Should I just let it go as "palpitations" and do the "reassurance" work-up? Oh Lord she still hasn't stopped. It's like some Monty Python recital. How many patients are waiting to be seen just now? Gaaahhh.


  1. I worked a citizenship fair last weekend. I had many similar experiences. In one case I said to my interpretor, Jesus, "Okay, but ask him what the charge was, what did it say on the paper?" Jesus would comply and then the individual would give the interpretor about five minutes of answer before I got the translation, "I don't think he knows," and a laugh to go with it.

    Mine would have been much more fun had I been able to understand the digression.

  2. Gosh, this has never happened to me.

    No wait, it has happened 5 billion times. Sorry. Got mixed up.

    Well done!


  3. This patient makes me want to slash my wrists when I am in triage!

  4. Arhhh... I think I know that lady... Just another night she was in the ER I was working in...

  5. Umm... no. The Cubs didn't win today. They don't, as a rule, win when they could potentially make up ground.


  6. Patients like these are frustrating, simply because we know after about a minute that nothing is seriously wrong with them, but we also are often inclined to do a megaworkup to CYA for all of their potentially serious complaints.

    So after a complete blood count, electrolyte panel, cardiac enzymes, d-dimer, ECG, cardiac monitoring while in the department, X-rays, CT of the head and possibly chest, and occasionally a few other expensive tests, we get to tell them what we knew after 60 seconds of hearing their crazytalk....there doesn't seem to be anything seriously the matter.

    And yet, if they are over 40, we'll still probably admit them for further workup with ECHO, EST, and MRI/MRA. Just in case.

    Cha-ching! Your anxiety disorder just cost $20,000! I hope it was worth it to you.

    When can we go back to using clinical judgment?

  7. ha. I recall asking "what's Fluffy's emergency" one time and the owner started in with "well, when we got him from the breeder, he had a missing whisker, and ever since then, he kind of leaned to that side when he was tired. Then, two years ago, he stopped doing that. But, he still acted like he missed that whisker. Then he got a sore spot on his paw, and we used some cream on it but he licked it off." at that point, I interrupted and said "Ms Jones, it's really great that you are able to give me such a detailed history and I promise, we'll get back to that, but right now, please tell me exactly what happened TODAY that you decided is an emergency, and then I will ask you to elaborate after we get things under control." That's basically what I just keep repeating when they go off the deep end like that.


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