13 June 2008

The Magic Cure

There are some patients that you dread having to see. You just know in your heart before walking into the room, that it's going to end up badly -- an argument, a dispute over narcotics, a complaint to administration, something bad -- despite all your efforts to make nice. I saw her name on the chart when I picked it out of the rack, and my shoulders slumped as I recognized the name. I wondered momentarily whether anybody had seen me pick up the chart -- maybe I could slip it back in the rack for my partner to take. But my conscience wouldn't permit that, so I took a deep breath and squared my shoulders, and went bravely into the room.

This lady had a lot of problems. She was terribly addicted to narcotics, on well over 160 mg of oxycontin daily, had intractable headaches, anxiety problems, heart problems, abdominal pain with no clear diagnosis, and all sorts of other psychiatric issues. A challenging patient. What was she here for today?

"Doctor, I'm getting bruises all over for no reason," she said, extending her arm towards me as evidence. "I just started a new blood thinner and I read on the internets that if you have bruising to go to the ER immediately!"

Sure enough, she did have a bruise around her right wrist. It looked as if someone had grabbed her where her gold bracelet was and squeezed really hard. But she denied any trauma. Despite her statement, she really didn't have any bruises anywhere else. I inspected the bruise a little more carefully.

There was no swelling, but the purple-green coloration was pretty typical of an evolving deep bruise. I pulled at the skin a bit, and the bruise moved with the skin, which was a little unusual; generally you can pull the skin across the underlying bruise. This looked like it was in -- or on -- the skin. On a hunch, I got a wet paper towel and rubbed the bruise a bit.

It disappeared completely.

She looked at me in open-mouthed astonishment. Literally dumbfounded. I smiled broadly, "Well, you're cured."

She was horrified, embarrassed, and delighted all at the same time. She covered her face in mortification, and thanked me effusively for being "clever" enough to figure it out. Since she was now cured, I told her she could go home, hoping to get her discharged in that brief window of relief, before she could dream up another complaint. She was so embarrassed that she bolted the ER without even waiting for discharge instructions.

Score one for the home team.

3 comments:

Katie! said...

OH MY GOD.

Really? Seriously? Did that really happen?

OH MY GOD!!

dhep1980 said...

*high-five*

Rogue Medic said...

They need to put that warning label on the purple-green magic markers.

Maybe she was embarrassed that you discovered that her "gold" bracelet is really copper. She ran away before being banned from high society functions.

At least she didn't follow the advice to demand a CAT scan.