Abdominal pain & nausea = a burger and coke?

Seems like that sentence is backwards right? It should be “a burger & coke = abdominal pain.” Except last shift it wasn’t. Patient with long standing abdominal pain & nausea of unclear etiology (read: there’s no organic or radiological evidence to suggest a reason for the abdominal pain) with multiple ER and hospital admissions for IV pain control and GI rest. So we throw the bus at her: nasogastric tube for GI decompression/rest (refused), nothing by mouth (complained), IV Dilaudid for pain (Yay!), encouraged mobility, because believe it or not, your gut likes you to walk (refused). Flash forward three days when she finally wakes up out of her stupor when docs decrease her narc dose and lengthen the amount of time in between doses (irate!) and liberalize her food options (your food sucks!). This is generally how these stories play out. And yet I surprise myself because I still get surprised when the first thing they order after DAYS and DAYS OF PAIN AND NAUSEA is a cheeseburger and coke. Two cokes and “put this one in the fridge!”

It’s like a hip replacement wanting to do yoga or a triple bypass itching for some cross fit the day after surgery. Doesn’t happen like that. So if this sounds like you…at least try and fake it, for my sake. Order some jell-o first.

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I hate that word.

Sometimes I hate the word “nurse”.  Usually because its a patient yelling the word from down the hall because they’ve forgotten how to use their call light.  Or using it instead of my name.  Like at the end of my shift yesterday.  I’m doing my rounds, making sure everything is ship shape for the next shift & everyone is alive etc., and my patient says, “oh nurse, the ice melted in my water”.

[blank stare]. By me.  I mean, technically I don’t have to answer that.  It’s not a question.  But…

Three things.

First: Is it necessary to use the word “oh” in front of nurse?  Are we speaking in sonnets? Or iambic pentameter?

Second: It won’t kill you to polish off that water sans ice.  Or perhaps you would like a lemon slice when I bring the ice?  A lemon slice which I will desperately resist squirting on your surgical wound.  But lets not get carried away.

And third….you really don’t remember my name after 12+ hours? I mean…I remember your name, and I memorized pretty much every important detail about your body & your health.  And of my four other patients as well.

Guess I’m just not that memorable.  *sniff*

Excuse me…may I borrow that?

We borrow a lot of things from the outside world to put inside our bodies.  Metal for stents, plastic for joints, porcelain for teeth etc.  We also borrow things from other animals like pigs and cows for our heart valves and pancreas.  But what amazes me most is what we borrow from ourselves.  More like take, really, because it never gets returned to its original home.

There’s the obvious, like veins from our legs to bypass our coronary arteries.  The brilliant, like fat, tissue and circulation from our abdomen to make new breastsI (tummy tuck and new knockers all in one!).  And then there’s the slightly more bizarre, like taking colon to make a new bladder.  Neobladder.  Imagine the guy who thought of that one night after a few gin and tonics.  “Hey…I wonder if I can take that guy’s shitter and make a pisser?”

Dictation Errors

Often, doctors are too busy to type their own progress/history & physical/ED admit/surgical notes.  So they dictate them.  They dial up a phone number and dictate over the phone to a recording that then is analyzed by either a computer or a person (I’m not sure actually…maybe I should ask next time I hear one).  Sometimes its annoying because they do it on the phone in the report room where I’m trying to have lunch and watch an episode of 30 rock on my iPod.  However, it’s funny to listen to a doctor dictate because they have to also dictate their punctuation.  It sounds a little something like this… “patient presented to the emergency department complaining of extreme cramping abdominal pain period he stated it began the night before after consuming a large McDonalds meal comma after which he developed the pain and eventually vomited several times which provided partial relief of the pain period this relief was only temporary comma and he developed increasing abdominal pain overnight comma and also some explosive loose stools period”

I say that I am unsure whether it is a human or a computer who analyzes the dictation because some of the transcription/translation errors are so funny they almost have to be from a computer.  Or a guy with a degree in IT or something like that who can type fast and navigate his way through dictation software, but has no idea what a duodenum or a vulva is.

Example A: a patient was admitted for a gangrenous lower extremity that needed to be amputated mid shin.  This is called a “below the knee” amputation for obvious reasons. (as opposed to an “above the knee” amputation)  When we healthcare professionals talk shop to each other it is often shortened to “below knee” amputation, or BKA.  So here is an excerpt of this patient’s discharge summary. (paraphrasing, obviously) “Patient with gas gangrene of the left lower 3rd through 5th toes.  Did not respond to IV antibiotics and developed symptoms of sepsis which required a transfer to the CCU and an eventual bologna amputation.”  …. it took me a while to even get it .  I was confused at first.  What the hell? Bologna?  Then I read the sentence out loud.

Sometimes a fresh doctor or medical student does the dictating and forgets to use medically correct terminology, instead opting for a more lay term their dad used when they were a kid and scraped their chin on the driveway after riding their brother’s skateboard on their hands and knees (that never happened to me…) .  The medical term for pus is “purulence” and the adjective is “purulent”.

Example B:  patient admitted for a postoperative wound infection that they waited a good two weeks for it to stew and brew a nice rotten stinky hole in their abdomen before they went to the doctor.  The ED resident’s admit note sounded a little something like this, “Patient presented with leukocytosis and fever, blood cultures drawn and empiric Vanco started.  Upon inspection it was noted that patient had a very large, deep, foul smelling pussy area.”

Somebody should really do some proofreading.  Example B must have been transcribed by the IT graduate, and example A must have been the computer.  Lord knows I hope they never cut off my bologna or get a whiff of my crotch and live to tell the tale.