Due to popular demand, I will now share my personal worst “how are you allowed to go outside” patient story.
Pt limped into the ER with a complaint of a sprained ankle. I went out to the waiting room with my wheelchair and found two women in their early-mid 40s dressed in business clothes. Not to go by appearance, but usually a minor complaint made by a very well-dressed adult is a harbinger of a relatively easy, no-nonsense visit.
What I told myself was a lie
I helped her into the wheelchair and took her to my triage room.
“So, you sprained your ankle, huh?”
I asked her what she did to it. She said she wasn’t sure. I asked her what her pain level was out of ten, ten being the worst pain ever and zero being none. She thought about it and said, “I don’t know. Maybe… a two?”
I rephrased my question. “What about when you put weight on it?”
She thought about it and said, “I don’t know. Maybe… a three?”
I asked her how long ago she’d sprained her ankle. She said she’d “just noticed” that she’d sprained it today. I asked her if I could look at her ankle. She rolled up her slacks and revealed a very normally-colored, normally-textured, unswollen, and thoroughly unremarkable ankle. I asked her to show me where the swelling was. She crossed her leg over her lap and pointed at a tiny bump with a tinier pinprick of a dot in the center.
I mm hmmd and asked her if this was where her ankle hurt most. She confirmed that this dot was indeed the epicenter of her pain. She informed me that she believed it was a bug bite. I asked her how this related to her sprained ankle. She said that her ankle must’ve been sprained because it was swollen, and last time her ankle had swelled up, it had been because she sprained it. I asked her if she had recently tripped on anything, maybe stepped on her foot wrong, or anything else that might commonly result in a sprained ankle. She confirmed that she had not. I asked if her main evidence for the assumption of a sprained ankle was indeed just the bug bite. She confirmed that it was. I asked her if she was able to bear weight on the alleged sprained ankle. She said that she could.“Without an increase in pain?” “Without an increase in pain”. I asked her why she had limped into the waiting room and required a wheelchair. She said that it was because last time she had sprained her ankle, she’d been told not to put weight on it, as it could damage the joint, and she did not want to damage her joint. Incredulous but armed with my mask and poker face, I summarized her complaint -which I was sorry to ask her to repeat herself, but my triage sheet only allows me a small number of letters and I needed to be as concise as possible, which I hoped she’d understand-: she was concerned her ankle was sprained because of swelling surrounding a bug bite. She confirmed, that yes, that was precisely why she’d came in.
I smiled and nodded, and wrote down exactly that.
I wheeled her into one of my low-acuity rooms and told her the doctor would see her in a moment, that we would likely take some x-rays, and we would go from there, and if she needed me, I’d be right across the hall. She and her friend were agreeable enough. I brought her a blanket, and then went back to my room to stare at my computer in silence before triaging my next patient.
It was a busy night, shenanigans abound and a lobby full, so I couldn’t sit at my desk for long. Mostly, I was running circles around the ER. My desk is directly next to the waiting room doors, which can only be opened by an employee with a badge. If the door is opened without a badge, an alarm goes off. To prevent such incidences, we have several big, yellow signs on the door that say “🛑✋🏻 DO NOT PUSH DOOR”.
Unfortunately, people are stupidly, and they do it anyways.
I was making another loop doing ER nurse things when I heard the door alarm. I went to the hall to see who it was, and perhaps, let them out. To my surprise, the culprits were my patient and her friend. My patient was standing on one foot.
I asked her why she was leaving. After all, we hadn’t discharged her yet. Her x-ray results hadn’t even popped up yet. She said she thought she was good to leave after the x-ray. I informed her that the doctor needed to look at the x-ray and treat any injury she might have. She said, “oh. I thought you guys would email it to me”. I said no we would not, and how would we get her a brace or medication if she had indeed sprained her ankle. She said she assumed we would email that as well. I said we couldn’t email an ankle brace. She asked if we’d mail it to her. I said not on the same day, and asked if she needed a wheelchair to return to her room. She said she did not, and hopped on one foot back to her room.
The x-ray revealed no evidence of a sprained ankle. I don’t know what she said to the doctor upon receiving that information, but the doctor was in there much longer than I expected, and the conversation was vexing enough that the doctor put in a prescription for antibiotics because apparently it was easier to say, “we diagnose you with swollen ankle and you should take an antibiotic for it” than it was to explain to this woman that there was nothing wrong with her ankle except for a small bug bite which is surely something you’ve dealt with before since you are a 40yo who lives in the southern region of the United States of America. At this time, most pharmacies in town were closed, so I was to administer the first dose, and she would get the remainder of the course from the pharmacy in the morning.
I entered the room and asked if she was ready to go home. She said that she was. I explained that I had an antibiotic for her, which she would take now, and that she could get the rest from her pharmacy in the morning. She seemed to understand this well enough. I scanned her wristband, scanned the pill, put the pill in a medicine cup, and handed her the cup. She looked at the pill and then back at me, and asked what time it was. I gave her the time (which was sometime close to midnight). She hmmmd to herself, looked at the pill, and remarked that it was a very good thing we were giving her this pill. Now she wouldn’t have to take her other pills tonight! I asked her why she thought that. She said that if she got a pill at the doctor’s office, it meant she didn’t have to take her regular pills because if it came from the doctor’s office it would cover everything else. I asked her what meds she took. She said she didn’t know (which I should’ve expected). I asked if she took a blood pressure pill. She said yes. I asked if she took a “water pill”. She said yes. And I asked if she took anything for her heart. And she said yes.
I informed the patient that antibiotics would not help her heart or her blood pressure. She seemed confused. She said that whenever a doctor gave her a new pill, she stopped all her other pills until the new pill was finished. I told her that she should take her medications as recommended unless her doctor or pharmacist specifically said not to take them. She said, “Really?” And I said yes, and recommended that she go home and take her other pills. She asked me if that’s why she got headaches whenever doctors gave her new pills. I told her probably so. She took her antibiotic and signed her discharge papers. I asked if she wanted a wheelchair, and she said no.
I looked out to see my former patient and her friend had once again pushed the door. This time, they stopped themselves. I got up from my seat and told them I’d buzz them out, and to get home safe. I scanned my badge, and the doors opened.
But my patient and her friend did not move.
I watched them stand at the threshold, my patient standing on one foot.
The doors hung open. About twenty seconds passed, and then they slowly, slowly closed.
My patient pushed on the door, set off the alarm, and hopped out into the great expanse of the hospital parking lot at night.
Third place goes to the woman who checked in because three days ago she’d drank a soda at a sketchy wings place that turned out to have a roach in it. She’d called the restaurant and asked if there could’ve possibly been any more roaches in that soda, and if their roaches had diseases. The lady on the other end had told her no and no (I would’ve paid money to hear this conversation), but my patient wasn’t so sure, because every time she thought about drinking the roach-soda, or was drinking the flavor of soda that had contained the roach, she felt nauseous. After a visit with Dr Google, she’d come to conclusion that she had salmonella. The roach had given her salmonella. I asked her if the nausea went away when she was drinking a different kind of soda or wasn’t thinking about the roach, and she said yes.
It was a very short ER visit.
