Hey everyone!
It's been a while , that I've not shared my banter publicly. So , let's shoot!
I had this experience the other day ... first time in ED residency or in medicine as such. No wonder ER teaches you so much about life , shows you the mirror.
I received a call from airport center that they are referring a case to our ER. I had the preconception , that it is either going to be a priority 1 or attention seeking priority 3 case.
So history goes
Patient was unconscious but Responding to Deep pain stimulus not even to formalin.
But when they tried ryles he woke up and then continued the drama. ( Typical functional case).
Vitals were as follows:
BP 160/100
Sugars 86mg/do
Pulse 110
Respiratory rate 15/min
Saturation 100% on room air
Temperature 98 F
They had done a gastric lavage , because history of breakup with his partner was there. With emotionally labile youth , unknown drug overdose /poisoning is quite common. The doctor there said , they'd send him here within an hour .He had hesitation marks on his hand covered by tattoo.
I freaked out. Not that I'd never dealt with a functional hypochondriac before... Not that I never dealt with a high profile case before... It was the sexuality of the patient unfortunately that triggered the response.
A medical registrar was passing by. I discussed this with him . He smiled , "Don't panic first!" Examine it like any other case. System wise calmly. If you don't find any obvious sign. Do what you'd do for anybody like that. Advise admission for observation, send blood for analysis. Something will come out.
I hit myself for being childish. Calmed myself down.
He quitely listened till I finished. He said.
This kind of cooled me down and made me vigilant as well.
The patient was brought in stretcher with 2 attendants concerned. I walked up to them took adequate history examined him. He was roving his eyes when I was about to check his pupils. His reflexesr, ecgs were all fine. He was hemodynamically stable.I held back my laugh. Seriously spoke again to the attendants.
People who have worked in casualties or ER will know how anxious attendants of functional cases are! So , lots of counseling in midst of which one of the attendant burped out. He opened his eyes in the ambulance and closed his eyes again!
Now, most important task is to explain them that nothing has happened. In corporate setup you gotta advise admission for observation. Because they trust labs and not doctor's findings.SYA rule #1 ( Save Your Ass).
I contacted the physician. He came examined the guy. Look for marks, syringe pokings to rule out iv drug abuse. There were some hesitantion cuts covered with a tattoo. He too looked for the pupils and gave that , O My God! Not again kind of look.
He again dug the history ,
why is he doing this!
? He doesn't want to fly to the other city?
No, he doesn't want to leave his friend.
Who's the "friend"? The physician asked.
The father pointed at a Tall stout guy who stood next to me , who I assumed to be a relative. Now the picture was clear.
The physician was still confused. He did this for HIM? Seriously?
I raised my tone and said. Sir FRIENDDDDD! He got the point. He explained them the same. And walked away.
Few minutes later , I spoke again asked them what their call was. They found our setup expensive. Chose to take to other setup. DAMA ( discharge against medical advice) formalities were on and they called me .
Madam he opened his eyes!
The expenditure shakes all kind of people.
I walked up to him. Took a screen around the bed. Excused his relatives , asked them to wait outside.
The family was overjoyed to see the apparently unconscious patient get to normal.
He started to walk🤣.
His partner chose to take him home.
Moral. This was like any other young malingering youth. Girls doing this to get attention of their husbands/boyfriends. The gender was reverse this time. The sexuality bothered me for a while. Even though , I thought I was from this era. Broad minded. Despite having friends of varied orientation , I to be honest trembled. Take home point would be , to be unbiased. Human body is the same. Will react similarly to pain, disease, emotions in a similar way.
Thank you so far so much.
It's been a while , that I've not shared my banter publicly. So , let's shoot!
I had this experience the other day ... first time in ED residency or in medicine as such. No wonder ER teaches you so much about life , shows you the mirror.
I received a call from airport center that they are referring a case to our ER. I had the preconception , that it is either going to be a priority 1 or attention seeking priority 3 case.
So history goes
21 year old male history of unconsciousness following excessive crying since morning.
He was operated for glaucoma one year back. Was not on any other drugs. had no other comorbidities.No history of fever, ingestion of unknown substance,seizure,head injury .
The additional informal history was ,He apparently had a breakup. He seemed bisexual , They had found lipstick and foundation from his pocket.
Patient was unconscious but Responding to Deep pain stimulus not even to formalin.
But when they tried ryles he woke up and then continued the drama. ( Typical functional case).
Vitals were as follows:
BP 160/100
Sugars 86mg/do
Pulse 110
Respiratory rate 15/min
Saturation 100% on room air
Temperature 98 F
They had done a gastric lavage , because history of breakup with his partner was there. With emotionally labile youth , unknown drug overdose /poisoning is quite common. The doctor there said , they'd send him here within an hour .He had hesitation marks on his hand covered by tattoo.
I freaked out. Not that I'd never dealt with a functional hypochondriac before... Not that I never dealt with a high profile case before... It was the sexuality of the patient unfortunately that triggered the response.
A medical registrar was passing by. I discussed this with him . He smiled , "Don't panic first!" Examine it like any other case. System wise calmly. If you don't find any obvious sign. Do what you'd do for anybody like that. Advise admission for observation, send blood for analysis. Something will come out.
I hit myself for being childish. Calmed myself down.
An overthinking brain remains to be a overthinking brain until given some other task to think or work on.My ER incharge was about to walk off as he was done with his duty. A bugging soul myself. I discussed the same thing again with him.
He quitely listened till I finished. He said.
Wait! Let the patient walk in first. Be a professional. Do what is expected of you , examine and treat the patient. Remember,In noway will you make him feel that he is being treated specially or under treated because of his sexuality. These people are very sensitive to things like this. Convey the same to the staff too. Misbehavior will get you in serious trouble.
This kind of cooled me down and made me vigilant as well.
The patient was brought in stretcher with 2 attendants concerned. I walked up to them took adequate history examined him. He was roving his eyes when I was about to check his pupils. His reflexesr, ecgs were all fine. He was hemodynamically stable.I held back my laugh. Seriously spoke again to the attendants.
People who have worked in casualties or ER will know how anxious attendants of functional cases are! So , lots of counseling in midst of which one of the attendant burped out. He opened his eyes in the ambulance and closed his eyes again!
Now, most important task is to explain them that nothing has happened. In corporate setup you gotta advise admission for observation. Because they trust labs and not doctor's findings.SYA rule #1 ( Save Your Ass).
I contacted the physician. He came examined the guy. Look for marks, syringe pokings to rule out iv drug abuse. There were some hesitantion cuts covered with a tattoo. He too looked for the pupils and gave that , O My God! Not again kind of look.
He again dug the history ,
why is he doing this!
? He doesn't want to fly to the other city?
No, he doesn't want to leave his friend.
Who's the "friend"? The physician asked.
The father pointed at a Tall stout guy who stood next to me , who I assumed to be a relative. Now the picture was clear.
The physician was still confused. He did this for HIM? Seriously?
I raised my tone and said. Sir FRIENDDDDD! He got the point. He explained them the same. And walked away.
Few minutes later , I spoke again asked them what their call was. They found our setup expensive. Chose to take to other setup. DAMA ( discharge against medical advice) formalities were on and they called me .
Madam he opened his eyes!
The expenditure shakes all kind of people.
I walked up to him. Took a screen around the bed. Excused his relatives , asked them to wait outside.
I spoke in a very concerned tone.I hope you're ok.
You seem stressed.I pulled off the screen.
We examined you.
As of now everything seems under control.
But your close ones are really bothered.
I also see the ryles tube is making you uncomfortable.
Just hold my hand and sit if you are okay.
He held my hand . Sat up.
See , if you're better let me know.
Otherwise your family will have to cough huge amount to be reassured that you are okay.
You don't want to bother them . Right?
Answer me?
No. I am fine he said.
He asked me to remove the ryles tube.
The family was overjoyed to see the apparently unconscious patient get to normal.
He started to walk🤣.
His partner chose to take him home.
Moral. This was like any other young malingering youth. Girls doing this to get attention of their husbands/boyfriends. The gender was reverse this time. The sexuality bothered me for a while. Even though , I thought I was from this era. Broad minded. Despite having friends of varied orientation , I to be honest trembled. Take home point would be , to be unbiased. Human body is the same. Will react similarly to pain, disease, emotions in a similar way.
Thank you so far so much.
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