Ruin My Week
22.
“Rattlesnake bite. On a 2-year-old. Patient and dad out in the fields near a small town that is several hours away from the nearest big city, where I work. Dad takes the child to the ER in the small town with an obvious snake bite, doctor there says “Eh it’s ok she probably didn’t get envenomated.” Doesn’t give the patient antivenin, which they had at that hospital, and instead of electing to send the child to us by helicopter, he sent her by ambulance.
Several hours later patient shows up to our hospital coding, and ended up dying. Probably didn’t get envenomated?!? What the f-ck kind of stupid ass idea is that. If a tiny child gets bitten by a rattlesnake, you assume they’ve been envenomated and you treat them as though that had been. That means antivenin, physiological support, etc. Completely absurd.” –USMC0317
23.
“When in training I saw a child suspected of having meningitis. While I was new to pediatric medicine, I had a gut feeling just by looking at the 4-year-old patient that he was too sick just to be a regular child sickness.
The thing that tipped me off was the child having a slight delay in the pupillary reflexes. After seeing the child, I asked the head pediatrician to do a lumbar puncture to investigate the spinal fluid for signs of infection. She said there was no need and all signs pointed to some airborne virus that was roaming around that time. An unnecessary lumbar puncture can scar children for life and whatnot.
While I didn’t agree, I mistakenly doubted my own assessment and assumed the doctor with tens of thousands of hours of experience would surely know better than me. I shrugged I wrote everything down in the dossier and asked the pediatrician to read my evaluation afterward.
I went home after an exhausting evening, having worked almost 14 hours straight. 3 days later the child came back with fulminant meningitis that had taken a bad turn. When discussing the patient, she remarked she noticed bizarre pupillary reflexes in the patient.
Not only did she discount my suggestion of doing a diagnostic lumbar puncture, she also did not read my evaluation of the patient 3 days earlier. I learned to never doubt my gut feeling and it has led me some outlandish diagnoses sometimes.” –ThePhantomPear
24.
“My best friend was in her late twenties and was feeling constant irritation in her stomach. She went to see several doctors over the course of almost three years, and they all dismissed her saying she had an irritable bowel. She would try a new diet every few months, but nothing helped.
One day she calls me and tells me she broke her ribs. She didn’t know how it happened, but she started having horrible pain and her doctor said her ribs must be fractured. Long story short, it wasn’t fractured ribs. At some point when the pain became too much to bear, she went to the ER and got a CT. Turns out she had stage 4 colon cancer with 4-inch tumors in her abdomen that were compressing her organs and causing the pain. S
he died a few months later. She’d been seeing doctors about her symptoms for three years. If one of them had taken her seriously and sent her to get a colonoscopy she’d probably still be alive.” –LoxicTizard
25.
“There was a story pretty recently in the hospital I work for, where a cardiologist in the ER was doing a rather difficult nightshift and started feeling light-headed, dizzy and fatigued. Given how intense those shifts are (26+ hours, sometimes multiple times a week), nobody thought much of it, and the doctor in question went to catch a quick nap in the staff room. People just passed by him in the staff room every once in a while, but they just assumed the poor guy was exhausted and let him rest. He was dead for several hours by the time someone realized something wasn’t right.” –With_Trees
26.
“I am a psychiatrist, and I am frequently angered by the lack of care that our patients receive from some other doctors. Emergency rooms can be the worst about this when they are trying to shuffle patients through to psych admits as quickly as possible, sometimes neglecting other basic aspects of care in the process. Not every ED doctor is guilty of this by any means—and some are remarkably good about providing appropriate care for this population—but it happens far too often.
Probably the most egregious incident occurred a couple years ago while I was on overnight call at a VA hospital. So, it started with a relatively routine call asking to transfer a patient to our psychiatric unit from a community hospital emergency department for treatment of psychosis. He was an older guy (I want to say early 70s) who had come in acting strange and delusional. His son-in-law had told the ED staff that he had received care with use for psychiatric issues before. I asked them to fax the transfer packet, a bundle of the assessments already performed there, and I started looking at his chart in the meantime. However, what I found was that he had not actually been admitted to our psychiatric unit, he had been seen by our psychiatry consults team for delirium while he was admitted to the medical floor for decompensated heart failure.
For anyone unfamiliar, delirium can occur with any severe illness, where your brain basically isn’t functioning properly due to the physiological stress your body is under. Sometimes it just manifests as confusion or disorientation, but sometimes it can get more dramatic, with delusions and hallucinations.
From what I saw in his chart, he had no actual primary psychiatric issues and had only been seen by the consulting psychiatrist while he was delirious. So I get the transfer packet for this guy, and not only has there been no cardiac workup for this guy who has a known history of heart failure, there aren’t even vital signs on him. The only labs are a blood count (pretty unremarkable), and electrolytes/kidney markers. These chemistries are also not too abnormal, but I notice that his urea nitrogen is a little elevated. This is generally a sign of poor perfusion through the kidneys, as reabsorbing this urea also helps the kidneys reabsorb every last bit of water they can when the body is dehydrated. However, dehydration and low blood volume is only one possible reason why the kidneys might see reduced perfusion; another possible reason would if some had uncontrolled heart failure.
So I call the outside emergency room and tell them that I will not accept this patient onto our psychiatric floor without at least a basic cardiac workup. I tell them his history, that he has only had psychiatric symptoms in the context of delirium from heart failure and that the little bit of data they actually sent me points to that again recurring. They tell me okay, they will get the labs and vitals that I requested and reach back out to me. I didn’t hear back from them after this, and I assumed that they had found evidence of cardiovascular decompensation and reached out to the medicine floor to transfer him there instead.
So I am going about my night, and a couple hours later I get a call to come evaluate someone in the ED. I am down there and using one of the computers at their desk when I hear one of the ED doctors mention something about a patient coming in to medicine from the same hospital. Curious, I ask if it’s a guy coming in with decompensated heart failure. I am informed that not only is it the same guy—who will probably be getting a psych consult for delirium—but that he had ACTIVELY BEEN HAVING A F-CKING HEART ATTACK IN THEIR ED.
Needless to say, I was pretty upset that this outside ED had tried to send this guy to our psych unit, where it is a lot harder to get other medical treatments, without even getting vital signs on him or realizing that he was having a heart attack.
I tell this story to medical students who are rotating through psychiatry all the time to try to hammer home the point that just because someone is acting bizarre doesn’t mean that you can just throw the “psych patient” label on them and ignore everything else.” –PowerStacheOfTheYear
