It’s as true on the Internal Medicine Teaching Service as it is in a convenience store.
Customer #1:
The very mention of this lady’s name strikes fear in the hearts of the entire residency program. She has severe hypertension, and she refuses to expend any effort getting or taking any medication for it. You see, that is effort that would be much better spent obtaining and smoking crack. Those with even a layman’s grasp of pharmacology should have no trouble understanding that high blood pressure + crack = bad.
It’s always the same admission. She comes in because she has a headache, she has a blood pressure of around 280/150, we put her on a labetalol drip, she swears she didn’t do any coke and has no idea why the urine test was positive, she yells at anyone who walks in the room, she walks off the unit to smoke, she eventually gets fed up because we won’t give her enough Percoset and leaves against medical advice. Rinse and repeat, anywhere from a day to a week later.
She knows everyone on the service. She knows which docs will give her the drugs and which ones won’t. She knows which docs she’d better avoid, such as the attending she threw a telephone book at last month.
We have told the ER repeatedly that we will not admit her, since we have enough to do without taking her abuse. Still, the ER calls us whenever she comes in, and no one has the won tons to stand up and say that we won’t take her. (I, as an intern, have no say in the matter; I am at the bottom of the hill that the proverbial shit rolls down.)
Today, as I was trying to explain to her for the tenth time what was wrong with her kidneys and why we needed to get an IV back in her, she yelled, “Fluids, fluids, fluids! Why you keep repeating yourself like that?”
“Because you keep asking me the same questions,” I replied, calmly. “I also tend to think that when someone is yelling at me, they don’t really understand what I’m saying.”
“I AM NOT YELLING AT YOU!” she yelled. “Boy, you Southerners just don’t understand us. We’re just more blunt, or something.”
No, I’m sorry, you are not blunt, you are a loud bitch. I think people from all regions of these great United States and around the world would agree that you are a loud bitch.
You think we hicks can’t be blunt? Well try this–you have severe hypertension, you continue to smoke crack, and before long, you are going to die. A stroke, a heart attack, who knows, but let there be no doubt about it–you will die. People come in here trying to prolong your existence, and you yell at them, and throw telephone books at them, and sooner or later they’re going to stop giving a rat’s ass. You’ll be dead, and no one will care. That’s blunt. You are a loud bitch.
No, that’s not what I said. Instead, I walked out of the room, wrote her prescriptions, and told the nurses to keep the IV fluids going, and the second she so much as raised her voice to one of them, they were to hand her the scripts and tell her that she knows where the door is.
Customer #2:
This gentleman, for some reason, loves cardiac caths. He has had, near as I can figure, about a dozen of them at various hospitals around the region, three of which were at ours.
The problem is that he is genuinely nuts, but he also has genuine coronary disease. Thus, they can’t just ignore him when he says he has chest pain, and he’s had to have some arteries stented. Most of the time, it’s utter bushwa.
I admitted this man back in July, twice. He had a cath at one of those admissions; since then, he has had one done over in Winston-Salem. Without boring you with the medical details, this was a stent that shouldn’t have been done. He couldn’t get them to re-stent him, so he came back to us, where our team refused to cath him. They stressed to me that he needed to have a single cardiologist, and it needed to be the one who saw him in WS, since he did the last cath.
I was discharging him today after his negative stress test, and I explained this to him. “But he told me to come to the nearest ER,” he said. Fine, I replied; but the cardiologists here are going to try to get you to your doctor in Forsyth Co.
This was a mistake. I think you know what’s coming.
I got a page about two hours after I discharged him, telling me that he had come back into the ER, complaining of chest pain. He wants a ride back to Winston-Salem–maybe they’ll cath him there!
And to think, I admitted both these patients on the same day. What I did to deserve such a gomer daily double, I’ll never understand.
Tell me again why I didn’t go to cooking school?
Dr. J
