I know kung-fu

This is my favorite story from my Internal Medicine rotation, and it didn’t even happen to me. But, the hilarity and the moral of the story make it worthwhile to pass around.

The paramedics and EMTs often drive around our parts of the city, responding to calls or just looking out for people in trouble. One very hot mid-morning in July, they brought in an 80-something-year-old Korean man who we will call Mr. Kim (I never actually knew his real name). The EMTs found Mr. Kim looking unkempt and disheveled, diaphoretic (sweating), and leaning against a really fancy-looking apartment building. They brought him into the hospital, thinking he had dementia and heat stroke or dehydration. He had no ID or wallet, just a pair of keys. He spoke no English, only Korean. While in the ER, he kept trying to get off his bed and leave the hospital, and all he could say in English was, “I teach kung-fu!” All the doctors and nurses and ER techs were like, “Whatever, silly demented Asian dude who keeps trying to leave the hospital and doesn’t know what’s good for him,” and slapped on some arm restraints to keep him stuck to the bed. So, all afternoon he was sitting cross-legged and strapped to his ER bed, telling anybody who would listen that he taught kung-fu, and pantomiming random kung-fu movements at passers-by.

Finally, one of the interns on a different team was down in the ER to pick up his own new patient, and looked over and said, “Hey! That’s Master Kim! He taught me kung-fu when I was a kid!” Everyone went, “FOR REAL?!” And the intern said, “Oh yeah, he’s really famous — he teaches at West Point and stuff like that. His kung-fu studio is nearby. And actually, I think his apartment is close to here, too, because I went there once as a kid when he had a big party for our class.” So, of course, everybody is freaking out because maybe he’s not so demented and not so silly and didn’t need to be rescued.

Cut to a few hours later, when Mr. Kim’s daughter comes into the ER in search of him. She’d been looking all over town for him when he didn’t show up for his afternoon class at the kung-fu studio. She had called our hospital’s ER, but we didn’t have him listed as a patient because we’d spelled his name in some ridiculous way (this is the same hospital that misspelled my nametag two different ways, so it is not so surprising). She came in anyway, because she figured a name difficulty might have come up.

And the truth? The truth was, he had been disheveled and sweaty because he had just finished teaching his morning kung-fu class. That really nice building he’d been leaning against was his own apartment building. He couldn’t tell us any addresses because he just walked every day from his apartment building to his kung-fu studio and back. He had been trying to leave because he knew he had an afternoon class to teach.

The only thing that made it slightly less embarrassing for us and the profession of medicine was that he really was dehydrated on a disgustingly hot and humid day, and really did have some dementia that had gotten him in some trouble before. His daughter was very understanding and nice and our ER department was really apologetic, but still.

What I love most about this story is that he didn’t need us at all, but that health care people, in an act of hubris, patronizingly took him to the hospital to “protect” him and dismissed his talking as rambling crazy talk. This will forever be known as the time we kidnapped a patient from in front of his own apartment building, then restrained him when he rightly kept trying to leave. Whoops.

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Liar liar, pants on… Oh wait, nevermind.

During my Internal Medicine rotation, I had a patient who was picked up by EMS after he fell down and couldn’t get back up. He was pretty bruised and incoherent, so the ER people went through his bags and found discharge papers from a different hospital in New York, dated 2 days prior. The point of discharge papers from the hospital is to summarize why the patient was hospitalized, what was done (test, imaging, surgeries), what was found, and medications that the patient has to continue taking (and for how long). The patient gets a copy of their discharge summary and is supposed to bring it to their primary care doctor. (There are, of course, plenty of patients who don’t have the means to have primary care doctors or who have to use the ER as their primary care doctor, but that is a rant for another time.) The listing of the “admitting diagnosis” is generally listed in order of importance, and can contain other existing medical conditions. For example, if a patient came in for a heart attack, but also had pre-existing hypertension and then was found to have early type II diabetes mellitus and high cholesterol, all of those would be listed in the discharge summary after the diagnosis of a heart attack. My point is, other medical professionals (oooh, I just got a tiny thrill when I realized I am part of that group) read the discharge papers and depend on them as a succinct and honest summary of what happened.

So anyway, we read the discharge summary from the other hospital, and the leading diagnoses were “ethanol intoxication” and “mechanical fall,” which is just a fancy way of saying he was drunk and fell down. Well, that would explain the falling down and incoherence, right? It would be consistent with his liver function enzyme tests, which basically said that he had alcoholic liver disease and some liver failure. Because alcohol withdrawal can cause seizures, the ER is pretty aggressive about medicating any signs of alcohol withdrawal. So, they started this guy on a higher dose of medications, but it meant that he was even more out of it, and more incoherent. After a lot of time, we finally figured out what he was trying to say, which was that he was visiting New York from Scotland, and was trying to get in touch with old friends and family members he hadn’t seen in a long time. Further, he didn’t know where they were, or where he had been in the 2 days between when he was discharged from the other hospital and when he was brought to our hospital. Some of the details that he gave sounded pretty incredible, like how he used to be a musician in a band, and in the British Royal Navy after that as a longshoreman, and that he hadn’t seen these family members in over 30 years, and that he was friends with some kind of famous people. We asked if he had had any alcohol to drink, and he said no. But, given the discharge papers and his liver enzyme profile, we were kind of like, “Yeah, right,” and kept medicating like he would go into alcohol withdrawal.

A few days of treatment later, we tapered him off the medications and his speech cleared up. Once it cleared up, the patient was really able to give more details about where he’d been while in the US, and then gave us phone numbers so that we could check out his story with friends and family in Scotland. He also swore that he hadn’t had alcohol in two years, but did say that he used to drink “a lot,” which, in Scottish terms, must mean a LOT a lot. Anyway, I also called the other New York hospital and got in touch with the physician whose name was signed at the bottom of all the discharge papers. When I got him on the phone, I asked about the course of the hospital stay. The last question I wanted to ask was if the patient had actually come in with “ethanol intoxication” as the cause of his falls. And the physician was like, “Um. No.” I said, “Oh, really?” And he said, “Actually, we did a urine toxicology screen, and he was clean for everything; no alcohol, no drugs.” Understand that the discharge summary is not written until the day the patient leaves the hospital. So I said, “Well, then why did you write that the primary diagnosis was ethanol intoxication?,” which came out a bit rude, but I think a fair question, given that he flat-out said that they’d written a diagnosis that the patient didn’t have, and which also led us think that the patient had been lying to us for days.

We also finally got in touch with the patient’s friends, who told us the patient’s stage name from his days in the band. And lo, Google search turned up plenty of proof, including photos and interviews and discographies of the band. So, in the end, here was the tally:
1. Patient says he was in a band: true.
2. Patient says he hasn’t had anything to drink: true.
3. Patient says he is in town to see family and friends he has not seen in years: also true.
4. Patient says he is childhood friends with semi-famous actor: true, and they were raised in the same town.
5. Patient says he was a longshoreman: well, I stopped checking facts at this point, because he was up 4 points to our 0 points, and there was no way we were going to make up this deficit.

Anyway, the moral of this story is, people might lie about the little things, but I think they don’t tend to make up hugely untrue stories about who they are, and what they’ve been doing for the last 2 weeks. Maybe this way, I won’t get jaded about how “all patients lie” and will listen to their stories, no matter how outlandish the stories seem. But then again, my next rotation is in psychiatry, so perhaps not for this next set of patients who say they are Batman or psychically connected to Oprah.

Rookie mistake!

Today was my very first day as a third-year medical student. My very first rotation is a 3-month rotation in internal medicine. Today was interesting. We didn’t start until 10 AM, though for the rest of the rotation, I expect to be at the hospital well before 7 AM from Monday to Friday, and by 8 AM on Saturdays. Yes, there is a half-day of work (at least) on Saturdays. It’s still better than studying for the Boards, don’t get me wrong.

Anyway, today was the first day, and I got lost in the hospital only twice. Great success! In addition, I went to take the blood pressure of a patient, and needed to get a reading with the patient lying down and with him sitting upright. When I asked him to sit up, he said he was a little dizzy, and asked if he could have extra time sitting up. I said sure, put down my pen and paper, and exited the room to give him a few minutes. When I came back, the patient had vomited all over my pen, paper, and his bedside table. Oh, man. There is only one thing I fear, going into third year, and that is vomit. I’d said as much during our orientation week, and it’s as though the universe was saying, “GET OVER IT” in as obvious a way as possible, on the very first day.

Lesson learned: never ever put things down and walk away from them, if you want them back. Also, apparently, some patients will say they feel dizzy when they in fact feel nauseated. Potato, potahto.

Grace and Claire will be happy to know that I wore my new beige cotton blouse from BCBG that they peer pressured me into buying when we went outlet shopping and I said I needed new work clothes. The shirt did not get vomited upon. Success!