It all started with a pair of handcuffs.

Some of the best stories do.

In this case, it was a middle-aged man who was brought in by the police. The officer told me that he was complaining of wrist pain caused by the handcuffs and had insisted on being brought to the ER. So, into triage we go.

Naturally, I started by asking the patient which wrist it was, and he told me it was the right one.

"Can you rate your pain on a scale of 0-10?"

"What? It doesn't hurt."

At this point, the officer interjected: "You told me your wrist hurt. You insisted on coming here. That's why you're here."

Patient: "It doesn't hurt. It's metal."

Me: "You mean you have pins in it?"

Patient: "No, my whole wrist. It's metal."

Oookay. By this point, I had figured out that the guy was absolutely filthy stinkin' drunk. But it gets better! Next I asked him about his medical history.

"I'm a mental health patient at the VA. I should be going there but he wants to take me to jail."

Ah. The pieces are starting to fall into place. He perseverated from there on the subject of being transfered to the VA to be seen for his mental health issues, which I flatly told him we were not going to do. He also denied any suicidal or homicidal ideation, so he didn't even fit the criteria for our emergency mental health evaluation; and aside from that, he was DRUNK, so no mental health counselor would speak to him in that condition anyway. Basically, he didn't want to go to jail. Tough luck, buddy. Not my call.

He also told me that he needed to self-catherize in order to urinate. Remember this point, because it will be important later.

AND he lied to me, in front of the officer, telling me that they wouldn't allow him to catherize himself. The officer called him on it right there: "That's not true. You cathed yourself at the station."

Then the officer made him apologize to me for lying, which I found amusing.

Anyway, I got him into a room and put him in for an x-ray of his wrist, which he kept insisting had been "bent" by the handcuffs. (He did actually have a metal plate in it, but there was absolutely nothing wrong with it.)

Throughout his entire visit, he kept insisting that he wanted a mental health evaluation, and I kept telling him it wasn't going to happen. You can't have a mental health evaluation when you're intoxicated. It just doesn't work.

So, the doc reviewed his x-ray and pronounced him fit for jail. I thought I was off the hook, but then she threw me a curve ball: "Oh, and he needs a catheter before he goes."

Damn it!

Well, you know what, buddy: you cath yourself all the time. There is absolutely no reason that I need to do this for you.

Patient: "But you're going to measure it, right?"

Me: "There's a bag in the kit with graduated markings. You can measure it yourself."

But Mr. VA Mental Patient had found something new to harp on that he thought would get him out of jail: "If I get more than 200cc in my bladder I become nephrotic!"

Um...you turn into a giant kidney?

I don't know what it means to "become nephrotic," and honestly, I don't really care. I gave him his catheter and directed him to the bathroom.

But this is almost to the best part of the story!

I went back to discharge him after he had cathed himself, and he was INSISTING that he had drained 900ml out of his bladder.

"I want that documented! They won't let me cath myself! I'm going to become nephrotic!"

There's that funny word again. I want to see you turn into a kidney. Really.

By this point, the officer and I were both done arguing with him. He had already assured me that the patient had not only cathed himself less than two hours ago at the police station, but that they had additional catheter supplies for him on hand. Neither one of us felt like continuing to point out to Mr. VA that he was lying.

Now: THIS is the best part of the story.

I went into the bathroom to clean up the catheter supplies. I found the drainage bag sitting in the sink. The patient had disconnected the catheter from it. Would you like to know why?

The patient had had to disconnect the catheter because HE HAD FILLED THE DRAINAGE BAG WITH TAP WATER.

I was done. I just burst out laughing. Have fun in jail, Mr. VA Mental Patient!

A girl and her mom walk into triage.

The girl was kicked in the shin while playing soccer at school.

...

Oh, sorry, were you looking for something more than that?

No bruising, no swelling, no deformity. The girl did not have a single mark on her. Not even the decency to walk with a limp.

I asked the mother what exactly she was looking for.

"I just want to make sure that she's okay."

Trust me: she's okay.

You are the rudest person on the planet. Goodbye.

ER rule #437:

It is almost NEVER appropriate to walk into another patient's room to ask me a question about your loved one. If said loved one has suddenly stopped breathing or is otherwise actively dying, then you might be forgiven the interruption. However, if this is actually happening, chances are we'll know about it before you do anyway.

Wanting to know when your loved one will be discharged does not fall into the aforementioned category of genuine emergencies. Stay in your own fucking room.

There is a corollary to this rule, known as: "This is an ER, not a sideshow." I don't care how fascinatingly gory the patient in the bed next to you is. IT IS NONE OF YOUR FUCKING BUSINESS.

So, when the doctor is in the middle of suturing, and you wander out of your little cave and decide to park yourself at the foot of the bed to gawk, and I turn around, block your view, and with my nose two inches from yours ask, "Can I help you, sir?" in a decidedly UNhelpful tone of voice ... it does NOT mean that you should peer over my shoulder to try to get a better view.

It means BACK. THE FUCK. OFF.

NOW.

ER a la carte

Actual question asked by a patient while waiting for the doctor:

"If I change the reason that I'm here, will I get seen faster?"

Balls. Seriously.

Misconceptions of the Masses

So one of the first things any triage nurse learns is that when you ask patients what they're allergic to, you also have to ask them what kind of reaction they have, because 85% of the time it's a side effect rather than a true allergy.

For example, "I can't take morphine because it makes me throw up." NOT an allergy.

"Benadryl makes me hyper and jittery." NOT an allergy.

"Penicillin makes my throat close up." THIS is an allergy. Well done!

This is a conversation I had with a patient a few nights ago:

"Do you have any allergies to food or medications?"

"Epinephrine." Really? That's a neat trick.

"And what kind of reaction do you have to epinephrine?"

"It makes my heart race."

::headdesk::

Nursing Home Reports Revisited

I'm actually sad that this patient never actually showed up. The nursing home called report to us, but then the patient opted to go to a different hospital. So I can't tell you if the report bore any resemblance to the patient's actual presentation.

Although my guess is not.

She starts off describing a woman in her mid-fifties with a history of a stroke, chief complaint: "She feels like she's having TIAs." Patient has a history of anxiety, was given Ativan a few hours ago, blah blah blah... I interrupted her:

"You said she feels like she's having TIAs. Have you noticed any symptoms?"

"Well, no, but she was kind of shaking when she told me."

Okay. I could feel things heading downhill from there, but I still tried to give her the benefit of the doubt. Here's where she lost me:

"Does she have any deficits from her previous stroke?"

"Left-sided paralysis."

"True paralysis, or just weakness?""

"Um, well, um, yeah, I'm pretty sure it's paralysis. Yeah, it is. I never see her move it at all. She walks though!"

Dumbfounded.

They always underestimate the power of the sphincter.

He tied a string around it to make sure he'd be able to pull it out again. It didn't help.

It was a toothbrush.