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Brandt's Rants

Brandt's Rants

Communicating a Very Neville Voldemort

Brandt, Robert MD

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doi: 10.1097/01.EEM.0000462409.02414.cb

    Communication is key.

    I recently took a Priority 1 call from frantic EMTs who said they had a patient coming in with stabbing chest pain.

    I got the staff ready for an anticipated STEMI. EMS failed to convey that the patient did not have “stabbing chest pain.” He actually had “stabbing, chest pain” from a screwdriver that wound up in his chest. The patient did quite well, but my favorite part of the story (this is true) was when my fantastic nurse asked the patient, “Describe your pain. Is it sharp, dull, aching, stabbing.”

    Stifling a laugh, I thought, “Yes, does it feel like someone is poking you in the chest with a knife?”


    We must strive to speak the same language as our patients. In medicine, we often use varying vernacular to convey the same ideas. I once had an interaction with a young woman accompanied by her mother. The mother understood, yet my patient needed her mother as a translator. The interaction went like this:

    Me: Are you having any vaginal discharge?

    Her: Huh?

    Me: From your vagina? Are you having discharge?

    Her: What? (looking to her mother for clarification)

    Mom: Girl, are you creamin'?

    Her: Oh, yeah.

    Communication is key!

    How about the overhead codes in the ED? I currently only know three (of the possibly thousands) codes occasionally blurted overhead. “Code Blue” means someone somewhere is dying. “Code Red” means someone is smoking in the stairwell. And the administration recently added “Code Purple Active Gunman.” You read that correctly. They literally say “Code Purple Active Gunman.” If someone has a gun, and we are trying to avoid him, why do we say Code Purple first? We should just change it to “Code Get the Heck Out of Here.” Bureaucrats have never been known to decrease complexity, of course.

    Regardless, we must strive to have language that everyone understands. Younger patients often lack medical knowledge, and we must try even harder to communicate clearly. I had another interaction with a patient who had overdosed on several male-enhancement drugs he got at a gas station, and I had to explain priapism to him in terms he could understand.

    Just a quick word to the wise, do not Google priapism at work. In fact, do not Google it at all. Awful, disturbing, and terrible pictures await you there.

    OK, are you back from looking?

    My patient loved Harry Potter, so I explained priapism in terms he understood. “You see, priapism is when the special part of a man — let's call it the Voldemort — that gets really firm. Normally, when a couple loves each other very much, they can make sweet, sweet Dumbledore to each other. After making Dumbledore, the Voldemort normally becomes quite Hermione after you Quidditch in a woman's Hagrid. Sometimes men have difficulty getting the Voldemort completely firm or, in medical terms, Neville. If a man uses a poultice or elixir to make the Voldemort artificially Neville, it can become Neville for a prolonged period of time and become quite painful.

    “This is called priapism, and it is no laughing matter. Several options exist to solve the riddle of priapism. You can try a drug called terbutaline, which rarely works. More horrendous options exist that actually do work. One can perform a ring block around the Voldemort, and ram a 19-gauge needle into the Voldemort and drain off several ounces of Weasley. Another option is to inject phenylephrine directly into the Voldemort. This is what the urologist suggested to me for you.”

    So, I looked right into his Voldemort and plunged in for the kill. I would have yelled if not for my awkwardness at grabbing another guy's fully Neville Voldemort. Five minutes later, his Voldemort was no longer Neville. In fact, it was completely Hermione, so everyone was happy.

    Communication is key.

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