Sometimes I take a step back to observe the chaotic insanity in the emergency department that is rarely seen in other occupations. Then I usually start cackling like a hyena on ecstasy. I overheard the two following concurrent interactions during the beginning of a shift. Just enough has been altered to protect me from the HIPAA police. (Apologies to the “Who's on First?” comedy routine of Bud Abbott and Lou Costello.)
Pharmacist: Yes, sir, I know you were diagnosed with influenza. This is a call back for another test we did.
Patient: No, it wasn't my back. I had a fever and cough.
Pharmacist: I know, sir. I'm calling about a culture.
Patient: Do I need to come back? My back is fine.
Pharmacist: Well, are you feeling worse than before?
Patient: I wasn't feeling good before, that's why I went to the ER. I'm surprised they didn't give me some medicine while I was there to take the flu outta me.
Pharmacists are in charge of calling patients back whenever certain cultures or tests come back in our ED. Occasionally, certain tests (I'm looking at you, blood cultures) are ordered for, uh, reasons. Every once in a while, they come back positive. As you know, blood cultures can have false-positives. We are, however, still required to call patients back with the results. Often this check-in simply means asking how a patient is doing. When a patient has influenza, however, he likely still feels poorly, which was the case for this patient.
Pharmacist: I just want to know how you're feeling. Do you feel worse?
Patient: I'm still coughing! Listen to me cough. (He coughs violently into the phone.)
Pharmacist: Well, that's expected with influenza. I'm calling about your blood culture.
Patient: I'm not any better. You know, da Vinci once didn't sleep for four days.
Pharmacist: Are you getting worse? Wait, have you not slept for four days?
Patient: No, I'm sleeping great, probably too much. So should I come in?
Pharmacist: Are your symptoms worsening?
Patient: I feel like I felt when I left, which was bad, but maybe similar to the time that I forgot about.
Pharmacist: Um, well, I'm calling about your blood culture. It's positive, and we are trying to make sure you don't have a bloodstream infection, which would be considered a life-threatening emergency. If you are feeling significantly worse, you can always come in and be re-evaluated.
Patient: Oh, well, my blood feels fine. I was diagnosed with the flu, you know. That was two days ago. So when should I come back? Is tomorrow morning OK?
Pharmacist: Sir, if you have bacteria in your blood and have symptoms of a bloodstream infection (lists symptoms), then that is an emergency and you would need to come in now. I'm calling to see if you have any worsening—
Patient: Well, I'll see how I feel and maybe come in the morning. Hey, um, what organ is phlegm made in?
Pharmacist screams internally.
Keep On Swimming
A new patient arrived as this conversational circle commenced. We can call her Dory.
Dory came in with your typical complaint, sneezing and inebriation. Sure, no problem. She also came in with several nontypical accessories, including 75 pairs of earrings, a barrel of cheese balls, four bunches of bananas (not four bananas, four bunches), and a salmon. An entire fish.
Now this alone normally sparks my psych Spidey sense. Nope, she was normal, kind, and quite hilarious. She was inebriated but not overwhelmingly sloppy drunk. Let me back up.
We explained to her in triage that she could not take her entire salmon in with her due to it being an entire salmon. Fortunately for Dory, being a quick-thinking aquatic-meal-gifted individual living in Michigan during the winter, she did what anyone would—she buried the fish in a snowbank.
After her impromptu refrigeration process, she grabbed her 28 bananas (and her barrel of cheese balls) and went back inside. I suppose I should also mention that she spoke some English, but apparently, while drunk, she mainly spoke Swahili.
Dory was fine. She was speaking clearly, stable on her feet, and to be honest, she did not seem all that drunk. Then in the background I heard:
Pharmacist: No, you don't need to come in unless you are sick.
Patient: I am sick. They said I have influenza.
Pharmacist: But are you worse than you were?
Patient: How bad was I? How bad are any of us really?
Pharmacist: Do you feel worse than before?
Patient: Before what? I'm only a little better. What did you say about my blood?
Pharmacist: It was a culture.
Patient: I'm very cultured.
Dory was evaluated and subsequently discharged. Then she hung out in the waiting room, watching the news with a cup of coffee. She loudly answered the news people whenever they spoke to each other. Let me reiterate that she did not have any psychiatric problems. She eventually started gently feeding cheese balls to the news anchor on the television. She then ate a few bananas. Please note I did not say she peeled them first. Then she got up, walked out, dug up her salmon, and left. Simply amazing.
She was my nicest and favorite patient of the shift. Seriously. Everyone loved her. Except for the pharmacist who missed the entire interaction while on the phone explaining to her patient that he did not need more cultures and should actually not go to a musical due to his influenza.
Sometimes I just love the ED.
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Dr. Brandtis an emergency physician with the Grand River Emergency Medical Group in Grand Rapids, MI. He was the winner of the 2008 Writer's Digest Short Short Story Writing Competition (http://bit.ly/1kIBaOf). Read his blog and other articles athttp://brandtwriting.com, follow him on Twitter @brandtwriting, and read his past columns athttp://bit.ly/EMN-BrandtsRants.