One little old lady came in today for an abscess. She was very sweet. I drained her abscess, gave her antibiotics, and got all of her paperwork ready for her to go home; instructions on what to look for, prescriptions for antibiotics and pain medication. I even told her to come back to the ER in 2 days so we could check her infection to make sure things were getting better, which I never do... When the nurse went in to discharge her, she found that she'd been having chest pain for the last 15 minutes. I went in to talk to her... No big deal, just this nagging "pressure" kind of pain under her left breast (nowhere near where her abscess was, unfortunately)... On further questioning, "Oh, yes, this IS just like the pain I had with my heart attack..."
Ugh! So, thus began her chest pain workup and subsequent admission to the hospital... At least I don't have to see her again in the ER on Saturday...
I also had a patient "checked out" to me at physician shift change. Easy hand-off. This guy came in "suicidal" asking for help. He was waiting for a transfer ambulance to take him to the psych hospital. His only issue was that he had a history of a heart valve replacement and was on the blood thinner coumadin. Coumadin levels have to be checked regularly, and the doctor before me had checked his level so he could be "medically cleared" for the psych facility. OK, we actually monitor it with a blood test called a PT/INR that measures the clotting tendency of the blood, and not the actual "coumadin level," but patients tend to refer to it as their "coumadin level." Anyway, his level was almost twice what it should be, which essentially means that his blood wouldn't clot very well. This not only puts him at a high risk of bleeding, but should he start to bleed for any reason, it would take him a lot longer than a normal person to stop bleeding. Having levels this high is usually no big deal... You just have patients stop taking coumadin for a day or 2 and then recheck the PT/INR. And this guy was fine... No problems. Of course, that is, until about 10 minutes before the ambulance was due to arrive and he decided to go to the bathroom... And decided to shit a pool of blood in the toilet!
Ugh! So, thus began his lower GI bleeding workup, and rapid reversal of his coumadin to stop his bleeding... Oh, yeah... we also called the ambulance and told them not to bother coming. Can't send a guy to a psych hospital and have him start shitting blood in the middle of group therapy...
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