Wednesday, April 3, 2013

Diagnosis Of The Week

Given: a waiting room filled with patients, multi-hour waits for beds, and any number of which waiting visitors to the ER are complaining of acute onset abdominal pain, nausea/vomiting/diarrhea. Trashcan from home optional.

Medically, as events unfold, you would certainly be right to assume with a high likelihood of success that many of those patients are suffering from what is variously known as Traveller's Curse, Montezuma's Revenge, the Food Court Two-Step, or, in medical parlance, gastroenteritis.

And you'd be right.

But the most correct diagnosis would be : Not Dying Any Faster Than The Rest Of Us.

I say this because for most any but the uber-frail, the pregnant, the very young, or the very old, they aren't.

Gastorenteritis is a fecal-oral vector, meaning of course that someone, somewhere didn't lave los manos, and thus got their peanut butter in your cakehole. Maybe right before they made or served you your burrito platter, or grabbed that doorknob, or when their cute baby had an accident on that nifty plastic seat on the shopping cart that's now yours. It might even have been your baby.

For whatever reason, your bowels have now made you their bitch, because in a blatantly evolutionary move to self-preserve, they have, in a matter of hours since you so foolishly ate without washing your hands (or someone helpfully didn't wash theirs), decided to hold serial nuclear launch drills for everything not attached to you GI tract, from both ends.

Which, in short order, finds you alternately pointing one of your ends or the other at the porcelain altar whereon you will worship, in between those oh-so-soothing periods of momentary respite laying on the cool bathroom floor.

But eventually, even though all good things must come to an end, this hasn't, so during a temporary truce with your innards, you and/or some soul of your intimate association ends up driving you to see me.

Some things you should know, in managing your own care, not to mention expectations, while you wait.

There are generally two phases to gastroenteritis.
In Phase One, you're afraid you're going to die.
In Phase Two, you're afraid you're not.
I know that by the time you and I chat at the ER entryway, you're likely well into Phase Two.
Please believe me when I tell you that after an unfortunate encounter with a hygiene-challenged server at the local mall's food court a couple years back, in which I was re-acquainted with the syndrome of which I speak now, I truly do feel your pain.

That fact notwithstanding, please accept as gospel, that unless you produce either the winning Powerball ticket, serial 24K solid gold nuggets, or the body of Jimmy Hoffa, there is nothing in your barf that I, the other staff, the doctors, or anyone in North America wants to "take a look at". I don't care if you ate alphabet soup and coincidentally horked up the entire Revelation of St. John, in Greek, or launched out something that's the spitting image (you should forgive the pun) of DaVinci's Mona Lisa. Keep it to yourself, and leave it at home. Don't even use a clear bag.

And please, right after you ate tomato and red pepper salad, shredded beets, and two helpings of ice cream with strawberries, don't come up to me and tell me you/your spouse/your child/Sumdood in the seat next to you is "throwing up blood". For heaven's sake not if you needed a knitting needle and a magnifying glass to spot the "blood fleck" in your precious child's puke. If you didn't see a fountain that looks like Yul Brenner's Nile-side lawn ornament in "The Ten Commandments" spewing a bucket of it, it's probably not. We'll check it, but as a rule, when I see your 6 year old you rushed in here at midnight after you waited 6 hours for every nearby Urgent Care to close first, and he's watching TV and eating Flaming Hot Cheetos, I'm not buying a diagnosis of his esophageal varices ripped asunder, no matter what you googled on the internet before you came in, m'kay?.

On that subject, stop "checking" to see if you can't keep anything down by continuing to stuff things in your maw. No, really. When I ask how often you/your spouse/your child/your spouse who's acting like a child has been vomiting, and your answer is "every time he eats/drinks something", I'm going to gobsmack you with the mackerel revelation from the Groucho Marx School Of Medicine, and tell you to stop eating and drinking stuff. If this is news to you when you/they have abdominal pain, nausea, vomiting, and diarrhea, put "brain death" on the sign-in sheet under "additional complaints".

Thanks for bringing a bucket, trashcan, lawn bag, whatever. Bonus points if it was clean and empty when you left home. But don't use my trashcan, or sinks, for your sudden urges. I get barfierre bags free where I work, and there's no limit to how many I'll give you, esp. if I see you filling them serially. But the first time you miss because the trash can next to my desk, or the sink with the strainer where I wash my hands looked like a better spot, or because the bag I gave you is in your purse, pocket, or backpack, instead of ready in your hand, please understand that you're now on My List, and have been mentally moved from "In Pain" to "Being A Pain". Work with me, and I'll work with you. Screw me, and...well, you get the idea.

Be advised further: you can bleed on me, and I won't bleed on you. You could spit on me, and I won't spit on you. You can even pee on me, and I won't pee on you. (What I will do won't be nice, but it won't strictly be eye-for-an-eye retribution.) But, I want to make it absolutely clear, if you puke on me, it's coming right back at ya, and believe me, I wasn't sick today, so I've got a lot more material handy to work with. Use the provided bag, not my scrubs, my lap, or my face. JCAHO frowns on me shoving your head in a bucket, but they aren't here, and I am. Once again, participate in your care by not making me want to kill you.

That goes out in the waiting area too. Spewing a fountain once is guaranteed to get you some space out there, but moving to a new area, and then repeating the process, is liable to add "victim of assault" to your check-in complaint list.

Please - pay special attention here - I have, no $#!^, worked on more movies and TV shows than you've seen, and with any number of Emmy and Academy Award-winning directors and actors. So I know good acting. And bad acting. And the nurse in your ER, even without my experience, can spot it too, because we've seen the triage movie short subject "Death Of A Whiner" an average of 6000 times in our careers, and it never, ever, ever works. The part you're auditioning for is "The Invisible Man", because that's how you're going to be treated, likely as not. Skip any inclination to dramatic endeavors, and stick to your day job.
I know you're miserable. I know if only you could go back in time a couple of hours or days, you'd have skipped tuna, and gone with a nice fresh salad bar salad. But between your first set of vitals and until I've finally got the space for you to get seen, get some meds, perhaps some IV fluids, and anything else the Dr. thinks appropriate, and despite what you perceive as an end-of-life event, you likely really aren't dying any faster than the rest of us are.

Take the word "patient" to heart, and believe me, the soonest I can get you to a bed, to cash in your ticket for the Zofran Express, I'm going to do it. And until you're officially diagnosed, there's always the possibility that more may be going on, so yes, you needed to be here. But try to understand why we maybe took the 70-year old with stroke symptoms, or the 55 year-old lady with chest pain first.


  1. Well said. . . Print it on a brochure and make it required reading for every person who walks into the ER.

  2. This is the best ever. Also, you're my new favorite blog to read. Hope you don't mind the shoutout!

  3. Mind?
    I'm so shy and reserved, I wrote this on the internet, accessible from everywhere except Yemen and North Korea. And I've been to North Korea, and those people don't laugh. It's forbidden.

    Whether I can consistently keep anyone entertained is another question. I'm quite happy you enjoyed what I wrote, I offer my thanks for the shout out.

  4. "participate in your care by not making me want to kill you."
    I may have peed myself. It was worth it though!