Friday, April 12, 2013

Sour Trout

The title is one of the best and funniest sign-ins I've ever seen as a triage nurse, and I only wish I'd written the first 500 like that down, because I could write a book, and retire on the royalties. Or at least get a nice week on Maui.

In case you, unlike just about any ER nurse worth their salt, can't tell what the chief complaint is, it's "sore throat", approximated lovingly and with due diligence by someone whose English skills are somewhat lacking, which is about half my patients hereabouts.

And while that one isn't bad to read, it isn't the first time I've run across it.

Once upon a time, as a tender apprentice in the program at Seventh Circle Of Hell Hospital, where they took six months of class and clinical to push larval ER nurses out of their little Playdoh Fun Factory Mold, I ran across the same chief complaint.

Helpfully, they would do our classes two days a week, and run us through 3 days a week of clinical, on training wheels, with experienced nurses nearby. Which was good, because while I'd been a nurse for half a dozen years and worked without a safety net outside the hospital, their particular brand of patient experience was truly a priceless way to learn, by which I mean the place was ghastly in terms of volume, acuity, and overall suckiness. But hey, once you've played at the Palace, you can work anywhere, right?

So one day found me as the nurse in the back half, treatment, of the walk-in ward. The great part about this area was that everything would walk up, from hangnails to full-on heart attacks. We only kept the minor stuff, but in the pre-ratio days, that meant 8 hopefully minor patients for me, and 50 people waiting for the other nurse out front bringing them back.

And on this particular day, I not only had a brand-spanking new ER resident right out of internship, but the good fortune and favor of the Gods of Emergency Medicine had also helpfully provided me with Dr. DoneItAll. Dr. DoneItAll was able to open up his wallet and tumble out a cascade of about 200 cards, certs, training, and a like number of boards, peer-reviewed articles, etc. covering just about everything. Including probably radiation treatment in the Arctic for the hyperbaric chamber patient, come to think of it. On top of which, he was a really outstanding ED physician, excellent teacher, and a helluva nice guy to boot, which made him not just tolerable, but a genuine delight to work with.

And to help me in my monkey-see, monkey-do days of learning the business of emergency nursing, just the day before, the lectures had helpfully covered the main details regarding eye, ear, nose, and throat complaints we needed to pay attention for.

Thus when my patient presented with fever, sore throat, swollen neck, painful swallowing, drooling, and told me "I habb a sour trout" in the most classic I-have-a-hot-potato-on-my-tongue voice I could have hoped for, I wasted no time in stepping out to go tug on Dr. DoneItAll's sleeve, and inform him "You need to see the patient in Cubicle 2 NOW, please."
And, without questioning me, he stepped in, did about a 30-second physical exam, and stepped out.

"Peritonsillar abscess. Pt. to EENT Emergency, STAT."

And turned to me and said "Nice catch. Strong work."
Which, at Seventh Circle Of Hell, was the equivalent of hitting a home run.

But it's always nice when Fate lobs a nice slow breaking ball right out over the plate for you to smack over the fence in the first place. If only they were all that easy.

1 comment:

  1. Here's a diagnosis for ya- i went to Africa on a church mission trip. We had African interpreters doing the triage and writing down chief complaints. I saw this particular diagnosis at least ten times a day: "lash on the Virginia". (keep in mind, lots of Africans pronounce the "r" sound as "l".......