Thursday, September 16, 2010

Pooh continued

A lot of my phone calls involve bowel movements. I don't know if patients just don't get up the nerve to talk about them before 8pm, or if the night nurses just want something to do, but I end up dealing with other people's crap every night.

One nurse called just to tell me that a patient w/ a partial small bowel obstruction (who had orders for enemas q 2 hours until she had a bowel movement, no need to call the on-call doctor), that Mrs. Pooz had a "large bowel movement that was very green. I didn't know if you wanted to look at it or do anything about it..." Wha? Yes, she really did call to see if I wanted to hike my butt up two flights of stairs and go look at poop. One of my many talents is sarcasm, which I felt I restrained by only saying, "Thank you for that very useful piece of information regarding the patient's care. Although I am very interested in bowel movements, I will not change her care plan at this time." Nurse Literal, not getting the sarcasm, responds seriously: "Oh, I can call you if she has any more like that, I think it's interesting too!" I decided to be direct. "If you call me again for a bowel movement that has anything other than frank blood, I will make you do enemas for the rest of your shift." The funny thing is, that is the comment she didn't take seriously, and then she had a great chuckle and said how funny I was and never called me again that night. And no, she wasn't mad at me, those nurses call you for blood sugars of 90 (normal) at 3 o'clock in the morning.

This morning I had a bullshit admission (Kari, I know you're an ED resident, but sometimes I could just take a hose to the place) for a lady who has been admitted once a month for CONSTIPATION, nausea, vomiting, and abdominal pain. Ladies and gentlemen, this lady is why people whine and moan about the ED being misused by people who don't pay. If this lady had any intention of paying a hospital bill, I'll tell nursing that I want to see pooh all night tonight. But she said the magic word, "chest pain" that bought her a 23 hour obs stay courtesy of Medicaid. Funny thing is, her "chest pain" resolved with an enema, leaving her only with abdominal pain. Her troponins were negative x3 (she'd been in the ED long enough to have 3 troponins, which are drawn 6 hours apart), ECG was normal, basically I was more likely to be having a heart attack at that moment. But due to attendings who were off site and an ED doc who didn't want to reverse the previous shift's decision to admit, we had to admit the lady.

Ok. You want to fix your constipation? That is something I do well.

That lady is on Miralax, Senekot, Colace, GOLYTELY, and enemas q2. She is going to be crapping food she hasn't even eaten yet. My hope is to clean her out so well no stool will stay in her body for at least another month. You're welcome.

And no, I don't want to see it.

1 comment:

dr of common sense said...

It's cool. I hear the BS admissions. I hate calling them too. Not quite as much as I hate the patient sent to the ER for admission for intractable pain from, wait for it, PAIN CLINIC, or the person sent for chest pain rule out from, you guessed it, CARDS CLINIC. I told a cardiologist the number for the admission center the other day and suggeted he use it.