Thursday, November 11, 2010

"I'm not gonna lie Doc."

Sometimes first impressions are....absurdly funny.

I walked in to a patients room this morning with this history: 50-something male who blacked out while driving Sunday, losing control of bodily functions, crashed his car into a pole, woke up and decided to drive himself home, then spent the next few days occasionally blacking out while continuing to drive himself around town. That is, until he decided to drive himself to the emergency room.

He had a history of cancer, drinking, and has enjoyed more drugs than there are ways to "just say no".

I'm real excited to meet this dude.

I head into the room, and he looks like he's been rode hard, dragged through some cacti, and put away wet. He has multiple scratches and thick blood-crusted scabs and bruises on him. His hair is thin all over. He is painfully thin. He looks a little wild-eyed. Then there's the trach that he cleans with his hand (imagine you could reach into the back of your throat and pull out all the snot and spit with a swipe of your hand, only to wipe it on the front of your gown before offering your hand to shake with the doctor).

"How are you doing today?" I lead with. Pretty benign, usually. He grunted something and grabbed his belly just around his stomach under his ribs--you can't talk and use both hands at one time with a trach, you need one to push your speaking button.

"Does your stomach hurt?" I asked next. He responded by clutching his stomach, holding up one finger in a "just one moment please ma'am" gesture, then, jeez this deserves a new paragraph:

He then took that one finger, pushed his trach button, and without a word, turned to his left, and projectile vomited coffee ground looking emesis, managing to arc it from his bed into a trash can.

This was not that man's first time around a vomit.

I am positive my head left a dent in the wall behind me because my first and only instinct was to back up so fast I flattened myself against the first surface I hit. Seriously, I moved so fast my arms flew up; it's probably more like a snow angel impressioned in the paint.

The guy had just had coffee, otherwise as you know if you're in the medical field seeing actual coffee colored emesis means the dude is BLEEDING in his throat or stomach, both of which could happen in a man with his history.

When he was done, he turned back to me, pushed the speak button in his trach and said, "SORRY. BEING AROUND PEOPLE MAKES ME NERVOUS."

"That's ok. I might throw up myself," I said.

Probably not the most doctorly thing to say, but come on, I'd just about given myself a concussion and two weeks ago I wouldn't have even been able to get words out before I yakked on his hospital bed. But it actually worked out; this guy started to laugh, and I could tell he was visibly more comfortable with me after.

The title of the blog comes from other events in this guy's day. A few conversations passed to me:

Neurology: "How much do you drink?"
Mr Bad Decisions: "I don't drink."
Nurse: "Your blood alcohol is still 0.05%"
MBD: "I only drink to take the pain away."

My attending: "So, you're having a hard time without alcohol? (the patient is in florid withdrawal by this point).
MBD: "Doc, I'm not gonna lie to you. I ran out of my Vicodin two days ago and I hit the vodka instead. It's the only thing that works for the pain. So I been drinking a lot."

Ladies and gentlemen, my favorite patient of the day.

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