Friday, January 7, 2011

I'll give you something to puke about

Time for a Blahg. I started counting the number of times people told me I hadn't posted, and they added up to enough that I decided to post something.

On my mind this evening is the fact that I have to go back to work tomorrow and take care of a big fat faker. a PHONY!!

He claims to have cyclic vomiting syndrome. Look it up, it involves repeated bouts of vomiting. It has a psychiatric component, but the people (and here's the rub) do actually vomit.

Reasons I had a problem admitting this patient.

1. My senior resident foisted it off on me for no other reason than the fact that he could. Bastard.

2. Reading the note, something stank. This guy was referred here to see a particular GI doctor. At 3am, he had woken up with abdominal pain, then started vomiting, yada yada. His mother (uh, yeah, he's 36 years old) brought him to the ED, where he got a $2000 workup which was totally normal, was given IV fluids, and sent to his GI appointment. According to the ED note, he never actually threw up. When he was told he wasn't going to be given the dilaudid his primary care provider did not feel comfortable writing for anymore and instead sent to his clinic appointment, he "spit up" (from the note) in the trashcan.

3. After that episode, he proceeded to put on such a show in the GI clinic that the specialist called US and said he was too sick to go home. So we had to admit him.

4. Nobody wanted to re-admit him to the ED because they had already worked him up for nothing, so I took the senior medical student down to the triage area they'd put him in, showed them into the ECG room where we could examine him in private, and told the med student: "I don't trust my filter right now, so I'm going to introduce myself, introduce you, then let you do the talking. I'll interject when I have more questions and I won't let you miss anything, but I'm going to mostly keep my mouth shut and keep us out of trouble."

5. This guy was wrapped in a blankie hunched over like a two year-old in a wheelchair (which he had very recently been peacefully napping in according to the nurses), then as soon as we got him, Mom, and sis in a room he began rocking back and forth banging his hands and making unintelligible grunts. Luckily, Sis and Mom were all over it.

"Do you need water?"
"Do you need something to throw up in?"
"TRASH CAN RIGHT NOW"
"Do you want me to rub your back?"
"Do you need a drink of water right now?"

For the love of Zofran, this was some sick s@#$ going down. I would have thought the guy was autistic or developmentally delayed, but according to Sissy and Mommy, who also provided all the history down to the fact that he'd eaten about half a meal of pasta at 8pm last night--oh, no, you had some crackers and milk at 11--he used to be an engineer, prior to this vomiting and needing to go on disability and moving into his parent's basement apartment.

All of this would be pitiable, sad, yeah, a little weird with the drama-loving duo hovering so intensely I expected them to do a poop check any minute (something parents do to babies if you're not in the know), except for the very very important number:

6. That was a fake vomit.

I know my way around a vomit people. That was a fake. A crappy, unconvincing, F-U for effort fake. He basically coughed a few times, went "HUuuuhhHH", and spit clear just-outta-the-mouth spit in a trash can. Once.

Here's the thing about vomiting-if you're really committed, you can make yourself puke. It's called bulimia if you're really good at it. If you're not even that committed , don't try to pull one over on a pregnant lady. Not only do I know every which way to vomit, the fact that you're trying to fake me out after I've been eating saltines and Sprite for 8 weeks is going to piss me off.

He wanted dilaudid, he wanted IV ativan, and he wanted attention. And the fact that he was caught by nursing doing oh just fine (I can just picture him soft shoeing while eating a pudding snack) until Mommy walked in the room (at which point, more fake vomiting), and I can't go back tomorrow and say, "You have to leave." is one of the reasons I don't belong in patient care.

Hopefully I have a medical student to keep me professional.