clever patient...

It was 6am in the morning....I had a good night sleep, 3 patients seen (and they all came within the same 30 mins) and no call from the ward after 2am. The patient was a 60+ y/o male sent into ED by the local 911 ambulance. The nurse had told me that the patient claimed that he had an intestine rupture. I looked at the patient behind my desk when the nurse told me that complaint. The patient is bed-ridden and he doesn't look like a "medicine man". "Another clever patient..." I grumbled as I walked toward him.
The history taking was long and unpleasent as the patient is a case of old stroke, bed-ridden and suffered from dysarthria. It tooke me a while before I get a incomplete image of what had happened. He claimed that he had constipation problem and use to enema himself. During the enema he had heard a "pop" sound and severe pain was noted over his lower abdomen. Indeed, he had an distended abdomen c rebound. But I also notieced he had a over filled bladder(up till the umblicus). I ordered a urinary catherization and gave him an NSAID jab. The catherization produced around 500cc of urine and his pain was not relieved. I ordered an abdominal cat scan and managed to get the full story this time. He did not use a glycerine ball nor evac enema(bottle of 118cc of glycerine) for enema instead he slided a hose(yes water hose) connected to a tap and inserted the other end into his anus. "Holy XXX" , he is right,  definitely a rupture in the colon. What amazed me was he had left side weakness and his left upperarm was contracted.

 I gave him 50mg of pethidine and called the surgeon. No free air was seen on the CT scan as I expected. The surgeon came and concurred with my decision. He was sent to OT and Hartman procedure was done.

 
Well, you don't need a scan sometimes - proper history and physical examination concluded your diagnosis. Sometimes I would tell my patient and their family - I take the image because I want to let you see the lesion....most of the time it was waste of money and time but it protect my ass  ....

Uninvited...

It was a quiet night until 2am.. I had been disturbed by call from the wards and the ED. Around 3:30am , there was this family wanted an explaination and I walked out from my call room. The explaination was short and I walked back to the office minutes later. When I opened the door, I had seen a shadow moved inside the toilet. The toilet just at the right end of the room from the room, I could see the toilet door just when I stepped into the office.

The ED office sketch.....

 

I was stunt and waited for a second, before I asked "who is there?" A voice anwser from the toilet and "I came for a pee". "PEE" my ass I grumble. A voice means he is definitely human and not any being that belong to another word. I walked into toward a toile and slice the pie. I saw a person about 175cm tall wearing a cap and blue jacket. He saw me and told me that he couldnt find any toilet and so he came here. I was a little annoyed, "WTF" I grumble. I chased him away in a unhappy tone. He quickly zipped his pants and I walked him out from the room. I sat down and had a quick thought that he might be a thief - but I was too tired. The next day, I shared the incident with Lem, and Lem told me that he was definitely a thief. I went to our engineer department and told the manager what had happened. We traced the surveillance camera. Yes, he is definitely a thief. He had entered the hospital 20 minutes before he walked into the office. He had wandered around and took the lift to 7 floors. The nurse was sitting in the station but did not ask him what he wants when he walked into the ward. Then he wandered around the registration desk and waited for me to come out and see my patient. Fortunately I did not take too long to do so and I walked back in heavy paces. If I had not make any sound when I walked back I might had caught him red handed searching for something -then a fight and someone may get hurt....well, I was lucky, nothing was lost. I had a couple of hundred laying on the table along with my laptop, mobile phone....... well, I was lucky I don't have to confrant him ... or else someone might get hurt....

We had actually hired a security guard 3 months ago. However he was sitting in the ED instead of sitting where he should be. If he had sitted at the security desk and questioned someone who had entered the hospital but did not seek help in th ED, the thief might had walked out straight. But it is not the time to make a big issue about this neglect of duty - boss might think it is useless to hire them and we would be back to dark age again.