Wednesday, June 15, 2011

"Can It, You Nit!"

It as absolutely not, not, not necessary to relay every single, solitary, minute detail of your medical history when you come to the ER.  It is also not necessary for us to know your background, education, likes and dislikes, job history, the kind of car you drive, ability to speak a foreign language, or if you are able to sign your name with your toes within the first 2 minutes of your visit.  Trust me, if we want to know we will ask.  During triage the information that is required is need-to-know.  That is to say the information that I NEED, not necessarily what the patient is compelled to tell me.  I am speaking about that all-important first bit of information the REASON FOR YOUR VISIT.  It is most beneficial to be as succinct as possible, and least likely to piss me off. 

New Cathy and I spent 15 minutes jointly trying to triage a woman who WOULD NOT SHUT UP. All we knew is that we had to haul her ass out of a minivan (and she was not a light weight...are they ever?) because of a knee or leg or foot or ankle injury.  We had no idea because, again, she WOULD NOT SHUT UP, this bag of wind, bigmouth, blabber, blowhard, chatterbox, gasbag, jabberer, motor-mouth, etc, etc, get the picture.

Me: What did you injure exactly?
Verbose Patient:  Well...(I am always wary of responses that begin witht this) THIS is my bad knee, I have had surgery on this one, well both of them really, but this one was never as good as the other one since I was hurt at work I am, well, was, a nurse and I worked in (can't remember what type of nursing she did) until 2 years ago so this was originally a work injury, but I have some arthritis in my back, but I've been getting around pretty good even though I can't work anymore....
Me ( interrupting) Excuse me, what is it exactly that you have injured TODAY?
Verbose Patient: My knee.
Me: Which one?
Verbose patient: Well I was looking for Windex, we are visiting my son and his family, we are on from Florida and like I said I was getting around pretty well lately, we made the flight from Florida fine, no problem, so the Windex was on a shelf but the shelf was down a few stairs and I didn't see the stairs and next thing I know I was in space and fell.

This went on for 15 minutes.  I pride myself on being able to triage something like a knee sprain in no more than 6 minutes, and that includes individuals with 75 different meds and an equal number of allergies.  Of course, her allergy list was predictably long and included aspirin, tramadol, all 'cillins, sulfer, six different antidepressants, milk, whey, strawberries, kiwi, any medication beginning with the letter "Q" or the number "7", snakes, air, dirt, rum, black magic, pirates, and clouds.  All of which were, thankfully, on a computer printout that included every doctor's visit for the last 3 years so I didn't have to wait for her long-winded explanation on any of them.

I was fast running out of patience so I finally blurted, "you know, you're delaying your own care!  You're the only patient in the department and  could have seen the doctor 10 minutes ago....and already had an xray by now!  Let's just have the Reader's Digest version for now, okay?"

Her husband burst out laughing; "Guess she told you!  You always talk too much!  Just answer the questions!".  Little did I know that he was a windbag as well.

We eventually shipped her off to xray.  The husband chose to stand in front of our desk and give us a 15 minute commercial for their over-fifty community where they reside.  The golf, the hospitals, the restaurants; the types and prices of every house available, and on and on and on and on.  I eventually excused myself and went out to the desk where I called New Cathy, just so she wouldn't have to talk to him anymore. 

The wife was given a knee immobilizer, crutches and a prescription for Vicodin for her knee sprain.  The Vicodin because she only brought exactly enough of her own Vicodin to last exactly the number of days she expected to stay in town.  Oh goody.

At 6:00 PM I went in to fit the knee immobilizer, assess her crutch walking technique and give her discharge instructions, a task that should take no more than, oh, ten minutes being generous.  Even for a completely uncoordinated yutz.  I said to New Cathy, "It's six o'clock; I'll bet I won't be done with this discharge until 6:45 PM.  At the earliest".

It was exactly 6:40 PM when I shut the door of her minivan, two hours from start to finish.  She would have been in and out in less than an hour from start to finish if she would have just SHUT UP.  Thank you.