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In the last 3 months:
Patient came into the ER--woman in her 30's. Vaginal bleeding. Asked her if she had recently had a baby--no. Unit Secretary sees if she's ever been in the hospital before and whaddya know--she had a baby THREE DAYS AGO. And she had the baby with her.
Patient came in with bleeding. Asked the patient if they were taking any aspirin? no. Were they taking "blood thinners" like heparain, coumadin, warfarin? No. Were they taking any medications at all? No. Patients wife comes in about an hour later with a list of medications longer than my fucking leg. Including Aspirin. Including Coumadin.
Patient comes in with chest pain. Asks if they've ever had previous heart problems. No. Have they ever had a heart attack? No. Do they have high cholesterol? No. Give the patient a gown and they take off their shirt and there's a huge scar across the chest. Ask what that is. They say "Oh, I had a quadruple bypass a few years ago, but that doesn't have anything to do with my heart"
Patient comes in with really wacky lab values. Ask the patient if they've ever had any major surgery. No. Any surgery at all. No. Any past medical problems. No. Find out that they had gallbladder and pancreas removed in last 5 years. Patient says "I forgot about that"
12 year old boy comes in to ER after falling, hitting head, losing consciousness and has a seizure while in the ER. Ask the mother if he has a seizure disorder. She says no. Ask if he's ever had a seizure before. she says no. Ask if he's had meningitis, etc, in the past. Says no. Asks about his medication--he's on an anticonvulsant. Ask why he's on it. "OH, he has epilepsy, but that has nothing to do with seizures. He doesn't have seizures. He has episodes where he shakes and drools, but he doesn't go into a seizure"
Patient on medical-surgical floor. Ask patient if they have any medication allergies. They say no. Physician prescribes antibiotic. Patient has severe reaction to antibiotic. Asks patient if this has ever happened. Patient says "Every time I take this medication I get like this". Tell patient that is considered an allergic reaction. Patient says "No, I'm not allergic, I just react badly to it"
Patient presents to ER with vague symptoms. Ask patient if they have any medical history of things like hypertension, diabetes, heart problems, cancer, etc? Patient says no. Patient is listed as having unremarkable medical history. Find out after consult with patient's primary care physician that patient is has Diabetes Mellitus and has been for last 35 years. Patient has primary hypertension. Patient has peripheral artery disease.
Patient presents to ER with vague foot problems. ask patient if they have ever had any foot problems in the past. Patient denies. Upon removing shoe, it is noted that patient has symes amputation of foot due to diabetic ulcerations and gangrene.
Patient presents to ER with GI distress. Ask patient if they are on medications. No. Have they had GI probs in past. Yes, but long ago. Any surgeries of any kind? no. Nurse leaves room and returns after patient has changed into gown and begins physical assessment. Notes a colostomy bag. Asks patient how long they've had it. Patient says they don't know. Upon further investigation, patient not only had colostomy, but about 90% of intestines removed. Patient said "I didn't think that was important"
Woman comes into ER with vague symptoms. Ask patient if she smokes. She says no. Can smell cigarette smoke on her, but could be from person she rode with, lives with, etc. When getting into patient's room, patient asks what she has to do to get a smoke around here. Again, perhaps she just quit. 10 minutes later, patient is seen on sidewalk smoking.
Patient presents to ER. Patient is asked if they have consumed alcohol within the last 12 hours. Patient denies. Patient is drinking from a cup. Upon further inspection, cup is found to have beer in it.
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I'm not exaggerating. I'm not fabricating.
These aren't old patients. These aren't people with dementia. These aren't people with Alzheimers. These aren't people with mental illnesses. These are "normal" (in the medical sense) people who have no reason to lie. And I don't think they're "lying" in a purposeful way. I don't think they're doing it to deceive. THey just do it. I think people have become so accustomed to lying or hiding things from their doctors that they carry it through from PCP to ER or emergent situation
I think it's easy for people to lump ALL problems on the medical professionals. We're easy targets. We're SUPPOSED to be perfect, right? Mind readers. Psychics. Gods. Miracle Workers. But the reality is that there are ALOT of people who do not tell MD's and RN's the information NECESSARY FOR PROPER TREATMENT.
Same with hospital-aquired infections. SO many times we have patients that are on precautions--either neutropenic precautions because of their low WBC count, or contact precuations because of something they have (or decreased immune function makes them more suseptible to get things). And we have signs on the door for visitors to go to nurses' station before entering patient rooms. But you walk in the room and there's a snot-nosed kid sitting on Daddy's lap, and daddy is highly neutropenic with MRSA. Mom and kid never went to the nurse's station. Never gloved and gowned up. Never washed hands. Didn't even think that the sniffles Jr has could be serious detriment to Daddy's health. But if daddy gets sick while in the hospital, guess who's to blame? Mommy? Jr? No. It's the inept doctors and uncaring nurses that allowed daddy to get uncontroled viral infection.
Patients are on dietary restrictions related to their condition--low salt, low fat, low potassium, clear liquids, NPO (nothing at all), soft mechanical, ADA, CCU...all kinds of diet restrictions. Walk in the room of an NPO patient (who is NPO because of upcoming surgical procedure) and family member has brought in McDonalds which patient is happily munching down on. Or what about the elderly lady who was on a soft mechanical diet due to problems swallowing, and her loving husband brings her a home made sandwich which she proceeds to eat and choke on. Even though there was a large sign above her bed "DO NOT BRING FOOD TO PATIENT OR ALLOW PATIENT TO EAT WITHOUT NURSE PRESENT," he still blames the nurses for not making it more clear that she couldn't eat a sandwich.
Then there are the people who are on precautions for MRSA, C-difficile, VRSA, etc. Family members glove and gown up, but throughout stay, they remove gown and gloves. Touch patient then do not wash hands before touching themselves. Family member contracts C-difficile. Patient's family member tries to sue hospital for the infection.
What about the patient who kept losing weight and losing weight for no reason. Patient stopped having bowel movements after a time. Thought it was constipation so constipation protocol was put into place for patient--many laxatives and stool softners. STill nothing. Abdominal US was done, and there was no blockage and no stool. Did not make sense because every meal, the patient was recorded as having eaten 100% of their meal. Plates are nearly licked clean after every meal. Nurse walks in one day to find patient's wife eating patient's food (she was aware of the weight loss). Nurse asks patient's wife how long she's been eating his meal. She says every day since he's been in here. He doesn't like this food, she says. Patient suffers from severe malnutrition and electolyte imbalances because of this. Patient has to have feeding tube placed for gavage feeding. Wife objects, saying we are being unnecessarily cruel to her husband by placing a tube down his nose to feed him. Wife threatens suit against hospital for cruel and unusual punishment. Wife says she was doing nothing wrong by eating his meal and that we should have known before then that he wasn't eating all of his meal.
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But yea. It's the medical profession. Not the patients. Not their family. No. It's us. The workers. The ones that work unpaid overtime because of a nursing shortage. The ones that work 16 hours a day to make sure that patients are cared for. The ones who would rather die themselves than mistreat a patient.
It's us. Not them. NEVER them.....
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