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I had to go back in time, but I found the post I was looking for. We were joking about patients who come to the emergency department for our help and then won’t talk to us. I remembered this story from a previous post on a blog long ago and far far away …

A lady came banging on the locked door leading into the ED howling in pain. Had she been shot? No. Even worse. Her ear had been killing her for the past 3 days. And now the pain was “an eleven.”

She was being difficult with everyone. When the registration clerk asked her for her identifying information, she told her to look it up in the computer. When asked if she was still employed with the last employer on record, she told the registration clerk it was “none of your f*#%ing business.” Class act.

Not much more luck with the nurse. Not answering questions and not wanting to go through the triage process.

Then it was my turn. I walked in the room and she was flipping through the TV channels. Tried to ask her a basic history. She didn’t answer much. Her ear hurt and it was draining pus. The right ear had no problem.
On exam, the left ear was full of wax.

“Which one was draining?” I asked.
“I told you it was the left one.”
“Well it’s full of wax and I don’t see any pus now. I’m not sure how all the pus could have gotten through the wax. Are you sure it wasn’t wax?”
Rolling her eyes, she sung the word “Noooooo. Now are you going to give me some pain medication or not?”
“Any fevers?”
“Runny nose or cough?”
Then I had to ask the standard questions that we are forced to ask so that the almighty insurance companies pay us for our services.
“Do you drink?”
Rolling her eyes, she lets out a baritone “Nooo.” Like I should have known.
“Use drugs?”
“Ahhh … nooooo, ” as if she was trying out for a choir.
“Smoke cigarettes?”
Then it slipped out of my mouth … “Ah-HA!” I was joking around, but as soon as I saw the look on her face, I was kicking myself.
“What do you mean, ‘Ah-HA!’?”
“You smoke. I said  ‘Ah-ha.’ That’s a positive finding.”
“Yeah, but doctors don’t say ‘Ah-HA!’ when someone says they smoke. Maybe they’ll say ‘hmmm’ or ‘ah-ha’ but they won’t say ‘Ah-HA!’ So what did you mean when you said ‘Ah-HA!’?”
Now all of a sudden she’s a Chatty Cathy.
I started having Seinfeld flashbacks. I looked up and all I could see was George Costanza sitting there waving his arms.
At this point, I held the chart up in front of my face pretending to write. In reality, I was doing my darndest to keep from laughing. I’m sure she could see my stomach contracting underneath my scrub shirt, though. If I looked at her again, I would have lost it.
I let out a couple of coughs and said “Could you pardon me for a moment?” Without waiting for an answer, I scurried out the door and busted out laughing.

I asked the nurse to give her some Toradol, but the patient refused. So she got Tylenol … Number Three. Then she started arguing with the nurse about how much codeine was in Tylenol … Number Three.
“Listen, ma’am. Do you want the pills or not?”
“Give me the shot.”

I composed myself, went back into the room, and told her she’d need to follow up with the ENT doc to remove her wax. “That guy is a quack. I’d rather have the pain.” The way she was acting, I wasn’t taking the chance on perforating her eardrum. I’d never hear the end of it.

She left threatening to go to another hospital. Almost called their ED to tell them all to say “Ah-HA!” when she got there, but decided to leave it alone.

I can just picture the ending to the story on Seinfeld after the commercial break.
George, Jerry, and Elaine sitting at the diner. George with a big funky bandage on his left ear. The waitress brings him a Ruben sandwich and the camera fades in. George throws his arms up in the air, accidentally hitting the bandage on his ear and then jumping and yelling in pain.
“He said ‘Ah-HA!’ I knew there was something more to it than that. I knew it! What doctor says ‘Ah-HA’ when you tell them that you smoke?”
Jerry replies, “Are you going to eat that pickle?”


This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

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