A 17 year old patient comes in by ambulance for chest pain and tachycardia. His heart rate was in the 130s. He was hypertensive. He was sweating. He had a history of ADHD and was on Adderall. No other medications. No alcohol or drugs.

His exam was unimpressive and all the testing came back negative, but the patient still remained tachycardic. So we gave him a couple doses of Ativan, thinking he may have taken a little too much Adderall. Still no better. Then we started doing some additional tests to rule out the less common reasons for his symptoms. D-dimer normal. He denied alcohol or drugs, but we checked for them anyway. Tox screen normal. TSH normal.

His heart rate remained in the 140s and he was still hypertensive on re-evaluation. So the on-call doctor gets called for admission. He wants a cardiology consult. No problem.

The cardiologist recommended labetolol. Sounded like a little overkill, but we went with his recommendations.

So the patient gets started on a labetalol drip and we place the admit orders.

We go back to the room and inform the family of the discussions we had with the other doctors. The dad is not pleased.

Could this be due to him smoking that fake marijuana crap?”

“He told me he doesn’t use drugs.”

“Yeah, well he’s a f***ing little liar. He smokes it all the time. Probably smoked a bowl right before we got here.”

The patient shrugged his shoulders.

“K2 really isn’t really a ‘drug’ because they sell it over the counter … right?”

“Ummm … no. Not really.”

It’s sad that your parents are going to be stuck with a large bill for all the tests we did so that you could argue semantics.


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.


  1. A young man I know went to ER and was told the problem – anxiety – was all in his head. He was having feelings of panic – his heart racing. When the problem continued, he went back, and was diagnosed and treated for moderate hyperkalemia.
    I wouldn’t want this to be missed in another young man regardless of whether or not he is on any medicine. Poor diet, recent diarrhea, and working in landscaping were the cause of this young man’s low potassium level and it was easily corrected.

  2. I’d rather stick dad with a big bill than with the corpse of his child because I missed something. And why weren’t the parents involved from the get-go since we’re talking about a minor?

    • This is an interesting topic, though.
      Suppose that the use of Ritalin and recent use of K2 was known when the patient arrived.
      How much of a workup is “too much” when there is a known or suspected reason for a patient’s symptoms?
      I feel a poll question coming up.

  3. I’m most certainly no expert on anything medical, but isn’t this sort of thing preventable by a few choice questions along the lines of “Did you eat, drink, smoke or otherwise take in anything the last 24 hours? Do you have any idea what might have caused this?”

    Unless people are outright lying (in which case they deserve a high bill), wouldn’t this prevent wasting the precious time and effort of the ED staff?

    • That what the “No alcohol or drugs” statement meant. Putting the entire workup into the blog would’ve been redundant, because the whole point of the blog is that the boy WAS outright lying.

      And the boy knew what he was doing.

      It’s like when the lad was 6. “Did you break mommie’s favorite lamp” “No, Dad, the ball I threw did.”


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