So on the one hand you have crazy overprotective parents who constantly interject, thereby not allowing me to work effectively or efficiently, and on the other you have parents who obviously don’t care one way or the other, which is even more infuriating.
And then you have parents like Yvonne (not her real name©) who have no reservations whatsoever and allow their emotions to completely override any rational part of their brain and are JUST. FUCKING. CRAZY.
A laughing emergency physician is a dangerous emergency physician. When he chuckles as he starts to tell me about a patient, it means it’s either A) something so completely stupid and irrelevant that even he knows he shouldn’t be consulting me, B) something so bizarre that he doesn’t have the foggiest notion how to handle it, or C) a rectal foreign body. Sadly for me (and for you, I’d imagine), it was not C, but rather B this time when Dr. Mike (not his real name©) called me:
Dr. Mike: Hey Doc, so I have this very nice young lady who clinically has appendicitis, and I’d like to order a CT scan to confirm it, but her mother isn’t consenting to the scan.
Me: Oh, she must be very young then. But I don’t do kids, Mike. How old is the patient?
Dr. Mike: 22.
Dr. Mike: No, years.
Dr. Mike: Are you there?
Apparently Yvonne (the patient’s mother) was afraid of the radiation because her daughter Lilly (not her real name ©) was, and I quote, “so young”. Mike politely asked me (with a very nervous chuckle) if I would come assess the young lady and talk with her mother.
I audibly groaned, and Mike laughed again.
When I got to her room a few minutes later, Lilly looked mildly uncomfortable, but her mother looked significantly worse, pacing around the room as nervously as a bank robber in a police convention. On examination, Lilly was definitely tender in the right lower quadrant of her abdomen (right where the appendix is supposed to live). Her history was consistent with appendicitis and her pelvis was nontender, all things pointing to a single diagnosis. However, I explained to both Lilly and Yvonne that in a young lady of childbearing age, the right thing to do is a CT scan to confirm the diagnosis. It could be a Girl Part Problem (like an ovarian cyst or abscess, ovarian torsion, ectopic pregnancy, pelvic inflammatory disease, endometriosis, etc) and confirming appendicitis with a CT scan would reduce the risk of an unnecessary surgery from 20% to less than 5%.
“No,” Yvonne said adamantly, “I don’t want her getting that much radiation. She’s too young.”
I very calmly explained that the radiation from CT scans is much lower than most people think, and the amount from a single scan would only be a concern if Lilly were an embryo (yes, I actually said that).
Lilly sat there quietly looking at me while her mother shook her head and not-so-politely continued to refuse adamantly. Resigned to this overarching stupidity, I explained that because her history and examination and blood work were all consistent with appendicitis, and because Lilly was so uncomfortable, the correct next step would be immediate surgery, even though there was still about a 20% chance I was wrong about the diagnosis. I also explained again about reducing the risk of unnecessary surgery is as easy as a 10-second CT scan.
"Wait just one goddamned second, you insufferable twit. You’re actually asking me to make the same mistake your parents made and wait to operate on your daughter until her appendix ruptures and threatens her life? Are you that mind-numbingly stupid?"
Ok, there's a chance that I only said that in my mind. But I wish I had the balls to say it aloud because that’s exactly what was going through my head as I tried to explain patiently and rationally why waiting to operate was the wrong move without using the words “FUCKING MORON”. Finally, shockingly, she agreed. Lilly had remained silent the entire time, merely nodding occasionally.
And if that weren't bad enough, that's when the real craziness started: “Have you had enough to eat today? Are you well hydrated?” Yvonne asked me.
Wh . . . what? I’ve never been asked that before in my entire medical career. And before you think this was real concern over my well-being, it clearly was not. It was just lunacy.
About 30 minutes later Lilly was brought up to the operating theatre, where the anaesthesiologist witnessed Yvonne again asking me if I had had a bite to eat. “Yes madam," I forced myself to say, "I had a granola bar and a Coke.”
“Ugh, COKE? Oh dear! Oh my! I’m a nutritional microbiologist, you see. You drank Coke? Really? Ugh!”
The anaesthesiologist glanced quickly at me with a look that clearly said, “What the fuck is this lunatic raving about?” I laughed politely and said nothing, worried that one of the truly revolting thoughts that had been percolating over the previous half hour would come spilling out of my brain through my mouth.
Finally it was time for surgery. I inserted my laparoscope through a tiny 1cm incision, hoping to find a nice, plump, juicy, inflamed appendix, and the first thing that I saw was . . .
. . . a normal appendix. There was perhaps a slightly engorged blood vessel on its surface, but not the nice chunky inflamed organ I was expecting. DAMN IT. I guaran-damn-tee that this girl's mother is going to accuse me of doing an unnecessary surgery now. FUCK ME. I took out the appendix, hoping that there was inflammation inside that I just couldn’t see (this has happened to me in a handful of appendicitis cases). While I had the scope in there, I examined the ovaries (normal), uterus (normal), colon (normal), small bowel (normal), liver (normal), and gall bladder (fucking normal).
I heaved a great sigh and finished, bracing myself for the conversation to come with Yvonne. I went out to the waiting room to talk to Yvonne.
Deep breath, Doc. Deep breath.
I explained what I had found and that I couldn't be sure it had been appendicitis. I explained the other possible explanations, including food poisoning (which is due to toxins produced by bacteria), a "stomach flu" (which is actually a viral infection, not the flu), mesenteric adenitis, pelvic inflammatory disease (though I had seen no evidence of that intraoperatively), or possibly appendicitis that I just hadn't appreciated.
"So are you saying this was an unnecessary surgery?"
And there it is. Of course she would ask that. Deep breath. No, I told her, even without the CT scan, it was the right thing to do, and this was exactly why I had explained the possibility that it wasn't appendicitis even though her symptoms all fit. And why the CT scan would have been useful, idiot. We would just have to wait until Lilly woke up - if she felt better, it was appendicitis. If not, then we would have to keep looking for other causes and wait for the pathology report, which would still take a few days. I thought the insanity was over until she asked her followup quesions:
- Could she have room-temperature water when she woke up? Yes.