Tuesday, 5 May 2015


I wish there were remedial medical school courses.  Like detention or summer school, except for doctors.  I wish I could send some idiot docs I’ve encountered back to Medicine 101 so they could learn some things that somehow escaped them.  Some of the more important issues that I see way too often are 1) Examine your patient thoroughly, 2) Abdominal pain is not a surgical indication, and 3) Treat patients with respect.  I’ve said it here before, but probably the most important lesson for any doctor (that should be readily self-evident to anyone with an IQ greater than that of a fruit bat) is to listen to the patient.  If there were such thing as Medicine 101 (and perhaps there should be, as this story would suggest), that lesson would be taught on Day 1, and it would then be repeated EVERY SINGLE GODDAMNED DAY until it finally sank in, even into the most hard-headed idiot doctors.

Perhaps Dr. Hugh (not his real name©) would benefit from such a course.

I get calls from Outside Hospital every so often - these are usually small community hospitals that are not equipped to deal with trauma patients because they don’t have the personnel, the proper resources, or both.  The facility where Dr. Hugh is an emergency physician is not one of these hospitals, but for some reason on this fateful night they had no trauma surgeon available.  So I became their trauma surgeon.

Lucky me.

At 7:45 PM (at least it wasn’t 2AM - thanks, Call Gods), Dr. Hugh called me with an emergency.  He had a 70-year old woman who had fallen down the stairs and landed on her left side, and now she had a dangerously low blood pressure.  Normally putting such an unstable patient in an ambulance and transferring her to another hospital would be considered ill-advised, but he wanted to do exactly that anyway.

“We don’t have anyone willing or able to take the case, so I need to transfer her to you,” he explained.

Lucky me.

Since she had fallen on her left side, Dr. Hugh suspected she had ruptured her spleen, but he went on to explain that their CT scanner was old and would take over an hour to scan her, so he couldn’t even rule out internal bleeding before shoving her into the back of an ambulance.  But because her blood pressure was so low, he was very concerned she was bleeding to death, and he was shipping her to me whether I liked it or not.  

Wait, what?

He hadn’t bothered to consult me to ask if this was a very bad idea (it is), he had simply called one of the emergency physicians at my hospital (instead of me), gotten the ok from him (not from the actual doctor who would be seeing the patient . . . you know, me), and stuck her on an ambulance.  But it should be fine, he told me, because his hospital was only 15 minutes away from mine.

My blood pressure was rising.

I was afraid the patient would bleed to death in the ambulance, but something about this whole thing just felt wrong.  I had the distinct feeling that something just wasn’t right here.  Little did I know just how right I would be, though for entirely the wrong reason.

Exactly 115 minutes later (yes, I timed it and NO, that is NOT a typo - it took almost 2 hours), Bertha (not her real name©) arrived looking in better shape than most patients half her age.  She wasn't pale or sweating and she wasn't in pain, she was just sitting up on the gurney smiling, like she knew some big secret but wasn't about to spill it.

I liked her immediately.  

I wasn't too upset that Dr. Hugh hadn't told me about the bruise on Bertha's left arm, but it sure would have been nice for him to have mentioned the huge 20-cm (8-inch) laceration on her left lower leg.  

In his defence, he probably hadn’t actually examined her.  

Though her blood pressure was still quite low (about 80/55) when she got to me, her heart rate was completely normal, as were the examination of her heart, lung, and abdominal.  No pain, no tenderness, no bruising, nothing.  In fact, her only pertinent findings were the bruise and laceration. 

My Inner Pessimist kept telling me that something was definitely awry, though I immediately suspected the problem was more with Dr. Hugh than with Bertha.

“Bertha, do you have high blood pressure?” I asked, the suspicion building rapidly.

“No doctor, I never have.”

I had suspected as much.  Now the big question:  ”Do you have low blood pressure?” I asked with one eyebrow raised.

Her smile widened.  “Yes, ever since I can remember.”

And there it is.  “How low does it usually run, ma’am?”

“Oh, usually around 75-80 over 50.”  I looked at the monitor, which now read 84/45, exactly where it had probably been for the past 7 decades.  “I tried telling that to that doctor at the other hospital, but he wouldn’t listen to me.  My husband tried to tell him too, but he wouldn’t listen to him either!  He just sent me over here!  Couldn't they just give me stitches over there instead of taking all night sending me here?”

I touched her shoulder and smiled gently.  “Don’t worry, Bertha.  We’ll listen here.  I promise.”

Fifteen minutes later I was looking at her completely normal CT scan of her chest and abdomen, and thirty minutes (and 20 sutures) later I was discharging her home with her husband, still smiling. 

Many people think stethoscopes, CT scanners, ultrasound machines, and X-ray machines are the most important instruments doctors can use to make a diagnosis.  But those people would all be wrong.  So what is the most valuable instrument we have at our disposal?



  1. This is applicable to everyday life.

  2. As a person with asymptomatic low blood pressure, I feel this lady's struggle. I have had medical assistants take my blood pressure and go running for the doctor, sure i'm going to keel over any second. Apparently, 70/40 scares people, but my doc says as long as I feel good it's not worth worrying about. At the same time, as an ICU aide, I have seen docs do exactly this - we once had a woman assessed mentally incompetent b/c she couldn't say who the president was - but she couldn't talk and hadn't been able to for years! Mentally she was fine! If the doc had read her chart he would have known that.

    1. I've heard some great answers to the "can you tell me who the president is, please?"
      the other thing I've found useful: listen to the spouse/caregiver - they can tell you if the person is responding normally or not.

    2. My older brother was an ER doc at the VA. Occasionally, when he asked "who is the President", he'd get an answer along the lines of "that stupid son-of-a-bitch!" That answer got a pass.

    3. No matter who was in office.

  3. "The patient will tell you the diagnosis"

  4. So infuriating. All I do all day is look at my patients and watch their behaviour. They told me it everyday in nursing school and it hasn't let me down yet. You have a woman that says she's a "brittle diabetic" and her blood sugar is 35? I obviously have to do something about that but if she's laughing and talking to me and totally lucid in not on the phone with the dr having a panic attack unlike so many others I know.

  5. don't forget the brain. I understand that can also be a useful tool sometimes.

  6. Who ordered the CT of her chest and abdomen ?

  7. I'm a naturally tiny, fast metabolism, high heart rate individual who looks pale as death to start. I know when I get my blood drawn I'm going to pass out.

    I TELL them I'm going to pass out. Yes, even if I'm lying down. I also tell them I'll come around, have some sugary soda, and be able to walk back to the waiting room within a minute.

    I get vampired at least once a year to check my meds aren't doing Bad Things to me.

    yet it's ALWAYS some perky assistant who says "No, you'll be fine, just sit here and..."

    I go pale, then translucent, then unconscious or nearly so, and then I'm good.

    They always freak out, and go "no no no, sit here in the seat taking up room for the next patient, don't walk 2 feet back to the waiting room, oh you're so pale."

    I know I look underaged. I'm 25. You saw my ID. I've been getting blood drawn since I was 14. I know how I react to getting blood drawn. I'm not driving. I told you that. I'm just gonna go have my mountain dew in the waiting room with my mother. Stop being a bunch of panicky hens and let me go.

    1. Hah. Wow, that seriously sucks. It is incomprehensible to me as to WHY THEY WON'T LISTEN?! I seriously don't understand. Maybe it's because we don't have degrees, so we can't possibly know...

  8. When you have a chronic illness or five, this is STILL a huge issue. I went for YEARS without the proper diagnosis because three different doctors would not listen to me when I said that something else was going on and I suspected _____ because ______ and would they please look into it? The CAT scans came back fine, and so did the blood tests (except for the occasional elevated ANAs), so I was fine… right? Well, when I finally found a rheumatologist who would listen, I learned I had a rare connective tissue disease and Hypermobility Disorder, rather than the fibromyalgia I had been so vehemently questioning. (Did you know that once you have a working dx of fibromyalgia that every doctor glazes over and stops paying attention to anything, any new symptoms, and refuses to help with pain or other symptoms, because "you have fibromyalgia and there's nothing we can do"? Yeah. It sucks. Don't do this. Fibro should be the conclusion AFTER you rule out everything else, not the first disease you leap to. And it's not depression causing the problems. Trust me.)

    Sorry. I am just really frustrated with how the medical system has treated me and countless of my chronic illness friends. Our stories are near identical in some parts… most of them involving deaf doctors. Or very, very rude ones. I've got stories for that, too!

    1. I'm guessing ehlers-danlos syndrome? I have type 4 with type 3 symptoms

    2. I'm guessing ehlers-danlos syndrome? I have type 4 with type 3 symptoms

  9. Thank you for making a post about this. This has been such a point of frustration for me so many times in my life. On one occasion, I was hit on the freeway by a lady on her phone going 60 miles an hour, and wound up in the hospital getting an MRI. As the technician was about to insert the IV into the crook of my elbow, I told him that in the past only child-sized needles had worked because I have very small veins. He didn’t listen, and ended up stabbing me eleven times in the arm before he got the IV in. Later, when I returned to the hospital for a follow up examination, I requested additional pain medication (nothing out of the ordinary, I’d hardly been able to get out of bed to go to the bathroom for three weeks because my neck was so bad from the whiplash). After I asked this, the doctor looked disgusted and literally looked down his nose at the spot on my arm where the MRI tech had stabbed it eleven times. It was a huge mass of green , purple and brown bruising. He said “What’s THAT from?” I suddenly realized as though a tidal wave of mortification had broken over me that he was accusing me of being a heroin user. I was so infurated and humiliated that I found I had nothing to say to him, and chose not being able to sleep from the pain over trying to convince him that I wasn’t a junkie when he probably wouldn’t believe me anyway (maybe this was stupid of me, but you can’t imagine how angry I was at that moment).

    In another incident long ago when I was eleven years old, I was cooking my dad dinner for Father’s Day and I accidentally cut off the entire top of my thumb while chopping cilantro. My dad took me to the hospital (Happy Father’s Day, dad!) and the young doctor immediately grabbed my mutilated thumb and stuck it under a faucet that was turned on all the way (really high water pressure). I felt sick immediately and told him that I was going to faint. “No, no, you’re not,” he said. I repeated that I was, and he again insisted that I wasn’t going to faint. Guess what happened two seconds later. My dad had to dive to the ground to stop my head from cracking on the tile floor. Little background on my dad: when he was about my age, in his mid-twenties, he was driving in the ice in Alaska and he and another car both lost control on the ice and collided. He had a steel bar from the car stuck all the way through his chest and his spine collapsed like an accordion such that he lost two inches off of his height, among many other injuries (broken collarbone, ankle, etc). At first he wasn’t expected to live (the passenger in the other car didn’t make it), and after that, he was told he would never walk again. My dad can walk, however he is in chronic, terrible pain and has been ever since. Having to spontaneously dive to the ground and catch an eleven year old fucked up his back so badly that he couldn’t get out of bed at all for days. I think that made me even angrier than the first instance I mentioned.

    So many instances such as these could be easily avoided if people would just listen. I understand that it must be frustrating at times to be a doctor and to hear people trying to diagnose themselves, and insisting that because they looked up their symptoms on google for two minutes they know better than the doctor what’s wrong with them (I assume this happens all the time… curse you, web MD). However, I think it’s important to be able to distinguish between lunatics parading fallacious diagnoses and straight facts that no one but the patient would know about themselves (such as: I have small veins, or we have 1 second and counting before I crumple to the ground like a sack of bricks).

    P.S. Doc, I apologize for smoking in my profile pic if it's even visible. So you know, I quit four months ago, I just can't be fucked to change the picture


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