Wednesday, November 2, 2016

Memories...





"What should I call you for?"


This is a common question I get from nurses before I leave their station. They understandably want to know what things are important to me in a given patient's care. Exam changes, abnormal test results, medication problems, etc. I'm fine with answering them, too. It's part of treating someone.

In the early 90's I was an intern, covering the cardiology and general medicine floors. One evening I was meeting with the other interns at a nurses station, getting the nightly check-out. This consisted of them each handing me a crumpled sheet of paper listing patient summaries for me to refer to if called. The lists were folded into a big wad and crammed into my white coat pocket. As I stood up to go see someone in ER, a nurse came over and asked what I wanted to be called on. I absently mumbled "any concerning changes" and stepped into an elevator.

The night ticked on. Several admissions, some calls to discuss labs and medications, the usual smorgasbord of pages. Somewhere after midnight there was a break in the action, and I went to the call room to try and sleep.

I dozed for maybe an hour before the nurse I'd spoken to earlier paged me.


Intern Grumpy: "This is Dr. Grumpy, returning a page."

Nurse Smokey: "Hi, I'm calling you about Mr. Gomer, in room 564. Are you familiar with him?"

Intern Grumpy: "Hang on..." I switched on the light, grabbed the wad of papers out of my pocket (I still had my coat on) and began flipping through them for room 564.

Nurse Smokey: "No worries, I'll wait."

Intern Grumpy: "Okay, I have him. It says he was admitted for a heart attack 2 days ago, and is scheduled for an angiogram tomorrow."

Nurse Smokey: "Yes, but he has other issues. He also has a history of lung cancer, for which he had surgery and radiation 2 years ago. It recently recurred, and he's now on chemotherapy. There's also him having COPD from being a smoker, and last month he was here for a pulmonary embolism and is on heparin. He needs a left knee replacement, but that's on hold for now due to his other medical issues. Do you need a list of his medications and allergies?"

Intern Grumpy: "No, I have that here... What's going on with him that you're calling?"

Nurse Smokey: "He's on fire."

Intern Grumpy: "WHAT?!!!"

Nurse Smokey: "He's on fire. He's on oxygen, and apparently his wife snuck in some cigarettes and matches and..."


The phone fell to the floor. I ran out of the call room into the stairwell and dropped down 2 flights to the 5th floor. As I flew past the station, Nurse Smokey was still on the phone with my empty call room, calmly saying "Hello? Dr. Grumpy? Can you hear me?"

In room 564 I found Mr. Gomer, miraculously uninjured except for some minor burns and missing eyebrows. He was almost completely covered in ashes and fire extinguisher foam (which a terrified student nurse was still randomly spraying at anything that moved, including me). Another nurse was pulling off the charred oxygen mask and melted tubing, while a respiratory tech made sure all the oxygen valves to the room were closed.

This was a good reason to call the doctor, if not the fire department. Skipping his past medical history, under the circumstances, might have been a good idea, too.

19 comments:

Anonymous said...

So you learned to add an extra order, right after the stool softener, for all your patients: "Fire extinguisher foam, administer topically, PRN combustion"

Heidi said...

I think that's called burying the lead...

Anonymous said...

I am not even a little bit surprised to hear that.

One time, while working as a leasing consultant at an apartment community, someone called in for maintenance to replace the sprayer for his kitchen sink.

Why? Because it melted.

Why did it melt? Oh. The kitchen was on fire. During the phone call.

"What do you mean, did I call 911? That's your job."

And that's the story of the day that I 100% gave up hope for humanity.

Anonymous said...

This is actually a metaphor about the election isn't it. We just don't know yet if the patient will survive.

Liz said...

I think I would have led with the fire, let you know the fire had been extinguished, and let you know the gentleman was still alive, and THEN told you who he was.

bobbie said...

BAD nurse!!!

Anonymous said...

Dr. G I have a burning question...

Ms. Donna said...

Nurse was not bad, just sadistic. ;-) Nurses KNOW that news like that would get the intern running. Now foaming the intern was a little much, but student nurses DO need training. :-)

Packer said...

My name is Billy I quit smoking , no on Chantix, but when I exploded in a ball of flame.


Being that I was something of a teen aged wise guy I thought smoking would made me cool as I aged and became about the uncoolest thing on two legs I decided to quit. It was and is the single best thing I ever did, many years later I still wonder about those still smoking and realize how tough it is for many.

Packer said...

Why do I laugh at the idea of someone blowing himself up.

Anonymous said...

Oh anonymous @ 6:07am....thank you for making me laugh so hard today!

Don said...

When I was a firefighter/emt, I went to 2 nighttime fires started by smokers smoking while on oxygen therapy.

The strangest one was the 34yo with emphysema so bad he slept in a hospital bed in his living room. The oxygen tubing left carbon black on his face in a pattern that made him look very surprised.

Why did he do it? He can't quit smoking, yes he knows it is killing him, but he had smoked while on oxygen before and hadn't caused a fire.

The other, got burned in the house fire he started, he would have recovered from that, but while in the hospital, they discovered late stage, untreated lung cancer, he never came home.

Mage said...

Sometimes things are a little too real.

Shash said...

Points to the nurse for remaining calm. Points deducted for not starting with the primary reason for calling.

Anonymous said...

I had that happen to one of the pt's I was caring for, smoking on O2. Being a bedside nurse for 30 yrs, my sense of humor is some kind of strange. After I got him squared away and decided we were not going to blow up, I've never laughed so hard in my life at that idiot. Ahhh, the crap I've seen, so glad I'm retired.

Glen said...

I think there is ICD-10 code for that now.

Anonymous said...

A few years back I was having dinner with my parents while we were watching the cycling. My parents liked to light candles on the table during the winter.

One day I noticed that a tissue had draped from its box into one of the candles. I looked to see if my parents were paying attention. They weren't.

So I helpfully informed them, "The tissue box is on fire."

At which point my Dad just about peed and rushed the box to the sink.

I wasn't too concerned at the time because 1) the first thing I did was check if there was anything flammable near the box (there wasn't, plus the table was glass), and 2) it's hard to make me panic or show any alarm of any kind, but my parents love to tell the story about how I'm so unflappable that I once casually mentioned that something was on fire like it was no big deal.

Deborah Billings said...

Some 30+ years ago the same incident happened on our floor except that the patient called on the intercom and yelled that he was on fire. We quickly contained the flames and he was left with a nasal cannula melted onto his moustache. You bring back buried memories from my nursing career. Thanks!

R said...

So wash she calling for nicotine replacement therapy orders?

 
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