Gone with the IV and an ER Pow-Wow

Hospital life continues to be interesting. Here are two stories I'd like to tell you all about!
Patient 1: A 67year old frequent visitor to the ER comes in with a sycopal episode. She stated she was really dizzy when she stood up, passed out and doesn't know how long she was unconscious. Her husband (who is in his 40s) found her and brought her to the ER. As I do with a lot of my patients, I took a thorough drug history. The only medicine she stated she has taken was tylenol yesterday for her chronic back pain, and that was it for the week. Still, due to her history, I ordered a urine drug screen which as I expected came back positive for benzodiazepams (valium, xanax, klonopin, etc) and opiates (percocet, lortab, demerol, morphine, etc). I confronted her about the opiates and she said she did have one three days ago but only one because she still had 1/2 a bottle left over from her last visit three weeks ago. So, I then asked if she had taken any xanax's at all. She said she did have some nerve medicine, she thinks valium but it was months ago. I confronted her again and she said she didn't know who's urine that was, but she couldn't possibly have been positive. I continued by telling her that since her urine drug screen was positive, she would not receive any narcotics. She was quite upset with me. While I was waiting for all her lab work to come back, I had her hooked up to an IV to give her some fluids. About two minutes after I left her room, the nurse came running down the hall to tell me to come see, my patient had pulled out her IV. I went in and asked her why she did it and all she said was that it fell out. Not two minutes ago was that IV completely intact! So now there's blood all over the place. The patient was washing her hands at the sink when the nurse went to check her BP again because it had been elevated. As the nurse was taking her BP, the patient decided she wanted to go home, and got very beligerant with the nurse and said, "I'M LEAVING AND YOU CAN"T STOP ME!" Knowing that nothing was wrong and her vitals were stable, I didn't try to stop her. Maybe I should have, but I know she'll be back in two days anyway. Gotta love making people mad especially when they aren't getting drugs!

Patient 2: 22year old male who presented with hemoptysis. Of course anyone who says they are coughing up blood, a pulmonary embolism has to be suspected. So, I ordered a CXR, blood work, influenza screen, etc.. As I was awaiting lab results my patient came to the desk ALL upset because he wanted to leave. I told him he was welcome to, but it would be against medical advice and I would not suggest it. He then proceeded to tell me that he was the elder of the Cherokee nation and he missed one of his council sessions!! To give you a picture of this patient, he is a 22 year old (by no means an elder)... pale skin, whiter than me!... with dyed black hair! (seems like he was trying to grow it out).... a single dreamcatcher earring in his left ear! Very odd character! Not only was he talking about this elder position, but he talked about how he was a health care professional as well. Delusions of grandeur I do believe...maybe he has a Vitamin G (geodon) deficiency! :-) As I was driving home, I remembered that he had initially asked me for work excuse to a local BBQ restaurant! So this elder/health care professional works at a BBQ stand, huh? Interesting.... Then I got to thinking further, I think the whole reason he was in the ER was to get a work excuse so he could make his council meeting as a Cherokee Elder!!!

Wow, fun times in the ER!!!! Glad I'm off tomorrow, will enjoy a much needed break!