Hello, ladies and gentlemen of the ER.
It's happened to us all, and I would love to hear your experiences.
I work in a TINY 6 bed ER in the middle of corn town USA. There are 2 other hospitals of the same size near us, 5 miles, and 10 miles away.
Middle aged man comes in with his spouse, with c/o low abd pain for 2 mos, worse in last few days. Wife has a stack of test results, CT reads, etc, which is literally 1/2 inch thick, complete with CDs, mostly from nearby hosp.
She will not let him speak for himself, gets very angry when I speak to the pt, not her, concerning sx. He tells me he has trouble urinating, sense of incomplete emptying. Look through docs, US abd yesterday (at closeby hosp), states marked bladder distention consistent with bladder outlet obstruction, suspect prostate hypertrophy. Also seen is cholelithiasis.
Explain we will do UA, standard blood tests, will take approx 1 hr, will go from there. Super duper.
45 mins later, wife snaps on another RN that NOTHING has been done, we've been waiting here OVER AN HOUR, no one had bothered to check on them, he's hungry, hasn't eaten since yesterday.
Other RN talks to doc, he goes in, explains eating bad idea d/t abd pain, he's read US results, suggests bladder scan, and dependent on results, straight cath. Pt says "oh, yeah. They've done that before and I felt better right away." Wife argues with doc that it can't be urine retention, HAS to be his gallbladder.
Meanwhile, I go in with scanner, explain. Pt is cool. Wife starts with "I have to tell you. Your ER SUCKS! Your waiting room sucks! The staff here SUCKS! No one was in here. This should be like the ICU. You should be in here every 5 mins making sure he didn't fall out of bed!" ...etc.
Take the therapeutic high road. "Oh, I'm sure you are sick of hospitals, with your husband's hx of leukemia, etc. I wish it was like the ICU also, where there are only 1 or 2 pts per nurse, but being in the ER, we treat by severity not time of arrival.....blah blah blah."
Her response? "Well in (other hospital) they knwo what's wrong. They would've had an IV in already. What the hell is wrong with you? Why isn't he getting fluids?!"
Explain, "we suspect urinary retention, giving fluids isn't recommended..." etc.
*evil glare*....."are you going to scan or just stand there?"
Deep breaths...do scan... >725ml is result. OK, now please go urinate...nope, can't.Not at all.
OK, I'll tell doc. Insist they are going out for a smoke. Explain no smoking on grounds, you leave grounds, you're AMA, etc. They go anyway.
Should have signed them out AMA....but in the interest of pt care (didn't want his bladder to explode) did not do this.
Guess what?! Now go do a straight cath, doc says. I love my job, I says. Yeah....not happening. Curling up, can't get past prostate. Get OK for coude. That works, eventually. 825ml out, 100% relief of pain.
Wife now silent, her MD from Google University called for gallbladder, it was retention, now she's really ******. Go in to give dc papers, follow up with urologist, etc...."thanks for nothing. ("*****" muttered under her breath).
Wanted to say, if you think we suck it so hard, and X hospital is the place to be, why did you come here? But I didn't.
Thoughts? ****** me off. Solved your problem, but you're more worried that YOUR WebMD dx was wrong, than your husband isn't in pain anymore. I'm sure a complaint is coming, not that concerned, documented everything till Hell wouldn't have it.
Thanks!
