Wednesday, March 19, 2014
Patient 1, Internal Medicine rotation.
* Image from Google Images
**While the following case is based on a true patient, the true identity of the patient has been changed in the interest of privacy.
Dr. B: "Kimberly, how good are your powers of persuasion"?
I knew as soon as Dr. B asked this question I was once again being tasked with talking to a patient with serious medical "issues". Ironically, the exact same thing used to happen over 25 years ago when I volunteered at a rural health clinic. Why folks seem to think I'm skilled in this area I don't know, but I like a challenge, so I accepted not being sure of what I was agreeing to.
Doc201X: " I think I'm pretty persuasive...........hang on, what am I agreeing to?"
Dr. B: "Thank you Kimberly, you've just volunteered to talk our 400 pound patient into getting out of bed twice a day."
And with that he proceeded to give us the clinical presentation of Mr. Hernandez as we surrounded him at the "cart".
Dr. B: "Mr. Hernandez is a 450 pound well nourished Hispanic male, whose chief complaint upon admission to the ER was severe back pain. After an X-Ray, it was determined that Mr. Hernandez has a compressed spine likely due to his excessive weight. Kimberly, we've been trying for almost a week to get Mr. Hernandez to get out if bed, do you have any ideas"?
Doc201X: "Sure......Maybe, but I'll give it a shot anyway!".
As soon as I took one long survey of Mr. Hernandez's extra large bed with a mini crane looking attachment, I immediately identified the problem with Mr. Hernandez getting out of bed.
Dr. B:"Buenas Dias, Señor Hernandez, como' estas?"
Doc201X: "Buenas Dias, Señor Hernandez."
Mr. Hernandez: "Something in Spanish I did NOT understand".
I immediately looked at Dr. B in utter confusion because while my Spanish is pretty good, I can't understand a lick Mr. Hernandez is saying because Mr. Hernandez has NO teeth.
Dr. B: "Lo siento señor Hernández. ¿Ha tratado de salir de la cama hoy?
Mr. Hernandez: "No, mi espalda todavía me duele mucho. Y me caí de la cama cuando trataba de ponerse de pie."
Doc201X: "Perdone, pero no entiendo porque estás hablando muy rápido". Habla mucho despacio por favor."
He repeates himself slower this time.
Doc201X: "Lo seinto, señor. ¿Te gustaría una cama más baja?"
And with that, Mr. Hernandez's problem may have been solved. He was about 5'3" tall and his VERY large bed looked about 2 feet off the ground. So with him being so large, he would practically fall out of bed trying to get out of bed, hence his reluctance to get out of bed. DUH!!!
The assumption of the team had been that Mr. Hernandez was just being lazy. Which may have been true to some extent, but how no one noticed how high the bed was off the floor and how short/large he was in realtion to it, still boggles my mind when I think about it. I get why the Doc could have overlooked this because he has a thousand other patients to think about. But for the others to joke about the guy and write him off as lazy just rubbed me the wrong way. So after finishing up with his patient record and discussing what they knew of his life and history, it occurred to me to ask if a Psych eval had been done on him. The team looked perplexed by the question, but Dr. B asked me why I thought it was necessary. I responded that no one I know wants to be 450 pounds and given what we had discussed about his history of using the ER as a primary care facility and other family/medical issues, that perhaps he needed a Psych eval. Dr. B mulled it over for a second, then ordered the Psych eval.
Clinical medicine, here I come!
I almost forgot to mention that I'm interviewing for a Bioinformatics Informatics fellowship tomorrow!!!