(caution:  this post is a little graphic)


Little brother was in a car accident last night.  He’s ok, got admitted though since he had chest pain, a clear seatbelt mark along his chest and neck, and an abnormal EKG.  He’s had EKG abnormalities before, but his last EKG was a while ago and not at the hospital the ambulance took him to.  Oh for better medical records.  Without a recent EKG to compare it to, they went the conservative approach and admitted him for cardiac monitoring.  I’m glad, since until they came back in to announce that, little brother was insisting on going home with my parents to Small Pilgrim Town in the Middle of Nowhere, where the local hospital is Ye Olde Baby Shack and practices emergency medicine with the skill of a team of drunk frat boys playing Operation.

It was interesting to see how the ER staff treated him.  Overall, I’m pretty happy with it (other than the rotating teams of residents plus med students, fellows plus residents, and random attendings who don’t announce their specialties or names).  So it was a CT and an admit for him.  I’m glad they admitted him.  I remember my ex telling me about a car accident patient he saw who he almost discharged.  Everything seemed fine.  No apparent injuries.  As he was getting ready to discharge her, he noticed she had two little cuts at the base of her nostrils.  He thought that it was from a nose piercing that got caught and ripped (this was the 90s, nose piercings abounded) but on a whim, he told me, he reached down and gently nudged her nose.  “And it just lifted right up!  Holy shit!”  he said he had a hard time not yelling that while examining her.  Instead, he said “you know, I’m actually gonna have surgery come in for a moment…” and hightailed it out of the room to cancel the discharge.  It turns out that although she didn’t remember it, she had impact to her face. Steering wheel was what husband figured, although I guess it could have been airbag.  Again, the 90s, and not all cars had airbags.  “I can’t believe I almost discharged her” he said the next day.  “Can you imagine if she’d gone home?” and he shuddered, imagining horrifying scenarios having to do with what would have happened to her nose had she gone to bed and rolled over onto her face.  This was not the first or last “almost discharged” or did discharge only to have a parking lot readmit my ex ran into in the 7 years we were together.

It’s easy to miss some things.  This is something I know, something patients are not supposed to know, or are supposed to pretend they don’t know.  And patients are not always aware of what is important about their story.  It can be hard to know what “what happened” means in an acute or emergency situation.  I imagine eliciting a correct and complete history must be one of the more difficult things that doctors have to do.

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  1. I sure hope your brother’s OK – and good that they admitted him. About the nose patient, I have to admit I thought is was funny (…). Anyway, that is reality isn’t it?

    • It was funny in an “oh my frikking god” kind of dark hospital humor way. Ex would have been much less amused by it if he hadn’t caught it and the woman had gone home like that. As it was, the story was a good one to affirm to other residents and junior attendings that sometimes the little things are important and that assumptions can be dangerous, but with some humor on the side to make it easier to go down.

  2. Hope little brother is doing OK? Good thing you were there, even if it was Big City Hospital, since you know more than those residents. I’m glad you brought up the issue of medical records. I believe this is getting overhauled soon with Obama’s health care reform since everyone has to go electronic (yes!). I presume that means they can pull records from wherever and put an end to this ridiculous way of doing medicine. Not sure.

    Your last sentence reminds me of “House.” That was what irked him the most about people. Well, sending well wishes to little brother…

    • I don’t think they ever did get the EKG from the other hospital. My brother ended up with an xray, CT, EKG, and cardiac ultrasound. The ultrasound is a repeat since I KNOW he had one for EKG abnormalities before, I remember talking about it with him. He has a congenital chest malformation called “pectus excavatum” and I believe that the last time he had an EKG and subsequent ultrasound, they decided that the EKG abnormalities were a result of that. And when I say “excavatum” I mean it. When we were kids, he could put his fist in his chest.

  3. Glad your brother is okay. I hope they figure out what the abnormal EKG is all about.


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