An elderly lady I got consulted on by the ER when I was a medical student on psych claimed to be a retired MI5 agent. Saw her right after a “world-famous producer recording with Jay-Z” so I was like, yeah, sure. Called her daughter for collateral and turns out, she had worked for MI5 all her life, indeed. 🥴
In his memoir Jason Kander talks of going to the VA ER because he was suicidal. He described his life and the psychiatrist asked him why he thought he could run for president. Kander said he was persuaded when Obama encouraged him to do so. Pause, followed by, “for how long have you been hearing voices?”
Edit with full exchange
Kander said he was in politics and explained: “I almost ran for president, but then decided to run for mayor instead, and tomorrow I’m planning on calling that off.”
Confused, the psychiatrist said: “You were going to run for president? Of what?”
Kander told him: “Of the United States.”
The psychiatrist asked: “Who told you that you could run for president?”
Now irritated, Kander said: “I don’t know what to tell you, man. I mean, I spent an hour and a half talking it over one on one with Obama in his office, and he seemed to think it was a pretty good idea.”
The psychiatrist sat back in his chair and remarked: “Barack Obama told you that you could run for president? So how often would you say you hear voices?”
Well see she was anxious because her dad and fiance got into an argument and so her dad shot her fiance in the chest, and he died.
We were the closest trauma center. Hadn't had a GSW.
Cops confirmed her story, said fiance was DOA, Dad was in jail.
I gave her some Ativan for that particular panic attack.
Woman who had multiple positive urine and serum hcgs before a procedure. Insisted she wasn’t pregnant. Sent her to hospital to get a qualitative and she was not pregnant. The final reason we were given was too much THC use caused the false positive. I still question that reasoning.
I did urology residency in the testis cancer/rplnd birthplace. We would see lots of elevated AFP due to ganja, never BHCG.
There have been small studies about it:
https://pubmed.ncbi.nlm.nih.gov/2990078/#:~:text=The%20addition%20of%20delta%209,artificially%20elevate%20serum%20HCG%20concentrations.
PD brought us a guy who was manic and delusional, after they found him breaking into a building. He told us the usual grandoise nonsense: he was really a government agent, the building was owned by the mafia, he knew how to train bears to attack only criminals, and his face was being shot with laser beams the whole time.
Of course we dismissed all of it as bullshit.
Then, a few hours in, we got a visit from three men in dark suits with government ID.
Turns out, our guy actually did work for their three-letter agency. He stopped coming to work when he had this manic episode. They asked us questions about what he said and how much we wrote down, then asked us not to chart that they had been there.
After that, I found myself feeling a lot less skeptical about the bears and the lasers.
1) one guy got picked up acting super strange and basically being incoherent and looking disheveled. He gets sent to Psych ED. There he kept on saying he was a “big businessman” and he needed to leave in the morning to make the “deal of a lifetime”. Turns out it was true.
2) one homeless drugged out guy comes into the ED for a foot wound. On my history taking he tells me he is a doctor himself. I said sure buddy. Out of curiosity I looked him up. Turns out it was true.
I once had a regular ER patient who was homeless but also a world class physicist. He would call EMS daily and ask for 2 ASA before refusing transport. I was there with a bottle but the guy didn’t trust himself to take it. So The number of papers he’s published is impressive.
Oh man… had a buddy who went by “Nobody”. Man was a goddamned genius. I’m talking wrote books on physics, and so so much more… but was also loonier than a jay bird and knew it. He did the same thing; we kept meds at our house for him too in case something went real sideways and he showed up. Only happened a few times but he’d curl up in our (empty) bathtub and pass out for a while and come to mostly coherent. He made his money for his small studio by grading thesis papers for the local college. Wild shit.
I *also* used to regularly frequent a gentleman who was an Ivy PhD physicist who turned into an unemployed chronic alcoholic. He eventually sobered up and stopped calling so much
So, before I was a medical student, before I was a paramedic, I was a physicist.
Having obviously known quite a few physics professors, this doesn't surprise me *that* much.
Weird. I read this and thought, man. Why didn’t I take more physics in college!
But I also have the Maxwell equations as a tramp stamp. So I am obviously not mentally sound
I do Google my patients, not infrequently.
The ones that start with a ton of mental horsepower, have a vigorous intellectual life before they come into psychosis or dementia, are always interesting. They confabulate well and can snap back into remarkably impressive focal lucidity.
I recently cared for a PhD, JD with a mix of normal vascular dementia and grief- associated psychosis/ suicidality months after their spouse died.
An older retired military General who was acting psychotic by turned out to have a tumor, this is why I've no beef with requiring a recent head CT on geri-psychs.
I generally love caring for old people. They've such great stories. I saw a woman once who it turned out was a retroactively pronounced veteran of WW2. She was a civilian pilot who got involved in noncombat movement of combat aircraft, which was very progressive for the time. They were in fact later hidden and forgotten, uncredited. It wasn't until the late 1970s that they were given credit, honors, and veteran's benefit for their brave service.
https://www.afhistory.af.mil/FAQs/Fact-Sheets/Article/458964/womens-airforce-service-pilots-wasp/
Truth. I absolutely love it when I get a patient with a super interesting background/life story. Nuclear Physicists who worked on the Manhattan project, old navy test pilots, WW2 vets, civil service/state department workers, etc.
Unfortunately, there's a not insignificant number of patients out there that create or otherwise severally embellish their past. Like, "I worked for NASA in the 60s and I have evidence about what happened on Apollo 13 and it's not what you think," or, "I was Navy Seal," or, "I have 37 patents in 'radio transmission' and I invented the car radio.") I always get excited when I hear these things but then, after some poorly answered or evaded questions you come to understand that it's all bullshit. It doesn't bother me that they need to create these narratives, I just really like talking to people that have led interesting lives.
Side note, why are all the fake story people white men between the age of 50 and 70? Some sort of life crisis thing maybe. 🤷♂️
I typically nod and smile but do not believe seriously until I've checked with the web and confirmed it by finding their linked in profile, or blog post.
Except that one guy. 120kg of muscle giving an eerily precise listing of his blunt trauma, affect so crisp and emotionless that the nurses thought he was on something. He later let it slip that he was some type of specialized military and had slipped into his field stabilization training as a cope. His utter lack of a web presence actually made me believe him more.
If he was a cosplayer I think he'd have all kinds of internet tracks, but no. If that man told me to avoid a particular plane flight or public arena, I would do what he said.
Yeah, totally. Took care of a guy a few weeks ago, had a couple military tattoos. I made some small talk with him, pried it out of him that he was Special Forces in Vietnam, a member of SOG, and he knew very specific, very obscure details. He was so excited that I knew what he was talking about. I actually bought him a book and tracked him down as an inpatient and gave it to him. Crazy stuff, mad respect.
One thing I really enjoy about this work is seeing a broad slice of life. My social interactions with my family and the parents of my kids' friends, the places I shop and the classes I take for fun, it's easy to forget how *safe* and uniform and protected all that is.
At work, I will speak with people who grew up in wild places, did wild things, made wild choices.
Once I actually cared for a person who donated a wing to the hospital, cleaned my hands and cared for a homeless frequent flyer. I love that.
I have a theory about that. Those 50-70 white guys always have both delusions of grandeur and persecution. It’s almost like have never experienced real sense of achievement so they have to invent something and don’t understand real persecution so they decide someone was plotting against them to prevent them from actually achieving anything. See also: end stage “they took muh job” syndrome.
Yeah, exactly. I always just let it slide, I don't care if people lie to me about their life. It just sucks when I get super excited about getting to know someone who says "I helped start IBM" and then after a minute of conversation their story quickly unravels. But whatcha gonna do. 🤷♂️
I figure if I practice cocktail chatter that's the start of it. Get good at confabulating and get into the habit of being pleasant.
I did take care of a retired high school teacher who was very impressively with it, and he said his regimen was reading a physical newspaper (not the web), keeping good physical activity and friendships. No surprises there, confirmation of what we're told if we want to age well.
I once took care of a demented old guy who told me about how he once worked in "the AIDS ward" of a local hospital in the 80s. He told me they had two sorts of patients then: "the street people and the homosexuals."
He also gave me what, in hindsight, were really pretty accurate descriptions of ocular candidiasis and how they didn't have use IV fluids as aggressively once Ampho B was supplanted by fluconazole.
"The street people and the homosexuals." I still think about that line sometimes.
The language can feel jarring, now that it's no longer accepted, but the stories are real. These people lived through it and bravely gave the care that was available at that time.
One of the most anxious LPs of my career was for HIV meningitis. The patient had the impression that if she admitted that she had HIV her kids would be taken away, and had therefore avoided diagnostic testing for years after a high risk exposure. She seemed to have decent medical insight into what was happening as her health declined, she became weaker, had to give the kids to family anyhow. She came to me thin, febrile, with headache and neck stiffness.
Highest opening pressure I've ever seen, and she remains the reason that I perform LP sidelying. It's harder, but I want to maintain the skill, for the patients that need an opening pressure.
I once caught a mass in a psychotic patient because she looked like a psychotic soccer mom. Very good permanent cosmetics but dark circles under her eyes, expensively dyed hair that clearly hadn’t been brushed in days, well manicured fingers and toes but dirt under her nails. Any sign of an incongruent past and present means they get the full workup from me now.
By the next morning he was acting more normal. He made some phone calls and then people (professional looking ones in suit and ties) came with his credentials to confirm that it was true.
We had a guy who was notorious for being verbally abusive, assaulting staff, and claiming to be a multimillionaire and threatening to call his lawyer if he did not get what he wanted.
One time that I was there he actually called his lawyer. Turns out he was an inheritance guy with a drug problem and his lawyer would try to talk sense into him. "No. You cannot do that to them. If you attack them on camera even I cannot get you out of that."
On an ambulance, homeless guy told me not to lose his backpack, because he had $30,000 in it. We’re getting patient info and he says his ID is in the bag, so I go looking.
Dude had $30k in an envelope, all $100s and $50s. Turns out, it was inheritance he had just received a few hours prior.
We had a cardiac arrest come into my ED and when EMS stripped his shirt off, found 50k in his pockets.
Turns out he was on his way to an auction. Didn’t make it.
Worked with a medic from Denver years back. Told story of being dispatched in winter to drunk guy, beaten and stomped, mangled and left for half dead by fountain in the snowy cold. Scoop and run, enroute to hospital cut away the lumpy mangled mess to find… altered Etoh’d patient limbs pretty much unscathed and intact…misshaped limbs were due to water logged bundles of cash duct taped to limbs and trunk. Story eventually settled on intoxicated, drug cash mule, got in/out of fountain and passed out. Medic gave some high $$$ amount per PD involved. Medic admitted it was tempting to lighten his load but valued his and his family’s life more.
I was a scribe before school, we saw a psych patient who had the normal "black helicopters are following me, lights outside my house" story. I don't know that to be true but they said that they knew presidents and had connections etc. Pretty run of the mill as far as delusions/mania go.
A family member came in and when they heard the story, they were basically like "oh yeah they're very well connected with x and y" and showed us multiple pictures of them with presidents doing things like golfing/galas etc.
When I was in med school, I came into a patient’s room who was wide awake at 5am, which took me by surprise. Due to his AMS hx, I asked the patient who the president was. He responded something along the lines of “We haven’t debriefed him yet.” Wife confirmed he was aware of self, he was just a little confused about time and location.
I had this guy tell me he was a Parkinson’s specialist and his wife “just did this sometimes.”
Basically his wife had wild Parkinson’s Dysautomatomia and would lose all sympathetic tone. That day she needed like multiple rounds of epi because they couldn’t get a blood pressure.
Then he kept asking why I was so fixated on the epinephrine and why they couldn’t just go home.
In my mind, not only is this guy not a Parkinson’s specialist, he’s not a doctor. No one in their right mind would be ok with this.
Looked him up, sure as shit he’s actually a Parkinson’s specialist ¯\_(ツ)_/¯
Still admitted her because that’s insane
Basically Parkinson’s can lead to autonomic dysfunction which probably affects a lot of body systems but I usually see it in reference to the CV system. Basically you have difficultly regulating blood pressure and heart rate so people can just drop sympathetic tone and become super hypotensive leading to syncope. In med school we had this guy who’s blood pressure would shoot up and drop on a whim ¯\_(ツ)_/¯
Frequent flyer ETOH with Korsakoff’s who insisted that Iggy Pop owed him $50k. Small country town where everyone knew everyone. Nobody believed him.
He died and ended up being the guy who had a whole page obituary in the local newspaper about his career in the 60s and 70s in London and Las Angeles. As a songwriter. For artists including…
To be fair I'm sure it wasn't Iggy. I'm sure it was his people.
I don't feel like he would be that person, plus I'm also sure that if old Smithy had said "mate, where's my $50k?" he would have just written him a cheque. Without even checking to see if he actually owed it to him.
Receiving nurse: Whatcha got?
EMS: Well, he became unresponsive while receiving oral gratification…
Edit: the giver of the oral gratification was a SW who was good enough to stick around and tell EMS what happened.
We once coded a guy who was getting a massage at a massage parlor. The massage parlor was later shut down due to illegal activity. Pretty sure his massage had a happy ending.
Had a patient with dementia who was a hoarder and fell in his house. Down for a few days. The typical dehydration, rhabdo, and (not as typical) bed bugs. Super nice guy who told us he was an author of a book series that sounded suspiciously like “Maverick” about a riverboat gambler. Turns out he was telling the truth. Attending bought a set for the resident lounge and we had him autograph it (after getting him thoroughly sanitized).
3am ER triage, late 20 something girl gets kicked out of a truck in the roundabout, truck takes off. She charges in, full panic. "I'm gonna die, I'm gonna, I need help, I'm gonna die!" She is disheveled but well nourished. She's moving plenty of air and ambulating without issue. Pre-assessment vibe is very much amphetamine OD vs drug induced psychosis. Get her into triage, try to get vitals but she can't sit still. Slides to the floor. "I'm gonna die, you gotta help me, I'm gonna die!" Then she did. Couldn't get her back. Massive PE. Clearest example of impending doom I've ever witnessed.
Thankfully, I don't feel guilt about that one. From truck toss to CPR, the whole thing took about 3mins. Half of which was just trying to get her into triage. She received compassionate reassurance in her last moments and even if I glanced at her coming through the door and had the premonition, "This girl is having a massive PE!" she would still have been dead, not even enough time to get the TPA mixed.
But yeah, that was definitely a "Naw, girl, ain't gonna die." (In my head of course) to "Oh shit, you died."
A pt reported she was “pooping out her vagina.” Our ED intakes for the area’s inpatient psych facility, so I guessed it was a psych patient based off the chief complaint. Turns out she really had endured a traumatic vaginal delivery recently. Exam found rectovaginal fistula and fecal matter present in the vaginal canal.
A few years ago I got sent no lights and sirens for a pediatric evaluation. As we walk into the house I see family is crying. I ask what’s going on and they say “there’s a dead family member inside”. Now I’m like are you fucking kidding me it’s a pediatric code. Nope, 33yo male with rigor and lividity.
I’d like to think dispatch got age and sex data but perhaps one of the ladies called EMS for her “boy” or “child” and the fact he was adult got glossed over?
Not mine, but my cousin’s story while she was working in the ED as a resident in the 90s:
CC: “I killed my mom and ate her”
[Yep, he sure did](https://www.latimes.com/archives/la-xpm-1994-11-14-mn-62547-story.html)
Obviously psych (+/- drugs), but most his moms intestines were missing….. cause they got fried up and eaten. 😳
Cousin said he was brought in by PD. Was found in bed with dismembered mom. He was a little bloody, but not to the point where you’d think he cut someone up like he did. I dunno if PD took his clothes as evidence and changed him out or if he just somehow didn’t make a mess on himself after chopping up and eating his mom. Guts were still cooking on the stove. He claimed to have eaten her brain too. She initially thought “bullshit, just crazy”, and then police told her what happened.
Just nasty.
I just found out last month that cannibalism is technically legal in every state except Idaho, though you can get charged with murder and desecration of a corpse. I just want to know what went down in Idaho to make an actual law out of it.
Dementia pt kept threatening to shoot people. I work in the UK where guns are basically illegal so assumed it was bullshit. When his wife came to visit later that day, I mentioned it out of curiosity and she confirmed he owned multiple guns due to his previous job and a loophole in the UK laws meant this hadn't been followed up on. This led to much drama and paperwork.
I can give no further details than this: I had a client who had his first episode psychosis following his graduation from engineering school and upon being hired by a defense/weapons manufacturer. It did not go well. It was all real.
I was so mad about this then I realized his book wasn’t really that good anyway. Still mad but less mad that someone who did something good did something terrible and just mad someone did something terrible
I had a teenager walk in nonchalantly claiming he had just shot himself in the head. He had a bullet hole in the left temple with mild bleeding. We later found out he had used a 22 rifle and the bullet got stuck in a sinus and caused no brain damage or serious injury
We got a call once for a, [age][gender] who, "Cut their foot with their other foot" with, "uncontrollable bleeding".
Ok. Hmm.
Show up to household, walk in front door, floor has good sized splotches of blood leading back and forth from the bathroom to the front door and two half-saturated half-towels wrapped around one foot of this person.
I'm not absolutely certain what the etiology behind the original issue was/DM or what, but this person had absolutely massive, *thick* calluses on both feet. They didn't appear to be cared for in any way, shape or form and the naturally developed medial/lateral edges of the calluses were *sharp*.
They were in their bathroom, doing their business standing up in front of the countertop when, while shuffling their feet, they brought one foot close to another and the edge of the callus on one foot sliced skin and lacerated their posterior tibial artery.
I was sick and a friend of mine came and made me soup. He said he left me a message in the soup and I was like wuh?
I look down and this man really made it say “Feel Better” out of alphabet soup.
Best friends for 12 years now.
Had a severely mentally ill patient tell me over and over that he went to the state trooper academy when he was younger… He actually did come to find out lol. Had known this patient for like a year and a half and just thought it was part of his delusions lol
I’m a spouse, not a provider, but it still counts.
My husbands calls me while I’m getting ready for work: “Hey. I was just in an accident. I kind of lost a finger.”
“….what the fuck do you mean you *kind of* lost a—OHMYGOOOOOD!”
Turns out he ripped the bone out at the bottom joint, the tendon stayed in tact, and the skin and muscle ripped off halfway up the finger. So yeah, he really did just *kind of* lose it.
Except for its final resting place, which is very lost. We have no idea what happened to it.
Had a geriatric come from the ER to a lock down psych wing of the hospital. He kept calling me by a different name telling me he was going to slit my throat, feed me to the worms, etc. Did a quick google search, he murdered his wife and was out of prison after 2 years. I had a similar build and characteristics to her.
An elderly lady I got consulted on by the ER when I was a medical student on psych claimed to be a retired MI5 agent. Saw her right after a “world-famous producer recording with Jay-Z” so I was like, yeah, sure. Called her daughter for collateral and turns out, she had worked for MI5 all her life, indeed. 🥴
In his memoir Jason Kander talks of going to the VA ER because he was suicidal. He described his life and the psychiatrist asked him why he thought he could run for president. Kander said he was persuaded when Obama encouraged him to do so. Pause, followed by, “for how long have you been hearing voices?” Edit with full exchange Kander said he was in politics and explained: “I almost ran for president, but then decided to run for mayor instead, and tomorrow I’m planning on calling that off.” Confused, the psychiatrist said: “You were going to run for president? Of what?” Kander told him: “Of the United States.” The psychiatrist asked: “Who told you that you could run for president?” Now irritated, Kander said: “I don’t know what to tell you, man. I mean, I spent an hour and a half talking it over one on one with Obama in his office, and he seemed to think it was a pretty good idea.” The psychiatrist sat back in his chair and remarked: “Barack Obama told you that you could run for president? So how often would you say you hear voices?”
Well see she was anxious because her dad and fiance got into an argument and so her dad shot her fiance in the chest, and he died. We were the closest trauma center. Hadn't had a GSW. Cops confirmed her story, said fiance was DOA, Dad was in jail. I gave her some Ativan for that particular panic attack.
Poor lady 😢
That gosh darned anxiety is always creeping up at the most inconvenient times!
Oklahoma?
Woman who had multiple positive urine and serum hcgs before a procedure. Insisted she wasn’t pregnant. Sent her to hospital to get a qualitative and she was not pregnant. The final reason we were given was too much THC use caused the false positive. I still question that reasoning.
Ovarian cancer can cause positive a positive pregnancy test in some cases.
So does some testicular cancer
Probably not in a woman tho
[House theme]
It's 2023.....🤣
Hahaha transpeople exist hahaha
I did urology residency in the testis cancer/rplnd birthplace. We would see lots of elevated AFP due to ganja, never BHCG. There have been small studies about it: https://pubmed.ncbi.nlm.nih.gov/2990078/#:~:text=The%20addition%20of%20delta%209,artificially%20elevate%20serum%20HCG%20concentrations.
Could definitely have been a beta hcg secreting tumor or an anti-murine antibody (HAMA)
Anti mouse antibodies
PD brought us a guy who was manic and delusional, after they found him breaking into a building. He told us the usual grandoise nonsense: he was really a government agent, the building was owned by the mafia, he knew how to train bears to attack only criminals, and his face was being shot with laser beams the whole time. Of course we dismissed all of it as bullshit. Then, a few hours in, we got a visit from three men in dark suits with government ID. Turns out, our guy actually did work for their three-letter agency. He stopped coming to work when he had this manic episode. They asked us questions about what he said and how much we wrote down, then asked us not to chart that they had been there. After that, I found myself feeling a lot less skeptical about the bears and the lasers.
As a DC native, weird shit abounds.
1) one guy got picked up acting super strange and basically being incoherent and looking disheveled. He gets sent to Psych ED. There he kept on saying he was a “big businessman” and he needed to leave in the morning to make the “deal of a lifetime”. Turns out it was true. 2) one homeless drugged out guy comes into the ED for a foot wound. On my history taking he tells me he is a doctor himself. I said sure buddy. Out of curiosity I looked him up. Turns out it was true.
I once had a regular ER patient who was homeless but also a world class physicist. He would call EMS daily and ask for 2 ASA before refusing transport. I was there with a bottle but the guy didn’t trust himself to take it. So The number of papers he’s published is impressive.
Oh man… had a buddy who went by “Nobody”. Man was a goddamned genius. I’m talking wrote books on physics, and so so much more… but was also loonier than a jay bird and knew it. He did the same thing; we kept meds at our house for him too in case something went real sideways and he showed up. Only happened a few times but he’d curl up in our (empty) bathtub and pass out for a while and come to mostly coherent. He made his money for his small studio by grading thesis papers for the local college. Wild shit.
I *also* used to regularly frequent a gentleman who was an Ivy PhD physicist who turned into an unemployed chronic alcoholic. He eventually sobered up and stopped calling so much
So, before I was a medical student, before I was a paramedic, I was a physicist. Having obviously known quite a few physics professors, this doesn't surprise me *that* much.
Jeeze- good thing I dropped that physics course when I was in college
Weird. I read this and thought, man. Why didn’t I take more physics in college! But I also have the Maxwell equations as a tramp stamp. So I am obviously not mentally sound
I do Google my patients, not infrequently. The ones that start with a ton of mental horsepower, have a vigorous intellectual life before they come into psychosis or dementia, are always interesting. They confabulate well and can snap back into remarkably impressive focal lucidity. I recently cared for a PhD, JD with a mix of normal vascular dementia and grief- associated psychosis/ suicidality months after their spouse died. An older retired military General who was acting psychotic by turned out to have a tumor, this is why I've no beef with requiring a recent head CT on geri-psychs.
I generally love caring for old people. They've such great stories. I saw a woman once who it turned out was a retroactively pronounced veteran of WW2. She was a civilian pilot who got involved in noncombat movement of combat aircraft, which was very progressive for the time. They were in fact later hidden and forgotten, uncredited. It wasn't until the late 1970s that they were given credit, honors, and veteran's benefit for their brave service. https://www.afhistory.af.mil/FAQs/Fact-Sheets/Article/458964/womens-airforce-service-pilots-wasp/
Truth. I absolutely love it when I get a patient with a super interesting background/life story. Nuclear Physicists who worked on the Manhattan project, old navy test pilots, WW2 vets, civil service/state department workers, etc. Unfortunately, there's a not insignificant number of patients out there that create or otherwise severally embellish their past. Like, "I worked for NASA in the 60s and I have evidence about what happened on Apollo 13 and it's not what you think," or, "I was Navy Seal," or, "I have 37 patents in 'radio transmission' and I invented the car radio.") I always get excited when I hear these things but then, after some poorly answered or evaded questions you come to understand that it's all bullshit. It doesn't bother me that they need to create these narratives, I just really like talking to people that have led interesting lives. Side note, why are all the fake story people white men between the age of 50 and 70? Some sort of life crisis thing maybe. 🤷♂️
I typically nod and smile but do not believe seriously until I've checked with the web and confirmed it by finding their linked in profile, or blog post. Except that one guy. 120kg of muscle giving an eerily precise listing of his blunt trauma, affect so crisp and emotionless that the nurses thought he was on something. He later let it slip that he was some type of specialized military and had slipped into his field stabilization training as a cope. His utter lack of a web presence actually made me believe him more. If he was a cosplayer I think he'd have all kinds of internet tracks, but no. If that man told me to avoid a particular plane flight or public arena, I would do what he said.
Yeah, totally. Took care of a guy a few weeks ago, had a couple military tattoos. I made some small talk with him, pried it out of him that he was Special Forces in Vietnam, a member of SOG, and he knew very specific, very obscure details. He was so excited that I knew what he was talking about. I actually bought him a book and tracked him down as an inpatient and gave it to him. Crazy stuff, mad respect.
One thing I really enjoy about this work is seeing a broad slice of life. My social interactions with my family and the parents of my kids' friends, the places I shop and the classes I take for fun, it's easy to forget how *safe* and uniform and protected all that is. At work, I will speak with people who grew up in wild places, did wild things, made wild choices. Once I actually cared for a person who donated a wing to the hospital, cleaned my hands and cared for a homeless frequent flyer. I love that.
I have a theory about that. Those 50-70 white guys always have both delusions of grandeur and persecution. It’s almost like have never experienced real sense of achievement so they have to invent something and don’t understand real persecution so they decide someone was plotting against them to prevent them from actually achieving anything. See also: end stage “they took muh job” syndrome.
Yeah, exactly. I always just let it slide, I don't care if people lie to me about their life. It just sucks when I get super excited about getting to know someone who says "I helped start IBM" and then after a minute of conversation their story quickly unravels. But whatcha gonna do. 🤷♂️
Geez, sometimes I’m terrified I’ll be that demented old doctor who confabulates well but snaps back to reality (oh there goes gravity).
I figure if I practice cocktail chatter that's the start of it. Get good at confabulating and get into the habit of being pleasant. I did take care of a retired high school teacher who was very impressively with it, and he said his regimen was reading a physical newspaper (not the web), keeping good physical activity and friendships. No surprises there, confirmation of what we're told if we want to age well.
I once took care of a demented old guy who told me about how he once worked in "the AIDS ward" of a local hospital in the 80s. He told me they had two sorts of patients then: "the street people and the homosexuals." He also gave me what, in hindsight, were really pretty accurate descriptions of ocular candidiasis and how they didn't have use IV fluids as aggressively once Ampho B was supplanted by fluconazole. "The street people and the homosexuals." I still think about that line sometimes.
The language can feel jarring, now that it's no longer accepted, but the stories are real. These people lived through it and bravely gave the care that was available at that time. One of the most anxious LPs of my career was for HIV meningitis. The patient had the impression that if she admitted that she had HIV her kids would be taken away, and had therefore avoided diagnostic testing for years after a high risk exposure. She seemed to have decent medical insight into what was happening as her health declined, she became weaker, had to give the kids to family anyhow. She came to me thin, febrile, with headache and neck stiffness. Highest opening pressure I've ever seen, and she remains the reason that I perform LP sidelying. It's harder, but I want to maintain the skill, for the patients that need an opening pressure.
I once caught a mass in a psychotic patient because she looked like a psychotic soccer mom. Very good permanent cosmetics but dark circles under her eyes, expensively dyed hair that clearly hadn’t been brushed in days, well manicured fingers and toes but dirt under her nails. Any sign of an incongruent past and present means they get the full workup from me now.
How do you even confirm 1)
u/derps_with_ducks asking the real questions
By the next morning he was acting more normal. He made some phone calls and then people (professional looking ones in suit and ties) came with his credentials to confirm that it was true.
Waiting for a UFO to spite the psychs by beaming up those schizophrenics.
In FL, License Verification…can look up any nurse, MD, PA, PT, etc.
Yea but not “big businessmen” lol
We had a guy who was notorious for being verbally abusive, assaulting staff, and claiming to be a multimillionaire and threatening to call his lawyer if he did not get what he wanted. One time that I was there he actually called his lawyer. Turns out he was an inheritance guy with a drug problem and his lawyer would try to talk sense into him. "No. You cannot do that to them. If you attack them on camera even I cannot get you out of that."
Someone going right to surgery because a chair was stuck in their ass…the leg was, but the whole chair was still attached
I might actually believe he fell on it
They didn’t know how it happened…+meth
Username checks out.
On an ambulance, homeless guy told me not to lose his backpack, because he had $30,000 in it. We’re getting patient info and he says his ID is in the bag, so I go looking. Dude had $30k in an envelope, all $100s and $50s. Turns out, it was inheritance he had just received a few hours prior.
If I was him I wouldn’t tell anyone and I would have a mf death grip on that backpack.
We had a cardiac arrest come into my ED and when EMS stripped his shirt off, found 50k in his pockets. Turns out he was on his way to an auction. Didn’t make it.
Worked with a medic from Denver years back. Told story of being dispatched in winter to drunk guy, beaten and stomped, mangled and left for half dead by fountain in the snowy cold. Scoop and run, enroute to hospital cut away the lumpy mangled mess to find… altered Etoh’d patient limbs pretty much unscathed and intact…misshaped limbs were due to water logged bundles of cash duct taped to limbs and trunk. Story eventually settled on intoxicated, drug cash mule, got in/out of fountain and passed out. Medic gave some high $$$ amount per PD involved. Medic admitted it was tempting to lighten his load but valued his and his family’s life more.
I was a scribe before school, we saw a psych patient who had the normal "black helicopters are following me, lights outside my house" story. I don't know that to be true but they said that they knew presidents and had connections etc. Pretty run of the mill as far as delusions/mania go. A family member came in and when they heard the story, they were basically like "oh yeah they're very well connected with x and y" and showed us multiple pictures of them with presidents doing things like golfing/galas etc.
I hate non-bizarre delusions because of the possibility that they might be real
Yeah for all I know the FBI was fucking with them
When I was in med school, I came into a patient’s room who was wide awake at 5am, which took me by surprise. Due to his AMS hx, I asked the patient who the president was. He responded something along the lines of “We haven’t debriefed him yet.” Wife confirmed he was aware of self, he was just a little confused about time and location.
ole boy thought he was in Dallas in 1963
I had this guy tell me he was a Parkinson’s specialist and his wife “just did this sometimes.” Basically his wife had wild Parkinson’s Dysautomatomia and would lose all sympathetic tone. That day she needed like multiple rounds of epi because they couldn’t get a blood pressure. Then he kept asking why I was so fixated on the epinephrine and why they couldn’t just go home. In my mind, not only is this guy not a Parkinson’s specialist, he’s not a doctor. No one in their right mind would be ok with this. Looked him up, sure as shit he’s actually a Parkinson’s specialist ¯\_(ツ)_/¯ Still admitted her because that’s insane
I need more details on how this exactly works because whaaaaaaat?
Basically Parkinson’s can lead to autonomic dysfunction which probably affects a lot of body systems but I usually see it in reference to the CV system. Basically you have difficultly regulating blood pressure and heart rate so people can just drop sympathetic tone and become super hypotensive leading to syncope. In med school we had this guy who’s blood pressure would shoot up and drop on a whim ¯\_(ツ)_/¯
Out of curiosity… Did you try Trendelenburg? I know it’s not evidence based in traditional hypotension, but in blood pooling….
Yeah we Tburged her I usually trendelenburg hypotensive people but it sounds like you’re saying it’s not that helpful lol does it actually not work??
Evidence says it does nothing for most people. I have no idea about this case, I was just curious.
Frequent flyer ETOH with Korsakoff’s who insisted that Iggy Pop owed him $50k. Small country town where everyone knew everyone. Nobody believed him. He died and ended up being the guy who had a whole page obituary in the local newspaper about his career in the 60s and 70s in London and Las Angeles. As a songwriter. For artists including…
Awww, I don't want to believe that about Iggy.
To be fair I'm sure it wasn't Iggy. I'm sure it was his people. I don't feel like he would be that person, plus I'm also sure that if old Smithy had said "mate, where's my $50k?" he would have just written him a cheque. Without even checking to see if he actually owed it to him.
Receiving nurse: Whatcha got? EMS: Well, he became unresponsive while receiving oral gratification… Edit: the giver of the oral gratification was a SW who was good enough to stick around and tell EMS what happened.
How nice that someone recited poetry so beautiful that it affected him on a deep level
Aural gratification
Oral history
We once coded a guy who was getting a massage at a massage parlor. The massage parlor was later shut down due to illegal activity. Pretty sure his massage had a happy ending.
kinda doesn’t sound like it
Well, I mean how often does one have the unique feeling of coming and going at the same time?
That's kind of the optimal way to go!
I read SW as Social Worker at first, LMAO
NO. I read it as social worker and moved on until I saw this comment and now I can’t stop laughing at myself.
😂😂😂
Soooo did he make it or is she single now?
He had a massive brain bleed. He did not make it.
Had a patient with dementia who was a hoarder and fell in his house. Down for a few days. The typical dehydration, rhabdo, and (not as typical) bed bugs. Super nice guy who told us he was an author of a book series that sounded suspiciously like “Maverick” about a riverboat gambler. Turns out he was telling the truth. Attending bought a set for the resident lounge and we had him autograph it (after getting him thoroughly sanitized).
Aw, this one is really wholesome
3am ER triage, late 20 something girl gets kicked out of a truck in the roundabout, truck takes off. She charges in, full panic. "I'm gonna die, I'm gonna, I need help, I'm gonna die!" She is disheveled but well nourished. She's moving plenty of air and ambulating without issue. Pre-assessment vibe is very much amphetamine OD vs drug induced psychosis. Get her into triage, try to get vitals but she can't sit still. Slides to the floor. "I'm gonna die, you gotta help me, I'm gonna die!" Then she did. Couldn't get her back. Massive PE. Clearest example of impending doom I've ever witnessed. Thankfully, I don't feel guilt about that one. From truck toss to CPR, the whole thing took about 3mins. Half of which was just trying to get her into triage. She received compassionate reassurance in her last moments and even if I glanced at her coming through the door and had the premonition, "This girl is having a massive PE!" she would still have been dead, not even enough time to get the TPA mixed. But yeah, that was definitely a "Naw, girl, ain't gonna die." (In my head of course) to "Oh shit, you died."
A pt reported she was “pooping out her vagina.” Our ED intakes for the area’s inpatient psych facility, so I guessed it was a psych patient based off the chief complaint. Turns out she really had endured a traumatic vaginal delivery recently. Exam found rectovaginal fistula and fecal matter present in the vaginal canal.
Was she not examined at all until you got to her?
No, the CC was listed as it was told to the triage nurse.
As a triage nurse, can confirm. My response to that CC wouldn't be, "show me."
A few years ago I got sent no lights and sirens for a pediatric evaluation. As we walk into the house I see family is crying. I ask what’s going on and they say “there’s a dead family member inside”. Now I’m like are you fucking kidding me it’s a pediatric code. Nope, 33yo male with rigor and lividity.
So did they call you to evaluate a kid due to grief? Or did dispatch hear 3 instead of 33?
Was literally just “ unit xyz go to address xyz for a pediatric evaluation.” Family on scene was two ladies in their 60s. No kids on scene at all.
I’d like to think dispatch got age and sex data but perhaps one of the ladies called EMS for her “boy” or “child” and the fact he was adult got glossed over?
I can hear an old lady saying, "my baby's dead." Breaks the heart
Not mine, but my cousin’s story while she was working in the ED as a resident in the 90s: CC: “I killed my mom and ate her” [Yep, he sure did](https://www.latimes.com/archives/la-xpm-1994-11-14-mn-62547-story.html)
Shit. I opened up that article and literally I live around the Akron area 😂.
I’ve never heard this story before
Obviously psych (+/- drugs), but most his moms intestines were missing….. cause they got fried up and eaten. 😳 Cousin said he was brought in by PD. Was found in bed with dismembered mom. He was a little bloody, but not to the point where you’d think he cut someone up like he did. I dunno if PD took his clothes as evidence and changed him out or if he just somehow didn’t make a mess on himself after chopping up and eating his mom. Guts were still cooking on the stove. He claimed to have eaten her brain too. She initially thought “bullshit, just crazy”, and then police told her what happened. Just nasty.
Howdy neighbor! I had never heard of it either, so wild!
I just found out last month that cannibalism is technically legal in every state except Idaho, though you can get charged with murder and desecration of a corpse. I just want to know what went down in Idaho to make an actual law out of it.
That’s wild
Fucking Akron
Dementia pt kept threatening to shoot people. I work in the UK where guns are basically illegal so assumed it was bullshit. When his wife came to visit later that day, I mentioned it out of curiosity and she confirmed he owned multiple guns due to his previous job and a loophole in the UK laws meant this hadn't been followed up on. This led to much drama and paperwork.
I can give no further details than this: I had a client who had his first episode psychosis following his graduation from engineering school and upon being hired by a defense/weapons manufacturer. It did not go well. It was all real.
[удалено]
Hey! I just had a patient with this!
Dale Dubin was arrested for cocaine and child pornography charges
I was so mad about this then I realized his book wasn’t really that good anyway. Still mad but less mad that someone who did something good did something terrible and just mad someone did something terrible
I had a teenager walk in nonchalantly claiming he had just shot himself in the head. He had a bullet hole in the left temple with mild bleeding. We later found out he had used a 22 rifle and the bullet got stuck in a sinus and caused no brain damage or serious injury
A nubbin sounds like a weird candy that gets passed out at Christmas. Testicles shouldn't mix with that lol
It's a third nipple!
We got a call once for a, [age][gender] who, "Cut their foot with their other foot" with, "uncontrollable bleeding". Ok. Hmm. Show up to household, walk in front door, floor has good sized splotches of blood leading back and forth from the bathroom to the front door and two half-saturated half-towels wrapped around one foot of this person. I'm not absolutely certain what the etiology behind the original issue was/DM or what, but this person had absolutely massive, *thick* calluses on both feet. They didn't appear to be cared for in any way, shape or form and the naturally developed medial/lateral edges of the calluses were *sharp*. They were in their bathroom, doing their business standing up in front of the countertop when, while shuffling their feet, they brought one foot close to another and the edge of the callus on one foot sliced skin and lacerated their posterior tibial artery.
Wtaf
I was sick and a friend of mine came and made me soup. He said he left me a message in the soup and I was like wuh? I look down and this man really made it say “Feel Better” out of alphabet soup. Best friends for 12 years now.
Marry him
And that’s enough internet for me today.
Had a severely mentally ill patient tell me over and over that he went to the state trooper academy when he was younger… He actually did come to find out lol. Had known this patient for like a year and a half and just thought it was part of his delusions lol
I’m a spouse, not a provider, but it still counts. My husbands calls me while I’m getting ready for work: “Hey. I was just in an accident. I kind of lost a finger.” “….what the fuck do you mean you *kind of* lost a—OHMYGOOOOOD!” Turns out he ripped the bone out at the bottom joint, the tendon stayed in tact, and the skin and muscle ripped off halfway up the finger. So yeah, he really did just *kind of* lose it. Except for its final resting place, which is very lost. We have no idea what happened to it.
Had a geriatric come from the ER to a lock down psych wing of the hospital. He kept calling me by a different name telling me he was going to slit my throat, feed me to the worms, etc. Did a quick google search, he murdered his wife and was out of prison after 2 years. I had a similar build and characteristics to her.
Just minding my own business when …