The magical mystery land of community health

I don't make this stuff up!…but I do change identifying information.

Another Edition of the Totally Inappropriate Comment February 18, 2010

Filed under: Uncategorized — lesbonurse @ 3:35 am

Here’s another installment of the Totally Inappropriate Comment (TIC).

30-something year old patient with heart failure, renal failure and HgbA1c > 15, with point-of-care blood glucose of 439 (fasting): “Yes, I’ve been taking my insulin.  Yes, every day.”  Actual comment: “Have you been missing some doses?  Because you’re on a LOT of insulin, and it usually works better than this.” TIC: “You’re gonna die.  Soon.  Like, really soon.”

Patient requesting a pregnancy test: “Well, I finished my pills and I didn’t get my period, so I didn’t start the next pack.”  Have you been having unprotected sex in the 3 weeks since you stopped your pills?  Patient: “Well, yeah.”  Actual comment: “Had you missed any pills in the pack last month?”  TIC: “Well, if you weren’t pregnant before, you are now!”

Me, to ex-alcoholic patient who had been complaining of severe hip pain (and had been brushed off as drug-seeking over the past month): “So…the xray of your spine shows 2 compression fractures, and the xray of your hip shows something that we call ‘collapse of the femoral head.’  That’s a big deal.  That’s why you can’t really bear weight on your hip.”  Patient: “Does this mean I can get something stronger than naproxen for my pain?”  Me: “Yes.  I’ll give you something stronger for your pain today.  And we’re sending you to see Orthopedics asap.”  TIC: “Boy, were we wrong!  You’re not faking it at all!  I can’t believe you’ve been walking around on that non-existent hip joint! I’m sorry.”  *Lest you think I am a jerk, I did actually apologize for our clinic not catching the severity of the hip problem sooner, even though it wasn’t me that brushed the patient off.


Thursday Haiku February 11, 2010

Filed under: Uncategorized — lesbonurse @ 3:25 pm

Did not get snowed in.

Sadly, not able to catch

up on all my work.

Female sexual

dysfunction.  No, there’s no pill.

It sucks, I’m sorry.


Nursing Intervention FAIL February 3, 2010

Filed under: Uncategorized — lesbonurse @ 3:00 am

Me: Your blood pressure is still really high, even though we raised the dose of your medication.  Are you forgetting to take it sometimes?

Patient: No, I’m taking it every day.  Hey, do you think it’s because I eat a lot of fast food?

Me (practically salivating at this perfect opening for dietary counseling): Well, that’s a really, really great question.  Fast food is really high in sodium, which is salt.  And eating a lot of salt can raise your blood pressure.

Patient: Oh.  What has a lot of salt in it?

Me: Tell me what you ate yesterday, starting with breakfast.

Patient: I had coffee and a donut.  Then, after church, we went to Homestyle Buffet and I had fried chicken, mashed potatoes, salad and ice cream.  For dinner I had Taco Bell.

Me: There’s several things there that have a lot of sodium.  The fried chicken and the Taco Bell are really high in sodium.  You might not guess, but the mashed potatoes and salad dressing are also really high in sodium.  Any kind of sauce, like bbq sauce, also has a lot of sodium.

Patient: Whoa.

Me (starting to get really fired up): I’m printing you a handout right now about which foods are high in sodium.  If you can reduce the amount of salt that you eat, we might not have to add another blood pressure medication.

Patient: No, why don’t you just give me the pills.

Me: What?  You don’t want to try to cut back on the salt?

Patient: Naw, I don’t think I can do it.  You might as well just give me the medicine.

Me, crestfallen: Ok, but take this handout, too.  I still want to you cut back on your salt even if you are on more medicine.

Patient: Sure.