Brief ED post, no need for editing - nothing gross:
The next chart in the rack is Duncan Weisner, an 18 year old with chest pain. He's got no medical history, no relevant family history, no real risk factors. I don't know what's going on but I figure before I go into the room that he's not dying of a heart attack.
In the room there is a chunky young guy clutching his chest. He's hooked up to a monitor which shows an extremely normal heart rhythm. The nurses have put the EKG on the counter and it could not be more normal. Duncan has an equally out of shape friend with him who limps painfully around the bed, holding a half eaten bag of Doritos and winces visibly as he sits down.
"What's going on, Mr. Weisner?" I ask.
"I think I'm having a heart attack," he gasps. He does look miserable but I'm not convinced he is having a heart attack.
"Well, tell me the story of your pain. When did this start?"
"Cooper and me," he gestures towards his friend, "we're trying to get in shape. We're going to join the army so we want to get in shape." City X donates a lot of young men and women to the armed forces. It is the only way out for many people - and there is possibly a smaller likelihood of being shot in a foreign country than there is on the streets of City X. I see a lot of vets in my ED and a lot of very sad parents but I don't think I've ever seen people attempting to get into the army before.
"It's great that you're trying to get into shape. When did the pain start?"
"Well we rented this DVD that was supposed to be like basic training and, shit man, that shit is hard core. We were running and doing crunches and stuff. We must have done like, a million crunches and a million push ups and a million squats. Maybe more. But we're going to get in shape!"
"Did the pain start when you were exercising?"
"Nah. We both finished and then we had a couple of 40s. We deserved them after that shit. And when I woke up this morning I was having a heart attack."
"Hmm," I say, and do a physical exam.
Mr. Weisner needs to lose about 50 lbs but his heart has a regular rate and rhythm with no murmurs, rubs, or gallops; his lungs are clear. He's got mild diffuse tenderness in his quadraceps , hamstrings, gastrocs, deltoids, biceps, triceps and impressive tenderness along both sides of his anterior chest wall. I diagnose him with acute inflammation of his pectoral muscles from doing way too many push-ups. He is mortified. Cooper teases him. I mention that Cooper is limping and perhaps shouldn't throw stones. Mr. Weisner laughs uproariously and Cooper retreats into his bag of Doritos.
"So what motivated you to join the army now?" I'm killing time while I finish up my charting. This guy was brought back as an emergent patient and I need to get him out quickly to free up the monitored bed for someone who might actually be having a heart attack. The question agitates my patient.
"This country is a bunch of pansies who don't know how to fight. We're willing to go and kill a bunch of Arabs, but we won't stand up for our own people!" This confuses me.
"Do you mean the situation in Afghanistan?"
"No! They're just another bunch of towel heads. I don't even know what the fuck we're doing there, that Osama guy has moved on by now. I'm talking about America. America is being attacked and nobody is doing nothing."
"Um," I say.
"Yeah, we used to have a cold war and everybody was all nuts about it but now we have a hot war and nobody cares."
"Ah," I say.
"See?" Cooper says, heatedly, "She doesn't care either!" He turns addresses me directly, "I don't know what is wrong with you people!" I'm not sure what part of being a short, four-eyed, overeducated female he means by "you people," but regardless, I've been called worse.
"Lady," says Mr. Weisner, grabbing my wrist and then remembering who I am and releasing it as if he had been burned, "I mean doctor. Doctor, the Russians invaded Georgia. My grandma is from Georgia. Don't you care?!"
I discharge Mr. Weisner with a prescription for Ibuprofen and orders to ramp up more slowly on his exercise plan.
and, yes, this is a compilation of multiple patients. This seems to be a common misperception.
Tags: emergency medicine, humor, politics