Emergency Department Ping Pong
OK, Sports fans...it's Saturday night, 3 am and time for inter-service
hospital ping pong. Staff Internal Medicine has won the tossup and has
elected to receive. The other services are in position and here comes the
Chief Complaint: "feel bad"
History: Mr. Amos Leeks, 59 Y/0, 385 pound alcoholic, diabetic,
hypertensive male with history of three old myocardial infarcts, angina,
congestive heart failure, COPD, chronic renal insufficiency, gout,
hypothyroidism and "nerves".
The Medicine service jumps into position. Dr. Shafer Goodloe, medical
raconteur, man-about-town and big time babe magnet gets the nod from the
referee. Shafer enters the room with a spotless white coat, stiff bow tie
and gleaming implements of destruction hanging from every pocket.
The clock starts....Dr. Goodloe jauntily saunters into the room and sidles
up to the patient with a big cheesy smile....
"Hi there Mr. Leeks...ever been in the Army?"
"Yeah, but they threw me out for flat feet".
"Well....in the interest of continuity of care, we feel that you should
return to a Veterans Administration Hospital. The doctors there are
familiar with these problems and they can follow you in perpetuity"
"Naaaa...I don't like that place. The nurses are ugly and they let a bunch
of smart ass kids in white coats practice on me when they thought I wasn't
looking....I want to stay right here and have you take care of me."
FOUL! Serve again....
Shafer assumes his most intense young doctor countenance.....
"Hi there Mr. Leeks....... got any pain right here (does hand stand on
Amos's right upper quadrant).
"Hello, Surgery...we got a guy down here with excruciating right upper
quadrant pain, mild jaundice and a history of fatty food intolerance". He
needs to be on the surgery service.
"What else is wrong with him"
"Oh, just a few minor medical ailments"
"How much does he weigh?"
Oh, maybe three hundred and.." (click)
Shafer's face darkens..........
"Say...Mr. Leeks....ever taken any Valium?"
"Yeah....someone gave me some once".
PINGGGG! Psychiatry consult...
"Hello, psychiatry...we got a guy down here who looks pretty depressed. May
be suicidal. Has a history of Valium abuse. He needs to be on the Psych
OK, just have him sign a consent for electro-convulsive therapy and send
him around in the morning. We'll buzz him till he sees God".
"What about his work up?"
"What about it?" (click)
Shafer begins to sweat and his bow tie droops....the other services
nervously shift from foot to foot....
"Say...Mr. Leeks.....got any pain here? (pops Lumbar 5 with ball peen hammer).
PINGGGG! Orthopedics consult.
"Hello, Orthopods...we got a guy down here with exquisite low back pain
radiating to both legs, he needs to be admitted to Ortho."
"What day is today?"
"Sorry, back pain only on Tuesdays and alternate Thursdays. Make him a
clinic appointment for three weeks." (click)
Metaphorically speaking, Shafer takes the gloves off...No more Mr.
"Hi there Mr. Leeks.......have any pain in your head? (Shines
quartz-halogen light in left pupil dilated with homatropine)"
PINGGGG! Neurosurgery consult.
"Hello, Neurosurg....got a guy down here with an exquisite headache
accompanied by flashing lights and not relieved by anything. He needs to be
admitted to you."
"Hey....no problem...get him a CAT scan with and without contrast, lumbar
puncture, angiogram, EEG, put him on your service and we'll consult on him
in the morning" (click).
Medical team calls time out, stops the clock and pulls into a huddle. As
they whisper and murmur..a Senior Medical Student pops up to see if the
patient is still there...he is. After a moment they break and return to the
game with broad grins.
"Hello...OB-GYN....we got a woman down here with an imperforate hymen,
adreno-genital syndrome and bilateral femoro-labial hernias...."