The hysterical patient during a busy ER shift

by VeronicaB, MD

We’ve all had that hysterical patient.  The one that comes in during a busy shift.  Grabbing at their head, their chest, their abdomen.  Yelling out that they are in pain.

You know the one.  They makes the nurses’ eyes roll.  They add to an already chaotic scene.  Other patients stop to watch as the gurney rolls by.

You debate how long you’re going to wait to go into the room when the triage nurse hands you the chart and tells you the patient is so agitated that they can’t give her a history.  The EMS crew tells you the call came out as a chest pain, a headache, an abdominal pain.

This is the patient where you go in the room and try to patiently get a history.  You count under your breath as the patient continues to cry and “carry on.”  Finally, frustrated you tell the patient you can’t give them anything until they talk to you and tell you what’s going on.  Even then you might not get some useful information other than their presenting complaint.

You walk out of the room.  The nurse asks, “So what are we going to do with this one?”  You shake your head in exasperation.  ”I don’t know.  Let’s start with…”

You jot a quick note.  Go to tend to the other demands of the department.  A while later the EKG or chest x-ray or flat plate or lab result comes back, and you think, “Oh crap!”  You rush back to the room.  Suddenly that crying, wailing patient is the STEMI, the widened mediastinum, the free air in the abdomen.

You look at your watch.  How much time has passed?  What needs to be done?  You start to mobilize your team.  You get the nurse to run extra labs.  You order the CAT scan.  You call your consultants.

You go back in that room with a different view on the patient and start to explain what is going on, try to reassure them, ask them what you can do for them.  You get consents, place lines, make phone calls to families.

The patient is rushed off to the Cath lab, the OR, the ICU.  Then you wait.  You’re seeing your other patients in the E.D. but your mind is on that patient.  What did you miss?  What could you have done sooner?

You get some information.  The patient had a 100% lesion in the LAD, a ruptured AAA, necrotic bowel.  They’re going to Tele, the ICU, or they died on the table in surgery.

You stop and think.  Was I professional?  Did I make them comfortable?  Was I even nice?

Then the next patient comes in the door yelling and screaming that the only thing that’s going to help their pain is “something that starts with a D.. dill… doll…”  You take the chart, go in the room, and start again.

“VeronicaB” is an emergency medicine resident who blogs at The Central Line, the blog of the American College of Emergency Physicians.  Reprinted with permission from the ACEP.

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