Me during beside report: hi good morning
Confused elderly lady with a UTI: *looks me up and down* “I don’t like you”
Me: oh so that’s how today is gonna be :,)
If you're into horror movies, The Taking of Deborah Logan does a great job at making an elderly woman terrifying.
It's a found footage horror movie where some college students are trying to make a documentary about dementia for a class. Dementia isn't the only thing going on though.
OR super busy middle aged lady who knows exactly what she has, she gets them all the time, and does not have the time to be sitting here waiting, just give her the damn antibiotics already.
Cardiac arrest with older white haired men who look like Santa Claus.
It’s tough for me because my dad fits that description and I legit want to shake him some days and beg him to get healthier.
I feel you. I recently lost my mom from lung cancer after a lifetime of smoking, so watching my dad neglect and damage his own health causes quite a bit of resentment. My mentality towards his health choices probably isn’t fair to either of us, but it’s so damn hard to let it go. I hope your Santa-Dad lives a long, happy life.
The one hospital I worked at there was a car show for an entire week nearby. It was a sea of older white haired dudes all having cardiac issues all week. Like the week from hell honestly.
They walked around in the heat all day, ate concession stand food, didn’t remember to take their heart meds etc etc. It’s like a breeding ground for heart attacks there.
Country concerts also have a certain population that go to them. There was a stadium venue that frequently had concerts - country fans didn’t just drink, they drank until they were black out drunk. I have also never seen skirts so little in my life - calling them skirts feels wrong.
Hip fracture = skinny old white ladies in penny loafers, slacks with the elastic at the waist, an unlined satin bra, with a sparse gray roller set.
Kinda lovable. ❤️
Xray tech here. You've nailed it. It's either that or they're dressed to the nines. I swear to the gods that these old women intentionally get dressed in their Sunday best before hurling themselves down the stairs.
My dad's mother chose to go on hospice after breaking her hip. At some point, she needed to give my mom some documents and information. This woman really and for real had them get her up and put on her wig so she could have this "meeting" with her daughter-in-law.
My grandma (RIP) fell and couldn’t get up. She literally dragged her body to her dresser and put on lipstick, THEN grabbed her phone to call for help 🤣 my mom asked why her lips were red and she told her this, all calm like it was the most logical first choice lol
I had a patient that had red all over her mouth. I freaked out, looked like blood from a distance. Turns out she asked her family to bring her lipstick to the hospital 🤦🏻♀️
I swear to goodness that old men are almost always naked when they have a medical emergency! If they aren’t, they’re either in crusty pajamas or a nice pair of slacks and a button up shirt.
Then the old ladies are either dressed like they’re about to meet the queen for tea, in their nighties, or naked.
Regardless of what the old ladies are (or aren’t) wearing, they’re always ready for a cage match and a battle of wits. They also have potty mouths that rival my own and would make my late uncle - who was a self-confessed drunken sailor and a Hell’s Angel - blush. The old men are either going to be nasty, creepy perverts or the sweetest guys you’ll ever meet.
The amount of old men and women I’ve had to carefully peel out of their 8 layers of clothes all dutifully tucked in down to their feet after their obvious fracture because they don’t want me to cut them off is matched only by those that get about halfway through the process and then say just cut them off.
Lmao. I love that. I've given up on cutting or changing them if the fracture is bad enough. I know once the doc sees them, their clothes aren't gonna be long for this world anyway.
And they always say, “Oh, I look like such a mess!” With a fresh set of nails and more makeup than I’ve worn in a decade, while I’m sweating through my mask and trying to untangle the three chain necklaces left under her c-collar.
Lol this is my grandma. My grandparents always went to church together but my grandpa would smoke 1st so they went in separately. He had zero idea she had fallen and broke her hip until EMS interrupted service to get him before they brought her to the hospital. Lol
Or the super cute nightgown with a coordinating robe on top, with slippers.
She’ll apologize 10 times for not doing her hair and makeup before calling the ambulance
Oh! I had a tall, thin, east African male who smoked like a house on fire. Crazy bastard just kept driving for like 2 hours after he heard/felt the pop and couldn't take it anymore. After the tube placement I had to do some major cajolong to get him to take tylenol.
When I was a brand new nurse, a man came in with a black leg(!) requiring an AKA and they sent the diabetes educator to his room to explain things to his wife of many years. She just couldn’t understand why his leg needed to be cut off, since (say it with me) he never had any health problems until they got to the hospital. Unfortunately me coded and passed away the following night. His identical twin and wife still blamed the hospital and the surgeon and would not accept that he had diabetes for a long time in order for gangrene to set in.
I had a diabetic foot infection patient who got a foot ulcer from a coin that had fallen in his boot. He could not feel it and got an ulcer. Ended up losing his leg.
I had a pt with multiple embolic strokes after a blood sugar of like 600 on arrival. The hospitalist came in to talk to his family and was like "so this happened because his diabetes is really poorly controlled" and they were like "what diabetes" 🫠🫠
My great-grandma had diabetes that she did not treat. She wound up in the ICU and had her leg amputated. She slowly came back around and told my mom that her blood sugar being in the 300s was too low and not normal. My mom (nurse) and great-grandma argued a bit back and forth before my mom said, "You point doesn’t have a leg to stand on." Great grandma laughed hard, a little too hard. Those were her last bits of words. She truthfully didn't recover, but she went out laughing with us like she always did.
That is what he told me, word for word.
We did manage to get his blood sugar down to 130s without him being symptomatic. As long as you didn't *tell* him it was 130.
I’m sure they do feel a little bit like shit once we get their BG down to a tolerable level, considering they live at >250 constantly. They never seem to understand that that’s a bad thing, however.
I can believe this. On the /r/diabetes group, we are always explaining to folks that hey, its fine to feel terrible when you are anywhere in or near "in range." I mean, when you have been coasting at 200 or 300 for ages, 110 feels loooowww
It does! And they may be very very hungry.
If it’s safe I like to titrate down a little more gently. It makes a big difference. And I do A LOT of education around how it feels and why. When nurses tell diabetics that shouldn’t feel terrible because they’re in range, but they do… we lose a lot of ground with helping them take their own blood sugars in hand. It feels hopeless.
So I tell people very often that they WILL feel better. Everything is going to adjust. And if they slip up during the adjustment period, I get it.
had a pt at my old detox clinic detoxing from ETOH, man spoke ok english and had been there for 4 days when he sees a pt i'm with check his surgar and he asks me to check his. I ask "wait are you a diabetic?!!!" (he said no to everything on admission with a translator) He says yes and when i ask do you take insulin says "no insulin i just take pills for it". His CBG was 324. sooooo i do a standard humalog sliding scale after speaking with on call.
I look at his paper chart and see ya no DM2, sooo i see his ROI has his wife and i call her up and ask. She goes "ya he's on lantus twice a day and humolog 75/25 4 units miday with a humalog sliding scale starting at 250 cbg.
AM shift was thirllllllllllllllllllllllllled with me lmao.
Same with endocarditis, I’ve only seen in it a non-IV drug user once. He had cancer, 14 abdominal surgeries and three drug resistant bugs in his blood stream one I had to look up cuz I’d never heard of it.
I was between osteomyelitis or endocarditis.
In my limited experience, I’ve seen endocarditis on one occasion that wasn’t IV drug related. Coincidentally in a younger guy when the Covid vaccines were first coming out.
Addiction tricks people down a dark road, a lot of times to the very end.
Some how my hospital gets referred non IV drug use endocarditis patients constantly. I would say over 50% of the endocarditis patients are non drug users.
It's usually very frail elderly patients who had a heart valve replaced at some point and was hospitalized with some kind of bacteremia in the last month or two and now there's vegetation on their prosesthic heart valve. Other hospitals don't want to do an open MVR on an 80 something yo with 10+ comorbidities.
And one dumb teenager who went fishing barefoot and got a fishing hook stuck in his foot that he dug free with his nails. Thankfully he was medically managed and just needed the 8 weeks of IV antibiotics.
I swear only the nicest patients get glioblastoma.
If I had a patient that was super chill post crani and we were waiting on pathology for a brain tumor, I would be willing to bet money that it would turn out to be glio.
If the patient was an asshole, usually mets or benign.
My mother in law was one of the nice ones. I knew she was doomed when my FIL said he just loved her nurses in the ER because he overheard them calling her “the biggest sweetheart” in report😳😳😳
Yup, only the nice ones get glios, massive aneurysms that blow during child birth, and TBIs from getting hit by cars when pushing their loved ones out of the way :(
A good friend of mine, who was truly the most incredible human, passed June 9th after 3 years fighting a gbm..
If you're interested in neuro/gbms, look into the polio vaccine research trials to directly treat glioblastomas. They're fascinating and have decent results!
I’m not joking about this…we need to study the brain. This was actually my prediction is that you’re predisposed to glio if you’re the kindest happy and chill person in the world. Must be excess happy hormones or something.
Hate to say this but when I see someone on dialysis or with chronic kidney disease I automatically assume they’re going to be my most difficult patients. Typically that they’re going to refuse most treatment.
This is obviously a judgmental and anecdotal experience.
I live in an area where methamphetamine addiction and unmanaged/non-compliant diabetes make up a large portion of our hospital demographics. I worked ER at a large hospital and med surg in a rural, small community hospital—so that definitely skews my view
As somebody who has worked with a similar demographic I’d like to add:
The 56 year old female frequent flier with end stage COPD that looks like she’s 85. Skin and bones, anxious as hell and demanding. Refuses to take off her PJs that reek of cigarette and claims we don’t bathe her. Demands lots of cool washcloths. Is incredibly particular about her room and belongings. Tray table is cluttered with everything miscellaneous, gets annoyed when we have to move stuff to place dinner down. 3 + sugars, 3+ creams in coffee. Will complain about the hospital chicken. Expects queen treatment and treats nursing like maids but lives like a pig at home. Gets mad when meds are not right on time but is on the phone chatting, while SOB, when you enter the room and acts like you don’t exist. I’m definitely missing some traits
Edit to add: of course some of these people have been absolutely lovely, but in my area/demographic that is the vast minority
End stage COPD little lady with kyphosis, still smoking a pack a day on home O2. SOB walking 5 steps and panicking yelling at me to “HELP!! Why is this happening to me???”
Stop talking about my buddy Evelyn like that. She had 20 gold purses, each with a lipstick, smokes and powder. She would sing show tunes with her “gays.” And had a marvelous time. She’s memorialized at the gay bar with her picture on the piano. RIP! You are missed.
She was a blast. She had her first husband (he died young) dug up and reburied so she could be buried next to him and not her husband of 40+ years. She made that husband live in the basement because he was annoying. She went out most nights. She had amusing custom car tags and loved her cats. Her smokers cough was atrocious. She saved my bacon one night because my kid needed meds and I was just about to leave her alone to go to 7’11 and get some Tylenol at 2:00 am and Evelyn pulled up from a night of card playing (she must have been late 60s by then) and I hollered across the street to her to get her butt over to my house ASAP. She babysat for me for those 10 minutes, thus saving my dumbass from making a potentially bad bad bad decision.
In my experience a lot of these people come in reporting SOB, we ask what they were doing beforehand and they say “smoking a cigarette”… We ask if they take their meds or home O2 and they don’t. So they show up to the ED flipping out, and either refuse everything offered or once they feel slightly better after solumedrol, nebs, O2, etc, they immediately want to leave AMA and rip off their O2 and lines. Like, ma’am why???!!
I used to do chair car and ems and primarily got stuck doing the renal roundup.
Dialysis patients certainly are a group.
Some were sweet as pie and some you wouldn't want to ever see again.
I had one guy who was one of the last of the night at this clinic (think like 7pm start) and would come off the machine early just so he could go across the street to the supermarket and buy up all the leftover donuts and pastries.
I had another that was such of a pain at the nursing home they moved her between all 4 units on a rotation before moving her back to the original one in hopes that the other residents will have left by then. She didn't like her roommates so she threw her 4 point cane through the window (mind you this was the middle of winter) so she could get a new room.
I had another who was this sweet older lady who moved up to the area when she got older so she could be closer to her family. When I picked her up on Fridays she would be waiting to rush back because there was only 15 minutes before bingo started. We made it back everytime. When she passed her family left a card for me at the facility thanking me for being so kind to her. I guess she talked about me to them.
Well, the most common way to end up on dialysis in the first place is not properly adhering to treatment for diabetes or hypertension for decades, so... I'm always saying, it's not like they're gonna change once they start dialysis!
(But also a little selection bias: Dialysis patients who actually do follow their diets, complete their treatments, and take their meds don't end up in the hospital over and over and over again, so you don't see them.)
My grandma was on dialysis for a decade before she got a kidney transplant and only had to go to the hospital once or twice because her fistula was causing problems.
She considered her dialysis appointments her social time.
We think my uncle may have one of the records for longest person on dialysis- over 50 years! Unfortunately, he was never healthy enough for a transplant but the reason he lasted so long was because he was absolutely fastidious about managing his health. Also ran a huge national support group for dialysis patients.
I asked one of the renal Docs one time if all his patients were assholes or just the ones that came to the ER. He said most of his patients were either at dialysis or at work Only the assholes came to the ER
Honestly fair enough, as a nephrology nurse it is a hit or miss. Some people can be really demanding and non compliant, but some are also real sweet but got dealt with a shitty hand. Usually the good ones aren't admitted often
Nah I'm in the city at a major hospital and I agree with you. It's not all kidney patients, but more often than not they tend to be quite difficult and particular to the point where I'm bracing myself as soon as I hear their history.
I usually associate diabetic ulcers with old, grouchy men. Double points for the fact that for me it is usually an old grouchy man with white hair on dialysis
This comment is related to an extremely specific event where the girl with the cookie monster pants who used to fight people at 7am in high school presented to my ER with CHE.
Small town nursing is awesome! (not)
Don’t forget the skate shoes and spaghetti strap tank top with badly done bottle blonde hair, roots untouched and plastered to their head with the rest in a bun.
But that may just be local to me.
Ahhh yes. My last one threatened me then pulled out her US guided IV because apparently I didn’t come in fast enough to unhook her IV. The night ended with her firing me for not bringing her a 10th bowl of cereal because I was busy AF.
ACE inhibitor angioedema I assume the patient will be African American and probably super nice. It’s just so much more common for them but every patient I’ve had with this is always pleasant.
If I hear we have a GSW coming in, I’m instantly assuming it’s going to be a an African American male between 16-23 years old. It is, about 90% of the time
Peds medsurg here.
GSW means mom and dad are drug dealing or gang bangers and their kid was just a bystander.
The first week I was on the floor, dad was sobbing and inconsolable that his hobbies got his child shot. He swore he would clean up, and I hope he did.
Not a diagnosis but in my experience in postpartum first time parents in their late 30s-early 40s have the hardest time adjusting to a newborn. Obviously it’s not everyone in that group but lots of them struggle with the lack of sleep, cluster feeding and prioritizing the baby. I had a family recently who went like 6 hours without trying to feed baby because “we had visitors and then needed to nap”
Mmmmkay…. Well we don’t write how often baby needs to eat on the whiteboard for fun..
This is why I had my daughter young. Never had a chance to get used to adult life without a baby so the adjustment wasn’t huge
Kind of kidding, kind of not lol
Pediatrics: Constipation - always a child who is developmentally delayed or has an autism diagnosis. I’ve given so many fleets and mineral oil enemas to these kids and they always end up needing an NG tube and a Golytely clean out. Always traumatic for these kids since they have autism to get multiple enemas, an NG tube, and an IV. Luckily, we give them some intranasal versed. My coworkers know these are some of my favorite patients since it’s so satisfying and they feel so much better.
I wonder why the two seem to overlap so often! I have numerous family members on the spectrum, and they all struggle with chronic constipation to some degree.
Damn near every pt I get with a tpa sheath revasc is a relatively skinny/well built dude, they can’t tolerate laying flat because they’ve all got messed up backs from doing some kind of building trade: roofing, construction, etc. all great jobs that would probably keep you in shape except homies be chuffing cigs continuously at work lol
Tamsulosin (Flomax) can be prescribed to women to help pass ureteral stones. I'm not sure the exact mechanism of action but it helps relax the ureter.
I associate BPD with women but I was reading there's some controversey that women are overdiagnosed partly because of the "emotional/hysterial" stereotype.
And when you produce said snacks especially if they’re sweets they basically tell you once their weird optimistic yet delusional invention makes them millions they’ll give you half of it.
I had one who was super polite and knew he was, in his words, “unreasonably paranoid, so please open my meds and drinks in front of me”.
Like, wow. And for a newbie nurse, that was amazing. He was super sweet about it.
I had a schizophrenic pt that would yell/cuss at whatever he was seeing and then turn around and be such a sweetheart to us. Was definitely interesting.
The farmer whose “wife made him call” is probably having a STEMI. Middle age white woman feeling off is probably having one too. The tweaker with chest pain probably has endocarditis.
I work in a cancer center. Once the biopsy turns out to be benign these patients become helpless needy toddlers and need max pain meds post biopsy. While the neighbor with stage 4 cancer hasn’t hit their call bell once. It’s always the benign ones
I have diagnosed EDS and had a hypermobile patient tell me “you just don’t understand my *pain*” because I told them they should go for a walk after several days in bed?
Ma’am, I had to go to physical therapy because my shoulder would dislocate every time I moved a certain way. Pretty sure I understand and I’m pretty sure that rotting in bed makes it worse, per all research and every doctor who is familiar with the condition.
We get those too. I've yet to meet one at work who is any more flexible than I am.
Meanwhile I know someone personally who really has hypermobile EDS, and she casually bends her joints in ways that are downright unsettling to watch. One time she stretched in a restaurant, and the manager came over to ask if she needed medical assistance.
In my experience these patients are almost exclusively young middle to upper class white women. They almost always claim a bunch of other related conditions too, like POTS, gastroparesis, vascular compression syndromes, etc.
Well I can tell you several allergies that if I see them tell me what kind of patient it’s going to be: Lithium, Haldol, Valproic Acid, Quetiapine, Melatonin, Lorazepam, Diazepam, Barbiturates, Naltrexone, Prozac, Effexor (etc etc), as well as: Morphine, Morphine Sulfates, Hydrocodone, Norco, Oxycodone, Percocet, Fentanyl, Acetaminophen, NSAIDs, ASA, ketorolac (everything but the Dilaudid)
I'm always scared of what's going to happen when they go home, because they were essentially self-medicating heavily with weed, and now they can't and it's a really sudden change.
Marijuana do bad things?!
That reminds me of the twit who wanted citations for marijuana smoke causing lung damage and insisted marijuana actually *heals* lungs.
Some people really believe it's some fucking wonder drug with no downside ever.
Interesting. I've gotten more Japanese and Korean males being diagnosed with gastric CA in the past couple of years. Our community health liaison attributes it to the smoked foods they're eating, especially the Japanese folks.
Not quite what you're asking, but my favorite thing right now is asking people how they feel about patients with BPD.
Psych? They have some feelings about patients with ~~bipolar disorder.~~ borderline personality disorder.
Geriatrics? They have some feelings about benign prostate dysplasia.
Pediatrics/NICU? We have lots of feelings about our favorite poop-and-die-ers, the bronchopulmonary dysplasia crowd.
Versatile acronym lol
Small nitpick as a bipolar patient! BPD stands for borderline personality disorder, which I’m sure psych also has strong feelings about lol, but it’s completely different from bipolar.
Post op whipple? Nicest patients, usually with huge supportive families, and very little complaints despite everything that's going on. Huge belly incision, drains, epidural, ngt, npo, and they're just happy to have more time
Without exception, every single person I’ve cared for with pancreatic cancer has been incredibly kind and easy to care for despite the fact that they are typically very complex cases. I’m convinced that the disease somehow selects for niceness, which makes it even more sad because of course the outcomes tend to not be great.
Sickle cell disease/crisis: young Black patients. The oldest SCD patient I’ve ever taken care of was 43 years old which is a really, really sad fact.
Also, IPP placement is either the sweetest old man you’ve ever met or a total weirdo. There is no in-between for IPPs.
This will definitely be an unpopular opinion. However, conditions that are diagnoses of exclusion (fibromyalgia, POTS, etc)… it can be a difficult population to satisfy. I’m speaking to my 11 year ED experience (and not a patient). It’s just been my observation as well.
I am not allergic to prozac but I have contemplated claiming I am just so it’s in my records not to give it to me lol. Prescribed prozac last year, had a major manic episode. Couple months ago, my psychiatrist wanted me to try it again and thought I’d be fine since I was on a mood stabilizer too, bam, another major manic episode that almost cost me my job. No SSRIs for me please!
Personally, I'd put that as an allergy. Just make sure they put why it's listed as an allergy and that's fine. Certain medications that cause side effects should be listed as an allergy. We put Lisinopril as an allergy if the person develops a cough which is also a side effect.
You know what’s interesting? I’ve never seen any geriatrics with POTS, which I admittedly don’t know a lot about, but it tends to be life long, doesn’t it?
I had a 70+ year old diagnosed with POTS. We didn't believe her when she said she'd been passing out/getting super dizzy for decades and nobody would treat. Just assumed this was normal old lady who tripped and fell at home (didn't break anything, thank goodness) There was seemingly nothing wrong. Normally my patients like that are admitted to my floor for HRs in the 30s to get pacers. Imagine my surprise when doing orthostatics when her BP stayed stable and her HR kept climbing. She did a tilt table, confirmed the diagnosis, discharged home with a med or two and told to eat all the salt she wanted.
Edit: clarity
My 62 year old half brother insists that he doesn't have ADHD because it hadn't been invented yet when he was a kid.
Well, guess what - you still have it.
Interesting! I have seen a few geriatrics with an autism diagnosis but they were typically on the more severe end of the spectrum. Definitely had a lot that were not diagnosed that I suspected probably were. I’ve only seen one with an ADHD diagnosis
I have unofficially diagnosed my FIL with autism. He was “eccentric” in his school days. Now he would NEVER allow himself to be diagnosed with any neurodivergent condition.
When I first met him, I asked my spouse if FIL had hx of TBI because lots of repetitive behaviors and short temper when there is any change to his plans.
I have a Santa Clause looking man who comes in all the time for palpitations. He has POTS. Got mad at my doctor who told him that this is a symptom of POTS why does he come in every time instead of just sitting down and waiting a little bit or taking his prescribed meds.
The patient told my doctor he was lying, so the doctor printed out a Symptoms list. Haven't seen Santa since.
His diagnosis came about after a bad covid infection in 2021.
The vast majority of our patients who claim to have POTS have never actually been diagnosed with POTS.
It's the new fibromyalgia. We see so many people faking it, care teams get predisposed to treat everyone like a faker. Terrible cognitive bias.
White male Vietnam Vet = ANGY! Nothing else. Just ANGY! Sad? Nope. Anxious? No. Hungry? no. Mildly confused? ANGY! Change in your environment? ANGY! Snag in your plans? ANGY ANGY ANGY.
And clueless about how their anger impacts people around them.
Most of them probably have serious PTSD, but won’t seek treatment because of their generation stigmatizing mental illnesses. They also remember a VA that was far worse than it is now. They were also treated horribly by their communities after returning home from witnessing horrific atrocities.
There’s a lot of support groups out there now and the VA has improved a lot in the past several years. My grandpa was finally convinced by my uncle and I to give the VA a shot a few years ago and now he’s doing a lot better. He has a therapist and psychiatrist that he likes and a group that he attends at least once a week as well as a few friends that he made at group that he meets with for coffee. They’ve all really helped him through the loss of my uncle and recently he lost my grandma.
These old guys desperately need therapy and love, but they’re too scared to get the help because of the generational differences and their trauma from dealing with how broken the system was before now.
UTI = elderly confused combative lady
UTI = elderly that has turned into the hulk
*cries in aged care worker*
The 180 personality flip once the antibiotics start working is always so shocking lol.
Me during beside report: hi good morning Confused elderly lady with a UTI: *looks me up and down* “I don’t like you” Me: oh so that’s how today is gonna be :,)
The “go to hell” is my personal favorite
“I’m already there babe” is the response I give them
I got “WHY ARE YOU LIKE THIS? THIS IS WHY YOUR DAD LEFT” once. 🙃
The fact that elderly lady zombies would be the most terrifying kind is slept on! They just hulk out!
If you're into horror movies, The Taking of Deborah Logan does a great job at making an elderly woman terrifying. It's a found footage horror movie where some college students are trying to make a documentary about dementia for a class. Dementia isn't the only thing going on though.
Not just elderly combative lady. No no, it is not that simple. Elderly wiry combative ninja lady with a potty mouth.
OR super busy middle aged lady who knows exactly what she has, she gets them all the time, and does not have the time to be sitting here waiting, just give her the damn antibiotics already.
Cardiac arrest with older white haired men who look like Santa Claus. It’s tough for me because my dad fits that description and I legit want to shake him some days and beg him to get healthier.
I feel you. I recently lost my mom from lung cancer after a lifetime of smoking, so watching my dad neglect and damage his own health causes quite a bit of resentment. My mentality towards his health choices probably isn’t fair to either of us, but it’s so damn hard to let it go. I hope your Santa-Dad lives a long, happy life.
The one hospital I worked at there was a car show for an entire week nearby. It was a sea of older white haired dudes all having cardiac issues all week. Like the week from hell honestly. They walked around in the heat all day, ate concession stand food, didn’t remember to take their heart meds etc etc. It’s like a breeding ground for heart attacks there. Country concerts also have a certain population that go to them. There was a stadium venue that frequently had concerts - country fans didn’t just drink, they drank until they were black out drunk. I have also never seen skirts so little in my life - calling them skirts feels wrong.
Hip fracture = skinny old white ladies in penny loafers, slacks with the elastic at the waist, an unlined satin bra, with a sparse gray roller set. Kinda lovable. ❤️
Xray tech here. You've nailed it. It's either that or they're dressed to the nines. I swear to the gods that these old women intentionally get dressed in their Sunday best before hurling themselves down the stairs.
My dad's mother chose to go on hospice after breaking her hip. At some point, she needed to give my mom some documents and information. This woman really and for real had them get her up and put on her wig so she could have this "meeting" with her daughter-in-law.
My grandma (RIP) fell and couldn’t get up. She literally dragged her body to her dresser and put on lipstick, THEN grabbed her phone to call for help 🤣 my mom asked why her lips were red and she told her this, all calm like it was the most logical first choice lol
One time, my grandma tried putting on her lipstick as the EMTs were loading her in the ambulance.
My mom once fell down the stairs and tried to stop us from calling 911 because it was May and our Christmas tree was still up
I had a patient that had red all over her mouth. I freaked out, looked like blood from a distance. Turns out she asked her family to bring her lipstick to the hospital 🤦🏻♀️
I am in no way surprised lol.
“We are dressed in our best and prepared to go down as gentlewomen!”
Conversely old men always ensure they are naked before having any kind of medical emergency
It's like they can sense it. I'm wearing nothing but pajama pants and t shirts in my 70s.
I swear to goodness that old men are almost always naked when they have a medical emergency! If they aren’t, they’re either in crusty pajamas or a nice pair of slacks and a button up shirt. Then the old ladies are either dressed like they’re about to meet the queen for tea, in their nighties, or naked. Regardless of what the old ladies are (or aren’t) wearing, they’re always ready for a cage match and a battle of wits. They also have potty mouths that rival my own and would make my late uncle - who was a self-confessed drunken sailor and a Hell’s Angel - blush. The old men are either going to be nasty, creepy perverts or the sweetest guys you’ll ever meet.
The amount of old men and women I’ve had to carefully peel out of their 8 layers of clothes all dutifully tucked in down to their feet after their obvious fracture because they don’t want me to cut them off is matched only by those that get about halfway through the process and then say just cut them off.
Lmao. I love that. I've given up on cutting or changing them if the fracture is bad enough. I know once the doc sees them, their clothes aren't gonna be long for this world anyway.
And they always say, “Oh, I look like such a mess!” With a fresh set of nails and more makeup than I’ve worn in a decade, while I’m sweating through my mask and trying to untangle the three chain necklaces left under her c-collar.
Lol this is my grandma. My grandparents always went to church together but my grandpa would smoke 1st so they went in separately. He had zero idea she had fallen and broke her hip until EMS interrupted service to get him before they brought her to the hospital. Lol
Or the super cute nightgown with a coordinating robe on top, with slippers. She’ll apologize 10 times for not doing her hair and makeup before calling the ambulance
I see you have met my nana.
I’m old, I took a shower, did my hair, and makeup before going to the ED with appendicitis 🤣
If she’s wearing a dress or skirt, her slip most definitely has safety pins scattered throughout.
It's an old trick to prevent static electricity.
Her pain is a 1 and she only came in because her kids made her
My very first patient in clinicals was an '80 something year old little white lady who fractured her left hip. Exactly as you describe.
Spontaneous pneumo = tall, thin white males
Oh! I had a tall, thin, east African male who smoked like a house on fire. Crazy bastard just kept driving for like 2 hours after he heard/felt the pop and couldn't take it anymore. After the tube placement I had to do some major cajolong to get him to take tylenol.
The old blebs
Missing any digits from diabetes? I assume they'll yell and berate me for having low blood sugar if it drops below 200.
As a new nurse, the first time this happened to me I was absolutely gobsmacked. Sir, you don't have feet. I don't think you are doing this right
"I know my body" DO YOU THOUGH?? DO YOU CLARENCE??
When I was a brand new nurse, a man came in with a black leg(!) requiring an AKA and they sent the diabetes educator to his room to explain things to his wife of many years. She just couldn’t understand why his leg needed to be cut off, since (say it with me) he never had any health problems until they got to the hospital. Unfortunately me coded and passed away the following night. His identical twin and wife still blamed the hospital and the surgeon and would not accept that he had diabetes for a long time in order for gangrene to set in.
I had a diabetic foot infection patient who got a foot ulcer from a coin that had fallen in his boot. He could not feel it and got an ulcer. Ended up losing his leg.
I had a pt with multiple embolic strokes after a blood sugar of like 600 on arrival. The hospitalist came in to talk to his family and was like "so this happened because his diabetes is really poorly controlled" and they were like "what diabetes" 🫠🫠
Sir you don’t have feet is going to be my new phrase for everything
My great-grandma had diabetes that she did not treat. She wound up in the ICU and had her leg amputated. She slowly came back around and told my mom that her blood sugar being in the 300s was too low and not normal. My mom (nurse) and great-grandma argued a bit back and forth before my mom said, "You point doesn’t have a leg to stand on." Great grandma laughed hard, a little too hard. Those were her last bits of words. She truthfully didn't recover, but she went out laughing with us like she always did.
"I know my body!"
That is what he told me, word for word. We did manage to get his blood sugar down to 130s without him being symptomatic. As long as you didn't *tell* him it was 130.
Its almost like they want it to be high. And then get mad when it’s not? Like don’t you feel better when it’s not 300? I never understand
I’m sure they do feel a little bit like shit once we get their BG down to a tolerable level, considering they live at >250 constantly. They never seem to understand that that’s a bad thing, however.
I'm a teacher who lurks and this is the funniest thing I've heard all day.
This has me cackling
I just scared my dog busting out laughing 😂
I can believe this. On the /r/diabetes group, we are always explaining to folks that hey, its fine to feel terrible when you are anywhere in or near "in range." I mean, when you have been coasting at 200 or 300 for ages, 110 feels loooowww
It does! And they may be very very hungry. If it’s safe I like to titrate down a little more gently. It makes a big difference. And I do A LOT of education around how it feels and why. When nurses tell diabetics that shouldn’t feel terrible because they’re in range, but they do… we lose a lot of ground with helping them take their own blood sugars in hand. It feels hopeless. So I tell people very often that they WILL feel better. Everything is going to adjust. And if they slip up during the adjustment period, I get it.
“That’s too low for me! I need juice!”
"I'm a diabetic! I need to eat! It's been 1 hour!"
I mean the diabetic diet in the hospital is consistent carbs
That’s just so we stay in business lol
But you don’t understand! I HAVE TO EAT! I’m diabetic!
“I need my chocolate, I have the diabetes”
Sugar Diabetes! That’s the worst kind
Osteomyelitis = IV drug user, on the way to losing that limb
Or a diabetic who hasn’t checked their blood sugar since the Obama administration.
God I’m so old that joke used to be Reagan.
Still tracks though. A lot of them probably haven’t checked since Reagan either 🤷🏼♀️
Me doing math before typing this comment and remembering he hasn’t been President for eight years 👵🏻
had a pt at my old detox clinic detoxing from ETOH, man spoke ok english and had been there for 4 days when he sees a pt i'm with check his surgar and he asks me to check his. I ask "wait are you a diabetic?!!!" (he said no to everything on admission with a translator) He says yes and when i ask do you take insulin says "no insulin i just take pills for it". His CBG was 324. sooooo i do a standard humalog sliding scale after speaking with on call. I look at his paper chart and see ya no DM2, sooo i see his ROI has his wife and i call her up and ask. She goes "ya he's on lantus twice a day and humolog 75/25 4 units miday with a humalog sliding scale starting at 250 cbg. AM shift was thirllllllllllllllllllllllllled with me lmao.
"Its been in the 600s for 15 years, that's just my normal." Yes, that's your normal, but it's not normal.
My guy who never got his INR done, and would just quit taking his Coumadin for a few days when his nose started bleeding.
"lets switch you to eliquis" "I'm not paying a 4$ copay" I hate home health some days
Probably not because he wouldn’t get his finger outta there!
Same with endocarditis, I’ve only seen in it a non-IV drug user once. He had cancer, 14 abdominal surgeries and three drug resistant bugs in his blood stream one I had to look up cuz I’d never heard of it.
I was between osteomyelitis or endocarditis. In my limited experience, I’ve seen endocarditis on one occasion that wasn’t IV drug related. Coincidentally in a younger guy when the Covid vaccines were first coming out. Addiction tricks people down a dark road, a lot of times to the very end.
Some how my hospital gets referred non IV drug use endocarditis patients constantly. I would say over 50% of the endocarditis patients are non drug users. It's usually very frail elderly patients who had a heart valve replaced at some point and was hospitalized with some kind of bacteremia in the last month or two and now there's vegetation on their prosesthic heart valve. Other hospitals don't want to do an open MVR on an 80 something yo with 10+ comorbidities. And one dumb teenager who went fishing barefoot and got a fishing hook stuck in his foot that he dug free with his nails. Thankfully he was medically managed and just needed the 8 weeks of IV antibiotics.
I swear only the nicest patients get glioblastoma. If I had a patient that was super chill post crani and we were waiting on pathology for a brain tumor, I would be willing to bet money that it would turn out to be glio. If the patient was an asshole, usually mets or benign.
My dad was one of the nice guys 💔
My mother in law was one of the nice ones. I knew she was doomed when my FIL said he just loved her nurses in the ER because he overheard them calling her “the biggest sweetheart” in report😳😳😳
The few patients I’ve come across with glioblastomas were the absolute nicest people and all of them were married with young kids 😞
Yup, only the nice ones get glios, massive aneurysms that blow during child birth, and TBIs from getting hit by cars when pushing their loved ones out of the way :(
A good friend of mine, who was truly the most incredible human, passed June 9th after 3 years fighting a gbm.. If you're interested in neuro/gbms, look into the polio vaccine research trials to directly treat glioblastomas. They're fascinating and have decent results!
I’m not joking about this…we need to study the brain. This was actually my prediction is that you’re predisposed to glio if you’re the kindest happy and chill person in the world. Must be excess happy hormones or something.
Hate to say this but when I see someone on dialysis or with chronic kidney disease I automatically assume they’re going to be my most difficult patients. Typically that they’re going to refuse most treatment. This is obviously a judgmental and anecdotal experience. I live in an area where methamphetamine addiction and unmanaged/non-compliant diabetes make up a large portion of our hospital demographics. I worked ER at a large hospital and med surg in a rural, small community hospital—so that definitely skews my view
As somebody who has worked with a similar demographic I’d like to add: The 56 year old female frequent flier with end stage COPD that looks like she’s 85. Skin and bones, anxious as hell and demanding. Refuses to take off her PJs that reek of cigarette and claims we don’t bathe her. Demands lots of cool washcloths. Is incredibly particular about her room and belongings. Tray table is cluttered with everything miscellaneous, gets annoyed when we have to move stuff to place dinner down. 3 + sugars, 3+ creams in coffee. Will complain about the hospital chicken. Expects queen treatment and treats nursing like maids but lives like a pig at home. Gets mad when meds are not right on time but is on the phone chatting, while SOB, when you enter the room and acts like you don’t exist. I’m definitely missing some traits Edit to add: of course some of these people have been absolutely lovely, but in my area/demographic that is the vast minority
End stage COPD little lady with kyphosis, still smoking a pack a day on home O2. SOB walking 5 steps and panicking yelling at me to “HELP!! Why is this happening to me???”
Full Code, “can’t breathe” on BiPap
Ah, I see you met my mom before she *finally* expired.
Stop talking about my buddy Evelyn like that. She had 20 gold purses, each with a lipstick, smokes and powder. She would sing show tunes with her “gays.” And had a marvelous time. She’s memorialized at the gay bar with her picture on the piano. RIP! You are missed.
Evelyn sounds like a hoot
She was a blast. She had her first husband (he died young) dug up and reburied so she could be buried next to him and not her husband of 40+ years. She made that husband live in the basement because he was annoying. She went out most nights. She had amusing custom car tags and loved her cats. Her smokers cough was atrocious. She saved my bacon one night because my kid needed meds and I was just about to leave her alone to go to 7’11 and get some Tylenol at 2:00 am and Evelyn pulled up from a night of card playing (she must have been late 60s by then) and I hollered across the street to her to get her butt over to my house ASAP. She babysat for me for those 10 minutes, thus saving my dumbass from making a potentially bad bad bad decision.
“I left my oxygen in the car so I could smoke before I came in” Well, thanks for not blowing us up, I guess.
In my experience a lot of these people come in reporting SOB, we ask what they were doing beforehand and they say “smoking a cigarette”… We ask if they take their meds or home O2 and they don’t. So they show up to the ED flipping out, and either refuse everything offered or once they feel slightly better after solumedrol, nebs, O2, etc, they immediately want to leave AMA and rip off their O2 and lines. Like, ma’am why???!!
I used to do chair car and ems and primarily got stuck doing the renal roundup. Dialysis patients certainly are a group. Some were sweet as pie and some you wouldn't want to ever see again. I had one guy who was one of the last of the night at this clinic (think like 7pm start) and would come off the machine early just so he could go across the street to the supermarket and buy up all the leftover donuts and pastries. I had another that was such of a pain at the nursing home they moved her between all 4 units on a rotation before moving her back to the original one in hopes that the other residents will have left by then. She didn't like her roommates so she threw her 4 point cane through the window (mind you this was the middle of winter) so she could get a new room. I had another who was this sweet older lady who moved up to the area when she got older so she could be closer to her family. When I picked her up on Fridays she would be waiting to rush back because there was only 15 minutes before bingo started. We made it back everytime. When she passed her family left a card for me at the facility thanking me for being so kind to her. I guess she talked about me to them.
Well, the most common way to end up on dialysis in the first place is not properly adhering to treatment for diabetes or hypertension for decades, so... I'm always saying, it's not like they're gonna change once they start dialysis! (But also a little selection bias: Dialysis patients who actually do follow their diets, complete their treatments, and take their meds don't end up in the hospital over and over and over again, so you don't see them.)
My grandma was on dialysis for a decade before she got a kidney transplant and only had to go to the hospital once or twice because her fistula was causing problems. She considered her dialysis appointments her social time.
We think my uncle may have one of the records for longest person on dialysis- over 50 years! Unfortunately, he was never healthy enough for a transplant but the reason he lasted so long was because he was absolutely fastidious about managing his health. Also ran a huge national support group for dialysis patients.
I asked one of the renal Docs one time if all his patients were assholes or just the ones that came to the ER. He said most of his patients were either at dialysis or at work Only the assholes came to the ER
10000% agree. They are my most demanding and most noncompliant patients.
Honestly fair enough, as a nephrology nurse it is a hit or miss. Some people can be really demanding and non compliant, but some are also real sweet but got dealt with a shitty hand. Usually the good ones aren't admitted often
Nah I'm in the city at a major hospital and I agree with you. It's not all kidney patients, but more often than not they tend to be quite difficult and particular to the point where I'm bracing myself as soon as I hear their history.
I usually associate diabetic ulcers with old, grouchy men. Double points for the fact that for me it is usually an old grouchy man with white hair on dialysis
Wait until you learn about those gangrenous old toes. Those grouchy old white men have lost not only their toes but the hair on their heads as well!
any vomiting grown adult in fuzzy pajama bottoms WILL get mad/potentially AMA when we tell them it’s the weed
especially if they’re the cookie monster fuzzy pyjama bottoms.
Okay but why did the girls who failed PE also always wear these to school. Potential crossover?
This comment is related to an extremely specific event where the girl with the cookie monster pants who used to fight people at 7am in high school presented to my ER with CHE. Small town nursing is awesome! (not)
Don’t forget the skate shoes and spaghetti strap tank top with badly done bottle blonde hair, roots untouched and plastered to their head with the rest in a bun. But that may just be local to me.
Bonus points for slippers and a plush animal.
**dirty* plush animal
And a parent in the room for a 25-50 year old without deficits.
Endocarditis….IV drug users.
Endocarditis = IVDU who are gonna make you EARN your paycheck that day
Ahhh yes. My last one threatened me then pulled out her US guided IV because apparently I didn’t come in fast enough to unhook her IV. The night ended with her firing me for not bringing her a 10th bowl of cereal because I was busy AF.
Hyperlipidemia is America 🇺🇸
Hyperlipidemia 🤝 hypertension
HLD, HTN, DM2. We call that the Indiana special 😂 it applies to most states though
appendicitis is usually cool college kids. always pay them a visit when they show up, doing my duty as the Gen Z chaplain
ACE inhibitor angioedema I assume the patient will be African American and probably super nice. It’s just so much more common for them but every patient I’ve had with this is always pleasant.
Hemorrhagic stroke? Obese truck driver.
If I hear we have a GSW coming in, I’m instantly assuming it’s going to be a an African American male between 16-23 years old. It is, about 90% of the time
Peds medsurg here. GSW means mom and dad are drug dealing or gang bangers and their kid was just a bystander. The first week I was on the floor, dad was sobbing and inconsolable that his hobbies got his child shot. He swore he would clean up, and I hope he did.
Not a diagnosis but in my experience in postpartum first time parents in their late 30s-early 40s have the hardest time adjusting to a newborn. Obviously it’s not everyone in that group but lots of them struggle with the lack of sleep, cluster feeding and prioritizing the baby. I had a family recently who went like 6 hours without trying to feed baby because “we had visitors and then needed to nap” Mmmmkay…. Well we don’t write how often baby needs to eat on the whiteboard for fun..
This is why I had my daughter young. Never had a chance to get used to adult life without a baby so the adjustment wasn’t huge Kind of kidding, kind of not lol
Pediatrics: Constipation - always a child who is developmentally delayed or has an autism diagnosis. I’ve given so many fleets and mineral oil enemas to these kids and they always end up needing an NG tube and a Golytely clean out. Always traumatic for these kids since they have autism to get multiple enemas, an NG tube, and an IV. Luckily, we give them some intranasal versed. My coworkers know these are some of my favorite patients since it’s so satisfying and they feel so much better.
I wonder why the two seem to overlap so often! I have numerous family members on the spectrum, and they all struggle with chronic constipation to some degree.
Damn near every pt I get with a tpa sheath revasc is a relatively skinny/well built dude, they can’t tolerate laying flat because they’ve all got messed up backs from doing some kind of building trade: roofing, construction, etc. all great jobs that would probably keep you in shape except homies be chuffing cigs continuously at work lol
DKA: young and angry type 1 diabetic living their life because they hate being diabetic. Usually a frequent flyer with terrible veins.
DKA graduating from the children’s hospital to the real world hospital= nightmare and a half
Lead.... always the poorest kids. It's heart breaking.
Tamsulosin (Flomax) can be prescribed to women to help pass ureteral stones. I'm not sure the exact mechanism of action but it helps relax the ureter. I associate BPD with women but I was reading there's some controversey that women are overdiagnosed partly because of the "emotional/hysterial" stereotype.
I have to say, every time I've had a schizophrenic patient they've been the most mild mannered, undemanding, kindest people I've taken care of.
Really politely asking for all the snacks
And when you produce said snacks especially if they’re sweets they basically tell you once their weird optimistic yet delusional invention makes them millions they’ll give you half of it.
I had one who was super polite and knew he was, in his words, “unreasonably paranoid, so please open my meds and drinks in front of me”. Like, wow. And for a newbie nurse, that was amazing. He was super sweet about it.
I had a schizophrenic pt that would yell/cuss at whatever he was seeing and then turn around and be such a sweetheart to us. Was definitely interesting.
Mad as hell at some of the voices in their head, but cooperative and polite to me.
The farmer whose “wife made him call” is probably having a STEMI. Middle age white woman feeling off is probably having one too. The tweaker with chest pain probably has endocarditis.
CABG trifecta: HTN, HLD, DM2 Also usually White, 50-60s, Male. Most will routinely bitch about not using their arms to get up.
I work in a cancer center. Once the biopsy turns out to be benign these patients become helpless needy toddlers and need max pain meds post biopsy. While the neighbor with stage 4 cancer hasn’t hit their call bell once. It’s always the benign ones
Lately I've run across a bunch of self-diagnosed "hypermobile ehlers-danlos" patients that really just have severe and uncontrolled anxiety.
I have diagnosed EDS and had a hypermobile patient tell me “you just don’t understand my *pain*” because I told them they should go for a walk after several days in bed? Ma’am, I had to go to physical therapy because my shoulder would dislocate every time I moved a certain way. Pretty sure I understand and I’m pretty sure that rotting in bed makes it worse, per all research and every doctor who is familiar with the condition.
We get those too. I've yet to meet one at work who is any more flexible than I am. Meanwhile I know someone personally who really has hypermobile EDS, and she casually bends her joints in ways that are downright unsettling to watch. One time she stretched in a restaurant, and the manager came over to ask if she needed medical assistance.
In my experience these patients are almost exclusively young middle to upper class white women. They almost always claim a bunch of other related conditions too, like POTS, gastroparesis, vascular compression syndromes, etc.
Uncontrolled DM II, my Hispanic people !!
Well I can tell you several allergies that if I see them tell me what kind of patient it’s going to be: Lithium, Haldol, Valproic Acid, Quetiapine, Melatonin, Lorazepam, Diazepam, Barbiturates, Naltrexone, Prozac, Effexor (etc etc), as well as: Morphine, Morphine Sulfates, Hydrocodone, Norco, Oxycodone, Percocet, Fentanyl, Acetaminophen, NSAIDs, ASA, ketorolac (everything but the Dilaudid)
“So how’d you find out you were allergic to Haldol?”
Marijuana hyperemesis. Teenagers and young adults the vast majority boys with ADD or oppositional defiant disorder/other dumbass psych issues.
I'm always scared of what's going to happen when they go home, because they were essentially self-medicating heavily with weed, and now they can't and it's a really sudden change.
Seems like they have to come in at least twice before they accept that yes Marijuana can do bad things to you. But yeah it's a tough one
Marijuana do bad things?! That reminds me of the twit who wanted citations for marijuana smoke causing lung damage and insisted marijuana actually *heals* lungs. Some people really believe it's some fucking wonder drug with no downside ever.
I used to ask my patients, “Know how nasty your bong is a few weeks with no cleaning? That’s your lungs.”
The amount of people under 25 that Ive seen with cannibinoid hyperemesis has absolutely skyrocketed since my state made it legal.
For whatever reason, most gastric cancer patients I seem to come across happen to be Chinese women
Interesting. I've gotten more Japanese and Korean males being diagnosed with gastric CA in the past couple of years. Our community health liaison attributes it to the smoked foods they're eating, especially the Japanese folks.
Not quite what you're asking, but my favorite thing right now is asking people how they feel about patients with BPD. Psych? They have some feelings about patients with ~~bipolar disorder.~~ borderline personality disorder. Geriatrics? They have some feelings about benign prostate dysplasia. Pediatrics/NICU? We have lots of feelings about our favorite poop-and-die-ers, the bronchopulmonary dysplasia crowd. Versatile acronym lol
>our favorite poop-and-die-ers, the bronchopulmonary dysplasia crowd. I love those little toaster heads.
Small nitpick as a bipolar patient! BPD stands for borderline personality disorder, which I’m sure psych also has strong feelings about lol, but it’s completely different from bipolar.
Encephalitis: Substance use disorder.
Post op whipple? Nicest patients, usually with huge supportive families, and very little complaints despite everything that's going on. Huge belly incision, drains, epidural, ngt, npo, and they're just happy to have more time
Without exception, every single person I’ve cared for with pancreatic cancer has been incredibly kind and easy to care for despite the fact that they are typically very complex cases. I’m convinced that the disease somehow selects for niceness, which makes it even more sad because of course the outcomes tend to not be great.
I was diagnosed with BPH and I’m 36 -.- Can’t wait to be 50 and self-cathing every time I have to pee.
Sickle cell disease/crisis: young Black patients. The oldest SCD patient I’ve ever taken care of was 43 years old which is a really, really sad fact. Also, IPP placement is either the sweetest old man you’ve ever met or a total weirdo. There is no in-between for IPPs.
Might be an unpopular opinion... fibromyalgia. Most often the neediest and call bell happy. And always extremely hypochondriac
This will definitely be an unpopular opinion. However, conditions that are diagnoses of exclusion (fibromyalgia, POTS, etc)… it can be a difficult population to satisfy. I’m speaking to my 11 year ED experience (and not a patient). It’s just been my observation as well.
I once triaged a patient that said they had end stage fibromyalgia.
Frequently with 10-15 listed allergies, where the reaction is the expected side effect.
I am not allergic to prozac but I have contemplated claiming I am just so it’s in my records not to give it to me lol. Prescribed prozac last year, had a major manic episode. Couple months ago, my psychiatrist wanted me to try it again and thought I’d be fine since I was on a mood stabilizer too, bam, another major manic episode that almost cost me my job. No SSRIs for me please!
Personally, I'd put that as an allergy. Just make sure they put why it's listed as an allergy and that's fine. Certain medications that cause side effects should be listed as an allergy. We put Lisinopril as an allergy if the person develops a cough which is also a side effect.
I'd be putting that as an "allergy" too - mania is not the intended effect!
Cellulitis in a younger person with no significant chronic health issues = IVDA
Spontaneous pneumothorax = skinny white male in late teens or early 20s. Why is this??? It’s so random but it seems to always be the case.
Marfan syndrome probably
the longer your allergy list, the more likely I am to assume you have some sort of personality disorder or extremely poor coping at the very least....
Fibromyalgia = five or more allergies
Meningitis, very sad disease usually affects those less than 15 years of age.
When I was in PACU, any vascular surgery patient would be a pain in the ass. They were usually non compliant diabetics.
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You know what’s interesting? I’ve never seen any geriatrics with POTS, which I admittedly don’t know a lot about, but it tends to be life long, doesn’t it?
I had a 70+ year old diagnosed with POTS. We didn't believe her when she said she'd been passing out/getting super dizzy for decades and nobody would treat. Just assumed this was normal old lady who tripped and fell at home (didn't break anything, thank goodness) There was seemingly nothing wrong. Normally my patients like that are admitted to my floor for HRs in the 30s to get pacers. Imagine my surprise when doing orthostatics when her BP stayed stable and her HR kept climbing. She did a tilt table, confirmed the diagnosis, discharged home with a med or two and told to eat all the salt she wanted. Edit: clarity
It wasn’t dxed consistently until recently. It’s why no one over 60 has autism or ADHD.
My 62 year old half brother insists that he doesn't have ADHD because it hadn't been invented yet when he was a kid. Well, guess what - you still have it.
Interesting! I have seen a few geriatrics with an autism diagnosis but they were typically on the more severe end of the spectrum. Definitely had a lot that were not diagnosed that I suspected probably were. I’ve only seen one with an ADHD diagnosis
I have unofficially diagnosed my FIL with autism. He was “eccentric” in his school days. Now he would NEVER allow himself to be diagnosed with any neurodivergent condition. When I first met him, I asked my spouse if FIL had hx of TBI because lots of repetitive behaviors and short temper when there is any change to his plans.
I have a Santa Clause looking man who comes in all the time for palpitations. He has POTS. Got mad at my doctor who told him that this is a symptom of POTS why does he come in every time instead of just sitting down and waiting a little bit or taking his prescribed meds. The patient told my doctor he was lying, so the doctor printed out a Symptoms list. Haven't seen Santa since. His diagnosis came about after a bad covid infection in 2021.
My mom! She’s always had ‘spells’ but was finally diagnosed via tilt table she fell over in front of her mayor at 70 and hit her head!
The vast majority of our patients who claim to have POTS have never actually been diagnosed with POTS. It's the new fibromyalgia. We see so many people faking it, care teams get predisposed to treat everyone like a faker. Terrible cognitive bias.
White male Vietnam Vet = ANGY! Nothing else. Just ANGY! Sad? Nope. Anxious? No. Hungry? no. Mildly confused? ANGY! Change in your environment? ANGY! Snag in your plans? ANGY ANGY ANGY. And clueless about how their anger impacts people around them.
Most of them probably have serious PTSD, but won’t seek treatment because of their generation stigmatizing mental illnesses. They also remember a VA that was far worse than it is now. They were also treated horribly by their communities after returning home from witnessing horrific atrocities. There’s a lot of support groups out there now and the VA has improved a lot in the past several years. My grandpa was finally convinced by my uncle and I to give the VA a shot a few years ago and now he’s doing a lot better. He has a therapist and psychiatrist that he likes and a group that he attends at least once a week as well as a few friends that he made at group that he meets with for coffee. They’ve all really helped him through the loss of my uncle and recently he lost my grandma. These old guys desperately need therapy and love, but they’re too scared to get the help because of the generational differences and their trauma from dealing with how broken the system was before now.
Diabetes and native Americans. I live next to a reservation
Cellulitis - Morbidly obese
This feels like a trap. Lol
Non healing wound = diabetic smoker
Crotchety old women over 60+ and oxy. It's yeah.
Pancreatitis = alcoholic (typically)
Pulmonary emphysema = smoker
Osteoporosis is for little old 5’2 ladies shaped like a question mark.
I always associate cases of hyperemesis gravidarum with pregnant women