We had progressed through all the floor patients, and were in the ICU, having a fairly interminable discussion about one of our sicker patients. (I don’t understand physiology the way it’s handled in the ICU at all. I know theoretically what CVP and SVR and CO are (central venous pressure, a measure of intravascular volume, systemic vascular resistance, which affects blood pressure, and cardiac output, which could be low for a lot of reasons), but the medical and surgical ICU residents throw these words around, and derive logical arguments from them which I cannot follow at all. I need to find a book which teaches this the way it’s actually practiced.)
A patient was wheeled into a nearby room, and the nurses started doing their preliminary assessment. As soon as they put the thermometer in his mouth, he started screaming at the top of his voice, and cursing out everyone in the vicinity in the foulest language. Somehow you don’t expect that from nursing home residents. I remarked, “If he does that just with a thermometer, imagine what he’d do if you touched his belly.” Meaning, since he seems to have nonspecific pain, or is just delirious, an abdominal exam would certainly appear positive.
Teach me not to say things like that. Half an hour later, I got paged. “We have a consult for your attending; he was just brought in from a nursing home, febrile, they think he either has cholecystitis, or urosepsis, or possibly ischemic bowel. He’s in room 23, and he. . .” I stopped the nurse. “You mean the guy who’s cursing at the top of his lungs?” She dropped out of her official report mode. “Yeah, that’s him; we just gave him some haldol, I don’t think it’s making much difference.”
I knew my senior was not going to believe this. I went to see him, and sure enough, as soon as I touched his belly, he started screaming. Not that he’d really ever stopped. The haldol wasn’t touching him at all. The nurse was just working on her records; she’d given up trying to talk to him at all. On the other hand, if I touched his hand, or his shoulder, he screamed too. Also if I didn’t touch him at all.
The attending was thrilled when we called him.