Thursday, April 06, 2006

Triage Tales 10

Disclaimer: The following story is a work of fiction. All similarities to people, places, things and events are coincidental by nature.

59 year old patient comes in for epistaxis. Initial blood pressure is 160/100, taken by triage intern.

Patient comes in alone and has her BP taken without fanfare. Just after taking the cuff off her arm, concerned responsible companion (pseudonym Irene Castro) bursts into the ER and asks about her patient.

"What's her BP?"

The intern mechanically answers, "160/100."

"Take it again."

A good 10 seconds passed before it sank in. The intern looks incredulous for another second and then says, "Okay, I will take it later." Presumably after a short rest, as BP spikes are fairly natural after exertion; besides, the reading is more than likely to be the same, making the whole exercise moot.

"What did you say? I did not like what you just said. You will take it again," she points to my intern, "whenever I tell you to. This is supposed to be an emergency, right???"

As I have been neglected throughout the whole exercise, I respectfully turn to "Ms. Castro" and say, "What seems to be the problem, ma'am?"

"Am I talking to you? I'm not talking to you!" (Or, in the more blunt Filipino, Kausap ba kita? Hindi naman kita kinakausap ah!)

Blood rises up. I am red faced. But it is 11PM and I decide that the valorous thing to do is to call my senior. "Ms. Castro" continues to harangue the hapless intern as my ER Officer approaches the triage.

"What seems to be the problem?"

"I just want to have her BP retaken, how much trouble is that? This is an emergency and I need to know if your BP findings is correct... " And she trails off as my senior answers with an exasperated, "Okay, take the BP again."

Dutiful intern retakes BP and reports, "160/100, ma'am."

"Is it the same BP level?" She asks me. "Yes, it is the same level as 3 minutes ago."

She interrupts any further questions with a "Well, I just wanted to make sure, these things happen, lying about BP findings and all. I have to make sure."

"So, what is your next step? Since you don't trust our physical examination findings, this will become a problem for all of us." My ER Officer is adamant.

"Tell me, what is the next step. I am just trying to make sure. All these mistakes happen, you know. I could always bring her to a better hospital..."

My ER Officer is quick to think and offers, "Yes, you do that. I can provide you with a Contact Form so that you can transfer your patient to a better hospital."

"Ms. Castro" felt that she was one-upped by the Triage; fuming, she brings reinforcements, a middle-aged man. His first statement was, "I didn't notice any shouting from Ms. Castro here. Why is it a problem to treat our patient?" Sure, anyone would not notice any shouting from a good 20 feet away inside a tinted sedan.

"Just compress her nose, put some ice on the area, take this Contact Form, and transfer her to another hospital." My ER Officer was accomplishing the form while saying all these.

"Ms. Castro" returns after grudgingly transferring her patient back to the car.

"Let me get your names. I can sue you and place this incident all over the news."

"Sure," I tell her, "just let me get yours too. We will also report you to the hospital director for your behavior."

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