Sunday, April 09, 2006

Triage Tales 11

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

Greg House declares, "Everybody lies."

And lie they do.

64 year old male, pale as a ghost, accompanied by his wife, comes to triage.

Lie number 1 - they still came from Marinduque.

Lie number 2 - they have no money for fare (so please Mr. Triage Officer, we cannot afford to be transferred to another hospital even if there are no stretchers or wheelchairs to accommodate us...).

Lie number 3 - no other significant medical history.

After two hours, the hapless Triage Officer (who takes over the care of the patient as a Treatment Officer) discovers that

1. They are actually from Las Pinas City. Patient was born in Marinduque but they relocated 20 years ago.

2. They were able to buy everything on the initial prescription - IV catheter, macroset, blood vials, micropore, Foley catheter, urine bag, and even a blood transfusion set. Costing about P700 at least.

3. Patient has been admitted for melena three times in the past. 12 years ago, he had a Billroth II done; 4 years ago, an EGD showed erosive gastritis; and one year ago, colonoscopy showed no abnormalities. Patient is a typical "lost to follow-upper."

Lessons learned:

1) no matter how accommodating you become, sometimes your clinical history changes because some patients have a different story everytime;
2) some people lie even without motive.

And yes, the nonhypotensive patient with a soft abdomen and a normal rectal exam was admitted for a hemoglobin level of 58. I seriously doubt if he will return for another follow-up to determine the cause of the anemia.

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