Sometimes, I really just don't know what is wrong with the patient, despite their best efforts, their really valiant efforts, at describing their symptoms.
For example, my patient who decided that she had a problem that needed urgent attention at 3am on a Monday morning.
This was our actual conversation. ( bear in mind that she actually sat and waited for 3 hours in the waiting room to see me with this problem. Also bear in mind that I was pretty freaking tired so if this makes sense to any of you, and you can come up with a diagnosis please let me know.)
ME: Goodmorning, what is your emergency? And please let it be a freaking life-or-death emergency because that's all I should have to deal with at this time of the morning. ( No, not really - but that's what I wanted to say. Instead I just said "Hello, what seems to be the problem?" like the good little doctor I am.)
Patient: Well, Doctor, you see I have this pain in my right back side of my head.
ME: how long have you had this pain?
Patient: 6 months
ME: What the hell lady! 6 freaking months and you are here at 3 in the morning forcing me to listen to your chronic issues! Do you know the meaning of emergency unit? Do you? ( Again, no not really...but you're getting the picture, right?)
Patient: Yes so it starts in the right back side of my head, and then it like shoots to my left part of my chest. But sometimes it doesn't go the the chest it actually is in my back. Not my whole back, no not my whole back - only here on my lower back.
Me: So there's no pain in your neck?
Patient: No man - I told you, only in my chest and my back.
Me: And there are no other symptoms you're experiencing - like headaches, nausea, vomiting, blurred vision or weight loss?
Patient: No,just listen doctor: I said it's on the right back side of my head. Oh yes, but that's only during the day. But it's not every day - it's only sometimes, like when I've been drinking a lot of milk. And then at night - it starts in my foot and goes up , all the way up to my back again. Is it because of all the milk , Doctor?
This lady had just managed to describe pain from the top of her head all the way to her feet.
I honestly had no clue what was wrong with her. And at three in the morning my brain was not functioning well enough to play medical detective games. I toyed with the idea of telling her that EVERYTHING was milk-related and that she should stay away from all dairy products for the rest of her life.
But that would have been unethical, and wrong. So I did what any COSMO ( community service medical officer) in my position would have done.I gave her some analgesia from the pain cupboard and told her to come back in the morning for tests and x-rays.
It was honestly all that could be done after hours, and I didn't even have time to feel bad about it due to the numerous emergencies starting to roll in.
She was not the first, and she won't be the last non-emergency a COSMO will have to deal with during their slave-years. Some of the one's I can remember visiting the trauma unit at God-forsaken hours are: constipation, fleshy tags, eczema, and normal monthly menstrual periods.
The best is always the lady who comes in with "something moving in her tummy". And then that something, after a simple bit of magic called peeing-on-a-stick, turns out to be a baby!
I must say, that's the one non-emergency I don't really mind "treating" at 3 in the morning...