Nov 192010


HPI – “I have a sharp stabbing chest pain right here and it won’t go away.” She indicates the region of her xyphoid.

Me, Dr T: “When did it start?”

Pt:  “15 minutes ago.”

Me:  “15 minutes ago!  How the hell did you get to the hospital so quickly?”

Pt: “Oh I live in my car outside of the hospital”

WTF.  A brief glance at her extensive prior visits confirms her close proximity to the hospital at all times in the last 3 yrs.  She claims the pain is 10/10 and she has shortness of breath.  She lets me know that she has history of DVT and needs a full workup.  She then requests I call social services so that they can come and give her some money to pay for whatever prescription I’m going to give her.  She adds, “Can you just write me a prescription for a large quantity of Percocet instead of only 15 so that I don’t have to keep coming back?”

PE – Obese female in NAD, in fact very comfortably requesting a sandwich

Hospital Course – Pt remained visibly comfortable throughout her visit and was given toradol for pain.  Prior to discharge she stated that her chest pain was still present and she would like some morphine.  She had driven her car to our parking lot so I said no, I cannot give you morphine and then let you drive.  She glared at me and said “I won’t drive, I’ll just go back to sleep in my car.  My car is my home.  Duh.”

It was also revealed to me that she used to work in the ER as a secretary a few years ago.  That helped explain her close ties to the hospital as well as her ability to work the system.

DX – Workup including CTA of the chest is obviously negative, so I give her the diagnosis of pleurisy

Tx – Twelve Percocet which social services bought her.  A list of shelters and community resources given to patient yet again. 

Pt is uninsured so visit, CT scan and Percocet will not be paid for by her.  I’m not sure the post office delivers to the lot across the street.  In turn the hospital will eat the cost and raise prices.

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