SESAME STREET – As children around the world continued to hold candlelight vigils for Cookie Monster’s health, the shocking rumors that the muppet had left Sesame Street University Hospital (SSUH) against medical advice (AMA) are true. Apparently Cookie Monster was too tempted by all the soon to be placed cookies and milk for Santa Claus this evening. GomerBlog’s anonymous source at SSUH has confirmed these reports, and this informant provided GomerBlog with an exclusive copy of Cookie Monster’s discharge summary, as below:
Services Consulted:
– Pulmonary/Critical Care
– Cardiology
– Gastroenterology
– Endocrinology
– Nephrology
– Vascular surgery
– Anesthesiology
– Psychiatry
Principal Diagnoses:
– Uncontrolled diabetes with ketoacidosis
– Pastry dependence with withdrawal symptoms
– Cookie bezoar status post extraction
– Medical noncompliance
– Borderline personality disorder
– Morbid obesity
– Peripheral aneurysm status post repair
– Acute renal failure
– Acute on chronic malignant Stage 2 hangnail exacerbation (not otherwise specified), present on admission
Summary of Hospitalization:
Mr. Monster was admitted in critical condition due to diabetic complications. The patient also was noted to have a cookie bezoar (pathology indicated the bezoar was approximately 86% chocolate chip cookie, 12% sugar cookie, & 2% unspecified) which was extracted endoscopically. Initial concern for acute coronary syndrome prompted cardiology to perform an emergent coronary angiography. The catheterization was normal and was only complicated by contrast nephropathy with acute renal failure (requiring hemodialysis initiation by nephrology) and development of an acute aneurysm at the site of vascular access status post emergent operative repair.
Glycemic control was compromised by significant medical noncompliance as well as his report of new allergic reactions (“me feeling very strange and itchy”) to Splenda, Equal, Stevia & Sweet’N Low. On several occasions, the patient was noted to be consuming unauthorized cookies which had been smuggled into his room by his “associates” (the manic red muppet & the depressed frog, who were escorted out by hospital security many times). Mr Monster declined diabetes education and Accu-Cheks during the course of much of the hospitalization. Hemoglobin A1c was 74.8%, indicative of suboptimal control.
Intravenous access was difficult and required the assistance of anesthesiology at 2 a.m. Also, Cookie Monster’s cookie withdrawal symptoms & persistent combativeness required the use of bilateral soft wrist restraints. Psychiatry assessed the patient & recommended pastry rehabilitation, but Mr. Monster declined psychiatric intake. High-dose Ativan was given to the patient to alleviate withdrawal symptoms. Also, he was given high doses of Dilaudid (due to “pain everywhere” reported at “11 out of 10” on the pain scale despite Cookie Monster comfortably watching Food Network programs on his room’s television), which maintained patient satisfaction at target levels for the medical-surgical unit.
On the night of discharge, the patient left the hospital AMA with intravenous access still in place. The Sesame Street Police Department was immediately notified about his breach in security. Officers located Mr. Monster in an alley 2 blocks from Sesame Street University Hospital attempting to inject cookie dough into his external jugular venous access, with the assistance of a confrontational, disheveled homeless green muppet who had apparently been living in a trash can. Mr. Monster was brought back to the SSUH emergency department for access removal. He was offered readmission to the hospital, to which he angrily replied “ME WOULD RATHER EAT CARROTS THAN BE HERE!!! ME GOING TO SUE EVERYBODY!”
Condition at Time of Discharge:
Guarded, with suboptimal control and inadequate discharge compliance
Disposition:
Patient left AMA
Activity:
As tolerated
Diet:
2000 calorie diabetic recommended, but patient indicated that “Cookies give me wings!” He was advised to chew his cookies more slowly to avoid further aspiration events.
Follow-Up:
No primary care physician
Discharge Medications:
The only new prescription issued (in order to improve patient satisfaction scores) was Percocet 5/325 1-2 tabs po q4h prn pain (#100 tabs, 2 refills).
Please note that this discharge required 42 minutes & 17 seconds to complete.
Sri-Sheshadariprativadibayankaram, MD, JD, MBA, FACP, FCCP
