HAMPTON, CA – Kaiser Health Hospital had a close call this Wednesday. Thanks to the diligent efforts of Dr. Trevenstein, a neurology attending at Mercy hospital, a patient was appropriately admitted to the hospitalist service, narrowly avoiding being on a highly-specialized neurology service.
Mrs. Negevny, a community living 73-year old, was evaluated in the ED with progressive left upper extremity weakness and slurred speech. After the EM resident activated the stroke team based on the chief complaint, Mrs. Negevny was evaluated by Dr. Trevenstein and hospitalist Dr. Singh as part of the stroke protocol. After determining that the symptoms have been ongoing for 2-3 weeks, Dr. Trevenstein dropped a quick consult in the chart and headed back to the office, entrusting the care to Dr. Singh. A subsequent phone interchange was captured on tape:
Dr. Singh: I’m calling about that stroke code in the ED. Just want to make sure you will be taking her on your service.
Dr. Trevenstein: Yeah, but she was way past the TpA window, so there is not much for us to do. Admit her to medicine… Put her on telemetry… MRI/MRA carotid dopplers, statins… you know all the good stuff. We’ll consult.
Dr. Singh: Right, but this is a pure neurology case, I think that the patient would be better off with you.
Dr. Trevenstein (after diligently checking the lab results): Let me look at her labs. She has some WBCs in her urine… So it’s a UTI, so admit to medicine. We’ll consult.
Dr. Singh: You know I’m looking through her chart, and she also has Parkinson’s.
Dr. Trevenstein: Yeah, but we really cant admit a patient to neurology who has an active UTI and is possibly septic. We’ll follow along.
Dr. Singh: You know, I’m looking around a bit more and she also has multiple sclerosis… on betaseron and Tysabri.
Dr. Trevenstein: Yeah… but you know… UTI. I have not idea how to deal with this. I just looked at her labs again and she has 4+ epithelial cells in the her urine. How the hell did those get there? Sounds bad.
Dr. Singh (as he flipped through the chart some more): She had PRES (posterior reversible encephalopathy syndrome, a rare and puzzling swelling of the brain) in the past.
Dr. Trevenstein: UTI. Is no joke in my book…
Dr. Singh (interrupting): Oh wow! Carries a history of ALS!
Dr. Trevenstein: UTI… Do you treat that with antibiotics, still? Have they made any new ones since penicillin? I’d hate to play around with those drugs. But we’ll definitely consult.
Dr. Singh: You know, she was seen for generalized tonic-clonic seizures in your clinic just last week.
Dr. Trevenstein: After you treat the UTI, get an EEG, MRA/MRI. I’ll even talk to the tech for you. We’ll make it happen before Friday. Admit to medicine.
Dr. Singh: She’s having an active seizure right now!! 4 of Ativan IV stat!!!
Dr. Trevenstein: She is also having an active UTI.
Dr. Singh: Huntingtons!
Dr. Trevenstein: I’ll have to get our resident on this consult. May be an interesting case.
Dr. Singh: Devics (extremely rare disease where body attacks nerve fibers involved with visions)!
Dr. Trevenstein: UTI.
Dr. Singh: Myasthenia gravis.
Dr. Trevenstein: UTI.
Dr. Singh: Guillain-Barre.
Dr. Trevenstein: That’s not a real diagnosis. It’s now called AIP (acute idiopathic polyradiculoneuritis).
Dr. Singh: Chiary Malformation, Meigs Syndrome, MELAS, Kluver-Bucy syndrome.
Dr. Trevenstein: UTI, UTI, UTI and I’m pretty sure you made that last one up. Admit to medicine.
Dr. Singh: You will consult?
Dr. Trevenstein, (Doing everything he can to assure his colleague): I will send the resident in the morning.
At this point Dr. Singh called the admitting medicine resident to initiate admission. When asked about the “quick story” on the patient, he blurred out “UTI.”
Neurology..all talk, no show
LOL Maysun Ali, Aparna Sarma, Manan Shah, Lindsey Frischmann
Lol!! Got to share this one with my fellow hospitalists today
Yup- that’s the way it is and I’m good with that.
Hey hey hey!!!
Anh!
How would you know?
I blame Hopkins modules personally.
Wait, there are places where neurology actually admits patients primarily?!?!?
Dianne Radcliffe
As a hospitalist nurse…..this is my life more days than not.
As a hospitalist nurse…..this is my life more days than not.
Sad but true! Hilarious.
Sad but true! Hilarious.
Kim
Love it!!
This is hilarious and true
Just substitute “pregnant” for “UTI”…
Hahaha. Hilarious! Story of our life
So darn true ☺
Yes but at the point of ridged abdomen 102T 21000wbc it really doesnt matter what is causing it … Time to cut
Gotta make sure to consult medicine for all surgery admits. Somebody has to continue the home meds.
I definately remember some of this happening during residency. Usually this was sorted out by the residents so we tried to be fair and make sure patient’s with a primary neurologic illness were on our service. Very funny post though, beware the UTI :)
I definately remember some of this happening during residency. Usually this was sorted out by the residents so we tried to be fair and make sure patient’s with a primary neurologic illness were on our service. Very funny post though, beware the UTI :)
Rofl!
Rofl!
This is hilarious and so true. I don’t miss it!
Jerk. :-)
OD’d on onions!
Add ortho consult, too. She could have fractured something falling during her seizure.
Why not consult Urology also and ID? She might have ESBL and might need an indefinite foley…residents to be sent for consult lol let’s get everyone on board lol
The stock photo guy’s grin is so perfect for this headline.
Lindsay Pagano is this you?
Love this, it’s a medical “Onion”. Attn Mary Frances Mccarthy
Lol
Eileen Magnuski do Neuro docs do this? Haha
I really needed another “laugh out loud” GomerBlog this morning. Thanks.
Actually, GYN should have been consulted. The patient was a woman after all! Hahaha
One and only time I’ve ever seen hypokalemic periodic paralysis (in a healthy young guy) was as an intern in the MICU. When he was ready to be downgraded to the floor, we tried to send him to neuro. They felt medicine was more appropriate because the patient had an episode of diarrhea.
Lol too funny Amy Hale
God, that’s funny.
Works this way as a geriatric nurse, too. It never matters what s/sx my pt has, the hospital always sends them back saying “it’s just a UTI”. Very frustrating!
Truth
Kristy Kmit Hagen
Raechal Stoops I think this is how Frankston works
This is so true that its (almost) not funny
Katie Simmons Heather LaClair
Anna Sorokin , this hits too close to home !!
Funny, we are working on an article about a medical student diagnosing a heavy metal disorder on a patient with an acute appy
Julia L Mikell
Ain’t THAT the truth
Christi Ward, Grace Lee Henninger, Im sure you have never seen anything like this. Ever.
Sad but true ……
LMAO. Classic.
That was hysterical and unfortunately true had many of those exchanges with neuro and surgery and ENT. I had one surgery resident ask for the selenium level before he sees the patient (obvious acute appy) just admitted to medical with a surgery consult
Craig. ROFL.
Uti, uti, uti! I lolled.
Alex Pace
Residency woes? This is the current state of Hospitalist medicine!!
Lol! Residency woes :
Aisha Siddiqi