Monday, December 5, 2011

Tales From Residency: You be the detective

Two mysteries from my residency:

1. Our junior chief resident took about five patient files out of the clinic in order to dictate the patient visits at a later time. One hour later, he reported those files missing.

Question: Where were those files later found?



2. I saw a patient in clinic who was recently admitted to the hospital with severe leg pain. I looked at the discharge summary in the computer and saw the following identifying information:

30 year old male with chondrosarcoma [type of bone cancer] status post hemicolectomy [part of bowel removed] one month previously.

Question: Why did this patient with bone cancer need to have part of his bowel removed?


(Answers tomorrow)

11 comments:

  1. The bone cancer had spread to the patient's brain, causing him to develop Pica. He developed a craving for paper, and went to eat some paper towels in the bathroom. While there he discovered a bunch of patient files that had been left on the floor of a stall, and ate them instead. The paperclips on the files caused him to get a bowel obstruction, which required surgery.

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  2. Well Grumpy beat me bad one this one.

    1) Bathroom stall, duh.
    2) Patient was constipated due to pain meds, given laxatives by chief resident, rushed to bathroom stall to find it occupied by said chief resident, ruptured colon.

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  3. Oh, forgot to mention, both events occurred in the women's bathroom.

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  4. I think Grumpy M.D's is more believable :)

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  5. 1)The resident went to lunch and left the files in the refrigerator

    2) The chondrosarcoma was of the ilium and had extended into the colon

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  6. But this is medicine! The key is to use Occam's Razor to find the common denominator.

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  7. 1) Resident's girlfriend's house.
    2) Sarcoma was so large it crushed bowel, making it necrotic

    (Okay, less funny than the other answers).

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  8. Some people could just have bad luck. The chondrosarcoma and hemicolectomy don't necessarily have to be related. Correlation is not causation. Or he has a history of sticking strange things up his ass.

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  9. My money is on the patient highjacking the resident's charts and eating them, later to be found in the OR during the hemicolectomy.

    Or as is the case with the amazing top of the line automatated dictation system my hospital uses, the patient's hemipelvectomy from the chondrosarcoma was transcribed as hemicolectomy...oh how I love seeing my reports that state, "The patient was raped in a sterile manner prior to incision..." or "Physical damnation was within normal limits."

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  10. I'm with Grumpy. Bone cancer --> anemia --> iron-deficiency-induced pica --> patient eats charts, needs colon removed due to fiber bomb...?

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