Kleptomania and Patient Misunderstanding

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Sunday evening in the ED. We zoom around in a Brownian motion, distributing some Haldol here, a touch of Fentanyl there, and turkey sandwiches everywhere.

The CNA brings me an EKG. Unremarkable. In my world, that’s a good thing.

“Whose is it?”

“Room 5. Chest pain.”

Born in the 50’s. Ripe age for a heart attack.

I walk in and introduce myself.

“What’s going on?” I ask.

“I don’t know. You’re the doctor, you tell me.”

I love it when they say that. On my good days, I say: “You’ve got to know something, otherwise you’d be out fishing/shopping/having fun instead of being here.” Once, and only once, I said: “Well, if you can’t tell me anything you should go see a vet instead.” Sensitivity training, anyone?

I try again.

“You have chest pain?”

Curled in the stretcher, his bare chest covered in stickers but his lower half still clad in soiled khakis and muddy boots, the patient stares at me with bulging eyes. Gray flames of hair sprouting from his small skull make him look like a poor Einstein impersonator.

“Chest pain?”

“Yes,” he blurts, then cups his right chest with a thick, calloused hand. “When I breathe.” He takes in a deep breath then lets it out with a groan. “And when I move.” He twists a mere 10 degrees and bellows.

That’s not the chest pain I expected.

“What happened?”

“The boat.”

I wait.

“The boat trailer. It was stuck in the mud. I had to move it.”

“Ah, so you pulled it out and that’s when the pain started? You pulled too hard?”

He looks at me like I’m thick.

“I pulled it with the truck.” he says.

“So the pain started as you were driving?”

“I pulled it out. The boat. It left these deep ruts in the mud, since it’s been there since last year. I took a rake to them.”

“So the pain started as you were raking?”

“When I fell.” he says.

“You fell?”

He nods, shifts a little, and lets out another scream.

“How did you fall?”

“I dunno. I didn’t see. I was standing, then I was down.”

“You slipped maybe?”

He shrugs.

“What did you fall on?”

“The hitch” he says, holding on tight to his right lower ribs.

“Where did it catch you?”

He nods to the hand holding his ribs.

I palpate his right upper abdomen. He groans again. It’s the liver, I think.

My nurse rolls in the ultrasound machine. I look for a black stripe between the liver and the kidney, the sign of bleeding in his abdomen. There isn’t one, but he’s firm and exquisitely tender.

I have to scan him.

“When did this happen?”

“Yesterday.”

“It took you awhile to get here. What did you do, you walked?”

“Just about,” he says. “I don’t like doctors. I wouldn’t have come if it wasn’t for her.” He nods to the woman, short-haired and round, sitting by the foot of the bed. She hasn’t said a word since we shook hands, maybe not even then.

“She made me come.”

“Good for her.” I smile at her. She smiles back.

“He’s stubborn,” she says.

That I had noticed.

“I’m not like my father. He was a kleptomaniac,” he says, shifting a little and moaning again.

“How so?” I ask.

“He’d always go to the doctors for the littlest thing. A stubbed toe, a little bruise, and off to the doctors he went. All the damn time.”

“Did he steal things?”

“Steel things? No, mostly wood. He was a carpenter.”

“Hypochondriac,” I say softly.

“Kleptomaniac,” he insists.

I shrug. Who am I to disagree? I don’t even know his father.

‘I’ll have to get a CT scan to check your liver.”

He shrugs. That small move is enough to get him screaming again.

I scan him.

He’s got a liver hemorrhage. A small one.

“We’ll keep you in the hospital overnight to watch you. We’ll also take care of your pain,” I say.

He opens his mouth to say no.

His wife speaks first. “Good.”

She gives him a fierce look, daring him to say something.

He wilts under her heat, swallows the words he didn’t speak.

“Thank you.”

“It was my pleasure.”

That’s the truth.

Kleptomaniac?!

Rada Jones, MD, is an Emergency Physician in Upstate New York, where she lives with her husband, Steve, Gypsy Rose Lee, a German Shepherd and Paxil, who is deaf, black, and a cat. She is finishing her first novel, “Overdose, an ER Thriller” where a lot of people die in unnatural but exciting ways. Find more at RadaJonesMD.com, instagram RadaJonesMD and twitter @JonesRada. She is also a “2018–19 Doximity Author”.

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