I had a patient come the other day that I hadn't seen in several months. As soon as I walked into the room, I noticed that their color was just a little bit off. No really, I LOT off. I told the patient that they needed to go to the hospital.
Why? Ummm, Because you're yellow???? No niceties, just the symptom questions popped out like a barrage of gun fire.
When did you start turning this color yellow? When did you start noticing your sclera turning yellow? How long have you been so tired that you could barely get around? Any itching? Any muscle aches? Any abdominal pain? Trouble with bowel or bladder? Didn't the people in your family notice this or think that is was a bit unusual that you look nine months pregnant?
When they started to say that it wasn't a big deal, that's when I pulled out the BIG C word. You know it.. Cancer... The other big words such as liver failure, and of course the ultimate big word DEATH. They sat up a little higher and started to pay attention.
Or I thought, until they said that they couldn't take the time to go to the hospital because they had other pressing appointments to attend to. I reminded the patient that death waits for no man as they say. They asked if I was serious? Of course! I told them the patient needed an urgent evaluation for several possible scenarios. Gallbladder obstruction or cancer, pancreatic cancer, liver cirrhosis or cancer, and Hepatitis B or C to name a few.
Ohhh.. well I guess I will go in after my spouse's non-emergent appointment in two days..
Argh!!!!! At least go for a stat CT scan so I can at least know what might be going on! Okay. Now we are getting somewhere.
CT scan completed shows cirrhosis of the liver with ascites along with a gallbladder full of stones. Next on the list is to get the person admitted to the biggest hospital so they can be evaluated by a Hepatologist. Call goes out to the ER so they have a head's up about why they will be coming. A fax of the most current labs and the CT scan report sent.
Here comes the call from the patient... They want to ask you some questions (relayed through the nurse from the doctor who couldn't walk over to the phone himself).
Why is this patient here? (Did you even LOOK at the test results and the labs, let alone the patient???)
Has he seen a Hepatologist? (Ummm, No.. If you had read my enclosed note, you would have seen this is new to me and the patient!)
Why did you send him to us? (Well, the patient refused to be admitted two days ago locally and he requested to go to your illustrious hospital because he likes you.)
Oh, okay says the nurse. I guess we'll see what we can do.
Yes, I thought. Please do that.