Bring on the consults.

Yesterday was my first day back at Moore after our fabulous Diabetes camp all of last week. I was expecting a rough transition from cabins and mountains to sterile walls and lab coats, but I was most pleasantly surprised to find that my shift flew by yesterday. The fact that the day was sprinkled with quite a few very interesting patients likely contributed to this. Allow me to share my favorite:

Mrs. X was a 70 year old admitted for SOB and a productive cough. The M.D. was trying to rule out COPD, the alternate diagnosis being bronchitis with CHF exacerbation. Anyway, we actually got consulted to give the pt diabetes education. So I thought this was a perfect opportunity for my rotating R.D. to observe me doing a diet education. Yeah. After reviewing her labs and chart, I find out she doesn’t have teeth, so she might have problems chewing and swallowing. No problem. She also turns out to be a longtime smoker. Ok, so we walk into her room. We’re immediately greeted with the strongest scent of smoke. Three of the pts daughters are at bedside. I introduce myself and -per protocol- ask the pt to verify her name and DOB….this skinny pt looks at me and says in the most chipper voice, “lady, I’m crazy!”…and she smiles with her big, toothless grin. I’m taken aback for a second, because I can’t even tell if she’s kidding or really nuts. Briskly, one of the daughters takes me aside and says, “I’m going to be honest with you, I let her eat whatever she wants. She doesn’t eat much. I take good care of her.” So I proceed to ask her questions about her DM care and if she’s ever gotten any DM diet ed in the past, etc, etc. when to my periphery, I realize that the pt is sitting up in bed with a wad of something in her right hand, and a clear plastic cup in another, the contents of which look black and slimy. I then see the patient half spit, half drool this black substance down into the cup, and it hits me: this woman is chewing tobacco in her hospital bed. Except, she’s not really chewing, because she has no teeth, she’s basically just gumming the stuff! In fact, that’s probably exactly why she doesn’t have any teeth in the first place!!! (and it also might explain why this lady is having some pulmonary complications!) I managed to not react to the situation, but I realized DM education was not really going to go down in this room right now. Cool. Glad my rotating R.D. got to see me in my shining moment. We made a joke about it in the nurses station, both of us appalled at how the consult unfolded. Another instruction opportunity will present itself, I’m sure. This just goes to show one of my favorite elements about working in a hospital: you never, ever, know what the heck to expect when you walk into a pts room.