You know it’s halloween when Hallway Four comes back from the blogging dead to offer up a guest post.  You’ll find it convienently located below…   

10/10, in case you ever have those days when you’re too darn lazy/tired/disillusioned to produce a blog entry (10: um, that’s like everyday), I have a little story for you from a recent shift that you (and possibly your many-thousands (try tens) of readers) might enjoy.  It goes like this (and, you should know, I am not exaggerating – this is the real deal…)
The chief complaint on the chart was “Hernia”.  I walked in the room to find a morbidly obese female and her average-sized husband.  I began with my usual, “What brought you in to the ER today?”.  And so it began…

Husband: We’re here to have her hernia removed.

Me: Okay, why don’t you tell me about it.

H: Well, we were seen at another hospital and they told us she had a hernia and needed to see a surgeon.  We can’t get in to see the surgeon but this thing’s really getting in the way so we need it removed.  

Me: How long has it been there? 

H: I don’t know – a few weeks.

Me: When did it get worse?

H: Well, it just keeps growing all the time. She can’t even put on her pants anymore it’s so big. 

Me (interest piqued): Can you show me the hernia?

H: (lifting his wife’s shirt to reveal her belly) It’s right here.

Me:  Right where?  

H:  Right here (pointing to her large, overflowing pannus, or fat pad).

Me (confused):  I don’t understand, where’s the hernia?

H (getting mad): it’s right HERE (again, pointing to the pannus)

Me:  Sir, that’s not a hernia.  

H:  What do you mean? What is it?

Me (trying to be gentle): Well, that’s just tissue.  

H: Tissue? (baffled)

Me: Yes, tissue.  Fat.  That’s her fat and skin.  

H (really irate): Well, it’s gotten too big.  They told us she had a hernia and it could be fixed so I expect you to fix it.  You need to admit her and run some tests and fix this thing.  That’s your job.  You need to fix it or find someone who will.  This is not normal.

Me: You don’t understand. This is not a hernia.  She has a small hernia around her belly button, but all of this (pointing to the pannus) is not a hernia.  It’s just fat.  And I guarantee it didn’t develop over the course of a few weeks, or even months.  This has been a problem for a long time and there’s nothing that we can do about it in the emergency room tonight.  This is not an emergency, Sir. Now, I’d be happy to give you a referral to a PCP to help your wife with nutrition counseling so she can start to lose weight but I’m not admitting her to the hospital tonight….

Husband: But we don’t want a referral, we want this fixed…

 

As you might expect, this conversation went back and forth for awhile.  The poor wife, belly on display, was just lying there silent as we fought over the fate of her fat pad.  I felt horrible for her, but also pretty stunned by her and her husband’s lack of insight.  

 

Needless to say, she was discharged home shortly thereafter with a diagnosis of “Concerned about abdominal pannus”.  Is there an ICD-9 code for that?

 

Signed, 

The Artist Formerly Known As Hallway Four.

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