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Excerpt from the book
You Are the ER Doc!:  True to Life Cases for You to Treat
by Peter Meyer, MD

Taillight Sign

You are the emergency medicine doctor on duty in the Hometown Hospital Emergency Department.  Your patient is: Emma Olner, an 88 year-old female.  The complaint on the chart reads:  sick, hurting.  Mrs. Olner lies on the stretcher, her back raised at a 45-degree angle.  She rests quietly, her eyes closed.  Snow-white hair in a disheveled bun tops her head.  A worn, blue suitcase sits on the floor, beside the stretcher.

“Mrs. Olner,” you begin.

The old lady opens her eyes and inspects you through trifocals. The lenses of the glasses are smudged with fingerprints.

“Hello, doctor.”

“What brings you to the Emergency Department?”

“My son, Ronnie.”

“No, I meant what kind of problem?”

“I guess they thought I needed to come.”

“Who’s they?”

“Ronnie. And his wife, Rita. I stay with them. They take care of me.”

“What do you think? Is anything bothering you?”

“No.”

“Are you hurting anywhere?”

“In my back.”

“When did that begin?”

“Oh, 10 or 15 years ago. I’ve got osteoporosis, you know.”

“Are you having any new symptoms?”

“My bowels aren’t moving like they should.”

“When did that begin?”

“I’ve had that all my life.”

Question 1 — You should:
A) Examine Mrs. Olner.
B) Talk to the family.
C) Ask medical records to send down the charts of Mrs. Olner’s past admissions.
D) Consult your crystal ball and Ouija board for help.
E) Call in a gerontologist (a specialist in treating elderly patients) to figure out what is wrong with Mrs. Olner.
F) A), B), and C).

Answer—
F) is correct.
All three actions might help.

“Able, can you locate Mrs. Olner’s family?” you ask your nurse. “I need to ask them why they brought her in.”

“Not possible,” Able answers.

“Why not?”

“They’ve fled the scene. Outa’ here. Adios, amigos. A classic case, I’d call it.”

“A classic case? What do you mean?”

“A Granny Drop.  Also known as a positive Taillight Sign.  When the family wants a weekend off from caring for an elderly person, they drop the aged one
off at the ER, then speed off into the sunset before anyone can ask them questions. The only view you get of the family is the taillights of their car fading into the distance.”

“Mrs. Olner’s family really left?”

“Yep. And in case you missed it, Mrs. Olner also has a positive Suitcase Sign — the family packed her suitcase so she can stay at the Hometown Hospital
Hilton a few days.”

You shake your head in disbelief, yet recognize that Nurse Able speaks from her thousands-of-shifts experience in the emergency department.  You proceed to examine Mrs. Olner.  Physically, she is fine. Mentally, her mind wanders.  You cannot deem her responsible for her own self-care.

Question 2 — You should:
A) Call Mrs. Olner’s doctor and suggest that Mrs. Olner be admitted to the hospital for social reasons.
B) Call Mrs. Olner’s doctor and make up an emergency medical condition requiring admission to the hospital, a reason that Medicare will accept to pay for the admission.
C) Call the police to come pick up Mrs. Olner.
D) Send the patient to a local shelter for the homeless.
E) Notify the Highway Patrol to arrest the family and bring them back to the emergency department.

Answer—
A) is correct.

“I’ve got Dr. Jones on the phone,” says the unit secretary.

“Dr. Jones, I’ve got one of your patients here, 88 year-old Emma Olner.  Nothing new with her, but her family dropped her here and took off.  She’s unable to take care of herself. If we send her home, I’m afraid she might burn down the house or something.  There’s no way we can get social services to find her a sitter at 9 P.M. on a Friday night.  And, if we send her to a homeless persons’ shelter, someone might take advantage of her.”

A deep sigh emanates from the other end of the phone.  “Her family has done this twice before,” reports Dr. Jones.  “By the time social services finds a sitter or a nursing home bed, Mrs. Olner’s family shows up and reclaims the old lady.”

“Then you’ll admit her?”

“Yes, I will. Medicare may not pay, but we still have to think of the patient first.  At least for now, we need to protect her by putting her in the hospital.  I will ask social services to investigate the home situation, though. This is a form of negligence.”

“I agree. Thank you for putting the patient first, Dr. Jones.”

Nice job, doctor.  Sometimes the emergency department is the dumping ground for society’s problems.  Yet, you must uphold the physician’s golden rule: Always act in the best interests of the patient!

“Taillight Sign” is an excerpt from the book, You Are the ER Doc!:  True to Life Cases for You to Treat, by Peter Meyer, MD.  You are the ER Doc! is available at online bookstores.

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