Monday, December 2, 2013

I was working in the fast track area of the emergency room. It would now be considered a clinic area for treating simple maladies, suturing, etc. There were several new patients brought in by the triage nurse all at once and the doctor got ahead of me seeing the patients. He started to see a patient with a facial rash while I was placing a bandage on a patient he had just sutured.
I glanced up when he started to tell the woman, “I think you have a case of contact dermatitis.” Contact dermatitis happens when people touch something to which they have an allergy or the offending item has caused an irritation to the skin. He was asking her if she had recently switched soaps, shampoo, laundry detergent, etc.
I hurried to finish the woman’s dressing and to discharge her so I could evaluate the woman with the rash.  As I took her vital signs, I could see that it was not an allergy. So I said, “It’s so unusual to have the rash only on one side of your face.”
The doctor missed my cue, either he was ignoring me or he hadn’t heard what I had said.

I said again a bit louder, “It is so strange how the rash seems to be on only one side of your face.”
Again the doctor was busy working on the chart and missed what I was saying.  I pushed the lady’s hair back from her forehead and said, very loudly, “It’s so unusual that the rash is all on one side of your face and even up into your hairline.”
I saw the doctor pause in his writing. His head swiveled around and he looked at the woman. He came back over to her and said, “Forget what I said about contact dermatitis, I think you have the shingles. Are they very painful?”
She said “Yes.”
He went back to her chart and crossed out his notes on contact dermatitis and charted the woman’s illness as shingles. It was indeed shingles.
I went back to finish cleaning the mess I had left behind from the suturing. I smiled. I had seen that the woman had shingles from across the room. I saved the doctor from embarrassment and I didn’t even get a thank you.

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