Shaken or Stirred?

When James Bond says how he wants his martinis, both choices are refined, the choice is a test of internal character, of dashing charm. In the ED, though, it never seems to work out that way...

Part 1: 'Stirred'

A middle eastern fellow comes in complaining of 'twitching' and a funny feeling in his chest, and, sitting on the gurney, shakes his extremities violently and spasmodically, going red in the face. He still responds, asking, 'what is it, what is it' that makes him do this between episodes, and even throws up a couple times. He gets pads, monitors, a non-rebreather, and serum and urine tox.

History reveals that he's had 3 full-size Red Bulls that morning alone (it's about 10:30). He also says 'someone blew smoke in his face' and he didn't know what it was, right before he started jerking all the time. Riiight. U Tox comes back with...hmmm...cannabinoids. I go to tell him and have to excuse his father and older brother; his mother, covered head to toe in a hijab (they're Jordanian) doesn't speak English and just looks at me with a smile while I tell her son he's a pothead (which he denies, must have been that guy blowing smoke at him) and it doesn't mix with Red Bull. His father wants to know if he's doing drugs. I said, "I can't tell you, but as a father, you should parent him as you would based on your own impressions". The dood (thanks Nurse K) denied any pot use. Right.

Part 2: 'Shaken'

I'm walking down the hallway minding my own business when an uptight lady standing next to a gurney says, 'Are you an attending?' then before I answer, says 'I'm doctor so-and-so from the Children's hospital ICU, and I need to talk to you right now.' The Children's hospital is adjoining ours, and corridors connect us. She then gives me sign out about this guy who started having 'a seizure' in the cafeteria of Children's. Later the nurses said she was totally rude and I wish that I had told her something about EMTALA violations (since he was on Children's premesis) but I didn't. The guy is still shaking all over but looking at us.

'Sir, can you hear me?' He can. 'Can you stop?' He can. Sweet! Cured.

I start examining him briefly and tell him we're going to get a few tests--and he refuses blood draw. My staff comes in, and says--'Hi, Howard. We're not going to play these games today, OK? You give us blood and let us evaluate you, or you leave now'.

Howard starts shaking again, this time on his feet--miraculous how he can do that--then pretends to fall. Refuses blood draws. He gets put in a wheelchair, and says, 'I'm going right back to the cafeteria to have a seizure!' 'Go ahead', the attending says. He starts shaking in his chair again. 'Knock it off, Howard', says the tech, and he does. To myself, I'm thinking, did that ICU doc even look at this guy? Probably not. Way too old.

So the ED shaken or stirred question, not so glamorous. But way, way more fun.