Consult-Liaison Education Lessons Medicine Observations

Red Herring (V).

I called the emergency department that night. If she was released, I wanted to know. (Did she make it home safely?) If she was admitted, I wanted to know. (Did the staff know her past history? Experience had taught me not to rely on a paper trail alone, especially when the patient was travelling through multiple departments.)

Though nearly ten hours had passed, she was still in the emergency department.

“Were you the one who tied the note to her gown?”


The ED doctor on the other end of the line laughed. “We got that, thanks.”

He then told me about the evaluation—physical exam, labs, X-rays—and no significant medical problems were apparent.

“She’s going to be admitted to psych to rule out an eating disorder.”

Frowning, I sighed.

“Please give the admitting team my phone number,” I said. “I want to talk with them once she’s upstairs.”

Several days had passed. No one from the hospital had called me.

After leaving two messages with the attending psychiatrist, I finally got a phone call from the resident about a week later.

“How is my patient?”

“Your patient is fine… don’t worry….” She sounded bored.

“Did you receive my note with the past history?”

“Yeah… schizophrenia, eating disorder… we’ll take good care of her… she’s fine….”

“She hasn’t demonstrated symptoms of an eating disorder in almost two years. I’m worried about a medical etiology.”

“Uh huh, okay….”

“What is her weight now?”

“How much does she weigh? Um… I don’t know.” She suddenly sounded attentive.

“Can you find out right now, please?”

“Yeah, sure, sure… the nurses check it every day…”

“So what was it today?”

My patient wasn’t gaining weight. In fact, she had lost weight since her admission to the hospital.

“We’re locking her out of the bathroom for an hour after every meal so she can’t vomit. She seems to be doing well with that.”

Frowning, I sighed.

“But her weight is down?”

“Um… yeah.”

“Have you considered calling a medicine consult?”

“The patient was medically cleared in the emergency room. Anyway, we’ll probably discharge her soon and she can follow up with her primary care doctor.”

“Ideally, her discharge weight should be greater than her admission weight.” We both understood that my comment was a warning, rather than an opinion.

She quickly ended the conversation.

I visited her a few days later. She was more energetic, though still very thin. The hospital gown hung on her like a sheet on a clothesline.

“Hiya!” she greeted, her smile disproportionately large compared to the size of her face.

After exchanging pleasantries, we sat down on couch covered in dark blue vinyl.

“Have you been throwing up?”

“Yes. Sometimes.”

“You’ve been throwing up…?”


“They tell me that they keep you out of the bathroom after meals.”

“Uh huh.”

“When do you throw up?”

“At night.”

“Do you make yourself throw up?”


“Do you feel sick?”

“I’m fine.”

“Do you hurt anywhere?”

“I’m fine.”

I examined her face, halfway hoping that I could read her mind.

“Are they treating you okay?”

Yes, apparently they were, even though they really were locking her out of the bathroom for an hour after her meals. And, despite this, her weight was still dropping. My efforts to speak with the inpatient psychiatrists were unsuccessful.

I looked at her, unsure of what to say.

“Don’t worry,” she said. “I’m fine.”

Less than a week later, hospital staff called The Worker and told him that they were discharging the patient that morning.

“I wish they would give us more notice,” he grumbled.

He escorted the patient from the hospital directly to the office. We asked her to step on the scale. We all frowned as the digital numbers appeared.

“What? What?” the patient asked.

“93 pounds,” The Worker said. “You weighed 99 pounds when you went in.”

(Part five of an ongoing series.)