Pantshitter

"You have gastroenteritis."

I deliver my diagnosis confidently and in a tone that strives to quell any disagreement.

My patient, a 55yr old woman, looks dubious. She's had nausea, vomiting and diarrhea for three hours. It's terrible, she says. Especially the diarrhea. It's uncontrollable. Explosive. She hasn't travelled anywhere, taken any antibiotics, been exposed to anything that would put her at risk for C.Difficile diarrhea.

"It has to be more than that," she insists.

"No, I'm telling you, it's gastro. You feel miserable and awful, but your bloodwork is perfectly normal and your belly exam is nice and soft. There's nothing here that would suggest something awful or life-threatening or indicate that there's something worse going on than gastro."

"I want a scan," she says.

"I'm sorry, but I don't scan people arbitrarily. There's nothing to suggest that the benefits of scanning you outweigh the risks. Scans aren't benign, you know. The radiation is hundreds of times that of an Xray and if there isn't any reason to expose you to that, I won't."

"So I'm just supposed to go home like this?"

"This will get better in 24-48hrs," I say.

"You can't send me home like this," she pleads, "you have to fix me."

I remain unmoved. The nurse removes her IV. We get her dressed. Still bitterly complaining, she leaves the department.

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45 mins later

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"There!"

I look up from my charting to find myself face-to-face with my patient. A dreadful smell fills the air.

"I told you I was having diarrhea."

She's waving something around in the air. It's her pants.

Brown liquid shit drips on our floor.

I've had enough.

"Mrs X," I say curtly. "I didn't doubt you are having diarrhea. Bringing your shatpants as proof doesn't change my diagnosis. You have gastro. Go home."

Defeated, she slinks away with her little trophy.

This time, she does not return.