Presenting Symptoms: Severe abdominal pain
Onset: 1 week ago

This was all I picked up from the triage screen before I walked in to do my assessment. We see our fair share of abdominal pain so that I didn't think anything of it. I hadn't received report yet but I wanted to at least eyeball my patients and do a quick assessment because the nurse giving me report was tied up with a patient.

This is a summary of our conversation:

Me: Hi, my name is ernurse and I will be taking over from other ernurse.
Her: Hi, my name is ithurts, nice to meet you
Me: What brought you to the ER today?
Her: I have pain in my tummy, really bad
Me: When did the pain start?
Her: Last week
Me: Do you know what might have caused the pain to start?
Her: Well.... uhhmmm... I might have swallowed something
Me: Okay, swallowed something like what?
Her: Oh... you know... like something... you know... a poker chip
Me: You swallowed a poker chip? said with a straight poker face
Her: Yes
Me: Have you passed it in your stool yet?
Her: Uhmm... no, I don't think so. I might have swallowed a couple
Me: OKAY... about how many is a couple?
Her: Three, maybe four
Me: Did you run out of potato chips?
Her: Laughs... no, it just... I just wanted to
Me: Okay... does it hurt when I press....
...etc, the assessment continued

After I completed my assessment, I went to talk to the resident who was writing her admission orders and to ask him if there was anything we needed to do stat in the ER before getting the patient ready to go upstairs to her room. She had already been CT'd and all that. He looked at me and asked me, "did she tell you about the light bulb and the nails she ate before that?"

Apparently our patient suffered from Pica, a rare disorder which makes the patient feel a compulsion to eat non-food items. She was about 40 years old and had been eating stuff since she was a teenager. She had never seen a GI doctor and suffered abdominal pain silently. The resident asked her if she had ever seen a psychiatrist but she stated she didn't see the need to, so he was going to order a psych consult for her.

His parting shot to me - "make sure you didn't leave anything tempting on the bedside table". He actually put something to that effect in her admission orders too.