A 25-year-old man presented to a rural ER with “chest pain.” The doc, a resident out moonlighting from the big city, went through a standard H&P, obtained a normal EKG, and reassured him. Thirty minutes after discharge, the patient was brought back DOA with a self-inflicted shotgun wound — the family explained how he’d been hallucinating, needing to “blow out the devils in his chest.” Apparently they’d been too embarrassed to tell. That was a tough one; I was glad I’d been off that weekend.
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