The “Sammich Sign”
Posted by WhiteCoat on June 18, 2008
In radiology, the sandwich sign refers to bulky mesenteric adenopathy and possible lymphoma.
In emergency medicine, the “Sammich Sign” refers to a patient that creates a medical complaint as a pretense in order to get a room and ask for a sammich.
The latest patient I saw with a positive Sammich Sign was complaining of shoulder pain. He said that he had fallen a few days ago and was having pain in his right shoulder. He had a large lump on his clavicle as shown in the picture. It seemed weird to me because even though the bone appeared broken, it didn’t move around or crackle under the skin when I moved his arm around. We ordered an x-ray.
The weird thing was that the patient didn’t ask for pain medication. He asked for a “sammich” and some juice. Of course, he took the pain medications when we offered, but he was more interested in the food. He even rang the call light wondering where the food was. He was sooooo interested in the food that I had them hold off on giving it to him – in case he had to go to surgery or something.
After looking at the x-ray, I found out why the patient wasn’t in pain. The x-ray showed a fracture, but it also showed a callus (at the arrowheads) – meaning that the bone had been broken for at least a week or two and was in the process of healing.
He got his sandwich and juice, but I told him that we were on to his secret and that he wouldn’t be getting anything to eat or drink if he came to the ED complaining of the same thing again.
He nodded his head and thanked me. Then he stuffed the orange from the bag lunch in his pocket and sauntered out the door.
I just stood there wondering how many times he’s been x-rayed and how many orthopedic appointments he has blown off just so he can get a stale turkey sandwich and some apple juice with the plastic aftertaste.
Rogue Medic said
I haven’t ever had a meal that is worth putting up with a broken clavicle to obtain it. My ex is an excellent chef and we have eaten in some excellent restaurants, but no food is that good.
Hospital food?
I have always said that with enough of the right sauce, anything tastes good. Good, but not worth tolerating an unset fracture of the clavicle. And that’s even with the “right” sauce.
endochick said
Should’ve given him the local shelter numbers and addresses…
I know someone who faked a psychotic episode so they could be put in for a 72 hour eval during winter. They got a warm room, food, some nice drugs. Slept off a crappy blizzard. Eventually, the hospital figured out they weren’t nuts and discharged them to the nearest Homeless Shelter. It’s really sad the things people have to resort to sometimes to get some help these days.
I’ve had those meals in the ED. I would’ve given mine to the guy if he would’ve asked. lol They are definitely not worth a broken clavicle for.
I don’t think that he broke his clavicle to get the meals. I think that he had a broken clavicle already and never got it fixed. Then he just started using that excuse as a way to get into the EDs and get food/drinks/etc.
Liana said
If you think that’s bad, I saw a lady a few years ago who kept missing appointments to get her CHEST TUBE removed… I presume so that she could get pain meds, which is what she was asking me for.
After discussing it with the trauma surgeon who put in the chest tube 3 months prior, I pulled it out. There. No more chest tube, no more pain.
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