Thursday, February 26, 2009

My House, My Rules

While doing a shift in the local children's ER, a group of 3 kids needed to be seen for "marijuana exposure." My first thought was that I bet a lot of kids in the area suffer from this most common phenomenon. This case was more of a legal and social issue.
The local police were called to the apartment b/c the neighbors complained of smelling too much marijuana. When the police went to the scene, the mother (who I am sure was up for mom of the year) was holding a baby in one hand and a fat blunt in the other. When the police suggested that this activity wasn't legal, the great mom had a fit b/c she felt like since it was her apartment...she could do whatever she want. Even smoke illegal drugs with kids in the apartment. Now that must have been some good weed.

ER Doc

Tuesday, February 24, 2009

More Rectal Fun!! night back in the ER and a man is walking down the hall doing the "I've got something stuck in the wrong hole" walk. Complaint was "I haven't been able to get my dildo out for 2 days!" By the looks of the xray, it was obviously painful. I couldn't get this one out....he had to go to the operating room. The op-report was great. Report said: a large 17cm x 5cm black and pink dildo remains in the rectum with intermittent vibrations." I wish it would have said what batteries were used b/c those had to be best.

ER Doc

Tuesday, February 17, 2009


There are many reasons that patients come to see a doctor. For us, those reasons are called the "chief complaint." Common examples are chest pain, shortness of breath, pain, etc. You can hear about this daily in any clinic, ER, or hospital in the world.

However, there is one phenomenon that only occurs in psychiatry. About once a week, the triage nurse has listed as the chief complaint, "Found by police naked at (fill in the blank)." I have seen "Preaching Naked at the College Student Union" guy. I have treated "Parents Won't Let Us Have Sex So I Watched 'The Notebook' 10 Times and Read 'Lord of the Flies' then Covered Myself in Molten Chocolate and Ran Naked to My Neighbors' House" teenager.

I was reminded of stories like these today, when I saw a patient in the psych ER. He is a late 20-ish paranoid schizophrenic who just needed refills. He hasn't been hospitalized in over 4 months. Aside from an odd affect and suspicious behavior, he appeared to be doing fine. I asked him if he could tell when he was going to have a psychotic episode.

"Yes," he said. "I haven't had a really bad one since the '90s. When I start to get crazy, I just want to get naked and let it all out."

"One time, I really liked this girl," he continues. "But she got married. I think I must have felt jealous, so I went over to her house naked."

I asked him how that went.

"Oh, she called the cops."

I asked him if he could think of any reason why he might behave that way.

"I was just sad because everybody else can get laid and I can't."

I asked him how he deals with those feelings and tries to avoid hospitalizations.

"I'm still sad. But I smoke cigarettes and drink lots of coffee to try not to think about it."

And now you see why schizophrenia really sucks.

Saturday, February 14, 2009

What a Way to Go!!

This is one of those stories that's an "Oh crap that sucks," funny, and sad all at the same time. 2 times in my brief career I have had people die during SEX. Both were females in their early 60's. One had a stroke and the other a heart attack during sex. Both occurred in the early morning. The husbands called 911 appropriately, and they were rushed to the ER. Unfortunately we couldn't save them.

I have had lots of people, male and female, come in the ER after having a heart attack during sex (the ones mentioned above were the only that died). Lots of questions rolled through my head in these cases. 1 is I felt very bad for the spouse. It's got to be horrible to loose your loved one that way. I hope they don't feel like they killed their wife...b/c they did not. And I hope the wife initiated the sex b/c....damn that would be some guilt if the husband was begging for sex. Also I am generally curious what positions they are in when heart attacks occur during sex. It might be an interesting research project. Maybe there is a correlation between the reverse cowgirl position and heart attacks?? Maybe the pile driver is safer b/c of better blood flow to the heart and brain?? I've wondered how long it takes for the spouse to realize that their partner is having a medical emergency. I mean...if the female isn't much of a mover or moaner it could take a while to figure it out. I've also wondered about how does the spouse get dressed to come to the hospital. They would have to roll over, call 911, then decide between getting dressed and doing cpr. They always come to the ER clothed, so I am guessing there has to be some delay in the cpr.

Sex does take some physical ability. So be sure you exercise to keep your heart strong. 4-7 am is a increased time for heart attacks in the first if you have heart disease please defer your pleasure until later in the day.

ER Doc

Thursday, February 12, 2009

Lucky To Be Alive??

Lucky to be alive....I hear that term a lot. Sometimes its from the patients themselves when they overcome something great....and it's a good thing. But a lot of the time I feel really bad for people who are "lucky to be alive."

A few months ago on trauma a 23 year old was brought in by EMS after an electrical injury. The man was working near power lines and accidentally hit his head against a wire. He basically shocked his brain and literally blew off his face. It was one of the most horrible things I have ever seen. No bleeding, just a huge crater of a face. His cheeks, facial bones, nose, eyes, forehead....everything was gone up to his cranial vault. The rest of his burns or areas missing. His spinal cord was shocked too. We intubated him, resucitated him, and sent him to the ICU. I was for sure he was going to die. So was his family as they rushed into the er and lost their stomach contents as they saw their husband/son/brother lie there helpless and unrecognizable.

4 months later I started my Burn ICU rotation. Very sad floor. People with life altering, disfiguring, and disabling burns. My first patient was a man who was breathing by a trach (tube in the neck hooked up to a machine to help him breath). He had towels over his head. As I examined him, I removed the towels and discovered it was HIM. He was still alive. One side of his face had been covered up with a muscle from his back to close the area. Just covered...not shaped to a form of a face. He can't have a face transplant b/c he has no nerves. It was worse than I remembered. This time there were pictures of him and his family and kids all over the room. I try not to look at that. All I can do when I see him everyday is pray for him...and pray that he somehow has some kind of peace. His spinal cord.....still shocked. Can move his finger tips and toes...thats about it. And the worst part...he is completely cognitive. He can hear and understand everything.....and is helpless. I can't imagine being in that situation. Lying there without being able to move and without a face and eyes. Knowing you will never have one. Thinking about my quality of life and what my kids and family are going through. Is this guy really lucky to be alive??

There are so many cases like this. People burned from head to toe, nursing home patients who we refuse to let die, end stage cancers that have failed every treatment and trial getting sicker and sicker, etc. It costs millions medically, and that doesn't factor in the psychological burden on everyone involved.

Are we playing God by keeping people around to suffer? I don't get the purpose, but I also don't see how to change it in our society. Hospice and/or "letting someone go" has gotten a bad rap. It is not "PC" enough I guess. I am supposed to be a patient advocate, but a lot of the time I don't think I am able to advocate for what I feel is best.

ER doc


Just wanted to address a couple of comments we've received.

First of all, we will not be giving out any medical advice on here. Please do not ask questions, as we will not respond. Go see your personal physician.
Second, yes I have seen some political psychiatric fallout. Last fall, I had a patient whose first psychotic break occurred during the Republican National Convention. This was a mid 40s male. If I was a Republican, I might have freaked out too when McCain picked that airhead for his running mate.

Now for what this blog is supposed to be about - interesting medical tales with a sprinkling of what's messed up with today's health care system.
Yesterday, a female was brought to the hospital by EMS for a suicide attempt. Her blood sugar was a little high en route (200s) so they took her to the ER first. She wasn't seen in an urgent care bed, advanced triage, or even a short stay area. She was treated in one of the trauma bays, because the entire ER was full. This patient shouldn't have been taking up a trauma bed in my opinion. Keep in mind this is a brand new, 100 million dollar facility that was just completed. It is already at capacity. Where can we possibly put all these patients?
Now I never make fun of suicidality, but here is this lady's story when she got to psych.
"Why are you here today, ma'am?"
"I tried to commit suicide."
"Oh my gosh that is terrible. What did you do?"
"I tried to overdose on my pills but my boyfriend stopped me."
"Wow. How many pills did you take?"
"Oh, I didn't take any. But I was going to take three 800 mg Ibuprofen."

Just keepin' it real.


Monday, February 9, 2009

House of God

If you really want insight into what medicine is like day to day, then read "The House of God." It is an amazing book written in the 70s by a doctor going through his internships. The main lessons from it are that medicine is a painful journey. It seriously breaks us to the bone. It hurts physically and emotionally. Its like slowly developing a chronic "post traumatic stress syndrom." You learn how human you are. And if you aren't humbled daily, somethings wrong.
Also, people simply want to know what its like. I hear all the time from fam and friends, "so whats the craziest thing you have seen lately?" People want to know

In response to a message I received from someone I respect.....this blog is not meant to belittle others. It isn't "us" vs "them." In fact, the only reason "we" are working in this field is for "them." But life is funny. Medicine is funny. People are funny. But medicine also hurts...daily...and deep. We see deep into people's lives and deep into society, and honestly its scary. Bloggin about the funny things for others to read, complaining about the daily grind, and sharing the sadness to help ourselves heal might not be the best way to deal with it...but it is a way. People look for us for a fix of the things that plague them...and more often than not we can't help . Then, it's the same disappointing look in their eye that haunts you when you try to go to feel it in your stomach. We realize we don't cure...butthats what they want.

Last week towards the end of a long night, I cherry picked the chart rack for an easy case. Arm pain in a 27 year old...sounds easy. I examine the guy and it seems straight forward. Xray and out the door. But wait, its never that easy in the House of God. Xray shows a huge lytic lesion (cancer) thats obviously spread from somewhere else. I get to tell the young guy and his fiance that instead of getting a pain pill and going home, he gets to stay in the hospital while we find the cancer thats gonna kill him. Thats NOT funny. It sucks. That's some of the kind of stuff you will read here. SO excuse me if we also share the funniness of humanity that helps us get through the day as well. In the end, we end up loving the crazy patients with the funny stories...b/c they don't hurt.

ER Doc


A couple of one liners from recent patients.

"Why were you admitted to our unit?", I asked a 14-year old female on one of my first days on the adolescent unit.

Without even taking the time to ponder that question, she replied, "Because I can't stop f*cking."

The other night, in the emergency room, there was a 20-something black male in the waiting room for several hours, pacing back and forth, loud and verbose. Obviously he was manic or on some happy drugs. When the nurse brought him in for triage, she asked him if he was allergic to anything.

"Everything but pussy," he said.

Psych Doc

Sunday, February 8, 2009


This is the latest thing I have pulled out of someone's butt. It's pretty common. Always the same excuse too...."Doc I was constipated so I decided to put this in my butt to stimulate my bowels." Yeah sure, I bet that's not all your stimulating. Other things I have pulled out include: baseballs, dildo's, shotglass, cups, etc. This one, though, has to be most impressive.

--ER Doc