Tuesday, June 30, 2009

Michael Mania

I have never seen such an outpouring of emotions over the death of a weirdo. Don't get me wrong....Im a big fan and love the music.....but people are freaking out. The night of MJ's death....we had two BBFs and one skinny little white guy actually call the ambulance to go the the ER b/c they "couldn't catch their breath" after hearing about the death of Michael Jackson. They all required anti anxiety meds. I wanted to send them all to psych.

A couple of good Michael Jackson jokes I have heard recently:

1) When Farrah Fosset made it to the Pearly Gates, Saint Peter asked her what one wish he could grant her for her life of good deeds. She asked only that all the children in the world be safe. So he killed Michael Jackson

2) Michael Jackson hasn't been this stiff since being in bed with Macaulay Culkin.

Feel free to post more Michael Jackson Jokes in the comment section. Hee Hee

-ER Doc

Friday, June 26, 2009

Captain Clue Cell

I was a very green 3rd year med student starting a family medicine rotation when I was tasked with doing a pelvic exam on an enormous female. She was at least 300 pounds with fat rolls that could compete in a baking contest. She was there because she was having sex and her partner's condom fell off inside her and they could not find it. It was an enormous undertaking even for an experienced doctor, but I was very confident that I could remove the object.

The nurse helped Thunder Rolls down onto the exam table and then called in another nurse to hold the fat away from the vaginal vault. Upon removing the large pannus (fat roll), I got a whiff of rotten fish and almost puked. I then grabbed the largest speculum in the room. I lubed it up and dove in like an experienced crane operator. I got into the vault and saw nothing but pure human flesh. It was like a black hole, and I fished around with the speculum and followed the smelly trail to the back of the vagina.

Hell yes, there it was! I reached in like a fool with some forceps and pulled. As I pulled, however, it was adhered to the back of the vagina. So I pull harder, and then it gave way to a flying condom with smelly mucous that lands across my feet and sprays my eyes. I wanted to quit medicine at the moment. I wasn't sure if I should grab alcohol pads, water, soap, or eye drops. I got up and copiously irrigated my eyes. Thankfully, the patient only had clue cells which meant she had benign bacterial vaginosis. From then on, I was known as Captain Clue Cell. .

-Doc Sensitive

Monday, June 22, 2009

Tastes Like Chicken

A 37 year old women came in with abdominal pain and fever. Whenever a female comes in with this complaint we have to do a "female exam" to make sure there isn't a vaginal problem that could be causing this. Sure enough, her cervix was tender and she had a discharge. After sending some labs....it came back as Trich. I informed the patient of her diagnosis and her need of antibiotics. She asked is there anyway to "make her better without getting rid of the discharge?" Puzzled....I told her no and asked her why. She replied "Because my husband really likes the way it tastes and has been spending a lot of time down there."

I almost threw up.

-ER Doc

Tuesday, June 16, 2009

Morning Salute

A 56 yo male arrived to the ED walking with a bent over, shuffling gait. I asked the nurse "What's that guy here with?" The charge nurse said that he has had an erection for over 24 hours! I was a little puzzled because most sustained erections, or priapism, are associated with Sickle Cell Disease in African Americans... and this guy was a white male- kind of odd.

I knew this would be interesting so I went right into the room.

"Sir, I am Doc Sensitive. How can I help you today?"

This poor guy said, "Two women talked me into injecting 2cc's of this drug called TriMix into my penis last night to get an erection, and it hasn't gone away!"

I continued my history... "Sir was this your prescription? Do you have problems with erections?"

The man, a little embarrased said, "No, it wasn't my prescription. I just did it for sexual enhancement. I wanted to get really hard and last a long time like a porn star."

At that point, I almost started laughing but maintained my composure. I told him that I would have to call the urologist after a quick look down under. The gentlemen took down his underwear. Let's just say that stuff worked rather well because it would give John Holmes a run for his money. There was at full salute pointing right at me. It was obviously very painful because he was grimacing. I left the room and called the urologist.

According to the urologist, TriMix contains three drugs that work in concert to engorge the penis. It can potentially cause permanent damage if someone's erection lasts longer than 4 hours. The urologist came in and stuck a large needle into the engorged monster and drained it.
He said there was a chance that the patient would never have another erection again b/c there could be permanent ischemia- no more morning salutes!

-Doc Sensitive

Sunday, June 14, 2009

Popped Brain

A 45 yo female arrived by ambulance with her two sons with a chief complaint "she's not right." I arrived into the room with 3 med students and began my assessment. First, I asked the sons about her medical history and the events leading up to her "not being right." The sons stated that she has no medical problems, takes no medicines, and was last seen acting normal earlier that day. When they arrived home later that evening, the bedroom door was locked, and their mother was screaming for help. They broke down the door to get in and found her in bed screaming for help with her nightgown on.There were no signs of a trauma or blood anywhere. They then called "911" for help.
I examined the patient and started with the head and shouted to the medical students who were helping document. "Ears clear, pupils reactive 3-->2 but sluggish, mouth clear." When I examined her head, I felt around the top of skull and felt something squishy. I then moved over the light and tried to get a better look. Unfortunately her hair was covering the area. I shouted, "Okay I feel a large skull defect but no bleeding or bone fragments." The last time I felt something like that was during neuroanatomy in med school.... but surely it couldn't be brain! I then poked it a couple more times and she screamed "Ouch, ouch!" both times.

I screamed out, "Well guys, this feels like brain!" The entire room feel silent and the medical students thought I was crazy. One med student said "but there's no blood or bone fragments or trauma anywhere on the patient." I said, "I know, it doesn't make sense."

I ordered a CT scan of her brain and sure enough, she had a large skull defect with brain coming out! She had a bacterial brain abscess which ate her skull from the inside which explained why no bone fragments were found. When the abscess got big enough, it ruptured causing her to faint. She then fell exactly on the spot of the abscess and popped her brain! She ended up returning to work without any long term complications.

-Doc Sensitive

Wednesday, June 10, 2009

Out of Trees

A 30-something guy walks into my office.

"What brings you in today?" I ask.
"I ran out of trees," he says. Then pauses.
I say, "Tell me more about that."
"I don't have any more trees to chop down."
He pauses again. He's nervous. Enough of the open-ended stuff. "Sir, can you please explain to me why you're in the psychiatric ER?"
"I used to have a lot of trees in my back yard. I used my axe to chop them all down. The voices told me to chop up people, but I figured it was better to chop down trees instead. Now I'm out of trees, and I'm worried about what I will do next."
He pauses again, then says, "Could this be because I stopped taking my Risperdal 6 months ago?"

-Psych Doc

Tuesday, June 9, 2009


One of my least favorite chief complaints is "rash." The other day a middle aged female told me "I think I have fleas in my bush." Trying to keep a straight face, I asked her to explain further. She states that her cats had fleas, and now her crotch itches so she is worried she had fleas down there. She said she "shaved her bush" but that it still itched. I stayed professional, had the nurse come in and chaperone the exam, and went searching for fleas. Everything looked ok to me. I told her I didn't see any fleas or other rashes, but she kept grabbing and pulling at herself to show me where she thought the fleas were. In the end...I gave her a cream and reassured her that there were no fleas.

Of course on my way out....she asked me for a month's supply of Ambien with refills b/c she couldn't sleep with all the itching. Yeah right. I wanted to tell her to get a damn flea collar.

-ER Doc

Thursday, June 4, 2009

Torn From The Inside

A 58 yo male came to the ER accompanied by a scantily clad female in high heels. He was complaining of excruciating lower back pain that began suddenly in his hotel room. The married business man (very honest guy btw) was in town for a conference and was apparently lonely. He said he picked up a prostitute, and she was on top of him during sex when "his lower back when out." He stated the pain was ripping and causing his right lower leg to feel cold and numb.

When I evaluated him, he was diaphoretic (sweating) and unable to move is right leg. His right leg was cold without distal pulses. We immediately suspected that the prostitute ripped him from the inside causing a ruptured abdominal artery. However, the CT scan illustrated a Type A aortic dissection that ripped from the chest all the way down to the common illiacs (the aortic seperates into two vessels at the bottom of your stomach). This is a deadly thing to have. Though he was still communicating, the blood supply to his spinal canal, one kidney, and heart were being compromised.

When I told him the bad news and that he would need life saving surgery, he called his wife at home to tell her that "his big vessel in his chest and belly were tearing. " Of course, he left off the major story of how it happened! The patient was admitted to the ICU and was scheduled for an aortic repair, but died of cardiac failure shortly after admission.

When I was leaving the ER, one of my fellow collegues said "Hey, did you get that lady's number? I hear she can really f**k!? I shook my head in sadness for everyone that day.

-Doc Sensitive