Rabbit

As a 3rd year medical student I was learning how to properly insert Foley catheters. I was green and really didn't pay close attention during the teaching labs because we used fake penis's and vaginas.

One of my first rotations as a 3rd year was in psychiatry, and a patient developed urinary retention from her psychiatric medications and needed a Foley. I was very excited because this was my first "live patient." I entered the room and saw a 40 something patient holding a stuffed rabbit, petting it, and talking to it. So I stepped up to the patient, and the nurse handed me the kit. I placed the lube on the end of the Foley and spread the vaginal lips and pushed the foley into the "proper hole." I continued pressing and then used my fingers to get a better look. As I continued using my fingers, I noticed the patient moaning....so thought I was hurting her. I continued trying to insert the foley but kept finding resistance. As I pressed, the patient moaned to her rabbit. The nurses started laughing. I continued to struggle but finally asked the nurses, "Okay, this is my first Foley... why is this not going in?" The nurse said, "Student Doctor Sensitive, you are rubbing her clitoris and she seems to be enjoying it." The nurse then grabbed maneuvered hand to the urethra, and it went in without a problem. It was embarrassing for inadvertentlystroking her rabbit....but at least I made a patient happy for once!

-Doc Sensitive

Wooo Wooo Rocket Lube

Monday morning....9 AM. Call from EMS was they were en route with a 33 year old male who was uncontrollable. When they arrived, there were 4 police officers holding this man down. He was shaped average, white, and wearing only boxers. His eyes were wide open and he kept screaming "Wooo, Wooo Rocket Lube" as the cops kept trying to hold him down.

Here is what EMS said. "We got called about an unruly man in his apartment. The call was from a man he met an hour before on the internet. When the man showed up at his apartment to do whatever they were going to do, he said his new friend was flipping out. When we showed up, he was jumping uncontrollably on the bed screaming like he is now. There were candles lit and bottles of Rocket Lube were everywhere."

We started bolusing the guy with ativan to try an calm him down. He had 4 cops and 4 techs all holding him down, and restraints on every extremity. It became too much. After 50 mg of ativan he was still uncontrollable, so we induced a medical coma and intubated him. After he was intubated the nurses started to put a foley in. When they removed his boxers...the man was wearing 2 rubber cock rings!

Monday morning mind you....

So ten minutes later this guy was up bucking the vent and almost breaking through the restraints. Long story short...to keep him sedated he ended up needing a propofol drip at 100mcg/min, ativan 40mg/hr, and fentanyl 200mcg/hr. This is an unbelievable amount of drugs just to keep someone sedated. A normal person would die from a fraction of this. I was astonished. His drug scream was + for Methamphetamines. I've never seen a meth case like that before. Hope I don't again.

Monday morning....unbelievable.

-ER Doc

Deja Vu

Yesterday I had a guy come in who tried to kill himself by an attempted overdose. Run of the mill for our ER....except his name was Michael Jackson and he was 50 years old!! It was creepy seeing that on the board. Even more ironic....he was white too? This guys drug of choice was seroquel (antipyschotic), though. His OD was non toxic and I eventually transferred him to psych.

I had another lady come in by ambulance about 50 years old. Her goatee was thicker than mine. I try to see the ambulance patients right away to help the nurse decide if they need a bed or can go to the waiting room. This lady was freaking out. Screaming to me she needed her pants off. I asked her why, and she said b/c of all the itching in her legs, vagina, butt, and stomach. Then she told me how the worms were crawling out of her and started screaming. She kept trying to get her clothes off...which would have been devastating to everyone around. She had many other weird complaints, like discharge from her anus.

Being in such a big hospital....we have a separate ER for female (ob/gyn) issues. I begged the paramedics to take her to that section and only to mention the vag itching as the chief complaint. It was my 11th hour and I couldn't hand that kind of crazy right then. About 20 minutes later the female ER called to send her to us. They said they checked her out and the itching was from the patient pooping all over herself. I accepted her...then assigned her to the intern. She eventually ended up in psych as well.

Disaster averted!

-ER Doc

Squatting

I do some moonlighting for a local urgent care group. Here is an email that was sent out recently regarding a patient that had been making his way around the clinics. Goes to show ya even in the private sector you the weirdos will find you...

"This patient has been to several clinics requesting physicals from female doctors and midlevels. Specifically, he is requesting rectal exams while squatting. Dr. X has confirmed the phone number he gave us is not a working number. Please do not examine him."

Here's to you...Mr. Squatting while using your insurance copay to get off man.

-ER Doc

Clinic Fun

Okay, I know I've been slacking off lately. Maybe it's because I'm in clinic now, so there's not quite as many crazy ER stories. In clinic, the craziness and irrationality is still present, but on a smaller scale. Just thought I would provide some anecdotes from one week of working in an outpatient psych clinic for the county.

One day a week is child/adolescent clinic. Every other patient is a photocopy of this one. 7-10 year old boy comes in with mom. Mom complains that kid is acting up in school, getting into fights, suspended, etc. At home, he throws telephones and potted plants while calling mom the "C"- word. Dad has been in prison all the kids life. Mom never re-married but has had some boyfriends. Mom wants to throw some mind - altering drugs down the kid's throat and hope everything gets better.

Last week, I'm seeing a followup. 50-ish white female with anxiety after a near fatal car wreck that put her in a coma for a few weeks. She had on a T-shirt that said "pimpjuice" and that's all I could think of during the entire visit. I didn't know until today when I was looking for a graphic that it is an energy drink, a Nelly song, etc. If you have anxiety/depression and you think your life sucks, then take life seriously and throw away the dumb t-shirts. Just my opinion.

Yesterday, I was reading through a lady's new-patient questionnaire. She mentioned that she had trouble controlling her "dietbetes". I asked her what that meant and she said, "It's because of the insulin. If I don't eat, I feel bad. So I have to eat more than I should so the insulin doesn't make me crash. I've gained 50 pounds since I got diabetes." I guess she never thought of just taking less insulin. Or she has a crappy doctor (in addition to me).

Also yesterday, a 400+ pound guy comes in for a pain management referral. Basically the pain management docs want a psychiatrist's "street smart" opinion as to whether the person might have potential for narcotic abuse or addiction. On this guy's self-reported review of systems, he wrote down "can't masturbate". I understand that this is a quality of life issue but I asked what that has to do with chronic pain and he said, "Oh nothing to do with pain, I just can't reach down there anymore. Also, I can't wipe my own ass." The guy lives with his 80 year old mother and no one else. I did not ask him who actually does the wiping.

-Psych Doc

Dehydrated

I had to share this one. I went to pick up the next patient on the board and say "dehydrated" as the chief complaint. Sounded easy enough. Then I read the nurses triage sheet. Here is what I read word for word.

Pt was picked up at the Grey Hound bus station by police after calling 911 for an ambulance for "dehydration". Pt wearing only a dirty t-shirt and tennis shoes, smelly badly. Pt has flight of conversations and states "I need to be seen for dehydration and hypertension. I am hard of hearing and that is why I talk so loud, usually most lesbians do. My boyfriend has helped me to overcome my depression and I think my bone structure has changed. I am 37 years old...I know I look 14, i try to stay young. I am really dehydrated. I've been drinking plenties of water aid and keeping the AC at 60 but it still runs and I'm not sweating down there so I'm dehydrated." Pt has steady gait, A&Ox4. Answers questions appropriately. Pt was seen in the ER yesterday in the am and discharged as they decided she was not dehydrated.

Manic is a great drug.

-ER Doc

Chocking the Chicken

When I was an intern on trauma surgery, a 44 yo intoxicated male was admitted after sustaining some injuries in a motor vehicle crash. The patient was admitted overnight because he had some abdominal pain and was too intoxicated to clear neck from any damage. He was placed in a cervical collar to immobilize his neck, and the plan was to reexamine him the next morning when he was sober

The next morning we were on rounds with the attending physician. In our group was a very naive and innocent medical student who was tasked with presenting the patient in rounds. The medical student went into the typical "44 yo intoxicated male here after MVC sustaining blah blah."

After the presentation, the entire trauma followed the student into the patient's room to evaluate him. The room was shared with another old man. As we followed her in, the student turned bright red and opened her mouth in absolute astonishment. We then saw"Mr. intoxicated" in his cervical collar butt naked with his legs spread across hospital bed.... jerking off. The guy couldn't even see his penis b/c the c collar was on so he couldn't flex his neck, but he kept jamming away when everyone came into the room (no punn intended). The old man next to him looked so white we thought he may be dead.

The attending looked at the spectacle and said "Looks like Mr. Intoxication is feeling well and tolerating normal daily activities. Please discharge him." I ran out of the room laughing down the hallway.

The poor medical student couldn't look at us for the rest of the month. Hopefully Mr. Intoxicated was discharged with an accurate discharge summary.... "Pt on day of discharge was in good spirits, tolerating a good jerk off session!"

-Doc sensitive

Nail Head

A 34 year old male came to the ER stating he had a nail in his head and that he needed taken out. He was a little swollen and red above his right eye. A summary of our exchange is as follows:

ER Doc: "Why do you think you have a nail in your head."

Him: "Well....I was working on my roof a week ago and the nail gun misfired and my head hurt afterwards."

ER Doc: "A week ago...surely you would have known sooner than a week later that you have a nail in your head. Are you in any pain now?"

Him: "No just feel like I have something stuck above my right eye."

ER Doc: "Well we can do a CT scan to find out."

Him: "I know its there Doc. I didn't think so but my wife kept saying it was. So she put a magnet to my forehead and it stuck there. See! "

He then pulled a magnet out and sure enough it stuck! The above pic is his actual radiograph. It was lodged just touching his frontal lobe. Neursurgery took him to the OR the next day.

-ER Doc