Tuesday, March 31, 2009

Chief complaint of the week

A lot of times, people with mania or psychosis believe that a famous person is in love with them. I'm sure that the specific objects of infatuation vary depending what region you live in. The president (and former president) is pretty common. Around here, so is a certain pro quarterback and his pop-star/reality-star/actress girlfriend who may or may not have a weight problem.

Last week, a young male was brought in for running naked in the streets. (See my post from a while back. I told you all it was common.) Among many other things, he told me, "(Pop star girl) was talking to me through the television. She said she loves me and we'll be married soon. Then she just kept handing me Christmas presents. I think they were Lifesavers."

Three days later, he put shaving cream all over his body, then walked out into the lounge on the psych unit with a paper cup in his hand. He proceeded to urinate into the cup, then drank it.

Bet you never saw that on Newlyweds.

-Psych Doc

Only In The Country...

Pretty amazing story.....
At the local children's hospital last week, we got a call about an incoming trauma from a outlying small town city. A mother and son were driving home from school. They were in a truck. The 11 year old boy was in the back seat of the truck. In the bed of the truck was a 5 foot crowbar. Before this event, I had no clue what a crowbar was. Apparently it is a huge, heavy metal bar with a sharp end. It weighed about 65 pounds.
While parked at a red light, a car rear ended them from behind. The pry bar went THROUGH the back of the car, THROUGH the boys backpack (with 3 textbooks in it), THROUGH his back and out of his stomach, then THROUGH his thigh (his legs were sitting up on the seat), THROUGH the front seat, and INTO his mother's back! The mom was able to get free, but it took firefighters and paramedics about 2 hours to get the boy free. They cut the bars length, but it was still going through his back and then through his legs. Amazingly, he was quiet stable. He was a little hefty, so it mostly when through the side fat of his back. We stabalized him in the ER and he was off to surgery. Last I checked, mother and son were doing great.

-ER Doc

Sunday, March 22, 2009


There are many stereotypes in medicine. We see so many people each day you start to recognize patterns. None is more true than for Hispanics (warning....don't get too offended b/c I myself am one).

Hispanic men and women tend to be very dramatic. Sometimes it's hard finding their disease through all the drama. When they come in to the hospital....all 18 children and brothers and sisters are in the waiting room on their cell phones updating the rest of the family. You have to let the Hispanic patient tell you their symptoms. If you ask do you feel ____, they will ALWAYS say yes. It is very common for a Hispanic person to have a complaint for every part of their body on one single visit. I have NEVER had a Hispanic patient without "chills" and "numbness and tingling" in their fingers and toes....no matter what the underlying complaint was. In addition to standard treatment, I generally throw in a medicine like valium no matter what the complaint. Sometimes I use it alone. For the Hispanic patient, it has done wonders in treating headaches, toe pain, heart attacks, etc. For some reason Hispanic people always poor rubbing alcohol on their loved ones before taking them to the hospital in an attempt to treat them....I haven't figured this one out yet.

So....in medical conversation we have come up with many different phrases and euphemisms to describe our beloved Hispanic patients. Below are our favorites from emergency and psychiatric medicine

1) TMD- Stands for "total me duele." Used to describe the Hispanic patient who has more than 3 organ system or body parts that hurt. A good sign that nothing serious is going on

2) Aye Attack- The room will be dead silent....until the doctor walks by. Then many different pitches and streaks of "AYE, AYE DOCTOR ME DUELE" can be heard across the department. If this is repeated more than 2 times, it is known as an Aye attack. Another good sign nothing serious is going on.

3) A bipolar hispanic person = A Manic Hispanic

4) A Hispanic who is OCD over cleaning = A Spic and Spanic

5) Hispanic Panic- This simply is a descriptor of normal Hispanic anxiety

6) AMA- in the Hispanic population this is not the normal AMA (against medical advice). It stands for Acute Mexican Attack. This is a couple notches higher than regular Hispanic panic

7) SMA- no...not the superior mesenteric artery. If the patient has the normal AMA, but is also clinically psychotic....this is known as a Severe Mexican Attack.

8) Wetback Setback- If the Hispanic patient needs to be hospitalized

9) Status Hispanicus- status epilepticus is basically a grand mal seizure not responding to meds. Status Hispanicus is similar, except there is no seizure is involved. Basically the Hispanic patient is freaking out enough, screaming, crying, with wailing of the arms and legs for no organic reason. Since he/she does not respond to verbal redirection, he patient is usually placed into a resuscitation room and given LOTS of valium until tranquelized to the normal Hispanic panic (see #5)

10) Hispanic person who hasn't showered in 2 weeks and who sees the Virgin Mary in things like peanut butter and dirty skillets = NORMAL

-ER Doc/Psych Doc

Sunday, March 15, 2009

Chief Complaint of the Day

For her reason to visit the ER, the patient wrote "I have an abscess in my vagina that squirts pus out when I squeeze it. Also, I think I got scabies from my baby." Quality mom....

ER Doc

Wednesday, March 11, 2009

Don't Swallow Your Gum!

A 33 year old female came in with abdominal pain, nausea, and vomiting. This is a VERY common complaint. Hard to even get interested any more. This patient, though, seemed very uncomfortable. Her stomach was very rigid. She had the picture of what we call an acute abdomen....meaning something might have perforated inside needing emergent surgery. She had no risk factors for this, though, so it was still a long shot.

Sure enough, xrays showed and intestinal obstruction requiring surgery. The surgeons were baffled as well b/c we could not come up for a reason why should would have this. Maybe it was cancer?? Nope. A couple of hours later the surgeons came down to tell me what they found.....a huge glob of gum completely obstructing the intestines. Since ice and peanut butter wouldn't get the gum out, they had to resect that part of her intestines and make a temporary colostomy (poop bag).

They don't teach you this in med school. I always figured it was a myth. Guess not.

ER Doc

Thursday, March 5, 2009

Fun With Foley's!

Foley catheters are thin, long tubes that are inserted to the urethra to drain the bladder. One end stays in the bladder, and the other is connected to a bag on the outside of the body for the urine to go into. Usually these are placed temporarily. Sometimes they are placed for prolonged periods of time and can be strapped onto a patient's leg for them to go home with

I picked up a chart with the chief complaint of "Change Foley." It struck me as strange as this is not an emergency department complaint or issue. I went to see the patient....a very strange white women in her 7o's, wheeling around to and fro in her wheelchair wearing. She was wearing a ratty old robe that was dragging on the ground. Her hair resembled Einstein's, and she had a fair amount of silver facial hair prickling out of her chin. Her husband had no teeth and never stopped talking, although his words were incomprehensible. These 2 were serving as great entertainment for the rest of our crazy patients.

I asked her what she came to the ER for. "To get a new foley. Put one in now Im ready for it," she screeched. I asked her why she needed one...and she didn't know. I asked her what happened to her old one, and she said she took it out. So....I asked her why and when she took it out. She said she took it out when she got to the ER so she could get a new one. I said ok and that I would be right back.

The nurses ran to me and all screamed that they weren't changing that crazy ladies foley again. They explained to me that she "get's her jolley's" from having her foley changed. She comes to the ER to go into a room with a nurse, expose herself, and help change the foley. They said she prefers male nurses, would spread her labia herself, extend a finger to her happy place, and moan and groan while the nurse would insert the foley. She loved "helping" during the insertion. It was the grossest thing I ever heard.

At first I tried to be a tough doc and refuse to give in. But this lady would follow me in her wheel chair while I saw other patients and screem at me to change the damn foley. Her husband was right behind her mumbling like the coach from The Water Boy. I had a department full of patients and didn't have time for this crap, so eventually I gave in and sent her to a room. Then...I couldn't find a nurse to do the job. I had to find a neive nursing student, give her the order, and NOT, tell her what she was about to get into.

I listened on the other side of the door as the student nurse gave this demented old hag what she wanted. Sure enough it sounded like some sick porn in there. The old lady left satisfied, and I haven't seen the student nurse back.

ER Doc

Sunday, March 1, 2009

Black History Month

Psychosis can have many themes. It can involve the FBI or other government agencies, super powers, ESP, or hyper-religiosity to name a few. Race is sometimes involved, and this past month was no different. Here are 3 brief stories.

1. A guy called me and said, "Can I come up there and get my psych meds? I usually go to the VA (Veteran's Administration clinic), but ever since we got that Muslim president, I can't get my meds."

2. I was doing an interview with a patient and inquired about his family history. "Well, my dad was arrested for lynching freed slaves." Funny thing is, the patient is a black man.

3. The police bring in a guy laying on a gurney with a red blanket completely covering his body, except I see a huge Afro and a bandana on his head. Looked like a cross between Jimi Hendrix at Woodstock and the black guy on Guitar Hero. He was barking like a dog. Then I noticed his feet sticking out from under the blanket. He had written WOOF WOOF on his feet and legs. And his skin was white!

The blanket came off and he finally stopped barking. He was telling our black staff members, "Look at my skin. It's the same color as yours. We need to get out of this state, because they will hang n****** like us down here." He told me I needed to go to a plastic surgeon and get horns implanted into my head so I would look like the white devil that I truly am.

He claimed to have had 50 surgeries on his groin, 30 of them at our hospital, for a gunshot wound. We were trying to do the safety search, and he kept saying, "You all just want to see my big black dick." The psych tech asked him how big, and he said "All the way down to my nutsack."

Meth is a helluva drug.

Psych Doc