Monday, July 27, 2009
Tuesday, July 21, 2009
Sunday, July 19, 2009
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.
Tuesday, July 14, 2009
Friday, July 10, 2009
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.
Thursday, July 9, 2009
Monday, July 6, 2009
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."
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!"
Thursday, July 2, 2009
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.