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Too old to do what? That is the question....

I see A LOT of very elderly patients. Most come from nursing homes, which is always challenging. I see many elderly patients who are very active. They are probably the most fun patients. They have a great outlook on life and are usually very humorous.

Fist patient to tell you about was a 71 year old female who came in for arm pain. She had an obvious forearm deformity. The X Rays were already taken before I saw her. She had a broken arm. "Ma'am, how did you injure your arm," I said. With a very straight face looking me straight in the eyes she replied, "I punched my granddaughter in the head." I immediately thought oh shit! I pictured having to call CPS and Adult Protective Services, getting this lady a geriatric eval for dementia, and all kinds of painful stuff. But then I asked her how old the girl was....thank god she was 18. And apparently, she deserved to be hit. I put her in a splint, and she said she was done boxing.

Second patient was a 71 year old male veteran. He came in for chest pain, and only because his PCP made him come in. He was convinced he was "healthy as a horse" and didn't need to be there. Chest pain questions are pretty routine. We always ask about alcohol, smoking, and drugs. Sometimes I feel bad asking seniors about drugs....like I am disrespecting them. For this gentleman: Smoking...NO. Alcohol...NO. Drugs...Not cocaine anymore, but marijuana...Yes. Ecstasy....Yes! I was obviously taken back. He said, "I probably got a bad blunt that made my chest hurt. I was around in the 60s and 70s, and it was second nature to use back then. Never felt the need to stop. Is that a problem, Doc?" He was admitted for his heart attack.

-ER Doc

More Rectal Fun...Homemade Pleasure

A 45 yo male arrived to ED walking with his legs wide apart and refusing to sit down in the triage chairs. Instead, he elected to stand up in a semi erect stance and demanded to see the doctor. The nurse wrote the following triage summary: "45 yo male in moderate distress here for a 2 day history of a homemade dildo in his rectum."

I have retrieved many objects from rectums including flashlights, apples, old spice bottles, glass bottles, and many lost commercial pleasure devices. This, however, was my first "homemade" device.

Sir, "I'm Doc Sensitive. How can I help you today?" Of course I knew exactly why he needed my help b/c I read the nurses notes.

The poor man was laying on his side and didn't want to face me... butt stated "Doc, I'm extremely embarrassed about this... but my girlfriend came over one night and told me she wanted to fulfill one of her fantansy's and brought over a plastic dildo she made herself and said that she wanted to have sex with my a**. So I was like, okay, why not. She then strapped it on to perform anal sex on me and all of a sudden she screamed out... 'Uh, I can't get it back out!'"

This guy had spent the prior TWO DAYS trying to remove it with various other foreign objects... including a spoon and a wrench, but was unsuccessful. He finally gave in and came to our hospital. The surgeons took him to the operating room, and they successfully removed a 12 inch first class homemade dildo. He left the hospital the next day without his girlfriend's dildo, or his manlihood.

-Doc Sensitive

PS: For more posts like these, check out our "Most Popular Posts" section on the right and look for titles about Rectal Fun

Snake Bite

A 25 year old disheveled male arrived to the ER and handed me a piece of paper with the following written in messy handwriting: "A snake bit my dick."

I laughed in my head and and said, "Sir, why do you think a snake bit your penis?"

He anxiously replied, "Because it burns and has two things that look like snake fangs!"

I then proceeded to look at his penis and quickly identified the lesions as herpes. I told him that he was not bitten by a snake, but infected with a STD that is passed on by unprotected intercourse and it would require antiviral medications for his whole life.

I asked if he had any questions. He replied, "Do you know what kind of snake bit me?"

He was not going to be convinced! I attempted two more times to explain what an STD was and how it was treated. I gave him a script for acyclovir and told him to follow up with the health department. I also advised him to stay away from that snake that bit him.

-Doc Sensitive

Close to Home

Special treat tonight. Psych Doc times 2.

Had a really unique scenario in clinic yesterday. Was looking at my afternoon schedule and I recognized a name that I know from long ago. I saw this guy's name and it was associated to a memory of his face and some relation to my life 15-20 years ago. I check in the waiting room and it's the same guy I pictured. I think I probably played ball against him in high school or something. Very weird cuz my residency is 350 miles from where I grew up.

I spoke to the nurse and she agreed to let another physician treat him.

I am interested to hear from other health care professionals, including nurses, doctors, and others. Have you ever treated a patient that you know (even very superficially) from an external environment? In psych, avoiding this scenario is pretty standard, due to countertransference/confidentiality issues, etc. But I wonder how others handle it.

Political sidenote. Usually my colleague is more vocal than I. But I gotta say something about Rush Limbaugh. He said we shouldn't donate to Haiti relief because 1) the contributions will probably be filtered through and used by the democratic party and 2) Obama is only supporting Haiti in order to unite light skinned with dark skinned blacks. Also, Pat Robertson says that Haiti is being punished because they made a deal with the devil. Look, I am a simple, very white Christian redneck, and these are some of the most offensive things I have ever heard. What is America supposed to do? Nothing?

Sports sidenote. I love the NBA. Former season ticket holder for 2 years (team to remain un-named). I love guns (owned them more than 20 years.) That said, what are you thinking, Gilbert Arenas? If a normal, non-NBA person brought a gun to the stadium, they would be screwed. If you want to keep them away from your kids, buy a safe. Don't take them to work. Just dumb.
Peace and Love, people.
-Psych Doc

Psych ER

Okay, this is a couple weeks late, but let me report on a recent psych ER shift. 12/27/09. Sunday. 2 Days after Christmas. Most Americans are at church, watching NFL, etc. Let me describe for you a few exciting patients who all came in during my shift.
1. Lady who swears she is pregnant with Obama's twin babies. Funny thing is, she is 72 years old.
2. Different female, running away from California because a group of Satan worshippers led by Ozzy Osbourne are harrassing her.
2. Asian female, found passed out in a shopping center. When she woke up, she told me all about how she was involved in 9/11 and Columbine. She begged me to please lock her up and commit her because she wasn't safe in her apartment. The people involved in Columbine were tapping her phone and trying to kill her. She was a little apprehensive about hospitalization though. "Everytime I go into the hospital, people who I don't know are killed." I thought, "Wow. That happens even if I'm not in the hospital."

4. Young White male, brought in for "kicking my dad's ass." Also threatened to drive himself into the lake and he interrupted a church service shouting"The Christ has come, bitches." He was oriented to time "Boxing Day", which I think may have been correct. He knew the date, but then said," It's December 27 here. But what about the other side of that pole. What about on that TV right there? Is it illegal if someone drops all of your belongings in the middle of the ocean?"

I have heard stories about some academic psych programs that get excited if they see a couple of schizophrenic patients during their entire residency. Yeah, I'm talkin' to you Yale and Harvard. ADLAC. That's All Day Long At County, Bitches.

-Psych Doc

Placebo

Placebo:

a. A substance containing no medication and prescribed or given to reinforce a patient's expectation to get well.

b. An inactive substance or preparation used as a control in an experiment or test to determine the effectiveness of a medicinal drug.

C. Something of no intrinsic remedial value that is used to appease or reassure another.

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A 27 year old male came in from the psych ER for eval of seizures. He was brought in by police for psychotic behavior. The psych ER called and asked for help b/c he "was in status" and wouldn't stop seizing.

I have seen some really interesting seizures in the past. Some will even fake urinating on themselves. This guy was great. He did make his whole body shake...but the rhythm was sooo organized it was obviously not seizure activity. But the biggest issue was his face. This guy would talk to you and look at you during his "seizures." He would jerk all over, and during the shaking would say "Look...it's happening to me! This is a bad seizure huh?"

After his seizures temporarily stopped...we had a discussion about his seizure meds. He said no meds would work on him. He tried them all. Dilantin didn't work, or Keppra.......nothing in my PDR.

"Sir, what then does help you?" I said.

"There is only 1 drug that helps me. It is secretive. It is an experimental drug in phase 5 research trials" he said.

Even though I knew this guy was FOS....he had my attention. "What is the name of it?"

He said, "The name of it is called... Placebo. Placebo is the only seizure medicine that can help me. I have been off of it b/c they kicked me out of the trial. Now I am in withdrawl."

I promptly got a Tylenol tab, told him it was Placebo, watched his seizures melt away, and sent him back to the psych ER.

CHECK OUT THIS GREAT VIDEO ABOUT PATIENT FAKING A SEIZURE!!! http://www.youtube.com/watch?v=_m64cy1MMPg

-ER Doc

The Not So Great Escape

Being the county hospital, we see all of the jail patients. The patient in this story was an illegal immigrant male from Mexico. Like all jail patients, his hands and feet were cuffed. During his stay he needed to use the bathroom. The standard procedure is that the officers walk the inmate to the bathroom and stand outside. They are not uncuffed.

After ten minutes of this patient in the bathroom...we started asking questions. Was he OK? We have had many patients vagal or even code in the bathroom. So we asked the officers to check on him. They knocked on the door.....no response.

About the same time, we started hearing a noise across the ER...about 40 yards from the bathroom. It hit us all about the same time....then.... CRASH!!! The crafty jailbird came flying down. You have to give him props. With his hands and his feet cuffed...this guy stood on the toilet, made a hole in the bathroom ceiling, climbed through it, and almost escaped! Below are the pictures. The first is the bathroom. The second is the ceiling he fell through.

I knew they were good swimmers....but didn't know about the climbing skills!! (I'm Hispanic myself so I can say that.)

-ER Doc