Diability

Patient's frequently come to the ER with different forms they want filled out. In the ER, we do not really fill these forms out. They are usually for monetary purposes....disability, workman's comp, social security, etc. It is not proper for an ER doc to fill these out when we don't know the patient and will never see them again. If you come to the ER with these papers, we usually suspect it is something frivolous.....bc most patients that have these forms actually have a doctor who will do this for them. They don't need an ER doc they have never met before.

This patient was a real winner. Here is a copy of his chief complaint and nursing note

CC-

Pt here with c/o having back pain for last 30 days. Pt states "I'm a mental health patient and I'm trying to get diablility for my back because I deserve it". Pt then said he would need to get some medications so he can convince social security that he needed diability

So of course I said no and explained why it was inappropriate. He was upset, but agreed to go as long as I gave him a supply "of those 10/650's" (strong Vicodin). I said no again. The patient became belligerent, was screaming, and tried to attack me and the staff. The police arrested him and took him to jail. The jail promptly sent him back b/c his blood pressure was "high." It was only like 160/95 and they had a doc there. They just didn't want to deal with him....so guess who got to again!

-ER Doc

Dumb, Dumber, and Dumbest

Here are a few dumbest snake incidents I have seen:

Patient 1: Snake bit his thumb. How you might ask?? Well...he was clever enough to get the snake in a 2 liter coke bottle...but he couldn't find the lid to the coke bottle. So instead he used his thumb to cover the top of the bottle. Didn't take the snake long to bite his finger. I noticed he was missing the tip of his thumb on the other hand. Why?? B/c he had done the SAME EXACT thing in the past. Idiot.

Patient 2: This time a female stops on the side of the road b/c she saw a cool looking snake. She grabbed a long stick and decides to poke it. I have no clue why.......bc she was dying from the venom after being bit and I had to put her on a ventilator.

Patient 3: This guy caught the snake, picked it up, and was holding it in the air. With his other hand, he pulled out his gun and tried to shoot the snake. Let's just say he missed the snake...but got his brother in the shoulder.

For some reason all the patients I see bit by snakes are white, have less teeth than the snake, wear cut off tee shirts with the confederate flag on it, live in a trailer, and have a relative named Bubba. Irony I guess. "Emergency Medicine, defying natural selection one patient at a time."

-ER Doc

See Doc Sensitive's old post on a snake bite here

White Coat's Call Room Post

Here's a link to a funny post on White Coat's Blog (The Medications Worked). It sounds all too familiar. I hate it when the police bring back patients like this just for acting a fool.

-ER Doc

Ouch!

I think the picture says it all. I did a digital block to anesthetize the finger then pulled it out pretty easily. No major damage, but made for a great pic.

-ER Doc

Does Your 12 Year Old Little Girl Shave??

If yes.....start asking questions. This 12 year old girl came in b/c she had itchiness to her vagina and vaginal discharge. My first thought was it was probably just a yeast infection. But no....the history proved otherwise.

She stated that she has been shaving her private area with old razors. So medically, she could have cut herself with a dirty razor and got a skin infection. But my duty was to ask, "Why at 12 years old are you shaving down there?" The answer.....b/c she was already having sex! She looked no older than 10 years old, very immature, and was already sexually active with a florid STD. All of this was said in front of her Aunt, and Auntie didn't seem too surprised.

Very sad. Not to mention against the law. The SANE nurse was contacted as well as CPS.

-ER Doc

Only in the Country: Sunshine

A 26 year old male came in by EMS after an attempted suicide. The report over the radio was that the patient was combative after a standoff at his house with police. He arrived to the ER at 12:30 PM. Supposedly he had taken 40 Xanax at 9AM in an attempt to kill himself. I didn't believe the story b/c if he had taken that much Xanax he would be totally knocked out. Instead, he was the opposite.

The point of this post isn't really the medical stuff. He was fine. He needed to go to a psych hospital. The idea of this post, though, is the humor surrounding this wacked out patient. .

The patient had recently received his 2nd DWI. He was in trouble with law b/c after posting bail, he drove straight to the nearest gas station and bought an 18 pack of beer. He was then pulled over with the unopened beer in his truck....not good. So the next morning (same day he came to the ER), he tried to call his parole officer to explain. His PO didn't answer the phone, so he decided to try and kill himself.

He was wearing ripped up jeans, a no sleeved t shirt, was covered in dirt, smelled of gasoline, and He had a nice tatoo on his arm that said "Sunshine."

His wife had recently left him for what he described as "Nasty ass dope dealing redneck mofo."

He also told me...."My mom tried to kill my dad."

When it was time for him to drink charcoal, he asked if I could mix it with jagermeister.

Next classic quote...."I think this is the same room my mom was in when she tried to kill herself by drinking antifreeze. How come she could go outside to smoke but I can't? Is it because I'm white?" (Yes his mom is white too).

About 6 different police officers from 2 different counties came in to either issue him a ticket or camp outside his room b/c he was a danger to others. ALL of the different officers knew him by name. 4 of the officers had tazed him at one point in their career.

He became very unruly so I had to give him haldol to calm him down. It worked great, except for when it was time for him to go to the bathroom. He was given a big bottle to urinate in his room. We heard a scream from the room saying "the toilet is clogged!" There was no toilet in the room. He was pooping in the bottle and was having trouble....go figure.

After about 8 horrible hours, he was escorted to the nearest psych hospital 2 hours away.

-ER Doc

Stopped Snoring

Every month I spend one day covering the psychiatric ER. Last month, I came onto my shift with an elderly patient who had not yet been evaluated. He had allegedly overdosed on Vicodin. Let's call him Jimmy Vikes. His drug screen was positive for tricyclics, acetaminophen, and opiates. He got Narcan in the ER then they punted him to psych. He was sound asleep when I came in, so I figured I would let him sleep while I discharged all the drunks on a Saturday morning.

While I was interviewing a 50-year old manic guy who assaulted his 80-year old parents, the psych tech came over and said "Jimmy Vikes stopped snoring." So I excused myself from interviewing the rambling, abusive jobless manic dude. Jimmy Vics had a thready pulse, about once every 10 seconds. No respirations. I felt my sphincter tighten. I haven't done a code since I was an intern 2 years ago. I told the nurse to call the stat team and I started BLS. They showed up after what seemed like an eternity (our ICU/ER is literally across the street from the psych ER). They intubated Mr. Vikes and took him to ICU. I expected the worst.

A week later, I found out that Jimmy V was discharged from ICU to home. He was alert and at his baseline. A google search indicates that the survival rate of in-hospital CPR is 18%. It's gotta be less than that on a psych unit. My good friend ER doc often references the book "The House of God." Its author describes patients who will not die, no matter what happens. They are called GOMERs. They will not die, despite insane degrees of illness and heroic interventions.

I tell this story not to brag about my life-saving prowess. I am the last doctor that you want doing BLS on you or your loved ones. I am telling you this so that you're aware that another Gomer lives and walks among you. That Gomer better be happy for psych techs with good hearing.

-Psych Doc

"I'll Show You!!"

A 31 year old female and her husband were in an argument while driving on the highway. Things got a little out of control. At one point, she threatened to jump out of the car. The husband didn't believe her, she shouted "I'll show you!" and jumped out of the car. Well...that's the story we got from the husband. I wouldn't doubt if she was pushed out.

She was intubated on scene. Unfortunately she had a large head bleed and a pneumothorax discovered by XRay in the ER. Somehow the XRay was read as normal by the astute radiology resident, but we put the chest tube in anyways.












(Not images of this actual patient. Images "borrowed" from google).


She made it up to the ICU alive, and that's the last I heard of her. Sad part is that was the 2nd case we had that week of the same story. The last patient, though, didn't make it to the ICU.

-ER Doc

Another Great Mom

The police brought in a 27 year old female for "psychotic behavior." They were called b/c the patient....we will call her "Ms. C"..... was running in the streets of her neighborhood barefoot holding her 6 month old baby and yelling jibberish. They said it took 4 officers to restrain her. Ms. C's brother claimed she was a drug addict and an unfit mother. At some point, she was diagnosed as bipolar.

When she arrived the the ER, she was pretty calm in her 4 point restraints. Of course she denied drugs or running in the street. Ms. C said her brother was trying to break in her house to take her kids away to give them to the Easter bunny. And oh yeah....she was claiming to be 7 months pregnant. She had a flat belly, so I wasn't too concerned.

But the pregnancy test was positive! Her HCG quant showed her to be about 6 weeks pregnant. She was also positive for PCP and cocaine....big surprise. We transferred her to psych and OB was going to see her over there.

I followed up on her the next day. The psych social worker found out that this 27 year old had EIGHT other kids. 4 of them were with their grandfather. He did not know where the other kids were. He said they were usually with random friends or family. CPS was called...thank god.

The patient was released....I wish to jail. Mandatory sterilization anyone??

-ER Doc

Anniversary

Cat scan showing a subdural hemorrhage (bleeding in the brain. The blood is the white stuff)

What a way to spend your 25th wedding anniversary. You try to wake up your husband to tell him happy anniversary....but you don't get much of a response. About an hour and a CT scan later....you realize it will be your last anniversary. Sad story.

-ER Doc

Dream Interpretation: On the Flip Side

Dear ER Doc,

I have made attempts to interpret multiple dreams of yours. I hope it has improved your quality of life. Now I ask for your assistance.

Over the past two or three years, I have had some version of the following dream at least ten times. I am playing basketball. It is always against some town I played in high school, with guys I know from my school and the other schools. The weird thing is, sometimes the basketball courts are bizarre. Usually they aren't flat. There are more than 2 baskets and they are at different heights. Some baskets are really high, probably 12 or 14 feet. The basketball courts always look like Salvador Dali designed the stadium.

The dreams are great. I am dunking on everybody. Nothing fancy, but 2 handed putbacks, drop step dunks, etc. Making behind-the-back passes. A total stud, not a great ballhandler or anything, but dominant. Rebounds everything. Like the high school version of a Larry Bird/Bill Russell clone. If you hate the Celtics, sorry, come up with another scenario.

Here's the weird thing. I could never dunk in high school, or even now. I was a rebounding machine. Please help me understand why I can't get over the fact that I will never dunk a basketball.

ER doc, I respect your knowledge of basketball and myself. Please help.

-Psych Doc

----------------------------

Dear Psych Doc,

I am glad you came to me for help. Yes, your dream interpretations have helped me. I have learned that I am curious about gay midgets, I am hard up and have a gobstopper that is stuck in my shaft, and that I'm inadequate as a man so my wife is trying to bang Santa. Quality shit.

I know nothing about dreams. In fact, I'd like to know why do I still have wet dreams every few months....sometimes even AFTER I've had sex??? Anyways, I'll give it a shot.

In our many years of knowing each other, I've learned that high school was a pretty "dry" time for you in regards to the females. You had the potential to make lots of lays (or layups in your dream), but never did. Now you have the knowledge and the nuts... but time has passed, your happily married, and you can't go back and make those conquests. The guilt in your subconscious won't let you dream the obvious dreams of pure sex, so you transfer it into basketball.

Like you said...the courts aren't flat...like what you screwed in high school (the bed). You never dunked, meaning you never had sex. You said there are more than 2 baskets at different heights. That just represents the different girls....different sized women and lots of them. Dunking on everybody transfers into mounting anyone in your site. You are not a very fancy guy....very down to earth (a compliment btw). In your dream you said "nothing fancy...two-handed put backs and behind-the-back passes...but dominant." That translates into wild but controlled sex. Two-handed put backs would be the reverse cowgirls position (hold on tight with 2 hands!), and behind the back passes would be doggy style.

"I could never dunk...but was a rebounding machine." Dunking involves putting the ball in the hole... we already established you didn't get any. Rebounding involves grabbing a loose ball...which for you means grabbing the lotion, and grabbing your glob as it as it flies across the room

Salvador Dali's mustache represents you smiling from all the poundings your giving. You did not mention any back court violations, so rest assured you are straight!

Your pal,

-ER Doc