Pull the Plug

Sometimes (ok all the time)....I really wish we could choose who we are going to spend thousands and thousands of dollars working up or saving. I'm not talking about the elderly demented or terminally ill. We will save that argument for another day.

Most county or community ERs have "frequent fliers." They are patients that come over and over for no good reason. Most are homeless, drunks, or drug addicts. The ER staff usually refers to them as trolls. Here's a link about 9 patient's that accounted for 2,700 ER visits in Austin, TX.

In my residency, I have at least 20 patients like this. All the staff knows them by name. We know what they want. We hate them. They suck the life out of us. No respect for the system. No respect for the taxpayer. They are extremely demanding, can ruin your day, and we have to see them each time.

One such patient, we will call him Troll-A, came in obtunded from drinking himself into a stupor. He was found down outside of the hospital under his normal bench. He was so drunk he could barely breath. So what do we do???? We have to save him. Why??? I still don't know the answer. I guess b/c we don't get to pick our patient's and who we choose to help in the ER. Even though EVERYONE in that hospital knew it was going to cost someone a ton of money to put Troll-A on a respirator and in the ICU.

So we did what we had to do and intubated him so he could keep breathing off his alcohol. About 16 hours later, his alcohol wore off to the point that he extubated himself....literally pulling the breathing tube out himself....and left AMA (against medical advice). Of course he pissed on the floor and cussed out the nursing staff before leaving. 2 days later he comes back for his chronic low back pain trying to get narcotics!

What the fuck ever. Just don't say "it's job security" like so many people do about these trolls. B/C its not. They are too dumb to go get on medicaid, so know one pays. When no one pays, it wastes money and therefore isn't job security.

Enough of my rant....bc If I don't stop now this post will get much, much longer.

-ER Doc

Longview

This past weekend had me thinking of the song "Longview" by Green Day. I love this song because it came out when I was in college and pretty much described my daily existence. Anyway, I digress. Let me describe 4 patients with a common theme that I saw in a 12-hour span in the psych ER.

1. A gentleman who was still with us from the night before. He had called 911 from his group home because his roommate was masturbating. He was worried that he might kill the roommate if he didn't stop wacking it it in front of him. This schizophrenic man gets an A+ for insight. Our social worker called the group home all day, and no one answered. Then at shift change (8 p.m.), the group home called, back wondering where he was. Meanwhile, he sat around watching the following acts all day long.

2. An older, demented Hispanic male was been brought in to the psych ER by EMS. His only apparent transgression was pulling weeds out of a highway median. He couldn't give us any working phone numbers and we couldn't figure out where he belonged, so he stayed. At some point, he sat next to this young, almost catatonic female and tried to start a conversation. Needless to say, his intentions became apparent, as he was later found with his hand on her breast and his other hand on his exposed junk. Funny part is that he was passed out before he could finish himself off.

3. Young guy was in for first-break psychosis. His parents were there with him, very sad to see this. He was pleasant but very disorganized. He told me the reason he was brought to the hospital was because he spoke English too well. After breakfast he asked the nurse, "Based on how much I just ate, can you tell me how much I should expect to sh!t?" Later, he had a pencil and paper and handed the nurse the following note: "I can't survive on this juice and crackers sh!t. If I masturbate some more will I get more food?"

4. And finally, EMS brought in a 30-ish female. Chief complaint: Lying in the street, masturbating. They had her hands cuffed to the gurney to keep her from touching herself. She told me she hadn't been doing drugs, but the paramedic told me that last time she had been huffing embalming fluid. Yes, there was a last time...She just got out of our psych unit a week ago for the same thing! She also was positive for cocaine then. I told the paramedic, "I don't know what kind of drugs makes a woman act like that, but I can assure you that for the sake of every man in America, I will try to find out."

-Psych Doc

Dumb Doctor

I get really tired of primary doctors who don't admit patients to the hospital.....but will send their patients in for bogus workups.

In the middle of a busy shift, I had a very nice 49 year old female who was there for an "emergent MRI." She had a history of an aneurysm 5 years ago. 3 WEEKS AGO she had an episode of dizziness. She correctly made an appointment with her primary doctor. This genious thought that with her medical history and dizziness 3 WEEKS AGO, and NO recurrence of any symptoms since then.....that she needed an emergent MRI. So after going to her doctors, then waiting 4 hours to be seen in the ER, she gets discharged with no emergent MRI.

Even she suspected her doctor was dumb. The only thing she wanted before leaving was the name of a new primary care physician. I was happy to provide her with that.

-ER Doc

Common Sense

A common phrase in the ER is "You can't fix stupid." Here are a few stupid things I have observed lately in the ER.

• A 33 year old Hispanic male came in for chest pain. I asked him what made the pain go away. He said taking his cholesterol pill took care of the pain, so it must be his heart. Yeah genius....daily cholesterol meds don't fix acute pain.

• A 29 year old female came in for pelvic pain. She could barely walk. Why? Bc on exam she had horrible herpes. She was so confused. How could she have herpes....she has only been with her husband...and there is no way he has been with anyone else! Naive.

• Patient came in with chief complaint of "my nose feels too warm."

• A 41 year old female who wanted her prescription in liquid form b/c she can't swallow pills.

• A 15 year old male who came into the ER for the 2nd time b/c when he lays flat then flexes his stomach, he see's a bulge in his lower abdomen. He was skinny. The bulge was his freaking abdominal muscle.

• An overprotective mom brings in her 9 year old son for a fever. How high? 102. She was concerned b/c he usually doesn't run 'high fevers.' Her daughter, on the other hand, always runs high fevers so she doesn't worry bout her getting a temp of 102. But mama's lil boy isn't supposed to get that hot I guess. Please.

• A 22 year old female came in b/c she had vaginal bleeding. Her last period was 2 months prior. She never took a pregnancy test, and assumed she was pregnant when she missed a month. So when she started bleeding, painlessly I might add, she came in to make sure she wasn't miscarrying. She STILL hadn't taken a home pregnancy test. We did one and it was negative. Congratulations dumb ass, you started your period.

• This brings up other stupidity....EVERY patient that comes to the damn ER to get a pregnancy test when we use the same shit the dollar store sells.

-ER Doc

Nursing Home...Not So Safe

(Disclaimer: Not endorsing this book. Never have even looked at it. Just needed a pic)

Warning: This story will make you mad and sad at the same time.

A 48 year old male was in a nursing home due to anoxic brain injury from a remote MVC. He wasn't completely paralyzed, but he couldn't really care for himself and had trouble understanding things....hence him being in the nursing home.

He was brought to the ER for a rape exam. When one of the attendants at the home went in to check on the patient, she found a male nursing home employee forcing the patient to perform oral sex on him! How horrible. Thankfully the exam didn't show any other signs of trauma.

I hope the offender gets castrated. For that matter....I think all child molesters and rapists should be castrated.

-A saddened ER Doc

Rectal Exams

We have talked a lot about the rectum on this blog. From foreign body objects stuck inside to prostate exams....it's always something to talk about for a laugh.

Last week I had a 57 year old guy who needed a rectal exam to check for blood. Boy did this spark up conversation. For some reason before he would allow the exam, he wanted to talk about how no one should get married. He was on his 5th marriage, and said he was talking from experience. He then told me a story how he caught "the clap" from a girl in his 20s. He broke up with her, then saw her at a club that weekend and told her and her new boyfriend that she gave him an STD. He said a week later his doctor told him he did not have the clap....but had prostatitis.

"Ok sir....can I check your stool for blood now?"

"If you have to Doc. How far do you have to stick it in there? I never could understand how people do this for pleasure. Thank god you hands aren't bigger."

I think this guy was a closet homo....not that there's anything wrong with that. But....married 5 times, prostatitis in his 20s (shouldn't happen unless you are playing bedroom catcher), and the quotes from above set off my gaydar.

-ER Doc

Not So Emergent Complaints

The ER is for EMERGENCIES. I understand that with our health care system, the ER the safety net for most peoples health care. But if you come into the ER for a freaking cold and you have to wait a few hours longer because we are taking care of real emergencies... like heart attacks, strokes, traumas, etc....then you need to freaking chill and be appreciative that you are even going to be seen. Here are a few non emergent middle of the night complaints from a previous shift:

1) A 55 year old Nigerian male who is studying to be a nurse came in for nasal congestion. He used to get allergy shots, but says he can't get them anymore b/c of school. So he wants me, the ER doc, to give him freaking allergy shots once a week. He is tearful b/c the nasal congestion is sooo bad that sometimes he wakes up in the middle of the night breathing out of his mouth. Grow some freaking balls man! I offered him a decadron shot and some decongestants, but of course he wasn't happy with that.

2) A 39 year old Hispanic female came in b/c she had TMD (Total Me Duele). She was off her Etolodac and wanted a refill. I sighed and thought "Fine let me refill this ladies meds and get her out of here." But no....she wanted more. She wanted a pain shot b/c the total body pain had gotten too mucho AND a B12 shot to give her energy. I told her it wasn't going to happen b/c it wasn't an emergency. She quickly stated it was an emergency to her and kept demanding the shots. In the end, she got nothing.

3) A 41 year old Hispanic female (could have been sisters with the above patient) came in b/c every time she goes outside her eyes water and she sneezes. Wow...what an emergency. Take some freaking allergies pills (over the counter ones of course) and get out of my fucking ER.

4) A 49 year old white male presented for wanting his blood pressure and pain meds refilled. At first I played along. He needed his Vicodin for his chronic back pain and Clonidine 0.3mg (huge dose) for his hypertension. He said had been out of them for 3 weeks bc he was in jail. Funny thing was, though, his previous ER visits did not list Clonidine as one of his meds.

"Sir, what did they give you in jail for your pain?" I asked.

He said they gave him Motrin for pain and nothing for his blood pressure. I said, "Great, so you have been off your Vicodin for 3 weeks now... you should continue the Motrin. And your blood pressure is normal today, so you can see a primary doctor for a refill on your BP meds."

That didn't go over well, and he continued to demand his Vicodin and Clonidine. Enough games I thought. "Look man, your not getting either. I am not dumb. I know what happens when you mix Clonidine and Hydrocodeine (you get a prolonged high). You are either going to get high yourself with it or sell it. I looked at your history and Clonidine isn't one of your meds. You aren't getting either, so get the hell out before I call the police!"

Such a rewarding career.

-ER Doc

Thank You iPhone

So I get a slim 31 year old female in the ER for bloody stools. She had constipation for 2 months. For the last week and a half she was having blood in her stools. I was lucky enough that she decided to come to the ER on my shift.

She took about 15 pictures of her poop on her iPhone....and she insisted I looked at every single one of them. She had some really large terds for such a small lady. Looking at her shit did not help make a diagnosis at all, so please don't try this at home. In the end, she just had hemorrhoids. But I was nauseous for the rest of my shift. Thank you, iPhone.

-ER Doc

Lesbian Temple Rub

A 26 yo Hispanic female arrived to the ED with multiple chief complaints- including headache, dizziness, numbness, tingling, weakness, and palpitations. When the patient arrived, I reviewed the nurses notes and eye balled her. I quickly realized this patient had nothing wrong because she had a bouquet of positive review of systems. So I turfed the patient to my intern and let him see the patient. I stood close by to observe the encounter.

He walked into the room with the Spanish interpreter (because we don't make out immigrants learn our language) and politely asked her what brought her in. In typical Hispanic Hystericus, she immediately started pointing to her head, chest, and made the infamous "my finger are numb signal." Within ten seconds I knew that she had anxiety and needed an outpatient psych consult....but my intern pressed on.

After asking her multiple questions regarding things that make her symptoms better or worse, he sat down and held her hand! He then said, "I'm here to help you, please tell me what's really bothering you?" So she let it all out. She said "Well, two weeks ago I was working at the hotel and a lesbian rubbed my temples! Since then that's all I keep thinking about! It consumes my thinking and is causing great distress in my marriage. I can barely sleep!"

I could barely contain myself. Now every time I see a Hispanic Hystericus, I can't help but think that "LTR" or lesbian temple rubbing, might be the root cause!"

-Doc Sensitive

Drunk Bicycling

Some people have too much free time.

A 21 year old male was brought in by EMS after a "bike accident." We assumed it was a trauma from a motorcycle accident, but we weren't sure after glancing at the guy. We asked EMS what kind of a bike...trying to figure out if it was a bicycle or a motorcycle. One paramedic replied, "I think it was a huffy"......so needless to say there was no trauma activation.

The guy was completely naked riding his bicycle in the streets. He had a bush bigger than a 70s porn star. This winner hit a curb and went flying face first and opened up the front of his head. After hearing the chuckles from the staff...he replied by giving us the middle finger with both hands high in the air. It was classic.

We let him calm down for a while. When we went to check on him later and asked him how he was...he started screaming "I feel BEAUTIFUL. I feel GORGEOUS. I feel BEAUTIFUL!" That lasted for about 5 minutes. In the end he suffered no serious injuries.

-ER Doc

Blasphemy

Psych ER last weekend. Lady comes in because she feels like she is going to hell because she has sinned. A few weeks ago, she heard a voice talking to her and told her friends it was a demon. A few days ago, she learned that it wasn't a demon, it was actually Jesus. Now, because she mistakenly called Jesus a demon, she feels like a blasphemer. The Father, Son, and Holy Spirit are now punishing her for this sin. They tell her to urinate and defecate in her bed. Then they tell her to lick up the mess. They also tell her when to start and stop walking. She was unable to do anything until "Jesus" told her it was okay.

Why does psychosis so frequently contain religious themes? And why would your God force you to lick your own crap? Please discuss.

-Psych doc