La Cucaracha

It's been a while since my last blog because I have been busy getting all my academic requirements completed and am happy to report that I am officially done with residency. This story occurred about a month ago.

A 32 year old Hispanic female arrived holding her left ear and screaming at the top of her lungs. She was yelling in Spanish so I didn't know what she was saying. The triage nurse came up to me and told me that she had a live cockroach in her ear. I immediately went into the room and looked. Sure enough, a rather large cockroach was at the very back of her ear by the tympanic membrane (TM). I could see the tentacles moving and it's legs scratching at the membrane. It was the scratching which was causing her distress so I attempted to flush the thing out with some saline. In the process, I would periodically check to see if it had moved. Unfortunately, the roach would simply crawl back up into the ear after each irrigation.

I then put some viscous lidocaine in the ear to help with the pain and to try and kill the roach. Shortly after, I re-checked the ear and noticed that the TM perforated and now had a large hole in it! The roach had crawled into the hole behind her tympanic membrane (in layman's terms....bad shit!!!). At that point, I broke down and called ENT and she went up to the ENT clinic for roach removal. To this day, I don't know what happened in the ENT clinic, but I doubt it was good.

-Doc Sensitive

Graduation Day (Warning Explic*t Language)

Well folks....the day has come. Doc sensitive and I have finished residency! Last night was our graduation, and today we turned in all of our shit.

I would like to say a few words about what a wonderful experience residency was....but I can't think of anything. Residency fucking sucked ass! It was years of abuse disguised as "learning experiences." Most of our attendings sucked. Our patients sucked the life out of us. We were overworked and underpaid. My motto in residency was "No good dead at this hospital goes unpunished." It was the truth. Anytime you tried to help someone/something out... you would get screwed.

It was great seeing our "Chairman" at the graduation. What a real fucking inspiration this guy was. He inspired all of us to be nothing like him. He never worked clinically. Once he asked me what was in Lortab. He wasn't pimping me....he really didn't know. He pretty much just sat in a chair all 3 years getting fatter. He only got up if a TV camera was around.

The worst part was dealing with other residents. Not our co ER residents, but residents from other departments (surgery, ortho, internal medicine, etc.). Yes most of them were assholes at heart, but residency brings out the worst in EVERYONE. Because we are all tired and stressed, everyone is in a bad mood. Everyone would try to turf their work to someone else. Making a consult was horrible. No one listens to the needs of the patient, they are "listening" to see what they can do to get out of the consult and turf it to someone else.

I didn't learn shit the traditional way. There was no "see one, do one, teach one" bull shit. No reading in books and being taught by an attending and then putting that knowledge to work. The attending told you what to do and that was it.... because they were worried about their license and that's it.

I learned by seeing other people fuck up, and by my own fuck ups, and by my iPhone and google. Never in med school or residency did I read a text book! It's bullshit. Whatever is in a text book is about 5 years out of date. The way I learned the most, and the source of most of my posts, was through moonlighting. It was being on my own where I looked something up on EVERY patient and find my way. In residency it was just do what each individual attending told us to do.

The most I every worked was 30 hours straight on trauma. Sometimes I wouldn't know what day or month it was. I must have aged 15 years in my 3 years of residency. I look like shit. I can't count how many times I was stab in the back or used up and spit out.

What about psych doc??? Psych is a 4 year residency, so he was 1 more year of pain and suffering. Please pray for him to whatever god you choose.

The best part of residency was the few good friends I made.....and then finishing. We are done. No rest for the weary.....start work tomorrow. Where are we going you might ask?? Only about5 miles down the road! Doc sensitive and I will be working together. We are going to another busy trauma center. Very high acuity....higher than we had in residency. No uppity patients for us. We like to take care of sick patients, and those patients usually don't have a Humana Gold Card. Time to practice our way. Never have I been more scared!




-ER Doc

PS THE BLOG WILL CONTINUE

Nursing Note of the Week

Here is a nurses triage note I came across lately:

"Pt here seeking treatment for new "spots" on his legs, thinks it may be ringworms. Reports he was released from jail last week and has been staying in a crack house x 4 days. Also reports "bugs" in his groin area and axillary area and reports when he smokes crack that the bugs in his groin area form a V. Unable to inspect this "V" or groin area at this time."

Pretty funny stuff.

-ER Doc

Bad Vision, Bad Luck

A 43 year old male came in after an eye injury at work. He had a history of bilateral cornea transplants as a teenager because of a congenital scarring disorder. He works as a air conditioner technician.

While working on an AC, a valve popped off and hit him in the face. When I took off the bandage, all I saw was a big crater in the center of his eye. His cornea had been torn off and he leaked out a ton of vitreous fluid. I wish I could have taken a picture of this one, but I felt too bad for him to ask. It was obvious he was going to loose vision for good in that eye. Poor Guy.

Here is a similar picture that I found on the web of what his eye looked like. The one on the right is closer to what his looked like except the pic shows it being repaired.

-ER Doc

Images removed due to graphic nature and wimpy stomachs of readers. Links provided below

CLICK HERE IMAGE ONE

CLICK HERE IMAGE TWO

Assault Your Own Mother?

A 59 year old women came into the ER with a broken jaw and a broken arm. Her story was suspicious. Eventually she admitted that her 33 year old son beat her. Turned out this was nothing new in their relationship, and she agreed to press charges. The police were called and APS was notified.

The police came up with a nice little plan. We agreed to call the son and tell him that his mom was being discharged and was ready to be picked up. The police then positioned themselves for when he arrived. When he did, they charged after him. The son was pretty quick, and the police had to chase him on foot. They eventually tased him. This was the first person I have ever seen tased in the head. It was pretty funny. The cops must have had there way with him...because he had another barb in the neck AND a broken clavicle. I didn't rush to get him pain meds though, and no one felt sorry for him.

I hope he stays in jail for a long time.

-ER Doc

A week in the life...

With apologies to my co-bloggers, I haven't contributed much in a while. Granted, I have been on vacation 2 of the past 3 weeks (score!), but in my first week back, here are my stories. All from this week.

Today, I worked our walk-in clinic. Kind of like an urgent care for psych. Saw many, many patients for med refills/acute crises. Saw 3 guys, all African American gentlemen, from a halfway house. Two years ago, this would have scared me. Today, it was, "Yes, Boss" and "No sir", just like I was Tom Hanks in "The Green Mile". Again, these guys were all pleasant and appropriate. Not trying to be racist or anything. But they were all wearing ankle monitors (one guy because he just eloped from the halfway house and got caught). I include all of this for justification of the Lindsay Lohan pic (ankle monitor, get it?)

I have tons of patients with borderline personality disorder. One that I saw this week epitomizes this condition. 20-year old female. History of several hospitalizations for suicide attempts, always tells me about cutting, etc. She disappeared from clinic for about 6 months and came in. Said everything was going fine except boyfriend broke up with her. This was interesting, because there was a male with her int he waiting room. I asked who he was. "oh just a guy I met yesterday." I told her I was surprised that she would let him know so soon that she was seeing a psychiatrist. "Well, I can't be alone. I need to have a man."

I asked how school and work were going. "Not so good. I have to come up with $1000."

Me: Why

"Well I totalled my mom's Honda. I have to come up with the deductible. So I'm having to work lots of extra shifts at Hooters to get the money."

From child clinic this week. Teenager with ADHD/ODD comes in with Mom and a cousin. It's summer, so these kids are usually going okay b/c they're not in school. The cousin has a hellacious sunburn. Most of his body is tanned but his shoulders and bald head are pink and peeling off. I made a comment about how bad it had to have hurt (I am severely white-been there before). The mom said, "I let these kids go down to Louisiana to stay with their dad. These boys came back with a sunburn. Louisiana gave my daughter herpes around her mouth."

It was all I could do to not laugh or ask any further questions pertaining to that.

All I can say is this: Ladies, watch out for a guy named Louisiana.

-psych doc

Oprah and Medical Advice

A 49 year old female with high blood pressure came in last night about 11pm. She was very big and jolly, had on a huge bow that made her resemble Minnie Mouse, and spoke in the highest voice I have ever heard from an adult before.

Me: "Hello, I am ER Doc. What brings you in tonight?"

Oprah's Twin: "I have been gaining a lot of weight lately. I used to only be 200 pounds. Now I shot up to 300. I walk to get my mail lately to stay in shape. So something has to be wrong."

Me: "Are you eating more things....like chips and fatty foods."

Oprah's Twin: BLANK STARE FOR TEN SECONDS. "I watch Oprah. Her weight changes like mine, and she said that we should get our thyroid levels checked. I would like that done, get my cholesterol checked, and have an EKG and CXR."

Me: BLANK STARE BACK AT YA, then talking slow me so my words might make it through her fat head. "Ma'am, this is the ER. Those aren't emergent tests, and you have no symptoms to warrant a CXR and EKG. And I think Oprah's problem has more to do with her munchies.....Do you have a primary doctor to see? You know, the one that prescribes you your high blood pressure medicines?"

Oprah's Twin: "Yes, yes I do. But you have to call her and make an appointment! And then it might take 2 weeks to get in!"

Me: "If your doctor can see you in 2 weeks, you have a pretty good doctor. Call tomorrow and make an appointment. Goodbye."

---This went on for about ten minutes. She just didn't get it. I hope she doesn't watch Dr. Phil too....or else Psych Doc might get a visit from her. That is....if he is still around. Where have my co bloggers gone?!?!

-ER Doc

Another Cock Ring Mishap

A 27 year old male was brought in by his partner b/c his cock ring was stuck. Let's call him Cock Sucker. Of course....Cock Sucker used a metal cock ring. If you haven't read my previous post on metal cock rings.....don't use them! If you must wrap something tight around your wang to make you last longer....use a rubber one.

Cock Sucker made the mistake of putting his penis AND his testicles though the ring. I have never worn one, but I am guessing there is a warning label on the package (cock ring package that is) to NOT do that.

With the perfusion to his balls and penis decreasing, we got to work. Lube wasn't helping. Ring cutters....nope. Eventually we got a heavy duty cutter from the OR that got the thing pretty loose. We had ice all over his package to shrink things up as much as possible. The intern lubed him up again to try pulling the ring off again.

Apparently Cock Sucker liked all the pulling...because he got a massive hard on. He closed his eyes and started breathing and panting heavy. Right as the intern (male) pulled the ring off, Cock Sucker got off and shot a huge load on the interns scrubs! He then smiled and let out a big sigh. I was expecting the partner to pull his pants down and ask for the same.

We are expecting great patient satisfaction scores from this guy.

-ER Doc

We Finally Made a List, EMT blogs

We finally made a list!

http://www.firesciencedegree.com/top-43-emt-blogs/

#23 of the top 43 EMT blogs. 23 is my favorite number....so I am pumped. Maybe it's good karma for the week. Even though I probably don't deserve good karma!

-ER Doc

Choking

A spanish couple who spole no English came running into the ER with their very gordo 1 & 1/2 year old boy screaming and motioning that he was choking. Generally, if you are coughing or passing any air, you are not choking. This child was in distress. One second he would be pink and breathing, the next he would turn ashy and not pass air. His oxygen sats would drop then pick up. Something was intermittently obstructing his airway.

This was at an adult ER, so everyone was kind of tense. We started a line and got ready to try to get this thing out. He was too anxious for me to do this without meds. I was going to have to sedate him, go in with an laryngoscope, and try to pull the unknown object out of his airway with some long foreceps.

I was scared shitless. Putting him down carried risks, and if I couldn't get out what was obstructing him on the first try he could die.

We pushed the ketamine (medicine to put him out), and he went to sleep. I got in and saw a metal object that was stuck in his valecula. When he would breath, it was moving into his airway causing the intermittent obstuction. It looked tiny, but as I started to pull it got longer and longer (thats what she said HAHA). I was afraid I was going to drop it into his airway completely from all the secretions. Luckily I got it out. The picture is below. It was somekind of bookcase hinge.

Another life saved. Another save without getting a thank you from the family. Oh well.



- ER Doc

High Pressure Injection Injuries

A 19 year old male came in for finger pain. There was no obvious signs of trauma, and he denied any trauma. There was just a little swelling to the finger....

One thing to look out for in suspicious cases like this is high pressure injection injuries from things like paint. It is a common injury from pain sprayers. But it is hard sometimes to get a patient to admit to the injury if they were doing something illegal....like graffiti. This is a big mistake, because early on the physical exam of the finger is almost totally normal. but within 24 hours the finger can become necrotic and need to be amputated. Early debridement is key.



The white cloudy stuff is the paint/oil


-ER Doc

Love Me

A 27 year old male was found by police passed out in his car. He had all kinds of drugs with him. When he became combative, so they brought him to the ER.

He had a shirt on that said "IT'S ALL FUN AND GAMES 'TIL THE COPS COME." He sure nailed that one!

When the nurse (probably our best nurse in the department) tried to start an IV, he tried to bite her. So he was tied down to the bed. The same nurse go to have revenge by starting a foley on him. But the best part of all.....when she started the foley she noticed he had a tattoo on the shaft of his penis that said "Love Me."

You have to admire his dedication to get that tattoo. That had to hurt. The nurse told him, "Don't worry, I am sure you will get plenty of love in jail!"

-ER Doc