Saying Goodbye

Sorry for the long post...

Saying goodbye can be hard. As you all know, I am pretty numb to most things. Everyone once and a while there will be a few cases or families that bring my emotions out.

1- A 78 year old man came in confused. EMS suspected a drug overdose b/c they saw a bottle of Vicodin in the house. He did not look like a 78 year old pill popper, so I didn't let that story blind me. He was very nauseous and was diaphoretic (sweating), which always makes me nervous. I suspected a heart attack, so got an EKG which showed a posterior wall MI. As soon as I went to call the cardiologist to cath him, he started to code. So I went through the normal motions...intubation, central line, ACLS. We got him back with epinephrine. Then the following repeated itself like 10 times...code, chest compressions, one round of epinephrine, return of pulse for about 5 minutes. Over and over it happened.

Normally I wouldn't have gone so long on a 78 year old, but the patient's wife really got to me. She was so sweet. She truly loved him. She told me he was one of the original "Top Gun's" and a war hero, that he was all she had, and they were supposed to go on a cruise in 2 weeks. She asked me to do everything. Instead of being numb I wanted to save the guy for her. I tried and tried, but I couldn't....

2- A 41 year old female with a history of pulmonary arterial hypertension (much different than regular high blood pressure). She called EMS for weakness. By the time they arrived to the ER she lost her pulse and respirations. She was young so we went ALL out. After about 25 minutes of coding her, I went to talk to the family outside of the room. The patient's family present consisted of an 11 and 13 year old daughter, mother, sister, husband, and brother. Every generation.

They pleaded for me to save her... so it was time to empty the crash cart. I went through every vial of epi. I would occasionally get a pulse back, but then no blood pressure. Dopamine barely helped with that. After being maxed out on 3 pressures and having a pulse (albeit only at a rate of 30), she went into 3rd degree heart block. So I floated a transvenous pacer for the first time in my career....and it worked...but only for about 10 minutes. After 90 minutes, I had no choice but to pronounce her dead. Never before (and I hope never again), do I have to tell so many generations...offspring, spouse, siblings, and parent...that their loved one died. They were screaming. I held the 11 year old as she cried.

3- In this case, it was not hard for someone to say bye. A 47 year old female recently found out she had widely metastatic stage 4 ovarian cancer. She wasn't to start treatment for another 2 weeks. I can't imagine knowing I have a horrible cancer and having to wait weeks to start treatment, even though it really doesn't make a difference. When her husband found out, he said HE couldn't deal with it so he bolted and left her. Selfish ass. She didn't want to go home alone, so I made up an admission of "intractable nausea and vomiting" and admitted her to the hospital.


-ER Doc

Coincidence

This morning at 8 am there was an email from the pharmacy to the medical staff notifying us that they're having a shortage of (for the sake of having some anonymity) "Awesomely Potent IV Narcotic." The memo basically advised physicians of the indications for said narcotic and to use it only when needed.



At 1 pm I went over to cover our psych ER. There is a nurse from a med-surg unit being triaged in for psych eval. Nurse reports, "This patient is a nurse in our hospital. This morning, she got busted for stealing Awesomely Potent IV Narcotic intended for patients for the past week. She said she was stockpiling it in order to overdose on it."



I showed this to my attending and hilarity ensued. Hospital storage of narcotics....wait for it... because a nurse is stealing right from under your nose!!



There is obviously more to the story, but none of it was cool enough for this blog.



-Psych Doc

Chew Your Food!

An 11 year old boy came in by EMS choking on his chicken fried steak. He took a huge bite and didn't quite chew enough. Bystanders and EMS failed with the Heimlich maneuver. When he arrived to the ER he was blue and about to pass out. Somehow transferring him from the the EMS stretcher to our stretcher while performing the Heimlich maneuver dislodged the meat. Here is the pic of the monster meal.




His oxygen saturation never rose about 86% on room air after the event, so he had to be transferred to a children's hospital for monitoring, bronchoscopy, and further workup. My suspicion is that he aspirated part of the meat.

-ER Doc

Needle Drop Off

Working a shift when a local neighborhood patron brought by a water carton full of needles. She thought she should "turn it in" to us.

This was a pretty good thought b/c they needed to be disposed of, but the police might have been a better place to start.

Anyways here are the pics I took of the stash.









- ER Doc

Friday The 13th

Wow....what a Friday the 13th for our department. Not all of the cases below were my patients. Some were from my co-workers, including the lost blogger Doc Sensitive.

-Epiglottitis in a 40 year old male. This is a pretty rare diagnosis, and can be deadly. Follow the link for info about it. The on call ENT doc ended up coming in to intubate him.

-A 23 year old was shot in the chest at around 5pm and killed. We intubated him, put in bilateral chest tubes, and contemplated cracking his chest open but there were no signs of life.

-A 43 year old came in with angioedema. He got progressively worse. ENT felt like they had done their on call duty for the day from case #1 and would not come in. So for the first time, I did an awake nasal intubation with a fiberoptic scope. Scary shit but it worked.

-No shortage of the intoxicated patients. One was 24 years old who had her 5th child 2 weeks prior. She was horribly intoxicated screaming profanities about her children. Besides being drunk, she was positive for cocaine and marijuana. She couldn't even complete a sentence. "Dad" said all she does is drink...so I called CPS and sent her to a psych facility for postpartum depression. Who knows if she was really postpartum depression or just a low life, but I felt if I just let her sober up and go home....that by the time CPS showed up one of those kids would be dead.

-A 68 year old female with fibromyalgia who felt "anxious and stressed" after spending the night at a church lock in. WTF ?!?

-A 41 year old female that was soooo fat she could not take care of herself and had to live in a nursing home. Disgusting. Now for all your purists....she had NO medical reason to be this fat. She came in with shortness of breath....b/c she was literally TOO FAT TO BREATH. She ended up in the ICU

-Ended the shift with an average stab wound to the chest. Those "two dudes" were out again last night I guess, as they stabbed this poor patient in the chest as he was walking back to his car leaving the club minding his own business. He did fine, but if anyone can locate these two dudes (they have popped up in older posts), please notify your local authorities.

ER Doc

Pregnant and Not Pregnant

Lonnnnnggg day today. Sent 8 to the ICU. But in the middle of it all there were some humerus things to share.

1: Pregnant

A 25 year old pregnant lady. Why is that humerus?? Well it was more messed up than funny I guess. This was her 11th pregnancy! She was G11/P6/A4...which means 11 total pregnancies including her new one, 6 that were born, and 4 abortions or miscarriages. I recommended a tubal after this pregnancy. I am pretty sure she had been told that before though.

2: Not Pregnant

A 27 year old male came in after being discharged from a psych facility.

• Me: "Do you have any medical problems?"
• Him: "No, I just see things and hear voices."
• Me: "Ok, what brings you into the ER today."
• Him: "I came to get a pregnancy test."
• Quick double check at the chart to make sure this patient was indeed a male. "Uh sir...you are a man, why are you worried about being pregnant?"
• Him: "Well, a priest came inside me recently. He said he was baptizing me. So I thought maybe I was pregnant with Jesus."

Disposition back to psych facility!

-ER Doc

Divine Intervention

I think I believe in divine intervention.....

A very frail 84 year old female came in after passing out. Where did she pass out you might ask??? At the DMV renewing her drivers license!!! She was sitting down to take the picture and "fell out." The culprit was her blood glucose. She was very hypoglycemic. She took all her insulin in the morning but forgot to eat. Yes...that's who we need driving.

There had to be a power from above that intervened before her picture was taken.

-ER Doc

Out of Jail Headache

A 48 year old male decided to celebrate as soon as he was released from his 8 year jail sentence. He went straight to the bar. By 1pm....he was in my ER with a traumatic brain bleed. He drank himself into a stupor, got into a fight with "2 dudes" and was thrown against a moving car! Ouch!




His jail cell will not go empty long though. A few hours later we had a high speed motorcycle crash come in. This guy was a 27 year old who, when approached by the police, tried to throw his bag of crack in the bushes and take off on his motorcycle. When the police neared him, he jumped off his bike. Unfortunately (and amazingly) for him, he had no major injuries and was taken to jail shortly after.

-ER Doc

Is Church Bad For You?

No, of course not. But it makes for a good title.

Any Sunday in the ER there are always a couple of people that come in from church. Today, though, I saw FOURTEEN people who came in after getting sick at church. Two of them were preachers. It was really strange. Maybe God took the day off?

They ranged from the simple, "I got chest pain in church" to " I passed out in church" to "Grandma slumped over and couldn't move her left side during church and has been drooling since."

Most seem to come from Catholic church. I think it is from all the standing and kneeling. I heard that's what they do there. The Pentecostals come in a lot b/c of the emotional experience they tend to have at church. I am surprised we don't get more Muslims from all of their bowing when praying. I guess they are in better shape since they do it 5 times a day.

In summary, there were a lot of freaking sick people in church today. Be careful next time you go. I hope I didn't offend anyone too much. OK, that's a lie b/c I don't give a shit. Its my blog and I think its funny. Probably b/c I haven't been to church in a while and my conscious has gone missing. My mom would be so disappointed in my right now I hope she doesn't read this one

-ER Doc