Serenity Now's Last Compression

BECAUSE OF CERTAIN IDIOTS OUT THERE THAN ARE TOO SENSITIVE....THIS BLOG ENDS ASAP. I AM PUTTING SOME MINI RANTS BELOW OF THINGS I WANTED TO BLOG IN THE NEXT FEW WEEKS, BUT IT HAS TO END NOW. 
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• Home Remedies patients have told me about that I think are funny/stupid: Vinegar after too much pork or salt to help lower blood pressure, mustard with garlic for gas, people who wear cotton balls in their ears, peeing on a burn, mustard on burns, mayo on burns, eating cheese to stop smoking, eating oatmeal after fried foods to help "break it up", red or green rubbing alcohol for flank pain
• I am sick of Hispanic people who live in this country for years and don't bother to learn English. I don't know how many times I have seen someone who says they have been in the US for 10+ years, and don't speak English. And you expect me to be able to help you?
• I had a guy come in last week for hand weakness after "watching cinemax all night." And it was a Saturday night!
• A mom who had cigarette in mouth when going to pick up baby from high chair, slipped, and spit the cigarette in her eye causing a nasty burn to her eye
• Don't waste the fire departments time by having them check your blood pressure. Go to a drug store and have a machine do it. Don't waste the fireman's time
• Had a patient call 911 from her ER room in my ER last week because she was hearing voices in her head. Funny shit.
• Had a nursing home doc send me a patient to examine because her vision was getting worse. When I asked what her baseline vision status was....he said "oh, shes already legally blind, but she seems to be more blind now." WTF am I supposed to do with that?
• A 26 year old mom and her 13 year old son....both coming to the ER for different psych complaints.....
• A different nursing home sent the same patient in THREE TIMES in the SAME night for her trach falling out. And she didn't even need the trach anymore. The 3rd time she came I just threw away the trach and sent her back.

I will miss my real readers. Sorry losers had to ruin for you

Breast Augmentation

I love fake boobs. But this, ladies, is NOT how you do it.

An 18 year old came in for breast pain after "at home breast augmentation." She was visiting her friend in Mexico, and mentioned to her friend she wanted to go from a B to a C cup. So her friend, in true Mexican resourcefulness style, injected cooking oil into both breasts.

Yeah, that just happened.

So I examined her breasts. Luckily for her I didn't see any signs of infection. I was not, however, impressed with her friends work.

-ER Doc

"I Promise I'll Be Good This Time"

A 22 year old male came in for severe hand pain. He injected meth into his forearm a few hours prior (first time I have heard about injecting meth.) His hands were swollen, pale, and beginning to have decreased pulses.

We started and IV and gave him fluids, antibiotics, and morphine through the IV. As soon as he got the morphine, he jumped up and ran out of the ER screaming "see ya bitches!"

After this, I figured he had a chronic hand condition that he used to trick ERs into getting pain meds for. But 2 hours later he was back, and his hand was nearly black. "I promise I will be good this time" he said.

So he was admitted to the ICU on a heparin drip. He will probably loose the hand.

-ER Doc

80s Stars and Bad Vitamins

First, let me say that like ER Doc, I am starting to feel like I have described every kind of moron that can be encountered in a psychiatric setting. In order to prevent repetitiveness, it may be time to wind this thing down. Notice that I am describing a particular type of moron in most of my posts. Rarely do I exploit those with real psychiatric illnesses, but this patient had me straining to keep a straight face. I am not making fun of her, but what she said was funny. And her "voice" was telling her to get a gun and shoot herself, which is most definitely unfunny.

Warning: Strong Language to follow.

The patient was a female in her 30s. She has been more or less psychotic since she gave birth to her first child a decade ago. Her illness is not helped by a 20 year marijuana use history as well as K2 and other synthetics for the past 6 months. She began by telling me that since she was a little girl, a person named "Jane" has lived in her head and has been belittling her and "making me sell my soul. She calls me 'Punky Brewster' and 'Vitamin Pussy.' I don't even know what that means, but when I worked in Denny's, some teenagers looked at the menu and told Jane to call me that."


She said, "I know that Jane was harassing me last night because I woke up with morning breath." And interestingly, Jane caused her face to turn orange; "The same color as dog poo."


I mentioned that Jane has been around for a while. "Jane first came to visit me when I was 3 years old. At first she gave me happy dreams. Then when I turned 10, the dreams got all gay."


"Gay?", I queried.


"I dreamt I was making out with Emilio Estevez. I was so in love with him. I woke up all excited. I tried to go back to sleep and have the same dream again, but that bitch made me dream about a mermaid on a damn beach!"


"How has your illness affected your work and personal lives?", I asked.


"I can't get a job. Jane always puts me down. Every time I go on a job interview, she says, 'Nobody will ever hire you because your pussy isn't as pretty as their pussies.'"


Maybe that's why Soleil Moon Frye was never heard from after 1988.


-Psych Doc

How Do I Call The Ambulance

True story from this morning....

A 26 year old called the ER and spoke to the nurse. She had been seen last week in our ER, and had our telephone number on her discharge instructions.

Her question for our nurse was....."How do I call 911 to come get me?"

No this lady was not retarded. The nurse said "Just dial the numbers 9-1-1 on your phone."

Ten minutes later the lady was brought in by EMS.

-ER Doc

Medication Refill

I appreciate the kind words from everyone. Really I do a good job of venting to my friends Psych Doc and Doc Sensitive. The blog has been fun, but I think when the stories I have run out that will be the end. I received some interesting offers in the last week, so things might be on hold as far as shutting down production....for a little bit.

Anyways back to the stories......

A 63 year old male came in for a medication refill.

Me: "Hello sir, how can I help you today?"

Patient: "I was hoping you could refill my meds for my blood pressure."

Me (few basic history questions then...): "OK, what meds are you on?"

Patient: "I don't know. I have been on them for ten years."

Me: "I need a name if I am going to help you. Do you know what it sounds like, or what it starts with?"

Patient: "No, I just know I have been on it for a long time. Can you refill it?"

Me: "Sir, there are a lot of blood pressure names out there, can you think of anything for me to go with?"

Patient: "No, just refill them dammit!"

It was Sunday afternoon. No primary doc to call. He wasn't in our electronic medical records. He had no clue what the name even sounded like. He couldn't tell me what they looked like. He literally just expected me to be a genie and come up with his meds. I think I even said that at one point. I asked about 20 different questions that I was hoping would spark his memory. Nothing worked. Why the hell even come in?

-ER Doc

Patient Complaint

I received a funny patient complaint this week.

I had a 42 year old come in for scabies (we get a lot of patients with scabies, as you can tell by now).

I told him the treatment I would be prescribing him, but he had heard that a shot of decadron (steroid) would help, and he demanded it. We went round and round with me trying to explain why it wouldn't help, but he really wanted it so I gave in.

He called our office 3 days later irate stating the shot I gave him made him impotent. First...why are you having sex when you have scabies. Second...yeah the decadron didn't affect you morning salute, sorry man.

-ER Doc

On a different note, I am kind of sad to say this blog is shortly coming to an end. It has been fun. When we set out to do this a few years ago, we just wanted to have some fun. I don't have the longevity of the greats like erstories.net, gruntdoc, and white coat. Psych doc and I have talked, and we think we have pretty much described every kind of douche-bag we have seen, so it is time to bring things to a close. I have a few more things I want rant about, but then we will be riding into the sunset and will take down the blog. Thanks for your support. I recommend erstories.net, white coats call room, new nurse in the hood, and nurse k.

Now...and Free

Me: "What are you here for today, Sir?"

Patient: " I am here to have my gallbladder removed."

Me: "Are you having any symptoms?"

Patient: "No, but I have in the past, and they told me I need to get scheduled to get it out."

Me: "Well you should definitely do that, then. But this is an emergency department. We can only consult a surgeon if you are having an emergency with your gall bladder. It sounds like you need to follow up with a surgeon."

Patient: "Look, I don't wanna do that. It costs money. Now get me a damn surgeon. I want the surgery NOW, and I want it for FREE."

He got kicked out shortly after. This is the country we live in. Imagine if I went into a mechanic shop with my car and demanded them to fix it for free and right away. Gese.

ER Doc

8-Fer

A family of EIGHT came in for me to see. This isn't as many as my record (15), but it was definitely the 2nd most.

The family ranged from ages 7-79. They were in a Dodge Durango on the way to a graduation. They were rear ended at low speed. Everyone was wearing a seat belt. They all then went to the graduation and celebration.

Afterward, some 4 hours later, they decided to come in and "get checked out." And I discharged them ALL from the waiting room.

ER Doc

Weird Shift

Had a weird couple of nights this week....

1- A man was seen walking around the parking lot with a roll of toilet paper on a leash. He said he was looking for his mother's cat that took a cab to the hospital.

2- A 24 year old who came in for an ankle sprain...but was also grossly infected with scabies.

3- A 21 year old man called EMS for a toothache. I am not sure why they actually brought him...but they did. He walked in through the ambulance bay with the paramedics and his girlfriend, who had a bag of cheetos in her hands. I guess she needed a snack for the ride. When I directed them to go to triage, he got mad and walked out the hospital. Ooops.

4- A 37 year old man got released from drug rehab. He decided to celebrate by getting drunk and passing out on his porch and knocking out a couple of teeth.

5- A 22 year old female wanted a mammogram to see how far along in her pregnancy she was.

6- A 45 year old female came in intoxicated. She was afraid she was pregnant, so she decided to get drunk and do drugs to kill the fetus. But when she got the room, she decided she wanted to keep the kid (it would have been #9). Thankfully she wasn't actually pregnant.

7- A 37 year old male came in after getting "jumped" by 10 guys and 5 girls. Of course, he said they jumped him for no reason. On review of his past medical records, I learned he was seen a few years ago after being jumped. Somehow...his keys got stuck in his ass when he got jumped that time.

8- A 27 year old came in for a drippy dick. We counted on the electronic medical records that he had been seen TWENTY THREE TIMES in the past 2 years for a STD. Nice...

ER Doc

Be Careful

People....be careful. Young people die too. Its one of the hardest things in medicine. The hardest thing I have to do is break the news on someone young that died. Children are the worse. These cases involved 20-30 year olds.

A few friends were celebrating a graduation. I suspect alcohol was involved. At 3 am, their car veered off the highway and ran into a tree. Only one was wearing a seat-belt. The other 2 were ejected through the windshield and landed about 30 yards away. They were pronounced dead shortly after making it to my ER. The guy wearing a seatbelt.....no injuries. Both victims left behind young wives and parents.

A 23 year old was helping his brother fix their car. The car wasn't on proper lifts. When he stuck his head under the car to take a look, it came crashing down on him crushing his skull. It was horrible. He left behind a brother, sister, and parents.

We are never too young to die. Be careful.

ER Doc

Ironman 3 - Poo Siege

Hollywood would have you believe that "Thor" is the first blockbuster of the summer. I have it on good authority, however, that there is a pirated version of Ironman 3. I am now going to tell you the plot. Warning: spoilers ahead!

For those who don't know, we have a patient in common we have dubbed Ironman. See posts here and here. I also gave a brief Easter update. Since that post, Ironman spent a few more weeks in the big-time psych hospital. Once they determined for about the 10th time that there's nothing that can help this guy, he was discharged. I'm not sure where he was discharged to. He didn't stay there long. Within 2 days, he was back in the hospital where my residency is.

Keep in mind:

1. These hospitals are 70 miles apart and would involve travel through 3 counties, at least.

2. He has no home and owns no means of transportation.

He is, however, apparently blessed with the ability to remember every phone number to every hospital within a hundred mile radius. Not just the main numbers. He can direct dial most of the inpatient units and some social workers.

The real question is why is he back in the hospital? He just spent a month and the grandaddy of psych hospitals (in this state anyway). He should be cured, right?

Ironman swallowed some sheet-metal screws. He didn't pretend to do this. There is radiologic evidence. He had to wait on the med-surg unit for the screws to pass. This requires the poor nursing staff to inspect his fecal matter. I guess it can't be that bad, he's a superhero, they could probably sell it on Ebay. Finally, a nurse noticed large, coarse particles and began to celebrate. She might have even shouted "Eureka!", thinking her fecal screw inspecting days were over.

But, alas, it was only some pieces of wood and bark that he had swallowed some other time.

And for the first time ever, a nurse wanted a patient to screw her, and he gave her good wood, but she was left wanting more. To be continued...

-Psych Doc

Cage Em

A patient came in the ER with a severe ear laceration after being bitten by HIS BROTHER. One so bad I had to swallow my pride and call the on call plastic surgeon for help.

After explaining the case.....

Plastics: "Don't you think you can sew that up, give them a shot of antibiotics, and have them see me in clinic."

Me: "You mean like I do 98% of the time?? No. How about I take a pic and send it to your phone."

I sent him the following pic.....













And he called back shortly.....

Plastics: "I am on my way in. Please get me a plastics tray. And please get a cage to lock up these animals!"

-ER Doc

Put It In Here

A 23 year old female (moderately attractive) came in for headache, fever, chills, and stiff neck. Obviously needed to rule out meningitis.

So when it was time for the spinal tap....there was an odd tattoo to her lower back.

It had a sign that said "Put It In Here" and an arrow pointing down. And it wasn't pointing to the area of the lumbar spine that the needle was supposed to go in!

-ER Doc

Belly Fat Can Save You!

Forget about diabetes, hypertension, high cholesterol, metabolic syndrome, decreased libido, panniculitis, heart attacks, strokes, smelling bad, taking up too much space on an airplane, etc....being really fat can save your life!

A 22 year old male came in with a stab wound to the abdomen. But because he was 450 pounds and litterally had 20 inches of belly fat, the large knife only penetrated fatty tissue. The CT even read "penetration through 8 inches of subcutaneous fat, not in close proximity to the abdominal cavity." A couple of staples and out the door!

So at least there is one benefit to being a big boy.


-ER Doc

Chief Complaint of the Day

A 28 year old Hispanic male came in for "Left arm numbness and tingling after eating tacos. Thinks it causes a heart attack."

Uh yeah....quickest discharge ever.

-ER Doc

Happy Easter

Oh how I love working holidays (not really).

On Easter, we get hit with a ton of patients who pass out during church. Apparently the holy ghost is stronger than normal on easter. Grand total today....11 (1 was a pastor). One was a 17 year old who didn't eat dinner last night, didn't eat breakfast, and then got overheated in the crowded church and passed out shortly. How about just feed her instead of bringing her to the ER.

There was also some teens who decided to be cool and drive fast without seat belts on. Well they all got thrown out of the vehicle and have some pretty nasty injuries.

Then there was the onslaught of nursing home patients who finally get a visit from family, said family freaks out b/c they look like crap since they saw them last year, and then they send them to ER. Yay.

One was 81 years old. Her family brought her a big mac for easter. Well she promptly aspirated the big mac after only a few bites. She arrived to the ER hypoxic and had crumbles the big mac still in her mouth. Maybe next year they will bring soup.

Happy easter,

ER Doc

My Manic Patinent

I had a 23 year old truly manic female come in by EMS. She had been manic for days. Off her lithium and talking a mile a minute. EMS was called by a neighbor when she stormed into his apartment and started throwing his stuff off his balcony because she felt it was all evil.

Me: "Hello ma'am, my name is ER Doc."

Patient: "I know who you are. You were in my dream."

Me: "Oh really?" (expecting a compliment)

Patient: "Yes, you were satan burning on the cross!"

Me: "Who me!? Are you sure you don't have me confused with someone else?"

Patient: "No, you were definitely satan burning on the cross. You are evil."

Me: "But I am nice. And it is the day before Easter. I was even going to go to church tomorrow. Maybe I was an angel going to save the person burning"

Patient: "No you are satan and you were burning on the cross.

Me: "OK, well I will have to call Psych Doc then."

-ER Doc

Just Give Me The Damn Meds

Another snake bite. This one wasn't provoked. Poor guy was cleaning his shed and the damned snake latched on. Somehow he killed the thing and brought it in. It was a copperhead, which is never good news.

The bite was to his right hand. He was swelling quick and it was moving up his arm. He needed CroFab right away.

So I ordered the standard loading dose and asked the pharmacy to make sure they had enough vials ready...this guy was sick.

The pharmacy kept farting around, and we had to keep calling to rush them. Then the charge nurse came up to me and said, "ER Doc, the pharmacy wants to make sure you know how expensive the CroFab is. They said it is $2,000 dollars a vial." My reply was simple, "Get the pharmacy on the phone now please."

Me to pharmacy boss: "This is ER Doc. I heard you have concerns over the price of the crofab for my rapidly declining patient. You know I am not giving him CroFab for fun. Do you want to call the manufacturer and ask for a discount? Was there a new magic medicine made for this I don't know about? Or how bout I have Ortho come down and chop off his arm because that might be cheaper? Or....maybe I should just let him get worse and die? What do you think of all that? Do you have any suggestions since you are so concerned?

Pharmacy Boss: "Uhhhhhh"

Me: "Then just give me the damn meds."

The CroFab arrived shortly after.

-ER Doc

Mom Quotes

1) An 18 year old female came in for constipation for 3 months

Me: "Have you seen your primary doctor for this?"

Patient: "I tried calling my pediatrician, but he won't see me anymore since I have a kid now."


2) Patient: "I am here because I think I am having a reaction to my sons bug bite."

-ER Doc

Chief Complaint of the Day

What was the chief complaint you might ask?....

Patient: "I swallowed two thousand dollars worth of crack and now my stomach and chest hurt."

That's a lot of crack. His heart rate reflected it. He said he swallowed it pure. It wasn't wrapped in anything or stuffed in any orifices. The police showed up, he freaked, and shoved his hard earned drugs down his throat.

So my job was to basically keep him alive by not letting his heart explode. Thanks to a medicine called Ativan, in continuous IV drip form, this was accomplished.

-ER Doc

Virgins

An 18 year old female presented with rectal pain. One glance at the area and the diagnosis was clear.....genital warts.

Me: "Ma'am, you have genital warts. It is a STD."

Virgin: "That is impossible, I am a virgin."

Me (thinking yeah right I have heard it a million times): "Ok, well you still have anal warts and need to follow up at the county health department for treatment."

Virgin: "You don't believe I am a virgin do you?"

Me: "It doesn't matter what I believe, I am not here to judge. But no...I don't believe you."

Virgin: "Well I AM a virgin because I ONLY have anal sex."

Me: "Ahhhh, makes sense. And it hasn't worked out for you has it?"

Kids.....wear a condom even if your butt hole is a slut but your vagina is pure.

-ER Doc

Hit and Run

Here is a story from last winter....

It was snowing and the streets were covered with ice. A 43 year old woman hit not one, not two, but THREE cars in her neighborhood on her way home. The police were called and she was tracked down.

When they showed up to her door, she freaked and hid in the attic. Of course she had some outstanding warrants, so she was arrested.

As the police were escorting her out of the house to haul her off, she slipped and fell and shattered her radius.

So instead of bringing her to jail they had to bring her to the ER. As the police usually do, they got tired of waiting in the ER and released her from their custody.

Imagine the irony. She trashes 3 cars, and gets out of going to jail by breaking her arm in police custody.

-ER Doc

Security To Triage

Security was called to triage on a recent shift. We had a very upset patron.

A 22 year old female checked in with her 3 month old baby and boyfriend. Her chief complaint was "Paternity Test."

She was told that the ER doesn't do paternity tests, and she freaked out!

"What the f**k you mean you don't do paternity tests. How to f**k am I supposed to know if he da daddy!?"

She screamed this over and over for the whole waiting room to hear. She even grabbed a clipboard and threw it across the waiting room (with her baby in her other arm).

Someone eventually replied to her by yelling "Go on Maury if you want to find out!"

The boyfriend just stood there the whole time with a smirk showing his blinged out teeth...never said a word.

-ER Doc

The Return Of IronMan

Between Pysch Doc's hospital and mine, we are used to seeing IronMan frequently. (Click here for original Iron Man post if needed)

A month had gone by, and neither of us had seen him. I checked our electronic medical records, and it had been 5 weeks since he had been to any of the hospitals in my system. Had IronMan finally succeeded in offing himself!?!?

No it couldn't be. He is Iron Man. And although young, Iron Man is a GOMER, and GOMERs don't die.

Then 2 days ago he resurfaced in a triumphet return. He drank a bottle of rubbing alcohol and was vomiting everywhere. He said he did it b/c he was "frustrated" that he could only have his medicines as long acting shots instead of pills. The doctors had taken away all of his pill prescriptions due to his multiple ingestions.

Me: "Iron Man, where have you been? I haven't seen you in awhile"

Iron Man: "Hey ER Doc. I was at hospital-X for swallowing bleach. I'm not gonna swallow that stuff anymore. I went to hospital-Y for a week after swallowing a razor blade I put in a pill bottle. Then I went to hospital-Z for my normal Tylenol overdose. I really don't like hospital-Z. Can you send me back to hospital-A so I can see your friend Psych Doc. I like him."

Soo....I let time pass, treated his nausea, etc. He was cleared from a medical standpoint. And since he drank the rubbing alcohol b/c he was "frustrated" and not suicidal, I was going to be able to discharge him back to the group home instead of a psych hospital....a first.

But remember, Iron Man's goal is to live at a psych facility...not go back to a group home.

So he promptly made his way to the middle of the ER, fell on the floor and started shaking and screaming and acting like he was having a seizure. He kept screaming "THE VOICES ARE BACK THE VOICES ARE BACK." (He hears no voices but his own.)

So as everyone freaked out and went to get meds, I went to him and said quietly, "Iron Man, if I get you to a psych facility will you stop acting up and go back to your room?"

Amazingly the seizure stopped and the voices went away. He stood up and said, "OK, sounds good. I'll be sure to say I am suicidal this time. Oh yeah I ate plastic Chloraprep a few minutes ago too." I was pissed b/c the staff knows not to leave ANYTHING in his room.

So I called our psych liaisons, and of course their day was ruined. He was in the ER another 24 hours until a new facility accepted him.

This is the legend of Iron Man.

-ER Doc

Damn Dog

An 87 year old man was walking his dog when the neighbors pit bull got loose. The pit bull bit him right in the CROTCH.

He promptly fell to the ground....shattering his 87 year old pelvis.

This was the first time I had to consult urology (severe testicle wounds) and ortho at the same time.

And the guy is so nice he refused to report the dog.

-ER Doc


PS....for some reason if you google image search "pit bull bit crotch" Sarah Palins picture comes up. Weird

Transfer By Private Vehicle

A 37 year old alcoholic female was admitted to an outside hospital 2 days ago due to alcohol poisoning. She was being transferred today to a rehab facility. She was going voluntarily.

For whatever reason....and I have no reason why...the outside hospital transferred her by private vehicle. This means that instead of being transferred by an ambulance service, her husband was able to take her in his car.

Well, he decided to stop for gas. She went inside, and when she came out, he noticed she was completely trashed.

She downed some wine and 12 ounces of HAND SANITIZER. Hand sanitizer has an extremely high concentration of alcohol.

She said she did it because she wanted to get drunk "one more time before detox."

Her alcohol came back greater than 450, she continued to get more and more obtunded, and eventually required being put on a mechanical ventilator.

Some people.

-ER Doc

Surprise

A 23 yo female arrived through triage with a chief complaint of "vaginal bleeding and lower abdominal pain."

The paramedic put the patient in a wheel chair and placed her into one the examination rooms. After he helped her into bed, she started to scream and breath faster. He looked down towards her vagina and noticed a baby's head coming out!

The patient insisted that her last period was two weeks ago and that it was "impossible that she was pregnant." Her belly really didn't look that big and pregnant either.

I heard on the speakers... "Doc Sensitive to room 29 immediately."

When I arrived to the room the baby was crowning. I pushed down and up... and out pops a full term infant! The mother was in shock. She swears she had no idea she was pregnant, nor did she know who the baby's father was.

After looking through the records the next day, I learned she named the baby girl "Surprise."

Doc Sensitive

(Occurred on Fat Tuesday)

Let Mardi Gras Begin!!

The first chart I grab for the day was the dreaded "vaginal discharge and odor" chief complaint. I hang my head in shame, and walk towards the room. I walk into the room, introduce myself and ask what is going on.

"I don't know dude, it just smells real bad. And I've got a boil that needs drained in my arm pit."

... ugh ... "Alright." So I proceed to get a further history, decide I need to do a pelvic on this lady, When we get her to the pelvic room, she begins to make comments about how gross this is. "Dude, this is just gross." I'm tempted to tell her how un-excited I am to be doing this. When we get her in the stirrups and pull back the sheet she asks, "Isn't it gross? Can you smell it?"

I wanted to shoot myself ...

As I'm doing the exam, she has a discharge the color of a yellow highligher. I ask her if she has been sexually active ... she looks at me blank faced ... confused.

"I don't know what that is."

"ARE YOU HAVING SEX?"

"... no"

So I send her back to her room.

After I get the results back I go in to talk to her and drain the abscess. The abscess was small .. but you would have thought I was sawing her arm off. She literally went from "Jesus, please help me" to "IN THE NAME OF JESUS STOP TOUCHING ME" to "G.D. get your F*in hands off me!!!"

After I finish draining the abscess, I go into talking to her about my treatment plan. Antibiotics for the discharge and the abscess .... and it went a little something like this ...

"Your discharge looks like it is a bacterial infection. You got if from being sexually active. You need to be tested for all of the other STD's."

"I don't know what that is ... I'm from New Orleans."

Her friend chimes in ... "A SESHLY TRANSITTED ZEEZ" ... I am still speechless at everything I have just witnessed and leave before I hear anymore of her friend's definition of an STD. Perfect patient for Fat Tuesday.

ER PA

Popped

A 34 yo female arrived to the ED bent forward and holding her vagina. The patient was screaming in agony yelling, "Something is coming out!"

I immediately went to examine the patient and asked her what happened.

She stated that "My boyfriend and I were having sex and in the middle I felt a loud pop with severe pain. After he stopped, I stood up to go to the bathroom and THIS fell out!"

She pointed to her vagina. I then looked down and noticed her small intestines and omentum hanging from her vagina!!! I could barely look at the boyfriend without wondering what he was packing down there to bust his girlfriend like that. It turns out the patient had a hysterectomy and the boyfriend popped the sutures loose. Gyn on call immediately took her to surgery where she had an uneventful recovery.

-Doc Sensitive

Letting Go

I am very much for end of life care. I feel that someone at the end of their life should be let go peacefully instead of being put through painful tests and procedures, generally prolonging things for a long time.

Recently we had a very sick cancer patient whos wife would not let him go. He would be admitted, discharged, re admitted, re discharged, over and over. Despite all the counceling the wife received, she refused to put him on hospice. It got so bad that the hospitalists got the ethics board involved b/c the care was so futile. Finally, after a lonnnng and painful course, the patient died.

Yesterday I had a very different experience. I had an 85 year old female come in from home with her daughter. Her daughter had been caring for her since her stroke 3 years prior. She was unable to talk and could not eat on her own. Her quality of life looked very poor. She came in for decreasing mental status. She looked very ill. It was obvious she didn't have long left if we did not get aggressive in treatment (including a ventilator).

Of course, she was a full code. I had the normal talk with the daughter. Most families that I deal with refuse to make the patient DNR. They usually want everything done. I think there is guilt involved....maybe they think if they make them DNR they are saying they don't love or care anymore. But this patients daughter was very rational. She said, "you are right, she has suffered enough. Just make her comfortable."

So I got them both a blanket, turned down the lights, put on some music, turned up the oxygen, made the room peaceful, and gave just a little bit of pain meds. I checked on her every 20 minutes.... more so the daughter felt like I was doing my best to keep her mom comfortable. Within 2 hours she died....peacefully. I hugged the daughter, called the chaplain, and it was done. No dragging things out.

Maybe I'm just a death panel liberal, but I think this is the right way to do things.

ER Doc

Lap Bands

Lap bands and gastric bypass get on my nerves. They have all kinds of complications. I am sure they work for the most part, but all my patients who come to the ER with lap bands are still huge.

Today I want to rant about taking pills and lap bands. I hate when I write a script for someone with a lap band and they ask me, "Can you prescribe it in liquid? I can't take pills because of my lap band."

It doesn't matter if it is a pain pill... antibiotic... whatever it is... they want liquid. A grown friggin adult asking for liquid medicines. And they usually have just scarfed down a burger or Cheetos. I always ask "Can you eat food?" They say yes, but they still need liquid medicine.

WELL TOO DAMN BAD. I don't give liquid meds to a grown adult unless they have some disease where they can't swallow solids. I am not going to calculate some huge amount of liquid and make the pharmacist dispense 40 ounces of meds when you can make the adjustment yourself.

If it's a pill and you want to be a puss, then grind it up. If its a capsule, open it up and put it in yogurt. (Haha like they really eat yogurt...I meant cheese fries).

ER Doc

Man-Of-Da-House

A 10 year old came in by EMS in with a severe asthma exacerbation. Lets call him Man-Of-Da-House. He was accompanied by his 7 year old sister. They had been home alone all day, and little sis called 911 when Man-Of-Da-House was having a really hard time breathing.

It took 3 hours to find mom. She strolled in the ER like it was no big deal. No she was not at work during the ordeal. The kids looked 5 years younger than their actual age. I think b/c they are probably neglected.

Man-Of-Da-House wasn't getting much better, so we had to transfer him to a children's hospital. Most moms will do whatever to stay with their child when they are being admitted and definitely transferred. This one didn't...she said she was going home to change clothes. Poor little Man-Of-Da-House was transferred in an ambulance to a different hospital all alone. He looked terrified

I was livid. I was a Man-Of-Da-House myself....but at least my mom gave a shit.

-ER Doc

Religion

I admitted this guy to the hospital a few nights ago. I asked how he ended up there, and he started with, "Well you see, I'm a very religious person..."

This is almost always a bad sign. Nothing against religion, but it can take marginally crazy people and push them right over the edge. I can't tell you how many times I've heard "God is talking to me" or "The devil is in my head". Why doesn't anyone ever hear Uncle Leo? or a furry little rabbit? or a GI Joe? I digress.

This guy has been smoking weed and PCP, every other day, for 13 years. Except for the 6+ years he was in prison for his 7 felonies. A couple weeks ago, he was partying with some buddies, then decided to go into a bedroom to pray, while high. "I was talking real fast, real stupid, Doc, and I said some bad things. I blasphemed God. I felt really bad. I started thinking about what I should do about it. Then I remembered the passage that said 'God said you should cut off what offends him.'"

So a few days later, he was partying at a friend's house again (he's always at a friend's house because he has no house), and he busted out a steak knife and cut his tongue off. Not all of it, just the distal 1/3. Then, his caring friend, who had a bunch of warrants, dragged the patient into the front yard of the house next door with his tongue in his pocket, and called 911. Which was nice, because what would a guy with no tongue tell the dispatcher? "Ahhhhhh thit! I cut oth tha thip of my thucking thung!"

By the time I talked to him, his tongue was sutured back on. He was happy he did it. "My relationship with God is more calm now. I wonder what my future will be like with this speech problem. But I did the right thing. I shouldn't have blasphemed."

I tried to rationalize with him about other Bible teachings, like how we were created in God's image. If that's true, wouldn't cutting of your tongue be equal to cutting of God's tongue? "I never heard that before." Funny since he's very religious (refer to paragraph one.)

I think the passage is Matthew 5:30

"And if thy right hand offend thee, cut it off and cast it from thee; for it is profitable for thee that one of thy members should perish, and not that thy whole body should be cast into hell."

Taken in context, it seems most likely Jesus is speaking in parable or even sarcasm.

Think about it the next time some Bible thumpers gives you a literal, concrete translation of a Bible passage.

Sunday school is over. Drugs are bad.

-Psych Doc

The Invincible Ironman

Have you ever seen the patient who will not die? He who cannot be killed, despite every self-inflicted effort to do so? In the medicine ER, they may be called Gomers. Here is the story of the ultimate psych gomer, who I have christened Ironman.

Ironman has been coming to my hospital since my first year of residency. It started out as suicidal ideation. It progressed to overdosing on psych meds. He would get hospitalized on a med floor, transferred to psych, then sent to a nursing home/group home/state hospital. Rinse and repeat, multiple times. Then he started overdosing on a certain medication. A lot of it. I won't say the name, because I don't want to give anyone ideas. But they were real overdoses, with really high levels, that would have killed some people and given end-organ damage to lots more. He has done this multiple times, and the above sequence kept repeating itself again.

More recently, he started swallowing things. Non-food things. Batteries, pins, pens, paper clips. Even a tree branch. Again, any one of these could have been bad, but somehow he survives. The thing is, he IS NOT trying to kill himself! He really just wants to be institutionalized for the rest of his life. Lots of people have the same wish (believe that), but they usually lie to doctors and sometimes succeed. Ironman doesn't lie (at least about his "suicide" attempts), but despite his serious attempts, he continues to thrive.

What I have told you so far covers only his visits to my hospital. I know he has been to every other hospital in town several times. A few weeks ago, this text exchange happened.

ER Doc: You know a guy named Ironman? Says he was discharged from your hospital and overdosed on (that bad med discussed above).

Psych Doc: I'm surprised u never saw him before. Whatever he said, he prolly did it.

ER Doc: He looks pretty bad.

Then last week:

ER Doc: Ironman is back. Swallowed a tab off a coke can.

Unfortunately, I don't think my literary skills have relayed the scope of this guy's pathology. Oh, wait, here are some more examples.

1. He has ripped out IVs. Lots of them. Not because of agitation or delirium, but because he was mad at me for not admitting him to the psych unit.

2. Yes...we are getting burnt out on consulting this guy. Surgery consults all the time for swallowed foreign body, and my attendings won't even go assess for suicidality.

3. If he finds a new med student or doctor he's never met, he will claim that some psych med gives him priapism. I used to punish med students by having them check that one out for me. The best report I ever received from a med student was "half-mast, at best".

4. Once, he was particularly upset on our inpatient unit. He was trying to fight somebody, so he was placed in a seclusion room. He then started eating his own feces. I guess he thought it hurt us more than it hurt him. Cops were called in to help restrain him, and he grabbed onto an officer's apple bag so hard, he had to go home sick. Then Ironman was discharged to jail. At least I didn't have to see him for 3 months.

This is the story of the worst case of a personality disorder I have ever seen.

This is narcissism, borderline, antisocial, dependent rolled into one hot mess.

This is the man who will survive the apocalypse.

This is the legend of Ironman.

-Psych Doc

Bed Rest

A 24 year old patient that was 6 weeks pregnant came to the ER for a doctors excuse. What was the excuse for you might ask???

Patient: "I was on bed rest for my entire pregnancy last time. So I need a note for my job saying I can be on bed rest for the next 9 months."

Me: "Uhhhhh.....are you serious?"

Patient: "Of course, can I have the note."

Me: "I have never heard of anyone being on bed rest for their entire pregnancy. Were you high risk? What was the problem?"

Patient: "Are you calling me a liar? Are you going to give me a note or what."

Me: "Well you know if you were on bed rest that it needs to be managed by an OB/GYN, not by a random ER Doc you are never going to see again. And the fact that you can't give me some answers raises some red flags. So no, I am not giving you a note and you need to see an OB/GYN for your pregnancy."

Patient: "So.....can I be off for 9 months?"

Me: "Please leave now."

ER Doc

Valentines Day In The ER

Real pic from the ER last night. A nurse got flowers from her boyfriend. No vase.....so she had to use a urinal. Classic.


ER Doc

Tough On The Outside

A 37 year old male was taken to our trauma center for "car vs motorcycle." He was the person riding the motorcycle.

He had no complaints and didn't want to come to the hospital. He looked like a tough guy. EMS convinced him to come in since he wasn't wearing a helmet. He was about 6'2", red hair, and wearing all camo gear.

Part of going to a trauma center means you get stripped from head to toe while in the trauma bay. So the nurses took off his boots and cut off all his thick camo clothing....

And to our surprise, this tough guy had freshly shaven legs and a tiny pink and yellow woman's thong on! It was cold outside, but saying he had a little shrinkage was an understatement. It looked like he had a little acorn in his thong!

You definitely had to be there....but it was greatness.

ER Doc

Just Gross

A tall, burly paramedic student went to do an EKG on a 78 year old woman with chest pain.....

To do so, he had to life one of her saggy, 78 year old breasts out of the way to place a lead.

Old Lady: "Oh yeah...that feels good. Keep that up young man!"

Paramedic Student: "Uh, excuse me."

Old Lady: "You heard me, don't be ashamed. It's been 3 years since I have gotten sum!"

The student finished the ekg as the lady lay there in ecstasy. He denies any further stimulation to the patient.

-ER Doc

The Incredible Shrinking Member?

About 6 weeks ago, a 50-ish male presented to me for his first ever visit to a psychiatrist. He wouldn't tell the nurse why he needed to talk to a doctor. That's usually a warning that something very violent or funny is going to happen soon. Luckily, it was the latter.

He said to me, right off the bat, "Doc, my d!(k is shrinking! When I went to prison, I had a solid 9 inches. When I got out, the best I can do is 4 inches!" He went on to explain how he's been out of the pen for 3 years and hasn't been with his wife because he was too embarrassed. He bragged about his prowess prior to being incarcerated. On and on about the shrinking worm. He was clearly not psychotic, but did have some problems with irritability and moodiness. Also, he had the following things in his history that could contribute to erectile issues: 20 years of meth use, one MI, and type 2 diabetes. At that time, he had no insight into how those things could have affected him.

He said the reason he came in was because his PCP thought he was crazy. I emailed the PCP and ask that she please refer him to urology (why she couldn't figure that out, I don't know). I saw him about 6 weeks after the initial visit. This time, he admitted, "I think all those years of doing speed are what did this to me." I asked him if he was involved in NA or AA. Of course not, but he was thinking about getting active.

I told him he needs to go to NA and tell all the guys there to put down the pipe or your manhood could pay the price. He should go on a scared straight campaign to local high schools. He admitted that would be a good idea. Nothing should motivate a guy more than this predicament.

And this blog post is my anti-drug statement of the day.

-Psych Doc

FIBROMYALGIA

I ran across this book in the grocery store.... "What Your Doctor May Not Tell You About Fibromyalgia." I have a few ideas......

1) That it is a fake disease.

2) That you are histrionic/borderline personality disorder at the least, and are bat shit crazy at the worst.

3) That it is most commonly treated with antidepressants. Hmmm....

4) That your doctor hates you and you annoy the shit out of him.

5) To NEVER tell your ER doctor or nurse that you have fibromyalgia, because you will not be taken seriously.

6) That we think all your multiple drug allergies are bull shit, all your other chronic pain syndromes are bull shit, and we are not surprised that you have multiple divorces because it is too taxing for a man to be around you.

• That's right. I am assuming it is a disease of women....because it is. Over 80% of people "affected" are woman. Hmmm.....
  

7) If you are a man with fibromyalgia (I have never met one), then you are complete pussy.

I welcome any others you can think of in the comment section. Also, I am fully prepared for the line of fire I will receive for this.

-ER Doc

Drama Time

So an 18 year old dad and his 16 year old baby mama bring in their 10 month old child to the ER. The waiting room was busy, and the mom sat down without saving a seat for the dad.

This infuriated big daddy. When they got to a room, he started yelling at her. Things got ugly. The nurse called security. Before you knew it, daddy was beating the living hell out of this poor, young, baby mama. Everyone tried to pull him off, but his fury of not having a seat saved for him prevailed. He grabbed the baby, threw him across the room, and continued to beat the mother.

Eventually enough cops were there to contain him. When the mom was let free, she grabbed mace from her pocket and tried to spray him as he was being put in handcuffs. She sprayed it everywhere, unfortunately, and the little baby ended up with mace all over his face.

This was worse than any Jerry Springer drama.

-ER Doc

Eye Opener

Our Emergency Department uses a lot of traveling nurses (nurses that take on temporary assignments around the country).

Last week a new one did not leave a good first impression. She showed up an hour late....8am...and DRUNK.

The nurse manager came down and tried to handle it very respectfully. He even offered to call her a cab. She threw a huge fit. Long story short....she ended up getting arrested for public intoxication.

-ER Doc

Take A Bite Out Of Crime

Next time someone is robbing you, try biting as defense mechanism. This poor robber's neck will probably need a skin graft. It was bigger than the picture portrays.



-ER Doc

Nursing Home CPR

The guidelines for CPR recently changed. There is a greater emphasis for "compression only CPR," meaning to not do mouth to mouth and just do chest compressions until EMS arrives.

A 71 year old nursing home resident collapsed to the ground. The esteemed nurses at the facility called 911 and started CPR...or so they think.

They had heard of the new guidelines, but they got things a little backwards. They thought it was "ventilation only" CPR, meaning they ventilated but did not do compressions.... meaning she had no circulatory volume.

She didn't make it, obviously.

-ER Doc

2-fer

Sometimes you pick up a chart and you see that you are getting to see more than one patient. Usually a parent will bring in both kids to be checked out, etc. The most I ever had was 14. This was from a shelter that literally dropped off a van of people who had been exposed to scabies.

Last week we had a mom and daughter combo. The mother was in for "std exposure." She found out her boyfriend had Chlamydia and Herpes, so she wanted to be checked out.

She brought her daughter, who was TWELVE YEARS OLD, with her so she could get Plan B. Plan B is the "abortion drug," meaning the twelve year old was already sexually active.

We referred mom to county health and daughter to the local pharmacy (you don't need a script for Plan B) and planned parenthood.

What a 2-fer. Like mother like daughter I guess.

-ER Doc

Follow Up

So in my previous posts one of the cases I talked about was an aortic dissection. I have done some fun stuff lately at work, but this case I am very proud about (and I really didn't do much).

Aortic dissection are not common. When you do find one, it is usually too late and the patient dies. This patient was relatively young (40s), and did not have the classic symptoms of a dissection. The only reason I looked for it was because he had a new murmur. I very easily could have not gotten the cat scan (almost didn't), and he would have died.

So when I found it, I was thinking this guy might actually survive this b/c we caught it early. When I called the thoracic surgeon at midnight, he did not share my enthusiasm. He was PISSED b/c he had a big day scheduled and did not want to be operating.

He even asked if I could transfer him to another hospital! Of course I said NO I am sure other hospitals thoracic surgeons have big days planned as well.

So after yelling at me for finding this dissecting aorta in a young man, he was forced to take him to the OR. He huffed and puffed and said what a waste of time this guy is going to die.

Guess what....less than a week later, the guy went home today. He WALKED OUT of the hospital and should be fine.

Great save indeed, despite grumpy f***ing surgeons.

-ER Doc

Wild Shift

The last month and a half have been surprisingly slow. Acuity had been down. I had been complaining the last two weeks about my lack of intubations, central lines, codes, etc.

Last night things finally blew up the way I was hoping for.

A 54 year old with a big head bleed that required IV anti-hypertensives and eventual intubation....

Then a healthy 42 year old male with chest pain. Good chest pain story for angina. He had murmur though, so I scanned him for an unlikely aortic dissection. Sure enough he had one, so it was time for an Esmolol drip and a cardiothoracic surgeon...

Then a good old case of respiratory failure that required intubation and a central line.

Then a seizing febrile 9-year-old little boy. After a full workup including lumbar puncture...it was apparent that the flu got the best of him.

As I was wrapping up the LP, the charge nurse grabbed me b/c a trauma CPR was 3 minutes out. A 29-year-old was shot in the chest with a 9mm by his wife. I did a thoracotomy (cracked open his chest to try and repair the hole in his heart and clamp his aorta), but he died. I was feeling great tho!

Then 35-year-old who kicked the shit out of a concrete wall. He fractured and dislocated his ankle, meaning I got to consciously sedate him and reduce the injury.

My last patient was not exciting. He was a homeless man who wanted me to trim all his toenails. Fastest discharge EVER!

-ER Doc

A Spider Bit My....Penis!

This was the real deal. A poor 46year old Hispanic male was bit in the penis by a black spider. He went to another hospital initially and was discharged. Below are his nurses notes (pretty humorous). Fyi.... Pt= patient and OSH = outside hospital.

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Note 1: "Spider bite" (states it was a black spider) to penis while sitting on a toilet. States immediately cut his penis with a knife to extract the "venom". Pt was seen at OSF and given hydrocodone for pain and reports thehospital staff thought he was bitten by a human, pt denies this. Pt now reporting pain in abdomen and chest and feels as if his "nerves are tight."
Note 2: Pt to ER for spider bite to penis at 0900 this morning while on the toilet. Pt reports he visualized the spider. Pt was seen at OSF but reports that they believe he is lying and gave him Lortab and tetanus shot. Pt reports he cut the area of his penis to drain it. Pt reports white fluid came out. Pt with small superficial cut noted to penis. No bleeding. Pt reports pain as squeezing of testicles that radiates all the way up to his chest. Pt reports this pain is constant since 11 am. Pt reports vomiting X 1 approx 1 hour after being bitten. Denies nausea at this time. Pt appears anxious at this time. Awaiting MD eval.

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The guy was telling the truth. He was very anxious and his abdomen was rigid, which are true symptoms of a black widow bite. He received some IV muscle relaxants and went home about 6 hours later. I have no follow up to know if his penis fell off.

-ER Doc