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