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

The Picture Album

I love doing psych consults so much that I just did an extra elective. Something cool about hanging out with "real doctors" and seeing all the medical/psychiatric interactions. Or something. Anyway, I find that most consults are pretty interesting, and I've seen every imaginable kind of delirium, suicide attempt, drug withdrawal, etc. Or so I think. It's those stories outside of my normal comfort zone that make it to this blog.

Warning: Those with kids, especially moms, especially if you're a pregnant mom, be forewarned. You may not want to read this one.

Getting a psych consult to the Labor and Delivery floor can never be good. Usually it's some case of post-partum depression/psychosis, usually requiring a report to be filed with appropriate child welfare agencies, moms with 10 kids and no way to care for them, etc. Today, it got dialed up to an 11 for me.

A G6P3 21 y.o. female presented 2 days ago with acute pelvic pain. She was at 34 weeks' gestation. Sono showed intrauterine demise of the fetus. While waiting to spontaneously deliver, she got very labile, asking to go to a different hospital, etc. Basically, she was angry that the primary team didn't just surgically remove it. Seems reasonable to me, but damned if someone shows some normal human emotion in a hospital or else psych gets called in.

I saw this lady the day after she delivered. She is understandibly sad, tearful, and grieving. Her life had not gone according to plan, as evident in her age, 6 pregnancies, and 3 total miscarriages now. She reported her prenatal care, psych history, support network, etc., as I obtained a complete history and mental status exam. I gave her referrals to several different grief counselors and recommendations for meds and follow-up.

As I was wrapping up the interview, she asked me if I wanted to see pictures of her baby. I felt this twinge in my gut, telling me to say no. No human part of me wanted to see a dead baby. However, I knew it would be better for her therapeutically to show interest in her plight in this way. The patient needed her doctor to do this. To connect with her. It was going to be hard.

She brought out a small album. Her and her mom had put a new little red dress with a matching cap on the baby. They took 6 or 8 pics. Different poses. Closeups of face, hands, feet included. At first glance, it looked like a normal newborn album. But the reality of it all could be seen in the skin color and turgor. I was able to manage "She's beautiful" or somesuch, quickly tied up any loose ends, and left her room.

I just hope I helped her in some way. Because those pictures are gonna stay with me for a while.

-Psych Doc

Give Me Back My Child!

A 27 year old male came in for multiple lacerations. Let's called him Patient Dumbass. He had been doing PCP that day. Apparently, when he does PCP, he gets very "touchy."

While Patient Dumbass was fried out of his mind on PCP, he went over to visit his friends who had a 9 month old child. Apparently, when Patient Dumbess does PCP, he gets very "touchy." He decided to hold the baby, and became very touchy since he was high. This freaked the parents out, and they wanted him to hand over the baby. Well Patient Dumbass didn't want to let go of the cuddly lil' booger, so in normal PCP fashion he held on to the kid and tried to take off. With the baby in his arms, Patient Dumbass ran straight through a glass door, causing injuries to himself and the baby.

Word from the Childrens Hospital was that the baby would be just fine. The police weren't interested in Patient Dumbass, so I deemed him "a threat to himself and others," and he was shipped to a local psych hospital. I don't really think his issues were psychiatric but more just drug related, but there wasn't much I could do and I didn't want to just discharge him.

-ER Doc

Pregnancy Headache

Warning: Sad case for any pregnant readers.

A 23 year old, 16 weeks pregnant female came in with headache, vision changes, and right sided weakness. With pregnant females, we are always very conservative. But in this case, we had to do a cat scan. She was obviously having a big brain bleed.


Before her presentation with the bleed, she was completely healthy. We think she had a AVM that had always been asymptomatic. To date, she and the baby are still alive.

Weird thing is we had the same case in our ER 1 week ago, except the patient was 33 years old and 26 weeks pregnant. She wasn't as lucky.

-ER Doc

Borrowed Post, Condom Inhalation

While blog rolling recently, I found an interesting post from a blog called Life in the Fast Lane. Its from a group of Australian EM Docs.

Anyways, this post is about a women who inhaled a CONDOM! Wow. Had to be a stripper. Why else a condom during fellatio? At least now I can ask my patients with a cough, "Have you been sucking d**k lately and a load fired so strongly the wrapper came off?

Here's a copy of the post and the link.

------------------------------
27-year-old lady presented with persistent cough, sputum and fever for the preceding six months. Inspite of trials with antibiotics and anti-tuberculosis treatment for the preceeding four months, her symptoms did not improve.

A subsequent chest radiograph showed non-homogeneous collapse-consolidation of right upper lobe.

Videobronchoscopy revealed an inverted bag like structure in right upper lobe bronchus and rigid bronchoscopic removal with biopsy forceps confirmed the presence of a condom.

Detailed retrospective history also confirmed accidental inhalation of the condom during fellatio.

-ER Doc

Expensive Day

Today was the beginning for me to start repaying my student loans from college and med school. I haven't even been out of residency one month! More importantly, I haven't even been paid yet! Expensive day to say the least. Only 29 more years and 11 months to go at least.

-ER Doc

The Little Things

Where I work is action all the time. Today I intubated 2 people, 1 central line, sent 3 to the ICU, 1 chest tube, etc. But sometimes it's nice to get one of those classic cases that are simple, but offer the patient relief. Here are a couple of examples


1) A 76 year old female came in with severe dizziness. It had been getting worse over the last few weeks. Immediately all the bad stuff started going through my head like stroke, electrolyte imbalances, etc. But when I looked in her ears...look what I found!

















She said she thought she lost a cotton swab Q-Tip about a month ago. Looks like I found it. Treated her with some antibiotics and she should do fine. Probably the only 75+ year old I have been able to send home with dizziness.

2) A mom brought in her 18 month little girl in for a "red eye." Mom was convinced it was pink eye. Not a bad thought, but when I looked at the eye, I saw no signs of pink eye. Her eye was red, but just didn't look like conjunctivitis. And she was kind of guarding her eye with her hand. So I told the mom I wanted to stain the child's eye to make sure she hadn't accidentally scratched her cornea, causing a corneal abrasion. The mom thought I was crazy, and it took a lot of convincing for her to allow me to do the exam. Low and behold, this is what I found! (Similar image from online. Not actual image from patient didn't want to make her have to take a picture after her enduring me staining her eye for the exam)



Poor thing probably scratched her eye with her nails. She should do fine as well.


Neither case was exciting, but they weren't everyday things for my practice and they offered patient's actual treatments with good outcomes. In a very high acuity ER, this is nice.

-ER Doc