Wall of Saddness

A 22 yo male arrived via EMS after being in a head on collision at highway speed. There were already 2 fatalities on the scene. According to the paramedics, the patient was found 30 feet away face down with agonal breathing. He was intubated at the scene and brought into the ER as a Level I trauma activation under the code name of Alpha. The patient was in bad shape. He had a large skull defect, cerebral spinal fluid coming out of his right ear, & unequal pupils. These are signs of SEVERE brain injury...but he was being kept alive by residual brain stem function and the ventilator.

After we stablized him, three sets of parents arrived and were put into the family waiting room. I called the chaplain because none of the parents knew about the fatalities. We had no way to identify our patient besides his personal belongings. Our patient, the last alive and barely holding on, had a unique belt on.

I went into the family room to talk to the parents. I said "I am sorry to break the bad news but we had two deaths at the scene. The one survivor is here and is in very critical condition."

All I could hear was screaming and sadness. One family member asked, "Who is the young man alive?" I said, "Sir, we have no way to identify him except that he has a unique belt on." Then one hopeful set of parents started crying and said "Does it have a nickname and silver trim?" I said, "Yes." The parents then shouted "That's out son!"

The other parents were crying in agony. It was probably the worst night of my medical career. Trying to maintain composureI said, "You can come back to see him in 5 minutes, but he is in critical conditon with a serious brain injury."
The parents soon came back and identified him. Unfortunately the CT Scan illustrated irreversible brain injury with a cervical spine fracture. Again, I had to break the sad news to the family.

With more strength and courage than I could ever imagine, the mother said "I want to donate his organs so someone else can live. He wouldn't want to live like this." I was shocked b/c so far in my career, I've seen most make end of life decisions that maintain someone on a ventilator, prolonging the inevitable. I made the call to the transplant center and he became an organ donor. I left the hospital that day with a wall around my heart to seperate my emotions from reality.

I eventually forgot about Alpha until I received a letter in the mail one day from the transplant center. It said the following: "Dear Dr. Sensitive, Although Alpha died on June 1, 2008, we were able to harvest his liver, eyes, kidneys, & tendons. Because of your referral, 12 people were either saved or helped by Alpha's tissues. We are extremely grateful, and on behalf of our patients we thank you."

My wall came down and my emotions came back. Thus far I dealt with that night by building a wall, but now Alpha was a real person to me. I went home that night and googled his name. I found out that he was 2 minutes from his house, his girlfriend was following behind him, and she saw the entire accident. I discovered that he had a My Space Page and looked through it. It was strange to see him as a person, and I was saddened that his life was cut so short. However, through his death and his courageous mother, he saved the lives of 12 others.

-Doc Sensitive

Fact Check

Nice article I found on misconceptions with the Health Care bill. Link is provided if you are interested.

http://www.newsweek.com/id/211981?GT1=43002

-ER Doc

Allergies

Below is a copy of a "allergy list" from a recent patient, with only the hospital name taken out. It goes with one of my rules that "the more allergies the patient has the less likely the said patient is sick. " Also, the spelling is priceless. The only pain med this guy wasn't allergic to was demerol. Uh huh....




-ER Doc

Healthcare Reform and a Scary Fact

We haven't broached the politics subject yet....but figured now is as good of a time as any.

The US Securities and Exchange Commission Filings reported that profits for the 10 largest insurance companies increased from 2.4 billion to 12.7 billion from 2000-2007, while the number of uninsured increased 19%. Kind of hard to explain that one. And we are supposed to believe the rhetoric that if a public option exists the private insurers wont survive. Come on. Not to mention that the average salary for the CEOs of these insurance companies is 11.4 million!

Here is a link from a fellow blogger that has lots of the most up to date information and videos on the health care debate. View if your interested.

http://gardnersgate.blogspot.com/2009/08/white-house-responds-to-health-care.html

-ER Doc

Tough Love

A 32 yo male arrived via EMS in full cardiac arrest without a pulse. Despite our best efforts, and despite us coding him for over an hour, we pronounced him dead in the wee hours of the morning.

We all scratched our heads because this young man looked healthy, clean cut, and didn't appear to be an IV drug user. We went to the family waiting room and broke the bad news. It was tragic to all, including the nurses and doctors because its always hard to have a young person die.

Later in the evening, the hospital chaplin spoke with the girlfriend regarding their last moments. The girlfriend stated : "He had been looking at girls all night long and pissing me off. When we went to leave the bar he did it again, and I punched him in the chest and he took two steps and fell over."

When I heard the story I was shocked because I didn't believe someone could die from one punch! After some research, however, the condition is called "commotio cordis," results in V-tach, and can cause immediate death. Everyone should think twice before checking out girls in a bar!!!!

-Doc Sensitive

A Strange Case of Indigestion

This is a case that goes back to my intern year, where a portion of my Internal Medicine rotations were at an outpatient clinic. A 60-year old male came in for a routine checkup. He had most of the usual problems: hypertension, GERD, T2DM, etc. It seemed like a routine med-refill visit, until he asked, "Doc, I think I need some of that Mylanta."

Like a good little intern, I had already reviewed his med list. This seemed easy enough. "Sir, you're already prescribed Nexium. That should take care of everything."

"But I really think I need Mylanta," he said.

"Okay, if you really want it, I can't stop you. If your reflux acts up, feel free to buy some over the counter," I replied.

"But Doc, you don't understand. I have a new lady friend who's 20 years younger than me. I don't have the ability to give it to her as much as she wants."

"Oh, you must mean Viagra."

- Psych Doc

Rural Medicine

It's my 3rd year of residency. One of the perks about 3rd year is you are allowed to moonlight. Moonlighting is basically working outside of your residency part time and earning some semi-real cash. I actually started the last few months of my 2nd year at an urgent care....but this weekend I started at an Emergency Department in a rural hospital. The shifts are generally 24-48 hours b/c you can get some sleep since the volume is low at night. I was the only doc in the whole hospital all weekend...kinda scary

I'm a city guy...so this weekend was kind of an eye opener. I enjoyed the greenery on my drive in with all the cows and horses in the pasture. I quickly learned that not having a truck made me out of place....and the "Yes We Can" Obama sticker didn't go over well. The patients were generally very friendly and nice....which

was a pleasant change.

One patient was a bipolar manic gentleman off his meds. In the city, this kind of case is very easy to admit. In the country, it was a big ordeal... even involving the "sheriff." This guy was very agitated and wanted to smoke. The nurses refused to let him go outside since it was a non smoking hospital and he was under a medical warrant. I felt bad for him and wanted to keep him calm, so I volunteered to break the rules and accompany him while he smoked outside. He sat on the curb....but didn't pull out a pack of cigarettes. Instead he pulled out a bag of home grown green stuff and a white wrap. He rolled it and smoked a joint right in front of me! For some reason I was shocked weed is smoked in rural communities.

Next an old man came in after hitting his head. The story behind it was much more interesting: He was getting up in the middle of the night to get a drink when he walked into his "hanging bull skull!" Yes...a skull of a bull hanging in the living room. He passed out. When he woke up he tried to wake up his son to take him to the hospital. He kept banging on his son's locked door...but he couldn't get him to wake up. So he decided to go outside with his shotgun and fire it outside his son's bedroom window. That seemed to wake him up!

Speaking of guns....we got a heads up call from the local authorities that some kids were driving up and down their street firing a rifle repeatedly. They wanted us to know just in case someone got hurt. What's with country folk and guns? I've never even held a gun.

Overall....I had fun. I surprisingly like the outskirts and look forward to what's next. Only in the country.....

-ER Doc

Rabbit

As a 3rd year medical student I was learning how to properly insert Foley catheters. I was green and really didn't pay close attention during the teaching labs because we used fake penis's and vaginas.

One of my first rotations as a 3rd year was in psychiatry, and a patient developed urinary retention from her psychiatric medications and needed a Foley. I was very excited because this was my first "live patient." I entered the room and saw a 40 something patient holding a stuffed rabbit, petting it, and talking to it. So I stepped up to the patient, and the nurse handed me the kit. I placed the lube on the end of the Foley and spread the vaginal lips and pushed the foley into the "proper hole." I continued pressing and then used my fingers to get a better look. As I continued using my fingers, I noticed the patient moaning....so thought I was hurting her. I continued trying to insert the foley but kept finding resistance. As I pressed, the patient moaned to her rabbit. The nurses started laughing. I continued to struggle but finally asked the nurses, "Okay, this is my first Foley... why is this not going in?" The nurse said, "Student Doctor Sensitive, you are rubbing her clitoris and she seems to be enjoying it." The nurse then grabbed maneuvered hand to the urethra, and it went in without a problem. It was embarrassing for inadvertentlystroking her rabbit....but at least I made a patient happy for once!

-Doc Sensitive

Wooo Wooo Rocket Lube

Monday morning....9 AM. Call from EMS was they were en route with a 33 year old male who was uncontrollable. When they arrived, there were 4 police officers holding this man down. He was shaped average, white, and wearing only boxers. His eyes were wide open and he kept screaming "Wooo, Wooo Rocket Lube" as the cops kept trying to hold him down.

Here is what EMS said. "We got called about an unruly man in his apartment. The call was from a man he met an hour before on the internet. When the man showed up at his apartment to do whatever they were going to do, he said his new friend was flipping out. When we showed up, he was jumping uncontrollably on the bed screaming like he is now. There were candles lit and bottles of Rocket Lube were everywhere."

We started bolusing the guy with ativan to try an calm him down. He had 4 cops and 4 techs all holding him down, and restraints on every extremity. It became too much. After 50 mg of ativan he was still uncontrollable, so we induced a medical coma and intubated him. After he was intubated the nurses started to put a foley in. When they removed his boxers...the man was wearing 2 rubber cock rings!

Monday morning mind you....

So ten minutes later this guy was up bucking the vent and almost breaking through the restraints. Long story short...to keep him sedated he ended up needing a propofol drip at 100mcg/min, ativan 40mg/hr, and fentanyl 200mcg/hr. This is an unbelievable amount of drugs just to keep someone sedated. A normal person would die from a fraction of this. I was astonished. His drug scream was + for Methamphetamines. I've never seen a meth case like that before. Hope I don't again.

Monday morning....unbelievable.

-ER Doc

Deja Vu

Yesterday I had a guy come in who tried to kill himself by an attempted overdose. Run of the mill for our ER....except his name was Michael Jackson and he was 50 years old!! It was creepy seeing that on the board. Even more ironic....he was white too? This guys drug of choice was seroquel (antipyschotic), though. His OD was non toxic and I eventually transferred him to psych.

I had another lady come in by ambulance about 50 years old. Her goatee was thicker than mine. I try to see the ambulance patients right away to help the nurse decide if they need a bed or can go to the waiting room. This lady was freaking out. Screaming to me she needed her pants off. I asked her why, and she said b/c of all the itching in her legs, vagina, butt, and stomach. Then she told me how the worms were crawling out of her and started screaming. She kept trying to get her clothes off...which would have been devastating to everyone around. She had many other weird complaints, like discharge from her anus.

Being in such a big hospital....we have a separate ER for female (ob/gyn) issues. I begged the paramedics to take her to that section and only to mention the vag itching as the chief complaint. It was my 11th hour and I couldn't hand that kind of crazy right then. About 20 minutes later the female ER called to send her to us. They said they checked her out and the itching was from the patient pooping all over herself. I accepted her...then assigned her to the intern. She eventually ended up in psych as well.

Disaster averted!

-ER Doc