Squatting

I do some moonlighting for a local urgent care group. Here is an email that was sent out recently regarding a patient that had been making his way around the clinics. Goes to show ya even in the private sector you the weirdos will find you...

"This patient has been to several clinics requesting physicals from female doctors and midlevels. Specifically, he is requesting rectal exams while squatting. Dr. X has confirmed the phone number he gave us is not a working number. Please do not examine him."

Here's to you...Mr. Squatting while using your insurance copay to get off man.

-ER Doc

Clinic Fun

Okay, I know I've been slacking off lately. Maybe it's because I'm in clinic now, so there's not quite as many crazy ER stories. In clinic, the craziness and irrationality is still present, but on a smaller scale. Just thought I would provide some anecdotes from one week of working in an outpatient psych clinic for the county.

One day a week is child/adolescent clinic. Every other patient is a photocopy of this one. 7-10 year old boy comes in with mom. Mom complains that kid is acting up in school, getting into fights, suspended, etc. At home, he throws telephones and potted plants while calling mom the "C"- word. Dad has been in prison all the kids life. Mom never re-married but has had some boyfriends. Mom wants to throw some mind - altering drugs down the kid's throat and hope everything gets better.

Last week, I'm seeing a followup. 50-ish white female with anxiety after a near fatal car wreck that put her in a coma for a few weeks. She had on a T-shirt that said "pimpjuice" and that's all I could think of during the entire visit. I didn't know until today when I was looking for a graphic that it is an energy drink, a Nelly song, etc. If you have anxiety/depression and you think your life sucks, then take life seriously and throw away the dumb t-shirts. Just my opinion.

Yesterday, I was reading through a lady's new-patient questionnaire. She mentioned that she had trouble controlling her "dietbetes". I asked her what that meant and she said, "It's because of the insulin. If I don't eat, I feel bad. So I have to eat more than I should so the insulin doesn't make me crash. I've gained 50 pounds since I got diabetes." I guess she never thought of just taking less insulin. Or she has a crappy doctor (in addition to me).

Also yesterday, a 400+ pound guy comes in for a pain management referral. Basically the pain management docs want a psychiatrist's "street smart" opinion as to whether the person might have potential for narcotic abuse or addiction. On this guy's self-reported review of systems, he wrote down "can't masturbate". I understand that this is a quality of life issue but I asked what that has to do with chronic pain and he said, "Oh nothing to do with pain, I just can't reach down there anymore. Also, I can't wipe my own ass." The guy lives with his 80 year old mother and no one else. I did not ask him who actually does the wiping.

-Psych Doc

Dehydrated

I had to share this one. I went to pick up the next patient on the board and say "dehydrated" as the chief complaint. Sounded easy enough. Then I read the nurses triage sheet. Here is what I read word for word.

Pt was picked up at the Grey Hound bus station by police after calling 911 for an ambulance for "dehydration". Pt wearing only a dirty t-shirt and tennis shoes, smelly badly. Pt has flight of conversations and states "I need to be seen for dehydration and hypertension. I am hard of hearing and that is why I talk so loud, usually most lesbians do. My boyfriend has helped me to overcome my depression and I think my bone structure has changed. I am 37 years old...I know I look 14, i try to stay young. I am really dehydrated. I've been drinking plenties of water aid and keeping the AC at 60 but it still runs and I'm not sweating down there so I'm dehydrated." Pt has steady gait, A&Ox4. Answers questions appropriately. Pt was seen in the ER yesterday in the am and discharged as they decided she was not dehydrated.

Manic is a great drug.

-ER Doc

Chocking the Chicken

When I was an intern on trauma surgery, a 44 yo intoxicated male was admitted after sustaining some injuries in a motor vehicle crash. The patient was admitted overnight because he had some abdominal pain and was too intoxicated to clear neck from any damage. He was placed in a cervical collar to immobilize his neck, and the plan was to reexamine him the next morning when he was sober

The next morning we were on rounds with the attending physician. In our group was a very naive and innocent medical student who was tasked with presenting the patient in rounds. The medical student went into the typical "44 yo intoxicated male here after MVC sustaining blah blah."

After the presentation, the entire trauma followed the student into the patient's room to evaluate him. The room was shared with another old man. As we followed her in, the student turned bright red and opened her mouth in absolute astonishment. We then saw"Mr. intoxicated" in his cervical collar butt naked with his legs spread across hospital bed.... jerking off. The guy couldn't even see his penis b/c the c collar was on so he couldn't flex his neck, but he kept jamming away when everyone came into the room (no punn intended). The old man next to him looked so white we thought he may be dead.

The attending looked at the spectacle and said "Looks like Mr. Intoxication is feeling well and tolerating normal daily activities. Please discharge him." I ran out of the room laughing down the hallway.

The poor medical student couldn't look at us for the rest of the month. Hopefully Mr. Intoxicated was discharged with an accurate discharge summary.... "Pt on day of discharge was in good spirits, tolerating a good jerk off session!"

-Doc sensitive

Nail Head

A 34 year old male came to the ER stating he had a nail in his head and that he needed taken out. He was a little swollen and red above his right eye. A summary of our exchange is as follows:

ER Doc: "Why do you think you have a nail in your head."

Him: "Well....I was working on my roof a week ago and the nail gun misfired and my head hurt afterwards."

ER Doc: "A week ago...surely you would have known sooner than a week later that you have a nail in your head. Are you in any pain now?"

Him: "No just feel like I have something stuck above my right eye."

ER Doc: "Well we can do a CT scan to find out."

Him: "I know its there Doc. I didn't think so but my wife kept saying it was. So she put a magnet to my forehead and it stuck there. See! "

He then pulled a magnet out and sure enough it stuck! The above pic is his actual radiograph. It was lodged just touching his frontal lobe. Neursurgery took him to the OR the next day.

-ER Doc

Michael Mania

I have never seen such an outpouring of emotions over the death of a weirdo. Don't get me wrong....Im a big fan and love the music.....but people are freaking out. The night of MJ's death....we had two BBFs and one skinny little white guy actually call the ambulance to go the the ER b/c they "couldn't catch their breath" after hearing about the death of Michael Jackson. They all required anti anxiety meds. I wanted to send them all to psych.

A couple of good Michael Jackson jokes I have heard recently:

1) When Farrah Fosset made it to the Pearly Gates, Saint Peter asked her what one wish he could grant her for her life of good deeds. She asked only that all the children in the world be safe. So he killed Michael Jackson

2) Michael Jackson hasn't been this stiff since being in bed with Macaulay Culkin.

Feel free to post more Michael Jackson Jokes in the comment section. Hee Hee

-ER Doc

Captain Clue Cell

I was a very green 3rd year med student starting a family medicine rotation when I was tasked with doing a pelvic exam on an enormous female. She was at least 300 pounds with fat rolls that could compete in a baking contest. She was there because she was having sex and her partner's condom fell off inside her and they could not find it. It was an enormous undertaking even for an experienced doctor, but I was very confident that I could remove the object.

The nurse helped Thunder Rolls down onto the exam table and then called in another nurse to hold the fat away from the vaginal vault. Upon removing the large pannus (fat roll), I got a whiff of rotten fish and almost puked. I then grabbed the largest speculum in the room. I lubed it up and dove in like an experienced crane operator. I got into the vault and saw nothing but pure human flesh. It was like a black hole, and I fished around with the speculum and followed the smelly trail to the back of the vagina.

Hell yes, there it was! I reached in like a fool with some forceps and pulled. As I pulled, however, it was adhered to the back of the vagina. So I pull harder, and then it gave way to a flying condom with smelly mucous that lands across my feet and sprays my eyes. I wanted to quit medicine at the moment. I wasn't sure if I should grab alcohol pads, water, soap, or eye drops. I got up and copiously irrigated my eyes. Thankfully, the patient only had clue cells which meant she had benign bacterial vaginosis. From then on, I was known as Captain Clue Cell. .

-Doc Sensitive

Tastes Like Chicken

A 37 year old women came in with abdominal pain and fever. Whenever a female comes in with this complaint we have to do a "female exam" to make sure there isn't a vaginal problem that could be causing this. Sure enough, her cervix was tender and she had a discharge. After sending some labs....it came back as Trich. I informed the patient of her diagnosis and her need of antibiotics. She asked is there anyway to "make her better without getting rid of the discharge?" Puzzled....I told her no and asked her why. She replied "Because my husband really likes the way it tastes and has been spending a lot of time down there."

I almost threw up.

-ER Doc

Morning Salute

A 56 yo male arrived to the ED walking with a bent over, shuffling gait. I asked the nurse "What's that guy here with?" The charge nurse said that he has had an erection for over 24 hours! I was a little puzzled because most sustained erections, or priapism, are associated with Sickle Cell Disease in African Americans... and this guy was a white male- kind of odd.

I knew this would be interesting so I went right into the room.

"Sir, I am Doc Sensitive. How can I help you today?"

This poor guy said, "Two women talked me into injecting 2cc's of this drug called TriMix into my penis last night to get an erection, and it hasn't gone away!"

I continued my history... "Sir was this your prescription? Do you have problems with erections?"

The man, a little embarrased said, "No, it wasn't my prescription. I just did it for sexual enhancement. I wanted to get really hard and last a long time like a porn star."

At that point, I almost started laughing but maintained my composure. I told him that I would have to call the urologist after a quick look down under. The gentlemen took down his underwear. Let's just say that stuff worked rather well because it would give John Holmes a run for his money. There was at full salute pointing right at me. It was obviously very painful because he was grimacing. I left the room and called the urologist.

According to the urologist, TriMix contains three drugs that work in concert to engorge the penis. It can potentially cause permanent damage if someone's erection lasts longer than 4 hours. The urologist came in and stuck a large needle into the engorged monster and drained it.

He said there was a chance that the patient would never have another erection again b/c there could be permanent ischemia- no more morning salutes!

-Doc Sensitive

Popped Brain

A 45 yo female arrived by ambulance with her two sons with a chief complaint "she's not right." I arrived into the room with 3 med students and began my assessment. First, I asked the sons about her medical history and the events leading up to her "not being right." The sons stated that she has no medical problems, takes no medicines, and was last seen acting normal earlier that day. When they arrived home later that evening, the bedroom door was locked, and their mother was screaming for help. They broke down the door to get in and found her in bed screaming for help with her nightgown on.There were no signs of a trauma or blood anywhere. They then called "911" for help.
I examined the patient and started with the head and shouted to the medical students who were helping document. "Ears clear, pupils reactive 3-->2 but sluggish, mouth clear." When I examined her head, I felt around the top of skull and felt something squishy. I then moved over the light and tried to get a better look. Unfortunately her hair was covering the area. I shouted, "Okay I feel a large skull defect but no bleeding or bone fragments." The last time I felt something like that was during neuroanatomy in med school.... but surely it couldn't be brain! I then poked it a couple more times and she screamed "Ouch, ouch!" both times.

I screamed out, "Well guys, this feels like brain!" The entire room feel silent and the medical students thought I was crazy. One med student said "but there's no blood or bone fragments or trauma anywhere on the patient." I said, "I know, it doesn't make sense."

I ordered a CT scan of her brain and sure enough, she had a large skull defect with brain coming out! She had a bacterial brain abscess which ate her skull from the inside which explained why no bone fragments were found. When the abscess got big enough, it ruptured causing her to faint. She then fell exactly on the spot of the abscess and popped her brain! She ended up returning to work without any long term complications.

-Doc Sensitive