Tuesday, December 29, 2009
1. Overheard this discussion betweeen a new patient and the nurse (I didn't see this patient, the other resident did).
Patient: "My mom kicked me out. I am staying at Motel 6. I spent Christmas at ***** hotel - it's for dealers and whores!"
Nurse: "Why did she kick you out?"
Patient: "She says I've been neglecting my son. How can I neglect him if I'm not even there?"
2. New patient presents with anxiety. No psych treatment history. Anxiety problem started a couple of weeks ago. The only situation that makes him anxious? Urinating into a cup in front of his probation officer.
I'm sure it had nothing to do with having a possibly dirty UA. Especially after you've already been in prison. You should be pretty used to performing bodily functions in front of peers.
3. New patient, 20 year old kid. Chief complaint "I think I'm addicted to Adderall."
Me: "What can we do to help you?"
"I need a prescription for Adderall."
Right away, I have decided I won't be prescribing any schedule IIs to this dude. I went through the interview, and he just kept on giving me reasons not to. Uses ecstasy, meth, LSD, cannabis on a regular basis. Has purchased Rx stimulants from friends and off the street. No job. Dropped out in 9th greade. His goals are: 1) Record some of my music 2) videotape myself skateboarding, burn it onto DVDs, and sell them on the internet. Arrested x1 for possession of weed. Denies any history of violence/suicidality.
I let him go on and on, way longer than scheduled 30 minutes because I was documenting like crazy. He had some anxiety, no mood component or psychosis. I offered medical treatment that did not include stimulants (or benzos), and he started to get pissed. "I need to go out and get some fresh air. Can I leave my stuff here?" I told him that the interview was over and to please take the stuff (new patient forms) and complete them in the waiting room.
Next thing I know, Granny comes back and starts advocating for placing him on stimulants. "He's been clean for 2 weeks."
"Really? How do you know? He told me he did meth and weed last night."
"No he's been in jail for 2 weeks for possession of methamphetamine."
So now I know that he's lying to me about jail.
She also says she has to sleep with a deadbolt on the door because he assaults her.
Lying about assault history.
All this and she wants me to prescribe a med that he admittedly abuses, and will likely increase aggression.
After I let Granny vent all of her anger toward her worthless grandson out onto me, I gave her a referral to Al-Anon.
Just a day in the life. Check back later about a 12 hour shift in the psych ER.
Monday, December 28, 2009
A 34 year old male came in for a burn. Poor guy was ironing when he had a seizure. He knocked the iron to the ground then landed on top of it, making the 3rd degree burn to his back seen on the left. It sucked because he was therapeutic on his seizure meds, meaning he was taking his meds the right way. He ended up having to undergo surgery due to the depth of the burn
Sunday, December 20, 2009
Sundays are usually pretty slow days in the ER....especially during football season. Today, though, was the exception to the rule. It wasn't just busy...the department was full of sad cases. Here are a few:
- 64 year old female on blood thinners was putting up Christmas decorations, slipped, and fell. She had a large head bleed. The family will likely withdraw care
- 21 year old male was fixing his parents fence when the power lines somehow fell on him. He had severe electrical burn injuries, aspiration pneumonia, and is going to require multiple fasciotomies...if he survives
- A nice 19 year old hispanic male.....on dialysis!
- 37 year old female with newly diagnosed pancreatic cancer
- 44 year old female with newly diagnosed hepatocellular carcinoma
- 54 year old male with no past medical history came in with back pain and leg weakness. Ended up having a large epidural abscess and osteomyelitis
- 2 heart attacks
- 2 motorcycle accidents, 3 motor vehicle rollover accidents
- 1 gun shot wound to the chest
- 47 year old make, obese, diabetic, on dialysis, bilateral below the knee amputations...today gets a diagnosis of fournier's gangrene (horrible necrotizing infection of the scrotum)...so now he won't have testicles either
- A 45 year old with left upper extremity weakness. Normal CT brain....MRI showed an acute thalamic stroke
Friday, December 18, 2009
Wednesday, December 9, 2009
"10 year old female accompanied by her mother. Mother brought her daughter in because she has been having large bowel movements. Patients mother states her daughter is only having one BM per day and it is formed, but she is worried about the size of her stool. "
Thursday, December 3, 2009
A father noticed his young child was choking. He ran to go help his son by performing the Heimlich maneuver. After about the fifth thrust, his son became dramatically worse. When the child arrived to the ER he was dead. We noticed a lot of crepitus in his swollen neck. Autopsy results showed a thumbtack that perforated his trachea. The theory is that the boy swallowed the thumbtack and the effects of the Heimlich maneuver propelled the tack through his trachea. The back of the tack was sitting right where no air could pass, with the sharp part piercing a false track. The dad did everything he should have. I feel horrible for him.
Hard case to swallow...no pun intended.
Sunday, November 29, 2009
So when the patient got sicker and we couldn't figure out what was going on, the surgeons decided to see what exactly that possible foreign body was. Turned out it was about $10,000 dollars worth of cocaine stuffed inside of her. It was removed and IV antibiotics and time did the trick.
Sunday, November 22, 2009
Sometimes we hear medical terminology and associate it with what we think it sounds like. I had a patient who did suck that last week.
Phlebitis is defined as inflammation of a vein. My patient came in because she had been around fleas and wasn't feeling well. She was afraid she might have been bitten by the fleas and caught a case of "Flea-Bitis." Classic.
Wednesday, November 18, 2009
When the translator arrived, I asked him "How did the needle get into your thigh?"
He said, " I'm not sure."
I then asked him, "Don't you remember that LARGE needle going into your leg. You had to feel it when it happened."
He said, "No, but about two weeks ago I started feeling a sharp prick every time I walk. Maybe the needle was in my pocket and it just went in. Or maybe I laid on it."
I was puzzled as to how a large sewing needle got stuck in his thigh. I examined his thigh and he didn't even have a mark on him. To this day, I am scratching my head. We gave him an appointment to see a surgeon to have it removed.
Monday, November 16, 2009
Some more weird complaints from patients from my last moonlighting shift in the boonies:
Patient 1: Chief complaint of "I think I have forceps coming out of my vagina!" Oh course everyone was cracking up before I went into the room. The patient stated that she had a c section done a year ago. Since then, she had pain and pressure to her lower abdomen. She was convinced the doctors left forceps in her uterus and they were slowly falling out. I did the vag exam, and of course no forceps. But....Before I left the room I got some forceps from the drawer, gooped them withe some jelly, and brought them out of the room with my gloves on. I had a shocked looked on my face and told the nurses, "Look! She really did have forceps in her snatch!" I couldn't hold my laughter for long and they quickly figured out the joke.
Patient 2: Was actually a phone call to the nurses. The person called at 3 am b/c she cut her dogs toenails too much and they were bleeding. She was frantic and didn't know what to do. My nurse told her to call a vet. She said all vets were closed. So my nurse said, "So go to sleep!" and hung up the phone. Greatness
Thursday, November 12, 2009
Wednesday, November 11, 2009
Monday, November 9, 2009
A 27 year old male came in withe the chief complaint of testicular pain. On exam he had extremely enlarged, red/purple testicles. There was active drainage, he was febrile and tachycardic, and the infection had spread to his lower abdomen and thighs. It was basically a surgical emergency.
Usually this kind of infection stems as a complication from diabetes...but not in this guy. No past medical history. So what could it be?? The story is very hard to believe. His girlfriend told him that she heard "milking the prostate" can feel really good and make your man parts larger. Problem is they didn't know what that meant or where the prostate was. They KNEW the prostate wasn't in the penis, so it had to be in the testicles. So...they got a needle and syringe INJECTED MILK into his scrotum! Ouch.
I try to educate my patients as much as possible on things. I don't always do a good job when its really busy. But this time I was sure to explain what "milking the prostate" really is.
Poor guy lost both of his testicles from necrotizing fasciitis. Milk doesn't always do a body good.
Thursday, November 5, 2009
Working in a county hospital emergency department reminds me everyday that our healthcare system needs reform. I saw a patient the other day that was a sad example of this.
The patient was a hard working handyman who had been recently diagnosed with metastatic cancer. He had noticed a lump on his ribs a month prior, and it was discovered that lump was actually metastatic cancer to his ribs from a gastrointestinal source. He was in the ER for worsening pain. I looked through the computer to see what follow up appointments he had, and I noticed he was to be see in palliative care clinic in the next few weeks. Right then I knew his prognosis. Patients don't go to palliative care for cancer treatment, they go there so their pain can be controlled as the cancer spreads until they die. I talked to him and his wife for a bit, and could tell they still had hope of possible treatment. The past month had been a shock for them, as it would for any of us.
So let me get this straight... an honest, hardworking man who struggled to support his family now has an incurable cancer that was found only after it spread and became noticeable.... YES. We see it all the time. Why wasn't it caught earlier? Only if this patient had a primary doctor who noticed he was having months of weight loss (a classic historical point in cancer patients) or was anemic and needed further workup. If only he had a routine screening colonoscopy for a man of his age. Unfortunately, a lot of the time hard working people who support their family cannot afford health insurance, and in the end they sacrifice.
Health care in this country is the greatest example of the haves versus have-nots. I don't want to paint the picture that people who don't have healthcare are poor and homeless. They have jobs and families but just cannot afford the high cost of medical coverage. I see them every shift in the emergency department. It costs more to take care of a patient who has had a stroke because of untreated chronic hypertension than it is for that patient to have a primary doctor and take daily blood pressure medication. We practice reactive, not preventative medicine. Reactive medicine not only increases health care costs, it hurts people. I am not saying we need a socialist system, but people should not have to choose between medical care and supporting their family. That we should all agree on.
Tuesday, November 3, 2009
We all know that sleep walking can be dangerous...but I never thought of this happening. The cat scan shown is that of a poor patient from yesterday. 29 year old make walked in confused, wide based gait, and bruising around his eyes (racoon eyes).
Classic picture of someone with an epidural hematoma, and that's what he ended up having. His girlfriend said he was sleepwalking and accidentally fell down the stairs...about 22 of them. They had a gate on the stairs to prevent this, but I guess it didn't work. He quickly declined and had to go to the operating room to drain the blood. So far he is still alive and he should do ok.
Friday, October 30, 2009
Thursday, October 29, 2009
It was thirty minutes before the end of my shift. I had almost tied everything up and was planning on leaving on time for once. Out of nowhere, paramedics burst through the doors of the ER with a very sick patient. The patient was a 400-plus pound intubated Mexican man. No one in the ER knew he was coming in. We always get an alert when an ambulance or helicopter are on their way to us. With this case there was no report, no one called ahead, NOTHING! As the paramedics came closer, I noticed something out of the norm. All of the paramedics were Hispanic, and the writing on their uniforms were in Spanish. "This can't be what I think it is," I thought.
So as we got him into our critical care room, we learned that he was in a Mexican hospital for the past week and his family was disgruntled with the care he was receiving there. The doctors tried to transfer him to us a couple of days prior, but our hospital refused (It's not a law that we have to accept transfers from other countries). So after being rejected, his family paid a large some of pesos to rent a jet to fly him to the states, and had a helicopter waiting once they landed to transfer him to our hospital. That explained why we didn't receive any advanced notice of the patient. It was an illegal transfer, and the chopper just landed on our roof!
Not only was the patient critically ill and on the ventilator, he was unstable. The only history we had was a patient summary from his hospital stay in Mexico...and it was hand written in Spanish. His oxygen saturation was low despite being on the vent, his blood pressure was low, and his heart rate was through the roof. He had medications hanging through an IV, but the IV wasn't working! It was a mess. Eventually we stabilized him, and he made it to the ICU.
What's going to happen to the Mexican hospital? Nothing. They don't abide by our country's hospital ethics laws. What's going to happen to the patient? I don't know, but I do know that we just inherited all the substantial medical costs to take care of this unfortunate gentleman... and I left my shift and hour and a half late :)
Tuesday, October 27, 2009
A couple of male patients kind of weirded me out today. Both married med in their 50s.
The first needed a prostate exam to rule out prostatitis. He said he never had this exam done. After the exam, he thanked me and said it was the most action he had gotten in awhile, and said he couldn't wait to tell his wife that he was right... putting something in there doesn't hurt that bad. I asked that he wait until he gets home to tell her that.
The second needed a foley to measure his post void residual volume. I have NEVER met a man who enjoys getting a foley....but there is always a first. He thanked the nurses over and over again, stating that it felt so great and that he hasn't "gotten any" in over a year. He laid back and relaxed and asked for a cigarette!
No wonder I found my self washing my hands more than normal today.
Saturday, October 24, 2009
A 65 year old female arrived via ambulance with a heart rate of 220 and feeling very dizzy and lightheaded. After a 12 lead ECG, it was determined that she had a rhythm called supraventricular tachycardia (an arrhythmia originated above the ventricles resulting in a very, very fast heart rate).
I proceeded to give her the standard treatment... a fast acting medicine called Adenosine. I gave her 6 mg IV push and the heart rhythm never changed. I then gave her 12mg IV push and saw the characteristic long pause on the ECG (looks likeasystole )...which is the medicine "resetting" the heart back to normal. After the long pause, however, the heart went back to 220 beats a minute. I debated shocking her, but decided to give her someAmiodarone b/c the second ECG looked more wide complex then the first. After I gave her 150mg Amiodoarone her heart rate slowed down to the 160s, but had yet to revert back into a normal heart rhythm.
I left the room to check on another patient when the nurse pushed the code button and started screaming for help. I immediately ran back into the room expecting to see my patient inasystole... but instead found the patient's husband passed out on the ground. Unknown to us at the time, the husband had a habit of passing out in medical situations. After tending to the husband, I looked back up towards the wife. To my delight the husbands vasovagal episode scared the patient so much it caused her vagus nerve to fire strongly... which reverted her back into normal sinus rhythm!!!! She had failed three different drugs, but in the end all it took was her husband to pass out.
I told her to bring her husband to the hospital the next time she goes into SVT.
Tuesday, October 20, 2009
A patient from a neighboring country had a vascular problem with her foot. The prognosis given to her foot was grave, and she wanted a second opinion. Someone from her family recomended our hospital (which again is in another country) as her saving grace. They packed up and got in the car and started to drive. For some odd reason, they put her foot in ice for the drive to "stop the infection from spreading." So they drove, and drove, and drove (passing many large cities and hospitals on the way) for about 20 hours to our hospital....all with the foot in ice. So needless to say when she arrived her foot was hypothermic, black, and dead.
Not much could be done at that point. I guess second opinions can be overrated.
Monday, October 19, 2009
Non-Clinical Clinical Prognostic Indicators
-Your doctor hasn’t seen you yet, and you’ve been waiting for (insert average wait time) hours.
-You’re in a bed in the hallway.
-Your complaint consists of “months” or “years” of pain/nausea/headache/X Y Z.
-You’ve come to the emergency department for a second opinion, despite multiple subspecialist evaluations.
-You answer yes to every symptom the doctor asks you about.
-You get a blood draw, but no IV.
-The only medication you’re given is tylenol.
-Your doctor says the words “probably” and “virus” in the same sentence.
-You are talking on your cellphone, playing a game, or chit-chatting.
-You are talking on your cellphone, playing a game, or chit-chatting and the doctor has to ask you to stop.
-You “just wanted to get it checked out.”
-Your primary care doctor sighs on the phone when the emergency physician calls him or her.
-You get not one, but two IVs.
-You remark, as my GI bleeder did last night, “Boy, I’ve never been to a hospital so attentive and efficient!”
-You get your own personal doctor to take you to the CT scanner.
-Multiple doctors, nurses, and staff greet you in your room.
-The triage nurse walks you to your room and points at you while speaking to the doctor.
-You get a room all to yourself.
-You get a monitor.
-Your monitor keeps beeping, even though you’re not doing anything.
-Your doctor keeps checking on you.
-Your doctor sticks a finger in your bottom.
-You don’t argue with the doctor about getting this treatment or that one.
-You are kind, good-natured, and have been a good person in this life.
I will seek and find you.. I shall take you to bed and have my way with you. I will make you ache, shake & sweat until you moan & groan.I will make you beg for mercy, beg for me to stop. I will exhaust you to the point that you will be relieved when I'm finished with you. And, when I am finished, you will be weak for days. All my love, The Flu
Friday, October 16, 2009
Wednesday, October 14, 2009
An 85 yo man and 84 yo female married couple arrived to the trauma bay after a head-on-collision in which the man entered the freeway going the wrong direction. Both of their injuries were critical. The man sustained a severe pelvic fracture, and his wife had a hemothorax (blood in the chest cavity). The wife was more critical than the husband, so we intubated her and placed a chest tube to drain the blood.
Shortly after placing the chest tube in the wife, she became bradycardic and lost a pulse. After about 30 minutes of resuscitation, she died. Afterwards, I went over to the husband to reassess him. He kept asking me "how's my wife?" I couldn't answer him. I proceeded to get the CT scans that he needed. He again kept asking everyone "How's my wife?" At that point, we debated not telling him until he got to the floor. He kept asking and then said "We have been married for 65 years." We told him....and it seemed he let go. He died later that afternoon, shortly after he was told that his wife passed away.
Friday, October 9, 2009
Saturday, October 3, 2009
A 45 yo strange looking female arrived to the ED with chief complaint of "bright red blood per rectum." I went into the room and asked her "What brought you in today?"
Thursday, October 1, 2009
As an ED physician, you often encounter certain patients that make you wonder what kind of person they were to touch your life so genuinly- even if briefly. I'm not sure why he stuck in my mind. Maybe it was that he reminded me of my grandfather. I wanted to know more about his career and what "the war injury entailed." More importantly, I wished he was still farming and alive to tell the rest of his WWII stories. In a way, I feel honored to have served him during his last days, just as he served his country and the world during WWII. He served a greater good and higher power then I can ever dream to serve- salute and cheers.
Tuesday, September 29, 2009
Ok...a change in subject. I feel like I am sitting on the floor of the senate after reading all those comments. Great to have an involved debate though.
Monday, September 21, 2009
Sunday, September 20, 2009
Shoulder pain is a very common chief complaint in the emergency department. It's also a pretty easy work up and disposition. This case was no different, but the story behind it was classic....
Monday, September 14, 2009
Thursday, September 10, 2009
Dear Psych Doc:
I have had a LONG string of not remembering my dreams lately. I think it is b/c subconsciously I know you will interpret them for everyone to hear. Finally....I had a dream and remembered it. It was kind of dumb.
Tuesday, September 8, 2009
A mother brought in her 8 month old baby today for "breathing difficulty." She stated that for the last 2 months her child had been breathing worse and worse. He had a non productive cough and no fever. They had been to her pediatrician multiple times. Despite treatment with medicines, including breathing treatments, the child was getting worse. When she went to see her doctor today...she realized the baby had lost 4 pounds in the last 2 months...so she decided to come to the ER for a second opinion.
So the diagnosis was easy. Swallowed a coin. Consult for endoscopy....
But if ya think of it....this doesn't really make sense. The kid has been losing weight so I am confident that the coin was probably the culprit. But how does a baby that small swallow a coin? We are taught that a coin that is swallowed but doesn't make it to the stomach is a surgical emergency. But presumably the child swallowed this coin 2 months ago?!?! That means by now the child would have been septic, had a perforated or eroded his esophagus, the list could go on and on.
So....I'm stumped. Don't know if the swallow was recent and a red herring to what was really going on, or if he swallowed it 2 months ago and is some kind of miracle baby. He was admitted to the hospital to have the coin removed and further workup. I'll have to follow up and see what comes out of it.
Thursday, September 3, 2009
Below is a link of a blog post from a different website. I think it brings up important points that we don't hear enough of:
Wednesday, September 2, 2009
Here is a copy of a nurses triage note from the other night.
Monday, August 31, 2009
Friday, August 28, 2009
I am a "green" R.N and just pulled a 36 hour shift in a very understaffed hospital. I was tired, emotionally spent and considering my career choice. After reading your blog and seeing the way you use humor to deal with the day to day happenings it rekindled my faith and reminded me that I wasn't alone. Thank you.
Wednesday, August 26, 2009
Here is a direct copy of a chart I saw when looking up a patient's past history:
Patient presents with
- "My Cat's Burning"
HPI: Patient very difficult to interview and giving strange inappropriate responses to questions. Shouts, "AIDS!" long pause "Gonorrhea!" long pause "you want to see my penis?" long pause "My cat's burning and I need someone to look up under me." Finally interpreted to mean that she has burning when urinating for several days. Also complaining of vaginal pain and burning. Unsure if she's had any discharge. No abdominal pain, nausea, or vomiting.
-You can't make this stuff up!
Friday, August 21, 2009
I was at the mechanic the other day. I knew I needed some work done on my brakes, and I was getting a quote. Meanwhile, I made small talk with the brake guy while he was telling me all that I needed. Of course, I felt like he was trying to sell me more than I needed. I went with the minimum service. He said something like, "I bet that your psychiatry training helps you out with negotiations like this," implying that somehow I knew that he was trying to scam me. I did, but it had nothing to do with my psych training.
Another example is when someone recently mentioned that a way to keep guns out of the hands of suicidal/homocidal people is to make them undergo a psychiatric evaluation. Of course there would be a lot of logistic concerns (which psychiatrists would do it, who would pay, etc.) But what I want to make clear is that Psychiatrists can NOT read minds. I can only help you if you want help. If you are lying to me, maybe I can figure it out, but I probably can't. Sure, I may be able to tell if you're depressed or hearing voices. I can obviously tell if you're manic. But I can't tell if you're going to kill unless:
1. You tell me you're going to or
2. Your family/friends/police heard you make those statements or
3. Other aspects of your personal history (which you can lie about anyway) send up a red flag.
The third aspect of all this is what really hits home. I recently found out that the father of one of my daughter's classmates died. It made me confront my own mortality; I had seen him a few days before. He was fairly young and appeared happy and healthy. He did NOT look depressed. I figured he had a heart attack or car accident. Then I checked the medical examiner's website. He committed suicide. This was a person who on the surface had a loving family, a successful career, wealth, you name it. These are all protective factors for suicide that almost none of the patients that I treat at a county hospital possess. Who knows what his own personal demons were. But the point is: I'm sure nobody saw this coming.
I can't stop thinking about the hole that he left for his wife, kids, and friends. My initial sympathy turned to anger due to the selfishness of this action. That night, I told my family I loved all of them and promised to never do such a thing. It has been haunting me for a week now. Even though I didn't really know him, it touched me deeply. I am a mental health professional. I am supposed to help people like him.
Please, if you are having thoughts of suicide, or know someone who may be, please get them the help they need.
Sometimes they don't seek help on their own.
And don't expect a random psychiatrist walking down the street to read their mind.
Anyone can fake it.
Anyone can lie.
And I wouldn't know.
Thursday, August 20, 2009
Monday, August 17, 2009
Sunday, August 16, 2009
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.
Friday, August 14, 2009
Monday, August 10, 2009
Wednesday, August 5, 2009
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!!!!
Monday, August 3, 2009
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
Sunday, August 2, 2009
Monday, July 27, 2009
Tuesday, July 21, 2009
Sunday, July 19, 2009
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.
Tuesday, July 14, 2009
Friday, July 10, 2009
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.