Happy New Year!

To everyone planning to ring in the New Year tonight, a word of advice based on a recent patient of mine: if you're an 18 year old punk who weighs a buck twenty tops, it's probably not a good idea to pick a fight with a bouncer (and lose), only to later pick a fight with a cop (and lose), and then finally pick a fight with the medic trying to treat you.

Stay safe, and remember the holidays are much more fun to celebrate outside the ER.

One Way To Get Attention

Feel like you're lost in the shuffle in a busy ER? Try firing a flare gun at the ceiling. You'll definitely get attention, but probably not the kind you wanted.

Four More Years

Love being home, love catching up with the family, love being accepted to med school. The acceptance, however, does not mean that I am capable of diagnosing the perplexing array of symptoms experienced by assorted relatives. Nor does it mean that I hold the solution to health care reform.

Sorry guys.

Zombie Epidemiology

As I've mentioned before, we in the Big City ED have some of our best people working on Zombie preparedness. It's about time the New York Times took notice.

O Holy Night

Merry Christmas, one and all!

Home For the Holidays

Safely back home with friends and family for a few days to celebrate the holidays. Good luck to everyone still traveling (if you're stranded, I now know of at least one airport that will gladly sell you a $35 H1N1 vaccine while you wait)!

It's The Most Wonderful Time of the Year

You know the Christmas season must be upon us when the freezing cold EtOHers help spread some holiday cheer by offering the ED staff a spare pint of Dubra.

We Three Kings

Competition in the category for Best Presentation to the Big City ED Triage Desk was particularly fierce this weekend, but it is my honor to give you the three finalists...

Myrrh goes to the middle-aged gentlemen who performed a rambling rendition of every blood pressure reading he had ever taken. The saga unfolded something along the lines of "Well years ago a doctor told me my blood pressure was high but then it wasn't for a while until I checked it at a CVS once and I got worried so they started me on, uh, Lisin... um, Lisino, Linsinopoo, but then I stopped taking it," and continued until I asked him what he came to the ED for. His answer? A rash.

Runner up, Frankincense, goes to the dude who ran up to the desk with his finger covered under a large wad of tissues. Sobbing and shaking, he insisted upon sitting on his finger "to maintain the pressure." As the nurse explained that we needed to see the laceration for him to be triaged, I promised to have a large amount of gauze standing by should he have somehow nicked the critical 4th digit artery. Armed with a kling wrap to tie off the bleeder in one hand, I used my other to unwrap sheet after sheet of tissue until I discovered... what appeared to be a mild paper cut.

The Gold medal for Best Presentation to the Big City ED Triage Desk, however, goes to my friend, the Fellow with a Bunion. His award-winning performance went something like this:

FwaB: "Yeah, this has been really hurting for several months now."

RN: "It looks like a bunion, sir."

FwaB: "Is it serious?"

RN: "It's not an emergency."

FwaB: "Well, can somebody take a look at it?"

RN: "You're welcome to wait - it'll probably be around 3 hours - but there's nothing we'll be able to do for a bunion in the emergency department, sir. You'll need to make an appointment with your doctor."

Fwab: "Shouldn't I get an MRI or a CT scan, you know, since I'm here?"

Pure gold.

Blue Christmas

I don't envy the hospital Chaplain. There are few things worse than watching a family holding each other, sobbing, as they grapple with losing a loved one so close to Christmas.

My thoughts are with them.

Bah Humbug

Call me an ER Scrooge, but I still firmly believe that if you're well enough to text/tweet/facebook/whatever your local emergency room to determine how long the wait is, you're not having an emergency. Nor do I think you should be able to pay a service to hold your place in line while you wait at home, as this LA Times article describes.

Emergency Room. Not the Let's-See-If-I-Can-Fit-This-In-Between-Yoga-Lessons-And-American-Idol Room.

Hell No

I'm sorry, 95-pound-optho resident. I'm sure that your super-specific, one-of-a-kind, really expensive, unique type of forceps is awfully important to you. I sense the regret you feel from accidentally dropping it in the sharps box. I even wish there was a way I could help you retrieve it.

But did you really just ask me to try to fit my hand inside the container filled with used needles to fish it out?

Really?

Hand Hygiene

While the ED is still working towards 100% compliance with our hand hygiene goals, at least Hospital Epidemiology can be glad our docs aren't covered in rat shit.

Family Matters

She was septic.

Recovering from major surgery and a cardiac arrest earlier this year, she was hypotensive, respiratory rate in the upper 30s, oxygen sat in the 80s. COPD, bilateral effusions, altered mental status.

As I leaned over her to take a temperature, I could hear her whispering about how tired she was.

It didn't take long for her sats to drop into the 60s, buying her a tube and a ventilator. Her daughter watched from across the hall, crying silently.

There wasn't much I could do for the patient, though someday I hope to be the one intubating and starting the central line. For her daughter, though, I was able to find a chair, a glass of water, and a phone for her to call family while trying to explain what was happening.

It wasn't much, but as she grabbed my hand and thanked me, it felt like enough.

Sláinte

To the absolutely delightful patient from last night with a wonderful Irish brogue, thanks for a great conversation and for being such a pleasure to take care of. You made my night!

ER Texts From Last Night

A friend found this on Texts From Last Night and sent it to me.

(520): His second form of ID was an emergency room wristband from an hour ago. What the f@#% is going on right now
(310): Haha yeah he had an allergic reaction to the alcohol earlier. He thinks that if he only drinks vodka he will be ok...

If it weren't for the area codes, this could easily have been one of my patients from over the weekend.

Fiiive Blood Gas Kits?

KeepBreathing has started the Christmas countdown with a very respiratory-themed rendition of the Twelve Days of Christmas.

Go partake in the merriment while I down more cold remedies in the hopes of surviving my final papers and exams.

All I Want for Christmas is Clear Sinuses

Sick with a nasty, lingering cold that makes me look like Second Shift, the red-nosed ER tech.

Congested though I may be, I have thus far resisted the urge to march down to the ED, cough at people for hours in the waiting room, and demand a Z-pack for my viral illness because my next-door neighbor's cousin's sister once recovered from a cold after getting antibiotics.

Instead I just stay home in misery, fighting antibiotic resistance one Kleenex at a time.

Buzz Kill

Pt talking on her cell phone: "What's with them not letting us smoke around here?"

Why Can't We Be Friends?

It feels like hardly a week goes by when a patient doesn't threaten to kill/beat up/"get" me.

When I first started it was a little unsettling, but these days I completely ignore it. Most of the patients who make these threats are emotional, sick or injured, under the influence of their chemical of choice, or already in custody.

In short, I've accepted it as part of the job. I don't leave the hospital looking over my shoulder.

But then every so often a story like this comes along, in which an ER patient is arrested for making threats against the staff. What catches my attention isn't that somebody would threaten to kill the very ER workers they turn to for help, but that the person is actually arrested for it.

I guess I just forget that in the real world, it isn't acceptable to threaten to kill someone. Go figure.

Too True

The hilarious guys behind Indifferential Diagnosis have put together a "best of" post. If you haven't visited their blog, you should.

If you don't believe me, check out their all-too-true depiction of EM:

Pink Gloves

If you're not one of the four and a half million people who have already watched this video, I hope you enjoy it as much as I did!

Raindrops Keep Falling on My Head

Looking at the schedule, I found that I was assigned to the trauma bay for the first time since before Thanksgiving, and felt a quiet unease tremble deep inside me.

Looking at the trauma bay, I found the room spotlessly clean and fully stocked, and a suffocating sense of foreboding settled in.

Looking at the day shift trauma tech, I found that there had not been a single trauma code in 12 hours, and I could practically see the lights dim as the gathering storm approached.

Wondering when, not if, the onslaught would begin, I moved to wipe down a used set of monitor leads. As I reached for the BP cuff not 5 minutes from when I punched in, I turned over my shoulder to find medics doing compressions on a patient with a blue tinge.

No patch, not even an overage page that a code had arrived - they were just there. I took over compressions as the nurses and docs rushed in, and we went all out for the next 40 minutes. Epi, atropine, defib x 5. Actually managed to get a few organized complexes in between the V-fib and PEA, but ended up having to call it. After cleaning up, I was asked to help move a patient out of his car, and arrived to find that both the outside and inside of the vehicle were completely covered in vomit.

My name is Second Shift, and I am a black cloud.

Patients Say the Darndest Things

Pt's Husband: "Boy it's crowded. Bet you guys get a lot of folks without insurance."

SS: "We get a lot of folks with insurance, too. We take everyone."

Pt: "We have insurance, but when we called our doctor he said he couldn't see us so we should just go to the ER."

...And that's the problem. Many people assume that ER overcrowding is driven mainly by patients lacking health insurance who have nowhere else to turn. While we certainly see large numbers of uninsured patients, we also have large numbers of insured patients filling up the waiting room as well.

Whether these patients can't schedule a timely appointment with their own doctor, or simply prefer the ability to show up at the ER whenever they feel like it, I can't say. But as Whitecoat is fond of reminding us, insurance doesn't equal access.

Until the primary care system gets fixed, I'm betting packed waiting rooms and patients lining the hallway won't be going away any time soon.

Freudian Slip

MD: "I'm going to do a rectal exam on the patient in Bed 3." [walks away]

Secretary: "Where did the resident go?"

RN: "Oh he's in the middle of a patient right now."

Wannabe MD

I've been completely blown away by the amount of well wishing I've received in the days since I learned of my acceptance to medical school. The ED has always felt like a large (admittedly dysfunctional) family, but I am still extraordinarily grateful for all the cards, hugs, and hive fives.

Now that I've been accepted, the docs and nurses are going out of their way to teach me things before I start next August.

During a rare slow patch over the weekend, an intern, a few nurses, and I were hanging around the workstation. To the handful of patients stuck waiting for results, the scene must have appeared a bit odd. There I sat, eye level with an orange that rested on the counter, meticulously practicing my nascent suturing skills. Later, the intern and I swapped veins as we practiced starting IVs on each other under the nurses' skillful guidance.

Sure, it may have looked like Amateur Hour, but everyone has to start somewhere. And besides, we already have our best people working on more important matters.

Future Leaders of America

Lost count of the number of drunk, sloppy, tragic, vomit-covered, sobbing, bro-tastic, bile-stained and/or belligerent underage college students who paid the ED a visit this weekend.

After the umpteenth "Yes you're drunk no you can't leave yes you have to breathalyze no we're not the cops yes this sucks no you shouldn't say that about peoples' mothers" conversation of the evening, they all start to blend together.

Except of course the nearly unresponsive girl whose father was an ED attending at Out of State Hospital and drove a considerable distance to pick his daughter up. He must have been so proud.

Extreme EM

In my more idealistic moments, I often imagine myself working as an emergency physician for Doctors Without Borders at some point in the future (i.e. decades from now when I finally pay off my student debt).

While in one of my "save the world" moods recently, I came across the blog of an ER doc doing exactly that - working for MSF in Pakistan. Makes the chaos of the Big City ED seem pretty tame by comparison.

You Know You're a Frequent Flyer When...

...you comment on our recent change in blood pressure cuff manufacturer.

And you express a strong preference for the previous brand.

The Doctor Will Be With You Shortly

SS: "Hi, sir. My name is Second Shift, I'm one of the techs. I'm going to get you changed into a gown, hooked up to the monitor, and run an EKG while we're waiting for the nurse and doctor to step in. We'll see if we can help you out with your [non-life threatening condition]."

Pt's wife: "We called ahead. Why isn't Dr. Bigwig waiting for us? You need to page Dr. Bigwig for a consult stat, and he needs this this and that done right away, and here's a list of labs he needs drawn immediately."

SS: "Okay, that's something you'll want to speak with the doctor about. In the meantime, sir, I'm going to help you change and get you all connected."

Pt's wife: "I'm sorry, you must not understand. I'm not some average family member... I'm on faculty at the med school."

SS: "Oh, that's nice. I'm still going to change him into a gown, put him on the monitor, and get an EKG."

Look, I don't care if you're the bloody Queen of England, I'm just a tech. Every patient arriving in the critical care area gets and EKG and thrown on an monitor. People who get paid my hourly rate don't order procedures or consult Dr. Bigwig. That's the job of the person in the white coat. She'll be with you as soon as she's done intubating the dying person in the next bed.

Baby It's Cold Outside

Now that December has arrived, cold weather can't be far behind. Looking for a good deed to perform this holiday season?

Every winter, we're forced to cut the clothes off patients who arrive in the trauma bay. For many of our patients in the Big City, the sweaters we slice through are their only piece of warm clothing.

I know that there are many worthy causes competing for your attention, especially at this time of year. But as you're looking through your closets, if you happen to come across winter clothing that you no longer use, please consider donating it to your local emergency room. It's a simple way to have big impact, especially for many of the homeless men and women living in our communities.

And while you're filled with the holiday spirit, please consider saving a life by donating blood!

Alley-oop!

In the ER, you must always be on your toes. You never know when, say, a patient might decide to hurl himself over the rail of a stretcher.

Fortunately for this particular patient, the tech and paramedic who had just transfered him off the ambulance gurney were still at the bedside. In a particularly impressive display of reflexes, both of them caught the patient in midair, lifted him back over the rail, and deposited him gently on the bed.

Both are being scouted by the Harlem Globetrotters.

Welcome Back

After spending a wonderful week at home catching up with family and friends, I returned to the ER rested, refreshed, and ready to greet the sick and injured of the Big City.

Until a patient decided to spit in my face.

Now I've been working in the ED for a few years, and I've certainly been spit at many times. But this was the first well-formed spittle missile that made direct contact with my flesh just below the eye.

My knee-jerk reaction was a surprising amount of anger. Despite being a pretty non-violent individual, I truly wanted to jack the guy in the face. Here was a dood who picked a fight with the wrong crowd and lost badly, who then decided to take out his frustrations on the very people he turned to for help.

But unlike this patient, I controlled my impulses. I stepped away from the situation. I washed my face repeatedly. I went outside and checked my voicemail. And then I spent the rest of encounter treating him with the respect and dignity that he refused to show others.

Later in the night, one of the nurses showed me this, and I chuckled. Maybe I should become a surgeon?

Frequent Fliers

Their names may be different, but their stories are almost always the same. Every ER in the country has one, and most have several.

Today's Washington Post has a profile of one frequent flier from Washington, DC whose visits contribute to the estimated $32 billion wasted in non-urgent ER stays every year. It's a fantastic article and well worth a read.

Mix and Match

NewTech: "What the hell is that?"

Points to a white cloud floating in a urine cup that tested positive for large protein.

Second Shift: "Why, that's a little urine/semen cocktail your patient gave you."

Petty Theft

Cranky's encounter with supermarket larceny reminded me of the many people I've seen walk into the ER waiting room, only to grab a box of swine flu masks before turning around and walking out again.

Masks certainly aren't the only things I've witnessed patients try to lift from the ER. Other favorite include tissue boxes, wheelchairs, blankets and cordless phones.

But the winner in the category for best attempt at stealing ER goodies goes to trauma patient who opened the procedure tray cabinet, ripped open the sterile drapes and tried to walk out with a very large bolt cutter.

Not content with free medical care, it seems that certain patients feel entitled to parting gifts as well.

Happy Thanksgiving!

Many, many things to be grateful for this year, but once again topping the list is being home with friends and family today. And beating the guy dressed as a turkey in this morning's Turkey Trot.

Happy eating to excess!

On the Road Again

Road trip to State U today to pick up Brother Shift for the holiday. Happy Thanksgiving all!

Hot Water

Bathrooms are death traps.

Floors mats love to slide out from underneath their owners, toilets yearn to crush reproductive organs or trap other appendages, and now apparently the hot tub is just itching to finish us off.

The New York Times reports that an analysis of the National Electronic Injury Surveillance System revealed that hot tub-related emergency room visits skyrocketed from 2,549 in 1990 to over 6,600 in 2007.

Personally, I've never seen someone present with a hot tub-related complaint (presumably burns, water in the ears, or those dreaded pruney fingers), but rest assured that I will be hyper-vigilant about this issue from now on.

Punching Out

Preparing to fight my way through the battlefield of modern air travel this morning. I can't wait to brave the endless lines, strip down to my knickers at security, receive bruises and lacerations while fighting for the last inch of overhead storage space, and breath recycled H1N1-laden air as I fly home for the Thanksgiving holiday. Better have the trauma team on standby for when I land.

The Things They Carry

Discovered while cleaning up a room after a patient had been discharged: an aerosol spray can labeled "Apple Harvest Air Neutralizer Deodorant" that looked like it was made in the 1970s.

Unfortunately, when I dared to spritz a little in the room, I discovered that it smelled like it was made in the 1970s as well.

Are You Ready For Some Football?

Friends, food, and football this weekend. Throw in the fact that I've got some time off from the ED, and add a splash of EtOH, and life is good!

Mortality

KeepBreathing has a post up about how treating patients your own age can force you to confront your mortality.

Being one of the youngest working in the ER, most patients my age are lightweight college students puking in their stretchers. Recently, however, I took care of a woman only a year or two older than myself. Terminal Stage IV cancer. Beautiful, polite, and funny, she joked with her mother and the staff as we treated her for dehydration. The fact that she didn't even look sick made her diagnosis that much more shocking.

I firmly believe that no life is any more or less valuable than another, but there is something about a patient in what should be the prime of her life quickly dying from cancer that seems especially tragic.

Cancer sucks.

Trigger Happy

Dear X-ray tech,

When you announce that you're about to take an X-ray in Bed 2, and I'm on the other side of the curtain in Bed 3 yelling "Hold on!" as I empty a foley bag, please don't go ahead and shoot the film anyway.

I haven't made my babies yet, and I'd really prefer them not to glow in the dark.

Next time, if you'd like, I'll happily run out of the room with a white flag in one hand and a sloshing urinal in the other, shouting "Don't shoot... I surrender," if it will fulfill your trigger happy fantasies.

Just please don't irradiate my junk.

Sincerely yours,

Second Shift

A Sign of the Times

Courtesy of the New York Times - an unintended light bulb failure at what should read Elmhurst Emergency & Trauma Center:

A commentary on ER overcrowding?

Train Wrecks

When the sun goes down and the EtOHers start rolling in, the name of the game is getting them cleared to the drunk tank as quickly as possible. Last night, however, it seemed that each and every one of my patients was ready to start circling the drain.

Train Wreck #1 was a middle-aged EtOH all star who presented for nothing more than being found drunk on the street. He had a bit of a medical history, however, so the PA asked me to draw some basic labs. Turns out, in addition to being hammered, the patient also had positive troponin, low potassium, an elevated white count, uncontrolled diabetes, and renal failure. And a broken hand.

Train Wreck #2 also had a splash of EtOH on board, but would suddenly go from happily singing to dropping his head into his box lunch and going unresponsive. Another poorly controlled diabetic, his sugar would careen wildly from 180s following an amp of D50 down to 40 if he stopped sipping his orange juice.

Train Wreck #3 made his third EtOH-related visit in a 48 hour period at the beginning of my shift, got discharged, and returned as a heroin overdose by the end of my night. For whatever reason, treating ODs makes me really sad. Despite this, my patience was frayed as my last hour devolved into a constant game of reinserting the nasal trumpet the patient kept pulling out, and providing repeated sternal rubs to stimulate his oxygen saturation back into the 90s.

Next time I complain about straight drunks, I'll need to remember that it could always be worse.

Shock

It's one thing to read about shock in a textbook; it's another to see it unfold in front of you.

The other night a nurse and I were bringing a critical patient to CT scan to determine the extent of his internal bleeding. When we arrived, he was hooked up to two liters of fluid being squeezed in by pressure bags to keep his BP in the 120s, with a HR of 60.

One line needed to be D/Ced for IV contrast dye, and as the scan went on, I watched as the cuff recycled every 2 minutes to display an increasingly lower BP. With less volume to pump out, the heart tried to compensate by increasing the rate of its contractions.

By the time we returned to the area, both the pressure and HR were in the 90s. Thankfully, we had some O-negative waiting for us, and a surgeon ready to accompany the patient to the OR.

Nothing like the nerdy satisfaction of seeing physiology in action.

Coming Soon: Second Shift, MD!

Breaking news: Over the weekend I was accepted to one of my top choices for their medical school class of 2014!

It has been a long journey to reach this point. I am profoundly relieved, extraordinarily grateful, and still somewhat shocked that somebody thinks I have what it takes to be called "Doctor" in a little over four years from now.

I can't express how thankful I am to the many people in my life who helped me reach this point, nor how excited I am for this incredible opportunity. I know there is a long road ahead, but for the time being, I'm simply savoring the moment.

You Can't Make This Stuff Up

Wow and Wow.

Life in the ER, folks.

Trauma on Ice

Hockey tickets for this weekend!

Back in the day, I used to do EMS standby for hockey games. Now I just sit back, relax, and enjoy the trauma on ice.

You Can't Win Them All

During one particularly busy night (who am I kidding, they're all busy these days), with stretchers lining the hallway and our trauma bay full, EMS radioed in from the scene of a bad MVC with a report of three incoming traumatic cardiac arrests.

What's worse than scrambling to throw patients on portable monitors, playing bumper cars with stretchers to fill every last inch of hallway space, raiding unused monitor leads from exam rooms, spiking fluid bags and hurrying to change suction canisters before the patients arrive?

Finding out that all three were pronounced in the field. Three young kids already so far gone they didn't even make it to the hospital.

Save The Date

You know, I generally try to avoid posting personal information here. I mean, I'm actually kind of embarrassed... but I'm so excited I just have to tell people: I think I finally met the future Mrs. Second Shift.

I knew there was something there from the moment her pinpoint pupils met my gaze from across the ambulance bay. Staring at me through her sweaty, matted golden locks, I could hardly resist the chemistry between us. Listening to her lyrical sense of poetry cleverly employ words that rhymed with "duck," "itch," and "bunt," I realized that this was the one I could bring home to meet the family.

Her finely-manicured fingernails positively shined as she attempted to scratch anyone who came near her. Surrounded by the group of police officers who I hope will attend the wedding, I imagined that I was sliding a ring on her finger while I secured a restraint to her wrist. The spit mask placed over her head even resembled a delicately laced veil shimmering in the fluorescent lighting.

I think we'll try for a spring wedding.

It's The End of the World

Now that the novel-H1N1-pandemic-influenza-type-A-swine-flu-but-not-really-cuz-it's-not-from-pigs-but-apparently-your-cat-can-get-it virus is back from its summer vacation, the Big City ED is seeing its own share of low-grade hysteria.

Patients and visitors are strongly encouraged to wear masks while in the department to prevent transmission. The result? I've seen countless patients wearing masks upside-down, inside-out, covering their chins, covering their eyes, and in one memorable case covering a second mask.

There's also been a large spike in the number of patients presenting with flu-like symptoms, some real and others imagined. If you say you've been experiencing body aches, chills, and fatigue, and your temperature is 102.3˚ and your heart rate a bit tachy, odds are you have the flu.

If you storm the triage desk yelling that you had a 112˚ fever at home and need to be seen, odds are you're full of it. Or already dead.

The Need for AEDs

Last month, I posted an article about a man who died from cardiac arrest while riding a commuter train to Chicago. Like many people, I asked the question why Automated External Defibrillators - required on airplanes by federal law - aren't present on most trains. The Chicago Tribune is keeping attention on the issue, writing how Boston became the first major commuter line to install the life-saving devices on all its trains.

It's time for the rest of the country to follow their lead.

All In The Family

Despite the countless numbers of devoted and loving children, parents, siblings, family members, neighbors, friends and co-workers I've seen flock to the side of patients in the ED, it's always assholes who remain memorable.

Last night I took care of one elderly gentleman who was dropped off by family members at triage. When the left, we assumed they went to move their car, but instead they never came back. They left behind a confused, scared, and sick old man who spoke a language so rare that we did not have an interpreter readily available.

Later that evening, I took care of an older woman who had been stuck in the ED for most of the day. Finally ready for discharge, she gave me the phone number of her son and asked that I call him to drive her home. When I reached him, he told me that he had some "stuff to do" that night, and asked if we could just keep her in the ED until the morning.

I hope that when these two patients eventually die, they come back as ghosts and haunt the hell out of their ungrateful offspring.

No Surprise

Interesting, but not surprising, findings discussed on an LA Times blog today. The post reports on results published in a new study in the Archives of Internal Medicine that looked at ER utilization.

*The median wait time for ER patients increased from 22 minutes in 1997 to 33 minutes by 2006.

*The proportion of ER patients deemed to be suffering from a real medical emergency fell from 26.9% to 18.3% from 1997 to 2007.

*Per capita use of the ER was also up during the same period.

As previous reports have indicated, these numbers aren't driven simply by the uninsured, but stem from a general lack of access to primary care. Of course, I'd add the increasing public perception of the ER as a legitimate source of primary care to the list of casual factors.

Debating the merits of different financing schemes is great - and necessary - but until people have access to their own source of primary care, ER overcrowding will remain a serious problem.

Heads Up

A mind, as everyone knows, is a terrible thing to waste. That goes for the head, too.

Head Case #1 from this past weekend was a young teenager who decided to take a joyride down the highway at 90 mph in the wee hours of the morning. The medic's pictures from the scene - images of twisted metal that once belonged to Daddy's sports car wedged beneath a tractor trailer - clearly illustrated the two or three inches of space that hung between Junior and decapitation. That he survived with little more than a few bumps and scrapes is nothing short of a miracle.

Later in the weekend, two dudes accompanied their bro into the ER requesting sutures status post bar fight. A full two minutes after the nurse finished drawing labs on the patient, the entire department heard a powerful thud echo from the exam room. Turns out Bro #2 wasn't comfortable with the sight of blood and syncoped, landing head first on the hard tile floor.

But by far the best example of abusing one's noggin came from my patient who decided it would be a good idea to get some fresh air by sticking his head out the window of a moving automobile, just in time for his skull to make contact with very immobile traffic light.

Some people would do well to consider wearing helmets.

Fail

In my haste to cut through the clothing of a GSW victim, I sliced right through the IV tubing.

Carbon Monoxide Poisoning

Don't have a carbon monoxide detector for your house? Get one. And while you're at it, make sure to change the batteries in your smoke detectors.

Last year we had someone die from CO poisoning, last night we had an entire family hooked up to non-rebreathers after being exposed at home.

Symptoms of CO poisoning include dizziness and nausea - common complaints that may be mistaken for any number of illnesses. For more information, visit the CDC website.

ER Vocabulary Lesson

bold [bohld]

-adjective, -er, -est

1. not hesitating or fearful in the face of actual or possible danger or rebuff

2. showing your face again in the same ER where you drunkenly vomited and shat all over yourself to demand that the staff dig through the trash to locate the cell phone that you accidentally threw out along with your soiled clothing

Playing Possum

If I were trying to feign a mysterious medical condition to deflect responsibility from speeding through a red light and totaling another vehicle, I might be able to ignore the sternal rub. I seriously doubt that I could fake sleep through the 14g IV insertion. But I am certain that a 22g foley catheter (aka garden hose) inserted into my penis would make me jump off the stretcher.

Props to you, desperate fakeur, for merely flinching.

The Day After

What do you get when you thrown in a few vomit-covered superhero costumes, an aortic dissection, multiple "flu-like symptoms," real police officers passing by "naughty" ones, three septic patients arriving within minutes of each other, several gun shot wounds and stabbings, lots of chocolate, and a whole extra hour to enjoy it?

A special, 13 hour edition of Halloween on the night we gain an hour. Happy recovery!

Happy Halloween!

Have fun, stay safe!

Haunted ER

Reaching to remove the patient's tourniquet late one night, I paused for a moment as the lights began to flicker. Next came the sudden BANG of the fire doors slamming shut in unison, only to be followed by the slow creaking sound as the opened themselves up again. Fluorescent lighting tubes sizzled as the continued to flicker, monitor alarms rang loudly before suddenly silencing and going blank, fire doors opened and closed themselves at will...

Had the ghosts of patients past come back to haunt the ER, as my patient suggested?

Either that, or engineering was testing the backup generators.

Besides, we're already haunted by prior patients - we just call them frequent fliers, not ghosts.

ER Chainsaw Massacre

The metallic, buzzing sound of a chainsaw about to butcher us to death would probably sound more terrifying if its imitation wasn't slurred. Or occasionally interrupted by a gurgle of vomit.

"Chainsaw Killer," as one of our occasional EtOHers likes to be called, can be easily identified from triage by the buzzing noise he insists on making throughout his visit.

"I'm the Chainsaw Killer bitches," he'll scream, followed by a prolonged "Bzzzzzzzzzzzz" and dramatically accompanied by flailing arms.

After a few moments he'll tire out, nod off and begin to drool. But at random moments throughout the night (ideally when some new volunteer passes by his stretcher), he'll spring upright and repeat a chorus of "I'm the Chainsaw Killer bitches... BzzzZZzzzzzZzzz."

Whether or not he'd be able to operate a real chainsaw, let alone stand up straight, is open to debate.

Dr. Lurch

He's creepy and he's kooky, mysogynistic and spooky, he's all together ooky, he's... My Favorite Resident.

He lurks, he eavesdrops on conversations, and he breathes heavily while standing behind you.  I'll be he even sleeps suspended from the ceiling upside down.

Yet despite his past misdeed, no antics by My Favorite Resident have endeared him to the staff as much as his recent comments about Halloween costumes.  While a bunch of us were discussing an upcoming ER costume party, My Favorite Resident worked himself into the conversation by describing what kind of sexy nurse outfits the females in the group should wear.  Nobody laughed, a few people frowned at him, but My Favorite Resident kept describing his fantasy costumes until the attending finally had to pull him aside and tell him to knock it off.

What a creep.

Trick or Treat

Sometimes it feels like every night in the ER is Halloween.

Wearing her way-too-tight shirt costume, a patient walked up to triage:

Pt: "I feel weak and dizzy."

RN: "When was the last time you had anything to eat?"

Pt: "Yesterday."

RN: "Why so long ago?"

Pt: "I was too lazy to make anything."

RN: (eye role)

The patient was given a box lunch, which she dropped in her extra large purse, and promptly walked out of the waiting room.

Maybe we should just leave a bowl of candy on our doorstep?

Things That Go Bump In The Night Shift

As I wrote around this time last year, the emergency room can be a scary place.  Pale, listless creatures roam the hallways after midnight looking for blood, everyone's concerned about the undead, and no one in their right mind wants to work on a full moon.

To celebrate the upcoming holiday, I'll use the next few days to share some Halloween-themed stories from the Big City ED.  Because in the words of one patient, "this isn't a hospital, it's a zoo."  

A haunted zoo.

Change of Plans

Husband and wife for over 30 years, their original plan for the evening involved dinner reservations and concert tickets.

Instead, he ended up spending the night at her bedside, watching his intubated wife wait for admission after being flown in from Another Hospital following the onset of a massive hemmorhagic stroke.

I can't imagine what it must be like to have your life change so completely, so quickly.

Bummer Dude

I offered the drunk, frat boy freshman five whole dollars for his bro-tastic sweater vest, but my offer was sadly declined.

True Story

Pt: "Don't worry, I understand.  I heard there were a lot of trauma patients tonight; you guys gotta take care of them first.  I know you'll get to me as soon as you can."

Me: (Stunned silence)

While no patient in the ER is more important than any other, some are more critical, and traumas always get first dibs on things like CT scans.  To have a patient not only understand that, but endorse the idea while waiting patiently on a busy night left me speechless.