Wake Me Up When September Ends

They have arrived.  Some with friends, many alone.  Most with pants, a few without.  

Welcome to college.

Back in Business

Even though I had a great time vacationing away from the Big City for the past week, I knew there was part of me that secretly missed the ER.

During my first shift back last night, I opened the door to an exam room and discovered an older woman lying on a stretcher.  Our eyes met, and she suddenly began screaming for the whole department to hear:

"Get me some ice chips!  My vagina is on fire!"

It felt good to know that nothing had changed while I was away.

On Diversion

Off on a mini-vacation for the next few days.  Hope everyone enjoys these last days of summer!  By the time I return, the ER will be filling up with sloppy drunk freshman, so stay tuned!

How Meta

Patient presents to triage with a chief complaint of anxiety.

RN: "What is making you anxious today, sir?"

Pt: "All this talk about health care reform and hospital crowding and socialism!  It's giving me panic attacks, so I wanted to come get checked out."

Oh, the irony.

Coming Soon to an OR Near You

Every year, we have a bunch of summer program students rotate through the ER.  Most of them are great, and spend their few hours observing, asking questions, and interacting with patients.  Some, like the girl who put on a pair of gloves once she arrived and did not take them off for the remainder of her visit, were a little odd.  A special few, however, are quite memorable.

While checking lab results on a patient the other night, I turned to a student and tried to make small talk.  I asked him if he knew what field of medicine interested him.

His response: "I'm going to be a neurosurgeon.  It's the most difficult speciality."

Slightly bemused, I asked the kid if he had ever observed an operation or shadowed a neurosurgeon.

"No, but I'm extremely intelligent, so I imagine that it's the only field I will find satisfying."

I simply nodded, basking in his brilliance.  The highlight of the conversation, however, occurred when he asked me a question of his own:

"Do you know where the black people neighborhood of the Big City is?  I really want to buy some shoes."

Doesn't sound the kind of guy I want using sharp metal instruments to poke around my brain.

Saturday Night Live

Busy summer night in the ED this weekend.

EMS showed up at our door with a young male patient stabbed in the chest.  Quickly intubated, he had a hemothorax that required a chest tube to be placed.  As the resident sliced open the skin between his ribs, a liter of blood spilled out of the patient's chest and onto the stretcher.  After widening the incision, she inserted a clear plastic tube to drain the blood and help re-inflate the lung.

With that procedure still underway, a second patient arrived in the trauma bay after having been shot in the back.  Exam revealed six different GSWs, with several smaller holes apparently from a shot gun.  

He was sent up to surgery just in time for the next victim of the evening, a guy who had been stabbed in the stomach with a screwdriver and hit in the head with a hammer.  Needless to say, he wasn't in great shape, either.

With a gun, knife, and hammer already used, we were wondering if somebody out there was playing a real-life game of Clue.  

Here's hoping that the temperature and people's tempers start cooling off.

The Final Chapter

For those of  you, like me, who have been following WhiteCoat's gripping account of his medical malpractice trial, and can't wait until Monday for the conclusion to be posted, be sure to head over there and leave a comment!

If you haven't been reading the Trial of a WhiteCoat series, check out the first installment here.

Bad Ideas

In spite of the late summer heat, I think 9 out of 10 doctors would agree that carrying a "400 pound" air conditioner down the stairs by yourself is not a good idea.  Especially if you're drunk.

Likewise, I think 11 out of 10 people in the ER would agree that walking out of the trauma bay (C-collar still on, of course) on a quest to help yourself to the 13th ginger ale of your visit is also not a good idea.  Especially if your gown is open in the back, leaving your bum hanging out for all to see.

Somebody Page Urology

Bed 7: Young dude c/o of bloody ejaculation.  

Bed 8: Old dude with CHF, scrotum the size of a grapefruit.

I don't know which is worse.

Why Don't We Do It In The Road?

You know it's not going to be a good night when I round the corner to the Big City ED, only to find an ambulance and police car parked on the street, surrounded by a crowd of officers, ED staff, and onlookers with nothing better to do.  Elbowing my way through the crowd, I see a medic and one of the nurses trying to calm a hysterical woman.  Turning to one of the techs standing outside, I asked what happened.

Unsatisfied with her inability to score narcotics, the patient ripped out her IV, started screaming, and proceeded to knock over chairs as she stormed out of the waiting room.  Once outside, she promptly decided to lay down in the middle of the street.

Shockingly, this behavior did not convince the physician to prescribe her pain killers.

OMG Help

Earlier this summer, we had a relatively young kid arrive via EMS status post assault.  After getting the crap beat out of him by two older, bigger dudes, he spent his time in the ED texting his buddies and planning his revenge.  The result was a minor altercation in the waiting room that had to be broken up by security.

Now, however, I find that texting can be used for good instead of evil.  According to this article, a 911 service in Iowa now allows people to text in their need for emergency services.  A few months ago, the idea of texting ERs to determine the wait time sparked some controversy.  This new program, however, seems pretty cool.  I don't know how useful it will be for EMS issues, but the chance to stealthily text police will certainly come in handy.

Big City ED/Sports Bar

Took a break from the action Sunday night to catch the end of the Red Sox-Yankees series play out on the waiting room TVs.  With a crowd of patients, visitors, staff cheering or booing in unison, it felt like just another sports bar.  

I'm thinking if we set up a couple of stools at the triage desk and start spiking the ginger ale, we might just be able to finance health care reform on our own.

Murphy's Law - ER Corollary

Shortly after I began my shift last night, I spotted a pair of nurses running down the hallway pushing a crash cart.  Following them over to X-ray, I found an exhausted-looking med student performing (pretty weak) compressions on a patient.  I relieved him while one nurse pulled meds from the cart, another went to grab an ambu bag, and a second tech cut a longer piece of suction tubing that would actually reach from the canister to the patient.

After a minute or two of scrambling around, we had everything we needed.  The patient was tubed, regained a pulse, and transported back to the main ED.

Fast forward to several hours later, when we had a patient with severe chest pain who needed to be scanned for a possible dissection.  Before we left, I grabbed an airway kit, a med bag, ambu bag, full oxygen tank, extra liter of fluid, and a yankauer and placed them underneath the stretcher.  We also dragged the defibrillator along with us because the patient was bradycardic.

Of course, the patient made it through the scan without incident, proving once again that any patient that might code, will code... unless you are prepared.

Pet Peeve

Me: "Hi sir, do you need to see a doctor?"

Pt: "Yes.  I was seen here three years ago, you should have all my records in the computer."

Me: "Okay, first I need to get your name."

Pt: "Well, everything should be in the computer."

Me: "I still need your name first."

...

Me: "Any allergies to medication?"

Pt: "Don't you guys have all that in the computer?"

...

Me: "Do you have a primary care doctor?"

Pt: "His name should be in the computer."

At this point I generally reach under the triage desk, pull out a can of gasoline, douse the computer monitor in front of me and light a match.  Peering over the brunt plastic remains, I ask the patient to proceed as if the computer was never invented.

It Gives You Wings... and Seizures

In case I was tempted to load up on energy drinks to power through another long stretch of nights in the ER, my patient from the other day convinced me to stick to the occasional cup of coffee instead.

After substituting sleep for Red Bull and the like for days on end, the kid ended up in the critical care area after EMS found him seizing at home.

Time to lay off the sauce.

Recession Medicine

Bad news for the sick and injured of Los Angeles: as of today 15 fire trucks and six ambulances will be pulled out of service.  With a $56.5 million budget gap, the cuts are expected to cause an increase in response times - a result that some medics believe will compromise care.

DOA

Last night as I was busy restocking my IV cart, the charge nurse came up to me and asked if she could borrow me for a while.

Following her to the viewing room, I discovered a young male not much older than myself lying on a stretcher.  Dead on arrival, he had been found by family members in the garage, sitting in the front seat of a running car.  

There wasn't a mark on him, which somehow made things more difficult.  In the past, bodies I had helped bag were victims of trauma or cardiac arrest... people we had at least tried to save.

For this patient, however, all we could do was change him into a gown, place a pillow beneath his head and lay a blanket over the body before the family came in to grieve.

Seems Remarkable to Me

My patient in Bed 2 was a young trauma victim waiting for the results of a CT scan to determine which service would admit him.  Hoping to speed up what had already been a protracted ER visit, I tried refreshing the patient's results page every time I passed by the computer.  Finally, after multiple clicks, a little flag popped up.

Quickly scanning the report so I could inform the resident, my eyes ran over the typically dry prose of an official radiology reading until I came across a rather unexpected finding.  Buried the middle of a paragraph was the following observation:

"The ovaries appear unremarkable."  Oops.

Now, admittedly, I've only been working in the medical field for a few years, and don't have the same breadth of experience as most folks.  Nevertheless, I would find any ovary, no matter how healthy looking, to be remarkable in a male.

It Was My Pleasure

"You have lovely eyebrows."

"Is Perry Como dead?"

"You really shouldn't put the toaster in the rain, no no no."

"Where did they leave the melons?"

"I just saw Perry Como walking down the hall!"

"Thank you for taking care of me."

It was this last sentence, offered as she grabbed my hand before transport wheeled her upstairs, and said with a look of clarity in her often-confused eyes, that made everything else that night seem worth it.

Multiple Choice

Saturday morning, 0200, a patient walks up to triage.

Pt: "I got pain in my kidneys, heart problems, a bump on my toe and a cough."

RN: "Pick one."

Don't Tase Me, Bro

Seems like the issue of violence in the ED is getting a fair amount of attention lately.  According to this editorial, one Maine emergency department is purchasing tasers for its overnight security staff.

Personally, I'm not comfortable with the idea of electrocuting patients.  I think there's a risk of tasers being overused, and it runs contrary to the notion of a hospital as a healing environment.  But the fact that purchasing tasers is even under consideration indicates how serious the problem of ED violence can be.

This Week's Sign of the Apocalypse

Trauma patient, C-collar askew, standing in the hallway peeing into a sink.