In the ER we treat a lot of infections. Skin infections are very common. We see a lot of abscesses (pockets of pus under the skin) that need to be drained. This is not a fun experience for either myself or the patient. It is quite an uncomfortable thing for the patient, even with good local anesthesia. It is not fun for me because first of all it is pretty gross, and secondly, the pus that comes out usually has a very foul odor.
I recently saw a patient that had an abscess that had spread from her tooth to encompass the entire roof of her mouth. It was very large and I am sure was very painful. This patient also had chronic pain and so was on very high and frequent doses of narcotic pain medication. She was also very dramatic. These things put together make for a not very pleasant patient from my end.
I was trying to inject anesthetic into the area so that we could drain the abscess, but the patient was not being very cooperative. Every time that I would get close, she would jerk her head away so that I could not do anything and then she would scream about how much it hurt. I explained to her that I needed to drain the abscess or the pain would continue to get worse and to make it as easy for her as possible, I needed to numb the area. She said that she understood and to go ahead and she would hold her head still. She did hold to her word and held her head still. Of course, as soon as I started to injected the medication, she kicked up with her leg and hit my arm with her knee. This, in turn, jabbed the needle into the hard palate of her mouth quite forcefully. Needless to say, I was quite exasperated at this point and what sympathy was left in me for her was quickly draining away, much like what I wished the abscess would be doing. I finally was able to drain out the infection, although it took about 5 times longer than it should have. I am sure that the rest of the department thought that I was actually trying to murder the poor girl as well.
So, the moral of this story is, even if it is painful to have a procedure done, try and hold still so that you don't get needles shoved into places that they shouldn't be going. And also remember that the doctor, or nurse, gets to choose what size of needle they use. Just a thought to keep in the back of your mind.
Monday, December 19, 2011
Saturday, December 10, 2011
Sunday, December 4, 2011
Don't look at me there!!!
One patient that I had the privilege of treating was a young lady that hurt her foot while at work. When I asked about the details or the incident, I found that she worked as a stripper in a local club. She had been in the changing room when another "dancer" came and jumped on her. (They both were a little drunk at the time.) She fell and hit her foot on a table. You know, normal job related injuries.
She was sitting on the bed and I told her that I needed to see her feet to try and figure out how serious of an injury she had sustained. She told me that she did not want to take her socks off because she does not like people to look at her feet. It was all that I could do to keep a strait face and not laugh. My mind just kept thinking, "You are a STRIPPER!! You get paid for people looking at you naked. What is so bad about people looking at your feet?"
I guess that everyone is entitled to their own insecurities, but this one just caught me off guard at the time. It almost made me feel that I was violating her to take her socks off to examine her feet.
She was sitting on the bed and I told her that I needed to see her feet to try and figure out how serious of an injury she had sustained. She told me that she did not want to take her socks off because she does not like people to look at her feet. It was all that I could do to keep a strait face and not laugh. My mind just kept thinking, "You are a STRIPPER!! You get paid for people looking at you naked. What is so bad about people looking at your feet?"
I guess that everyone is entitled to their own insecurities, but this one just caught me off guard at the time. It almost made me feel that I was violating her to take her socks off to examine her feet.
Friday, December 2, 2011
Psychotic Adventures
We see many different types of patients in the Emergency Department. One large group of people are those being seen for psychotic and mental illnesses. I had 2 adventures within a week that were amusing and quite entertaining.
One afternoon, there was a young lady in her 60s brought in by ambulance screaming that she was in labor. She kept screaming "Get it out!!! Get it out!!!" By the time that I got in to see her about a minute after her arrival, she had taken all of her clothes off and was lying buck naked on the cot. Not only this, but she had her legs pulled back in the birthing position and was actively trying to push the baby out that she was sure was inside of her. She did not believe me at all when I told her that there was no baby coming out of her and that I was pretty sure that she was not pregnant. When she finally calmed down enough for me to examine her she made me push on her belly to feel the baby. As I palpated her lower abdomen her response was, "Oh! That feels really good!!" Needless to say, the abdominal examination was terminated at that point. Testing did indeed confirm that she was not pregnant.
A couple of days after that incident, I had another lady coming in reporting that she was also in labor. She, like the other woman, did not appear to be 9 months pregnant as she claimed. She told me that she had had sex nine months previously and so she had to be pregnant and was ready to have the baby. I told her that I did not think that she was pregnant and that she certainly was not in labor. I told her that I would run some tests to find out for sure if she was pregnant. Unfortunately, she was placed in a bed just across from my work station. I could hear her making phone calls to all of her friends and family telling them that she was in the hospital and was going to have a baby. She would also frequently call out to me when she saw me and tell me that she needed to have her cervix checked to see if she was dilated or not. She did not appreciate the fact that I would not check her "dilation progress". Her testing also came back that she was not pregnant. She of course did not believe me when I told her this and demanded an ultrasound, which was denied. She was sent to see a psychiatrist to get treatment for her psychosis and unborn child.
Now, I have never had a psychotic break myself (that I know of). But I wonder if I would think that I was pregnant and ready to have a child as well. Women appear very uncomfortable during child birth. It is interesting that the mind would choose something like that during an acute psychotic event. It is probably best for all of society that these adventures were not actual pregnancies. I would feel really bad for the babies having to go into a situation like that.
One afternoon, there was a young lady in her 60s brought in by ambulance screaming that she was in labor. She kept screaming "Get it out!!! Get it out!!!" By the time that I got in to see her about a minute after her arrival, she had taken all of her clothes off and was lying buck naked on the cot. Not only this, but she had her legs pulled back in the birthing position and was actively trying to push the baby out that she was sure was inside of her. She did not believe me at all when I told her that there was no baby coming out of her and that I was pretty sure that she was not pregnant. When she finally calmed down enough for me to examine her she made me push on her belly to feel the baby. As I palpated her lower abdomen her response was, "Oh! That feels really good!!" Needless to say, the abdominal examination was terminated at that point. Testing did indeed confirm that she was not pregnant.
A couple of days after that incident, I had another lady coming in reporting that she was also in labor. She, like the other woman, did not appear to be 9 months pregnant as she claimed. She told me that she had had sex nine months previously and so she had to be pregnant and was ready to have the baby. I told her that I did not think that she was pregnant and that she certainly was not in labor. I told her that I would run some tests to find out for sure if she was pregnant. Unfortunately, she was placed in a bed just across from my work station. I could hear her making phone calls to all of her friends and family telling them that she was in the hospital and was going to have a baby. She would also frequently call out to me when she saw me and tell me that she needed to have her cervix checked to see if she was dilated or not. She did not appreciate the fact that I would not check her "dilation progress". Her testing also came back that she was not pregnant. She of course did not believe me when I told her this and demanded an ultrasound, which was denied. She was sent to see a psychiatrist to get treatment for her psychosis and unborn child.
Now, I have never had a psychotic break myself (that I know of). But I wonder if I would think that I was pregnant and ready to have a child as well. Women appear very uncomfortable during child birth. It is interesting that the mind would choose something like that during an acute psychotic event. It is probably best for all of society that these adventures were not actual pregnancies. I would feel really bad for the babies having to go into a situation like that.
Friday, November 25, 2011
You did what?!?
I frequently have to deal with patients that have either tried to commit suicide or are thinking about doing so. Some of these situations are very sad, but others are frustrating because I have seen the people multiple times previously and it feels that they are just looking for attention. There are the serious attempts with weapons and overdoses which can be very sticky situations.
The other day I saw Mr. DePressed. He had recently discharged from a mental health institute for severe depression. When he got out, he found out that his daughter had been killed in a car accident. This would cause anyone some serious mental anguish. His response was to try to kill himself. He came in for help after his attempt. He told me that he had just swallowed about 60 thumb tacks. I had to ask him again to make sure that I had heard him correctly. This was not something that I had encountered previously. I ordered an x-ray to see if this was indeed the case, and if so, any internal damage was evident. When I looked at the x-ray, there was indeed several metallic objects in the stomach that looked like tacks.
Mr. DePressed did not succeed in killing himself from this. He did earn himself a trip to the operating room to have them removed. He did earn himself a lot of attention however. While his x-ray was up on the monitor, there were multiple people that were very willing to comment on the image and what type of person would do something like that. All I can tell you is that tack swallowing is not the most efficient way to go. It is very creative though!
The other day I saw Mr. DePressed. He had recently discharged from a mental health institute for severe depression. When he got out, he found out that his daughter had been killed in a car accident. This would cause anyone some serious mental anguish. His response was to try to kill himself. He came in for help after his attempt. He told me that he had just swallowed about 60 thumb tacks. I had to ask him again to make sure that I had heard him correctly. This was not something that I had encountered previously. I ordered an x-ray to see if this was indeed the case, and if so, any internal damage was evident. When I looked at the x-ray, there was indeed several metallic objects in the stomach that looked like tacks.
Mr. DePressed did not succeed in killing himself from this. He did earn himself a trip to the operating room to have them removed. He did earn himself a lot of attention however. While his x-ray was up on the monitor, there were multiple people that were very willing to comment on the image and what type of person would do something like that. All I can tell you is that tack swallowing is not the most efficient way to go. It is very creative though!
Friday, November 18, 2011
That doesn't look right!!
The other night as I was working on some charts, I heard screaming coming from the ambulance entrance. "The baby's coming! The baby's coming!!"
I hurried outside to see a very frantic woman running around a car screaming. Most of what she said was completely incoherent. All of the doors of the car were opened. There was a pair of legs sticking out of the passenger's door. This does indeed happen every once in a while.
After getting Miss Frantik to settle down enough to breathe, I found out that the other woman's water had just broke and she was about 6 months pregnant. I went to the car to find another very anxious woman. I quickly looked to see if there was a baby, and there was not.
We quickly got her on a cart and got her inside. Now that there was some light and I could see better what was going on, I took another look to see if I was going to have to deliver a baby right there in the hallway. As the lady spread her legs, a tiny little foot popped out at me.
Now, for those of you who know nothing about the process of delivery, the foot is not what you should she first. It should be a big round head, not a skinny little appendage with 5 little toes.
This is a situation that is not best dealt with in the ER. So, one nurse started pushing the cart as another nurse ran on one side with me on the other toward labor and delivery. Luckily, this was late at night and the halls were abandoned, although I am sure that the lady woke at least half of the hospital during our journey. We were able to get her to labor and delivery prior to her delivering any other portion of the baby. At that time I more than willingly let the obstetrician take over and quickly went back to my domain!!!
I hurried outside to see a very frantic woman running around a car screaming. Most of what she said was completely incoherent. All of the doors of the car were opened. There was a pair of legs sticking out of the passenger's door. This does indeed happen every once in a while.
After getting Miss Frantik to settle down enough to breathe, I found out that the other woman's water had just broke and she was about 6 months pregnant. I went to the car to find another very anxious woman. I quickly looked to see if there was a baby, and there was not.
We quickly got her on a cart and got her inside. Now that there was some light and I could see better what was going on, I took another look to see if I was going to have to deliver a baby right there in the hallway. As the lady spread her legs, a tiny little foot popped out at me.
Now, for those of you who know nothing about the process of delivery, the foot is not what you should she first. It should be a big round head, not a skinny little appendage with 5 little toes.
This is a situation that is not best dealt with in the ER. So, one nurse started pushing the cart as another nurse ran on one side with me on the other toward labor and delivery. Luckily, this was late at night and the halls were abandoned, although I am sure that the lady woke at least half of the hospital during our journey. We were able to get her to labor and delivery prior to her delivering any other portion of the baby. At that time I more than willingly let the obstetrician take over and quickly went back to my domain!!!
Dealing with Death
Working in the Emergency Department, there are times when things really are life or death. A lot of times rapid diagnoses are made and treatment implemented that help to stabilize and save a patient's life. Other times, things don't go so well and the patient passes away. That is something that I have had to learn to deal with as part of my job. The hardest part about it, is having to go and talk with the family members and let them know about the passing of a loved one. By far, the worst part of my job.
This week, unfortunately, I have had to deal with the passing of a family member. I wish that my ER training was good enough to let me know how to better deal with that. At work, there is always another patient in need of help to take your mind off of what just happened and to make you move on. When it is a family member, you cannot just move on and forget about it. It becomes a permanent part of your life that has to be dealt with differently. When I have to go and talk with a family, I usually don't have much support around me. At least at this time, there are others that are also affected. We can help support each other as we move forward in the new life that has been handed to us.
This week, unfortunately, I have had to deal with the passing of a family member. I wish that my ER training was good enough to let me know how to better deal with that. At work, there is always another patient in need of help to take your mind off of what just happened and to make you move on. When it is a family member, you cannot just move on and forget about it. It becomes a permanent part of your life that has to be dealt with differently. When I have to go and talk with a family, I usually don't have much support around me. At least at this time, there are others that are also affected. We can help support each other as we move forward in the new life that has been handed to us.
Sunday, November 13, 2011
Working Environment
To the gentleman sitting and waiting in the hall next to my work station:
I am extremely happy that you are not complaining about the length of your wait or demanding more pain medication, but....
I am not here to become your friend. I will not tell you about myself in all the details that you want.
I will not diagnose all of the problems that your family has, despite how interesting you may think that they are.
I do not want to hear about all of your other doctors or give you my opinion about whether they are competent or not.
If you haven't already noticed, there are a lot of other people that are here, and they are much sicker than you are with your toothache. If you can talk as much as you are, your tooth probably isn't really that bad. Of course, I'm not going to say that to your face!!
Sincerely,
WhatsupDOC
I am extremely happy that you are not complaining about the length of your wait or demanding more pain medication, but....
I am not here to become your friend. I will not tell you about myself in all the details that you want.
I will not diagnose all of the problems that your family has, despite how interesting you may think that they are.
I do not want to hear about all of your other doctors or give you my opinion about whether they are competent or not.
If you haven't already noticed, there are a lot of other people that are here, and they are much sicker than you are with your toothache. If you can talk as much as you are, your tooth probably isn't really that bad. Of course, I'm not going to say that to your face!!
Sincerely,
WhatsupDOC
Thursday, November 10, 2011
A Question of Health
WhatsupDOC: Do you smoke, sir?
Mr Raspy: No.
WhatsupDOC: Did you ever?
Mr Raspy: Yeah, but I quit.
WahtsupDOC: Good for you. How long ago?
Mr Raspy: Three minutes.
Oh the self restraint!!
Mr Raspy: No.
WhatsupDOC: Did you ever?
Mr Raspy: Yeah, but I quit.
WahtsupDOC: Good for you. How long ago?
Mr Raspy: Three minutes.
Oh the self restraint!!
Tuesday, November 8, 2011
Who's YOUR Daddy?
Conversation that I overheard while suturing the finger of a different patient. Luckily, my patient didn't speak english, so she didn't know what was going on behind the adjacent curtain. I never saw this other patient, but it was amusing none the less.
"Hi Daddy, it's me. I'm at the hospital....
Yeah, I'm doing OK. Daddy, can you come pick me up?
My name is Michelle....
They wouldn't let me check in under Miss Trickalicious. They made me use my real name....
I know Daddy, but you need to ask for me by my real name when you get here....
I should be fine to go out and work tonight, Daddy. I may need some of the other girls to help me with my hair and make-up though....
No, I can still go and work for us tonight, Daddy; even with a broken arm....
Daddy, will come get me now?"
Maybe it's just me, but you would think that your ownpimp Daddy would know your real name.
"Hi Daddy, it's me. I'm at the hospital....
Yeah, I'm doing OK. Daddy, can you come pick me up?
My name is Michelle....
They wouldn't let me check in under Miss Trickalicious. They made me use my real name....
I know Daddy, but you need to ask for me by my real name when you get here....
I should be fine to go out and work tonight, Daddy. I may need some of the other girls to help me with my hair and make-up though....
No, I can still go and work for us tonight, Daddy; even with a broken arm....
Daddy, will come get me now?"
Maybe it's just me, but you would think that your own
The start of a blog
Over the past several months, I have had many people ask me about things that happen in my life. This mainly relates to the crazy and amusing things that I encounter at work in the Emergency Department. I have tried to find a way to make it easy for lots of people to hear these tales and finally decided that this was probably the best way to do it.
Names, dates and some locations will be changed to protect everyone's legal and ethical rights to privacy. Please, feel free to comment on the stories and other things posted here, but please also repect these rights and do not identify anyone in the stories if you know the true identity of anyone portrayed here.
Please enjoy (or excuse) the many rants that I can perceive being posted here. There are many things that happen that irritate me and so they may end up here as well. All of this makes the ER what it is and that makes up a good portion of my life. Some of the things that I encounter are just too wacky and unbelievable not to share.
Happy readings, and please make sure and let me know what you think!!
Names, dates and some locations will be changed to protect everyone's legal and ethical rights to privacy. Please, feel free to comment on the stories and other things posted here, but please also repect these rights and do not identify anyone in the stories if you know the true identity of anyone portrayed here.
Please enjoy (or excuse) the many rants that I can perceive being posted here. There are many things that happen that irritate me and so they may end up here as well. All of this makes the ER what it is and that makes up a good portion of my life. Some of the things that I encounter are just too wacky and unbelievable not to share.
Happy readings, and please make sure and let me know what you think!!
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