Control Thyself

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.

Thanks Jill.

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.

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.