Ouch!! That hurts!!

OK.  Who has ever bitten the inside of their cheek while eating?  I have done it numerous times.  Who has ever gone in to the Emergency Department because of this?  Yeah, I didn't think that there would be quite as many for that.  But some people do.

I saw a young 20ish year old guy who had been eating some fried chicken when he bit the inside of his cheek.  He immediately stopped what he was doing and rushed right in.  After waiting for a couple of hours to be seen, I had the pleasure of examining the inside of his mouth.  No bleeding.  Not even any broken skin.  He hadn't taken anything to try and help with the pain.  His reason he came in?  He wanted to make sure it wasn't infected.  At least that concern is understandable.

Let me give you some advise for the next time you bite your cheek.  Chances are there is nothing that an ER doc can do for you and it most likely won't get infected.  Take some Motrin and finish your chicken.  There, I just saved you 2 hours of waiting in an ER waiting room and a nice ER bill.

If you do come in and end up waiting for a while, just remember this...

The Excitement of Parenthood

There are many people who do not understand a lot of things to do with medicine and the human body.  I get this.  That is why a lot of people go to see a doctor.  Even though I get this, it still amazes me some of the things that people do or ask me.

Case in point: I saw a young woman who was there with her boyfriend.  She was newly pregnant for the first time and started to have a little bit of bleeding.  She became concerned and came in to be evaluated.  Blood work and an ultrasound were done to evaluate her condition.  She was so newly pregnant, that a fetus was not visible on the ultrasound.

I went back in to the room to discuss the results with the hopeful parents.  As I told them that everything was very early, she had a positive pregnancy test (although the pregnancy hormone in her blood was still very low) and nothing was seen on ultrasound, they sat there and soaked it all in.  At the end I asked them if they had any questions.  The boyfriend piped up and asked, "Is it a boy or a girl?"  It is times like these that I am glad that all of my thoughts are not broadcast for everyone to hear.  Inside my head, all I could hear was, "We just talked about that we can NOT see the baby.  How are we supposed to know if it is a boy or a girl if we can't even see it at all!"  Instead we had another discussion, although this time it was the condensed Reader's Digest version, about how we can't tell anything since it was still very early and NOTHING could be seen.

It just amazes me the things that they taught me in medical school.  There are many things that I think are common sense, but then I start talking with patients and realize that isn't the case and that I must have gained even more knowledge in medical school than I thought.

The Tang-Tang Problem

Mr. Kool came in to the ER with severe irritation and dripping from his tang-tang.  He was not happy when a colleague of mine went in to see him.  This doctor is female and he was not happy about having to show his tang-tang to a girl.  This was kind of entertaining to all of us because it was due to the fact that so many girls had had such intimate contact with his dear tang-tang that he was in such a state that he required emergent medical care.  He was treated and sent on his way.  I am sure that it is not a matter of if, but when, he will return for a similar complaint.

Mind Your Own Business

A lot of trauma comes through the emergency department each day.  So, I have had the opportunity, if you want to call it that, to see a lot of extremely injured people.  Several of these injuries are due to gun shot wounds.  They are becoming more and more frequent.  In talking with several of these victims, I have found some very useful information that I wanted to share with everyone so that you can prevent yourselves from becoming a gun shot wound victim.

I would say over 90% of gun shot wound victims have a very similar story.  They were all in a pretty shady part of town known for violence.  But there is something even worse than that.  They were all standing on the corner minding their own business.  It just amazes me how so many people that are not causing any trouble and are minding their own business can get caught up in such violent situations.  Granted, a lot of them do kind of look suspicious just standing there, but I am not convinced that is the reason for this.

So, my advice to everyone is to never just mind your own business, especially in shady parts of town.  As it is a new year, I might just make it a resolution to be up in every one's business wherever I go just to make sure that I am protected from senseless violence.  You might want to do the same.

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.