Things I Learn From My Patients

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if you're walking the dog and an unleashed pit bull suddenly attacks your dog, DO NOT get on your hands and knees and try to break it up. the pit bull will bite the tip of your nose off and possibly eat it, too.

A tale from the medicine floor:

A very stubborn lady was brought in with a severe diabetic foot infection and needing a bka. She fired her original surgeon because it was his fault she needed a bka (never mind she continued to smoke, never tested her blood sugar, never took her insulin, never followed up with the wound center, and lived on Mc Donalds). Her second surgeon quit because the patient agreed on having the bka, the doc cleared her entire afternoon schedule for the patient, then the patient backs out because she had to wait too long on the gurney. Finally got the patient out to an ECF w/abx while she made up her mind. I'm waiting for the certified letter she threatened

Originally Posted by Annette

A tale from the medicine floor:

A very stubborn lady was brought in with a severe diabetic foot infection and needing a bka. She fired her original surgeon because it was his fault she needed a bka (never mind she continued to smoke, never tested her blood sugar, never took her insulin, never followed up with the wound center, and lived on Mc Donalds). Her second surgeon quit because the patient agreed on having the bka, the doc cleared her entire afternoon schedule for the patient, then the patient backs out because she had to wait too long on the gurney. Finally got the patient out to an ECF w/abx while she made up her mind. I'm waiting for the certified letter she threatened

Yes, I hate it when people don't take their amputations like a man. Suck it up, I say. We all have our problems.

Judd

Come into the ED with a chief complaint of a "human bite" in the "I'd rather not say region", give the registrar a phony name and then sign documentation with your real name. This will surely get you treated immediately. We will overlook this and ensure you the probability of a anaphalactic reaction to a drug your phony name isn't allergic too.

Come by ambulance sans sane mind. Insist you have hip pain at first, once you have been registered, wait exactly 10 minutes and complain to the registrar that you've been waiting 6 hours and can't stay due to surgery you will be performing soon. When asked if you know where you are, say you are visiting your daughter.

Be a frequent etoh flier. Have a breatholyzer reading of over 500 and tell us "that ain't no drunk, I be drunk when that **** hits 1000". We will all laugh and call you a crazy mother****er.

Don't take a bath for 2 weeks straight, drink profusely and urinate on yourself numerous times. Come to the CIU. While getting registered, finger yourself while naked in order to illuminate the prospect of sanity.

Although its very romantic and the symbolism is quite profound, using your wedding band as a cock ring is a terrible idea. Waiting 6 hours to come to the ED is worse.

If you've been stabbed in the head and blood is jetting out of your temporal artery taking a shower to wash off the blood before coming to the ER won't help.

Some of these stories seem really callous...

Originally Posted by Chartres

Some of these stories seem really callous...

Do you live in the real world? Do you work in an ED? Do you do EMS? Unfortunately, these are true stories. DocB and ERMudPhud are two of our more solid posters.

It's also unfortunate that the frequency of newbies coming in and criticizing us, or intimating (or outright stating) that we are morally or ethically inferior.

Look in the EMS forum for "Things I Learn on the Ambulance", or in the Pharmacy forum for "Things I Learn From My Patients".

If you think these are callous, either you're not in medicine, you are early in medicine, or you are still an idealist, and don't pay attention to the realities of your patients.

Ditto Apollyon. Heck, I'm a support worker in an ED, and I'm still an idealist... I hope to remain one throughout med school, residency, and beyond. The way I see it, a coping mechanism like this thread increases my odds.

To those who say it's inappropriate, I say have a nice day (and congrats on the excellent rectal tone)!

Originally Posted by Febrifuge

(and congrats on the excellent rectal tone)!

LOL

If you're a homeless guy who got bit by a dog don't spend your entire visit griping about how you had to wait and eventually went home last night without being seen. Don't tell me that we wouldn't treat you because you're homeless. I've got 1/3 of my beds filled with homeless right now and they're basking in the glow from their zillion dollar workups. I'm also going to give you shots and try to come up with low cost alternative drugs rather than just give you a script for Augmentin that I know you can't fill and bid you YOYOMF.

It is not callous if it is not expressed to the pt. I agree with the others, if you do not become at leaset a bit cllous then you will burn out VERY quciklly when you are really dooing the deed. Take it from one who has alrady burned out once, it sucks! Be a realist, it makes your world much easier to live in.

Originally Posted by docB

LOL

If you're a homeless guy who got bit by a dog don't spend your entire visit griping about how you had to wait and eventually went home last night without being seen. Don't tell me that we wouldn't treat you because you're homeless. I've got 1/3 of my beds filled with homeless right now and they're basking in the glow from their zillion dollar workups. I'm also going to give you shots and try to come up with low cost alternative drugs rather than just give you a script for Augmentin that I know you can't fill and bid you YOYOMF.

I feel sorry for the dog

If you are drunk, naked, stalking around the ER dragging your foley bag on the ground behind you you will not get any respect when you approach the charge nurse and demand, in a loud, slurred voice, to know the name and number of the hospital CEO so you can file a complaint about the way you have been treated.

I just want to say that these posts are really really upsetting.

You doctors, who have taken not just any oath, but the HIPPOCRATIC ONE, are spending too much time maligning the very patients that you have sworn (before GOD and EVERYONE) to protect and nurture, regardless of whether or not they've been pleasuring themselves anally with a garden sprinkler. When you should be cherishing their wayward physical impulses, you are making fun of their dalliances and shortcomings. It's sickening and disheartening.

I'm going to cry into my pillow for every louse-infested crown that you scorn.




JUST KIDDING, BABY!!!

These stories are hilarious. I only wish that I had my own "callous" comedy to contribute!

CARRY ON, YE MAD SCIENTISTS!

Love,

Funkless

Maybe it's just my own religious prejudice but consider it spiritual to say that Jesus told you to feed the hungry or help the poor. On the other hand I consider it crazy to say the Jesus told you to lock yourself in your apartment with your six kids and a BB gun and force the PD to kick in the door to get your righteous ass. I mean that just not really a Jesus thing to say. I also consider it spiritual to believe that Jesus talks to you figuratively. I consider it crazy when you are talking to Jesus while I'm trying to get a history. I don't even know what I consider it when you are loudly arguing with Jesus in your room. I mean He's Jesus right? Or at least you believe He is. Shouldn't you kind of take what He says at face value. I certainly don't think you want to piss Him off. He's liable to go Old Testament on you.

Blah. 3 patients suitable for posting in one night. I'm here 3 hours past my shift. I need a drink and a hot shower.

Originally Posted by docB

Maybe it's just my own religious prejudice but consider it spiritual to say that Jesus told you to feed the hungry or help the poor. On the other hand I consider it crazy to say the Jesus told you to lock yourself in your apartment with your six kids and a BB gun and force the PD to kick in the door to get your righteous ass. I mean that just not really a Jesus thing to say. I also consider it spiritual to believe that Jesus talks to you figuratively. I consider it crazy when you are talking to Jesus while I'm trying to get a history. I don't even know what I consider it when you are loudly arguing with Jesus in your room. I mean He's Jesus right? Or at least you believe He is. Shouldn't you kind of take what He says at face value. I certainly don't think you want to piss Him off. He's liable to go Old Testament on you.

Blah. 3 patients suitable for posting in one night. I'm here 3 hours past my shift. I need a drink and a hot shower.

Did you tell them your Dire Straits quote???

When I saw a patient the other day who I had just seen a few weeks earlier the questioning went something like this.

"Do you drink Alcohol?"
"Yes"
"How much?"
"I drink every day."
"The last time I saw you I thought you said you were going to cut down."
"I did, they are not longer scraping me off of the street."

Gotta love these people.

Originally Posted by Robz

Did you tell them your Dire Straits quote???

No. She didn't think she was Jesus. She was just arguing with Him about what He had done with her purse. I still think stealing a purse is a very unJesuslike thing to do. You'll never see scripture that goes "And He appeared before His congregation and bestowed unto them His divine love. He then grabbed a purse and ranneth off down the block."

Don't shoot yourself in the mouth with a crossbow. (The GSW to the head several years ago didn't work.)

mike

If you're feeling sad and blue...

don't pick up a #2 pencil, put it in your left nostril and jam it in as far as it will go...

Be glad that it was very sharp though, because it will pierce the base of your skull, dissect through your midbrain, and elevate a major vessel without causing any damage.

[Neurosurgery borrowed a pair of Vise Grips (c) and yanked it out, he walked out 1 week later completely fine.]

Its amazing what stupid people can live through. I would think a pencil jammed up to my brain would be a check-out ticket, guess not.

Originally Posted by MoCookiess

Its amazing what stupid people can live through. I would think a pencil jammed up to my brain would be a check-out ticket, guess not.

I concur. The way live forever is to drink, do drugs and basically be a miserable person...

Originally Posted by MoCookiess

Its amazing what stupid people can live through.

Nor the damage they can cause to others and still continue on.

MURDER, MANSLAUGHTER, VEHICULAR HOMICIDE, DUI
WITH SERIOUS BODILY INJURY AND FELONY DUI
Anyway, no drug, not even alcohol, causes the fundamental
ills of society. If we?re looking for the source of our
troubles, we shouldn?t test people for drugs, we should test
them for stupidity, ignorance, greed and love of power.
? P.J. O?Rourke

How many more times will you have to say " I'm sorry, Mrs and Mrs... but..."

Originally Posted by dingiswayo

If somehow a ping pong ball should make its way into your rectum and you cannot retieve it, do not mix yourself a cement enema--as this will only make your problems worse.

(I did not see this in person, but saw the radiograph. the hardened cement block was removed under anesthesia.)

In addition, you must absolutely try to convince the whole ER staff that whatever object is in your ass got there by a freak accident. "It was a one in a million shot, doc!" -seinfeld.

Originally Posted by EMRaiden

If you're feeling sad and blue...

don't pick up a #2 pencil, put it in your left nostril and jam it in as far as it will go...

Be glad that it was very sharp though, because it will pierce the base of your skull, dissect through your midbrain, and elevate a major vessel without causing any damage.

[Neurosurgery borrowed a pair of Vise Grips (c) and yanked it out, he walked out 1 week later completely fine.]

Your patient base must be more "cerebral" than that of FoughtFyr. I'm still cracking up about that bit he posted (paraphrasing) "The prison must be required to have at least one guy who jams pencils into his urethra."

And no you cna never kill these guys. I had this one guy brought in as a trauma arrest and he was dead. He was a piece of work, tats, tracks, bullet and lap scars. He had been hit in the head by another fine citizen with a board. I refused to believe that he was dead. You just can't kill those guys with a board. Maybe a tank....

Originally Posted by mikecwru

Don't shoot yourself in the mouth with a crossbow. (The GSW to the head several years ago didn't work.)
mike

Is this how suicide works for the Magic: the Gathering crowd?

--Funkless

P.S. Mike, can you enlarge your avatar in photoshop? Can't hardly see it!

Your patient is likely to be an IVDU when they get VERY upset when you remove their IV.

1) If you fall off a three-story high ladder, you should definitely drink a fifth of vodka in your buddy's car on the way to the ED.

2) Walking in and announcing "I just fell three stories" will make the triage staff move almost as quickly as they move when someone says "I have free cookies."

Do you ever wonder why the voices don't suggest good, smart, or kind actions?
V

Originally Posted by Virion

Do you ever wonder why the voices don't suggest good, smart, or kind actions?
V

The voices who suggest good things don't lead their hosts to the ER!

last night one of my pts was hearing voices saying" clean the house, clean the house".......not too dangerous as far as voices go...at the other end of the spectrum was another pt who was going to kill cops if the president didn't tell the secret service to dig him a bbq pit....

If you are 5'1", complaining of back pain so severe that you can't walk or move your legs, and you get angry at your ER doctor because you won't be getting your requested 150 of Demerol don't leap from your gurney and square off on the 6'2" doc. #1 he won't be impressed. #2 having demonstrated your agility and normal gait you can now be escorted from the campus by security.

If you're a crotchety old lady and you called 911 to have the ambulance bring you to the ER you probably shouldn't take the attitude "I don't know nuthin' 'bout 'nuthin and I ain't answering no questions no how." It really makes it tough to figure out what to do with you.

Hey, great stories everyone...I got a couple, not as good though, but i'll give it a try.

If you're a 16 year old rich kid having a party in your parents' duplex while they're away and your friend passes out in your bathroom from too much vodka and weed, it's a GREAT idea to put her under a cold shower to sober her up. When she then proceeds to turn blue, you should really contemplate for a couple hours whether or not you should risk calling an ambulance and having your party busted. After all, you've got TONS of other friends besides that one, all partying in the next room!

If you're having unprotected sex with your boyfriend at 4 am, immediately after you realize that there might be a chance of you conceiving you should march into the neighborhood ER and demand an EC pill. After all, it does begin with the word "emergency"...then, be shocked and appalled that you are:
not seen in the shortest time possible
getting a 600-dollar bill for a 40-dollar pill.

Originally Posted by annushka

getting a 600-dollar bill for a 40-dollar pill.

LOL!!!


--Funkless

Originally Posted by annushka

a 600-dollar bill for a 40-dollar pill.

LOL!! Around here the min bill for seeing the inside of the ED is ~$1000. One of my partners greets each patient with "I'm Doc S. What's your thousand dollar problem?

One of my first EMS internship ambulance ride-outs was to 30-ish lady who wanted to go to the ER for "lump in her groin" that had been there for 5 weeks, but was really beginning to hurt (at 7:30 am). There was nobody (her mom and boyfriend were home) to take her in a personal car and none of the cars in the driveway worked Especially the brand new and freshly waxed Ford sitting there.


Another call was to a house where they essentially call (repeatedly) the ambulance so they can get their BP checked.....wouldn't a $10 cuff be cheaper than the bills for the ambulance?

Still another was to the drag queen "lady of the night" who is a repeat customer for a LONG laundry list of problems. Maybe a quarter were real. The floor of the house was SOOOO sticky that the paramedics ,made me spray the bottom of my boots with Lysol back at the ambulance. Just in case.......

Your seizure disorder is poorly treated by a regimen of no diliantin and even more crack. You'll wind up a unit player doing the shake 'n bake while chewing plastic.

Posts are great, thanks for sharing!

I don't think venting where your patients can't hear is bad - if it keeps you sane (and entertains me) it benefits them!

If you are 21, and had a head-on MVC with no restraints or airbag, and bent/broke the steering wheel, and you remember nothing since being at the Waffle House at 0400, since you are stoned on pot, and have only a non-displaced nasal fracture (without septal hematoma) and a minimal tongue lac to show for the whole thing, don't fret over 1. the needle for anesthesia or 2. the two Vicryl sutures I put in your tongue, as far as cosmesis goes. Face it, if you get dumped 'cause your tongue has a scar on it, she ain't worth it.

I did learn today, though, "a piece of corn" (if the tongue lac is bigger than that, you sew it). Since this guy's lac was 2/ to biting his tongue, he had to have his tongue protruded when this occurred, and I can only picture this dude reclining, enjoying his buzz, with his tongued sticking out (?), until the accident.

If you have tried to kill yourself by slitting your own throat cleanly, scoring your trachea (but not transecting it), and miraculously NOT hitting anything important, (and you've tried to kill yourself because of your intractable back pain, and are a street drug pharmacopoeia), don't screech like a baby when I put the Cordis in.

Also, make me laugh when you point out the irony as I consent you for surgery that a possible complication is death.

if you are early in the 3rd trimester and desperate for nookie, don't try to pleasure yourself with a ketsup bottle. the cap will get stuck inside. don't then try to fish it out with your toothbrush because you will rupture your membranes and induce labor........

What a unique way to bring a new life into this world! My sister is due any day now - I'll be sure to advise her to stay away from ketchup bottles and toothbrushes!

Originally Posted by emedpa

if you are early in the 3rd trimester and desperate for nookie, don't try to pleasure yourself with a ketsup bottle. the cap will get stuck inside. don't then try to fish it out with your toothbrush because you will rupture your membranes and induce labor........

I thought that ketsup bottle/toothbrush induction was the newest thing in natural child birth?!?!?!?!

Why is it that the worst, most ungrateful patients always seem to have an attorney on retainer ("You'll hear from MY lawyer in the morning"), but can't find a dentist?

Originally Posted by EMRaiden

Why is it that the worst, most ungrateful patients always seem to have an attorney on retainer ("You'll hear from MY lawyer in the morning"), but can't find a dentist?

Dentists won't work on contingency. (But they will work on a retainer. Sorry, couldn't resist.)

Damn these are funny and sad at the same time. Sadly I want to become an EM Physician because of the chill people I'll work with (ER staff seem to have the best view on life: I think someone said calloused; that about best summed it up), and not necessarily completely for the patient base I'll be treating. If it were for the patients, I'd go into Plastic Surgery.

Yes, I too want to be calloused when I grow up.

EM Tox for me.

Originally Posted by SaltySqueegee

Yes, I too want to be calloused when I grow up.

One of my EM rotation evals stated that I was "too cynical for my 'medical age'"... I don't know if it was a compliment or not

Originally Posted by EMRaiden

Why is it that the worst, most ungrateful patients always seem to have an attorney on retainer ("You'll hear from MY lawyer in the morning"), but can't find a dentist?

An amazing amount of people will claim to have an attorney on retainer, but the number of people who actually do is pretty damned slim. The only people I know who have regular lawyers are those who own small/medium sized businesses. Most people don't have need for a lawyer but once in a blue moon.

Originally Posted by EMRaiden

One of my EM rotation evals stated that I was "too cynical for my 'medical age'"... I don't know if it was a compliment or not

In a casual conversation, I'd say it would probably be a compliment. On an official eval, I'd say they're concerned about an excessive of cynicism turning into burnout at an early stage.

My first clash with reality was when I met my first Smurf (according to the Attending) in the ER. It was then that I knew EM was the right place for me.

Sick, but the truth.