Medicine Sucks

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Had to tell a family "Yeah, the reason your 8 yo daughter has been having those headaches is because she's got a big old brain tumor." Medicine sucks.

Originally Posted by docB

Had to tell a family "Yeah, the reason your 8 yo daughter has been having those headaches is because she's got a big old brain tumor." Medicine sucks.

I feel your pain. At 8 a.m., just coming on to work (EMS several years ago) got the call for the unresponsive 12 yo girl. Way dead, dependant lividity, cold to the touch. Worked her anyway, had to do something in front of the parents, but not a chance, coroner said the AVM probably tore loose around 1 a.m.

Sucked!

2nd worst (also EMS). 43 yo drops mowing his lawn. His 10 yo son calls 911. We get there, he's asystolic. Worked him on the scene for a while, but to no avail. We call it. After we tell the wife (we have him in the bus, waiting for the coroner) the 10 yo comes running out of the house, charging at us, screaming, crying, punching. "I did what I was supposed to, I called 911, just like on TV. Now you are supposed to save him. Why don't you do your jobs. I did what I was supposed to - why don't you". F***ing TV shows.

- H

I tossed and turned all night about this one. It's basically just like assaulting someone. I sat in the doc's room and got all the info together and consciously thought "I'm going to go in there and ruin their lives. They'll never, EVER be the same again." I might as well have walked into the room and hit the mom in the head with a bat. She's a good mom. She probably wishes I had rather than what really happened. It had to be done and it's not my fault but it still just sucks.

Worst I had on EMS was a dead on scene MVA. Pt's are bagged, we're mopping up. Someone called the family and they show up on scene and freak out. They were assaulting us and yelling that it was our fault. One guy went to jail.

docB... that really blows. Thankfully every once in a while there are patients where we make a big difference and the family absolutely loves you (although this is rare). I think I tend to never remember those, though... just the "dropping the atomic bomb" encounters.

BTW, for the first time brought in a wife who's husband we were resuscitating. The extra sucky thing about that was she had lost her father and her daughter in the same month, now her husband. Her husband was out takign the trash and syncopized and coded... she was found doing CPR when EMS got there. It was pretty weird bringing her in (the nurses gave me the funny look), but I think it helped her.

Q

What I find most difficult are the cases which turn out badly even when you did everything right. Timely diagnosis, therapy and dispo do not always equal good outcomes.

I think of The Fat Man's Rule #4 of Medicine "The House of God" quite often:

The Patient is the One With the Disease

(From a book I consider to be required required reading for those in the medical community...)

Originally Posted by docB

Had to tell a family "Yeah, the reason your 8 yo daughter has been having those headaches is because she's got a big old brain tumor." Medicine sucks.

EMS a few summers ago; dog falls into the pool, 2 year old jumps in after the dog, 4 year old jumps in after the 2 year old....babysitter was "on the phone". We bring the two kids to Children's hospital, both asystole. We manage to revive the 4 year old on route. One of the attending physicians...is the children's father. 2 year old is pronounced on arrival; 4 year old was 6 weeks in PICU and sustained permanent brain damage. ...................Yeah!

Another sad one...

Working at Children's Memorial Hospital in Chicagon on the N/P-ICU ambulance. RN walks out of the transport office and says, "Would be better if he coded now and they cancelled the call." Turns out a 10 year old boy had a major asthma attack at 3am. Tried to use his nebulizer, couldn't, yelped for mom & dad. Fire Dept ALS unit gets there and finds dad doing CPR. They intubate, defibrillate and t/p to level 1 tauma center. We get to trauma center (they NEVER get calls like this) where the entire ER is at a standstill. Not a dry eye in the place. Mom is sitting next to her dying son, dad out in the hall crying. We t/p kid, code 3, to PICU at children's hospital where the extended family slowly begins to arrive about 5am. Kid coded and died an hour later.

I went home and cried and cried and cried. First fatal patient.

On my surg clerkship a friend came in with SOB. We did a CXR and her whole left lung was whited out. She's a non-smoker married to a non-smoker, and has 2 kids. We had to tell her she has lung cancer and her prognosis is poor. Now that sucks!!!

Had to do a detailed sexual assault history and rape kit on an 8 year old today. Perp was of course a partial care-taker/friend of the family. Yuck

Congratulations! It's a still born 19 week fetus!
God I hate these.

Originally Posted by docB

Congratulations! It's a still born 19 week fetus!
God I hate these.

I delivered a 11 week fetus yesterday, amnion intact. What joy....

I had this 60 M BIBA CPR in progress. Down 14 min PTEMS and 25 min PTA. Never had a pulse, just Vfib and this idioventricular PEA. Multi rounds of drugs and shocks. Nothing. I go out and talk to the family (wife and daughter in law). Tell them it looks bad but we're doing everything we can. I took thim into the code and let them watch, hold hands and then called it. A few minutes later I find out that the reason the guy is here in town with his family is that his son is in our ICU because he had a seizure (hx of Sz d/o) but this time he fell off a stool, whacked his head and gave himself a big subdural. So now this poor family not only has to cope with the son having a serious illness but the dad drops dead. They'll have to tell the son when he wakes up. That just sucks. What can you do? I got social work involved and we'll go from there. I need a vacation.

Originally Posted by docB

I had this 60 M BIBA CPR in progress. Down 14 min PTEMS and 25 min PTA. Never had a pulse, just Vfib and this idioventricular PEA. Multi rounds of drugs and shocks. Nothing. I go out and talk to the family (wife and daughter in law). Tell them it looks bad but we're doing everything we can. I took thim into the code and let them watch, hold hands and then called it. A few minutes later I find out that the reason the guy is here in town with his family is that his son is in our ICU because he had a seizure (hx of Sz d/o) but this time he fell off a stool, whacked his head and gave himself a big subdural. So now this poor family not only has to cope with the son having a serious illness but the dad drops dead. They'll have to tell the son when he wakes up. That just sucks. What can you do? I got social work involved and we'll go from there. I need a vacation.

dude you've had a rough month with patients. i'm sorry

Originally Posted by docB

I need a vacation.

Care to visit LA? Spyder and I can probably afford to buy you a few beers.

Originally Posted by Sessamoid

Care to visit LA? Spyder and I can probably afford to buy you a few beers.

Thanks. I don't want to impose my black cloud on someone else.

Don't make me and Spyder come out there and force a good mood on you. Cause that would be terrible, a road trip to Vegas. Yeah.... terrible.

Keep your chin up!

I remember our night shift team was having "one of those nights"....that lasted a month. I mean, it got to the point where we saw a 50 yo with CC: toothache that coded in front of us while we were handing him his PCN Rx! (WTF?!) We did more debriefing that month than many of us did during our whole ER nursing careers. We were coming on shifts *petrified* of yet more non-stop adult/pedi codes, multi-traumas.....Why do I bring this up?

Just when we thought it couldn't get worse, in walks an Aunt of one (of the many) pedi codes we had. We all said a collective "oh sh*t" b/c we remembered her as being...well...how shall I say this? "Very vocal" after her niece's code 2 or 3 weeks previous ("We're gonna sue," "you didn't do enough," etc, etc) -- generally whipping everyone into an (inappropriate) frenzy (including her Sister who's daughter it was). WELP, here she is...and looking for " 'NurseyK'..the Charge Nurse that night my Niece 'Suzie' died." Sh*t. Bracing myself, I walked up to her. You want to know something? She made a special trip there that night (after calling to see which night I was on) to tell me she was sorry. I told her no need, it was just grief, etc, etc. Can I tell you I spent 15 minutes in front of that woman listening to her describe *ALL* of my/the team's actions that night (we let the family into the code at the end)....all the way down to the tears in our eyes. Grateful she was, absolutely, positively grateful for all we did, how we behaved (like humans) after 'Suzie' died, and how we handled her acting like a flaming *****hole (politely and empathetically). She gave us a "In Memorandum" funeral tag, and a handwritten thank you note with the child's immediate family all signing it like it was a highschool yearbook. We cried like babies. (I'd luv to say here that the black cloud lifted, but it continued on for a few more nights before ending.)

Morals of the story (AKA: things I remind myself of): Remember that the families are watching you, watching them, handling their grief as well as how you're handling your own. Try not to get too hard and synical; it's ok to try to preserve a piece of your humanity. Lean on your team for support, it's not a show of weakness.

Take care of yourself --

Kat

Merry Christmas! Grampa's dead! Happy f------ holidays. Why do I pick up these holiday shift's?

Originally Posted by docB

Merry Christmas! Grampa's dead! Happy f------ holidays. Why do I pick up these holiday shift's?

I feel your pain. I once had to literally lay under the Christmas tree (pushing aside a just opened starship Enterprise toy) to intubate 48 year old Dad on Christmas day as his entire extended family watched.

Fortunately, I'm not working this holiday. May your shifts be much happier over the next couple of days.

Take care,
Jeff

Originally Posted by docB

Merry Christmas! Grampa's dead! Happy f------ holidays. Why do I pick up these holiday shift's?

yesterday it wasn't gpa, is was dad.

44 yo w/no other health problems went from slight chest pain at home to dead in the ED in less than an hour.

all i want for christmas is my parents to have clear RCA's.

Originally Posted by Jeff698

I feel your pain. I once had to literally lay under the Christmas tree (pushing aside a just opened starship Enterprise toy) to intubate 48 year old Dad on Christmas day as his entire extended family watched.

Fortunately, I'm not working this holiday. May your shifts be much happier over the next couple of days.

Take care,
Jeff

That is why we weren't allowed to wear anything seasonal (Santa hats, reindeer antlers, anything like that) while we were working - one of the bosses said, "You go into the house, coding grandma or grandpa in front of everyone, and the kids think Santa killed him".

Easiest tube I ever got was a car exhaust/garage suicide on Christmas about 5 years ago - guy looked perfect, except he was dead.

I've always had this kind of phobia of a woman coming with a precipitous delivery of a grossly deformed anencephalic fetus. I'm thinking of changing my signature to "ER - where your worst fears will eventually come true."

Originally Posted by docB

I've always had this kind of phobia of a woman coming with a precipitous delivery of a grossly deformed anencephalic fetus. I'm thinking of changing my signature to "ER - where your worst fears will eventually come true."

Don't you mean:

ER: All your worst fear are belong to us!

Originally Posted by Sessamoid

Don't you mean:

ER: All your worst fear are belong to us!

omg that phrase has now filtered into ER? we are doomed...

Originally Posted by Sessamoid

Don't you mean:

ER: All your worst fear are belong to us!

38 yo solid citizen guy with a family and a job, found down by his kids, 6 and 10, BIBA with one blown pupil. Tubed, stat CT, massive pontine bleed. I call the wife. Turns out the kids were home alone with Dad because Mom was in Reno on a business trip. Tell her how bad things look. She manages to get back to Vegas in <4 hours somehow. Talk to her at the bedside. Nothing can be done. EKG shows LVH, he was probably a long time unrecognized hypertensive.

38 yo with a family drops dead. Tragic, just tragic.

Yeah, my latest was a 6 week old girl. Happy and cooing when she was put to bed. Found hours later apneic and pale as a ghost. I gave it the old obligatory college try, with intubation, IO line, drugs, cpr, the works. Even from the start though it looked hopeless. The poor infant looked like it had been dead for at least a couple hours, with pupils mid-dilated and fixed. Very pale and starting to stiffen peripherally.

Parents obviously didn't take it well. It was my last case on an absurdly busy shift full of drunks (as mentioned in another thread).

it was certainly someone's "bad case". My best friend's dad passed away from a Brain Aneurysm on Father's Day when we were 10 years old. She and her mother were in the waiting room (their Father's Day gifts in hand- they buried him with those gifts although he never got to see them) and he was on his way towards checking *out* of the hospital when he collapsed from it. He was in his early 40s.

When I read this thread a while ago, it didn't hit home. I didn't get it.

My required 3rd year medicine rotation (3 months) ended today, well - ends tomorrow provided I pass this test. It has been like taking my heart out and dragging it along the sidewalk.

Daughters and code status, wives and hospice, a great patient transferred to surgery service for palliative gall bladder cancer resection and asking myself WHY this is so hard!?!

Then realizing it's all been in preparation for my grandfather to present with elevated liver enzymes, be diagnosed with metatstatic pancreatic cancer, have a stroke the NEXT DAY, flying to florida b/c he was intubated during his liver biopsy, help my family decide to extubate him (actually, he agreed ) and having him die within 10 days of "suspected", then confirmed, cancer. Makes me feel less like a future physician and more like an 8 year old little girl.

I really think my grandpa just didn't want to put up with any of that cancer crap.

Anyway, long story short, I agree - medicine sucks.

I'm really sorry to hear about that ATC2MD.

I have my own painful story since we are all sharing. The Sunday after thanksgiving this year I am doing my surgery rotation call. I am sent down to find something or other at oh 830 am (after being there for 2 hours). As I am about to return to the floor my pager goes off. I didnt think much about it (they were always paging me ) The Cheif looks at me and says "Dude, I am not trying to freak you out but call your wife right now!" (Of course this freaked me out).

Anyhow to make a long story short my father-in-law went into V-fib and passed away. We drove the 1 hour up and met up with her mom and her brother. I talked to the EM physician and did my best to explain to my wife and her family why this might have happened since the cardiologist gave him the all clear 2 months ago.

Medicine Sucks! But there is something to learn about every life event!

Ectopic!

Sometimes it sucks to have just enough knowledge to know how bad things are.

My mom was diagnosed with breast CA in 1995. The oncologist staged it as an optomistic II, more like a III. Went throught the modified radical mastectomy, chemo, and radiation and gets the all clear. Fast forward almost five years and she's having trouble putting sentences together. Provisional dx is TIAs. Three weeks later completely confused. Off to the ED and a brain CT which shows a very large black mass on the right frontal lobe. This is not good. My dad (a truck driver) is clueless. I get to translate what the radilologist is saying. Call hospice. Six weeks later have funeral. Again, this really sucks.

Brethren, I feel your pain.

I had one of the worst days ever last week.

At about 9 last wednesday morning a 5 year old girl who'd been hit by a car going at 40 mph was brought in. She was the daughter of a good friend of mine, I could barely recognise her. He was walking her to school and turned away to talk to someone for a second. She was playing another little girl, and she ran into the road.

Tryed so hard but couldn't save her. Completely heart breaking.

Originally Posted by JackJD

I had one of the worst days ever last week.

At about 9 last wednesday morning a 5 year old girl who'd been hit by a car going at 40 mph was brought in. She was the daughter of a good friend of mine, I could barely recognise her. He was walking her to school and turned away to talk to someone for a second. She was playing another little girl, and she ran into the road.

Tryed so hard but couldn't save her. Completely heart breaking.

I adds a whole other realm of suckiness when it's someone you know.

Originally Posted by docB

I adds a whole other realm of suckiness when it's someone you know.

and it is a child. Nothing worse than sick kids to tug at your heart!

That's terrible- the kind of thing that makes you think "I am never ever going back to work".

Originally Posted by JackJD

I had one of the worst days ever last week.

At about 9 last wednesday morning a 5 year old girl who'd been hit by a car going at 40 mph was brought in. She was the daughter of a good friend of mine, I could barely recognise her. He was walking her to school and turned away to talk to someone for a second. She was playing another little girl, and she ran into the road.

Tryed so hard but couldn't save her. Completely heart breaking.

Good God, I have a 4 year old. I can't even imagine.

Originally Posted by docB

Had to tell a family "Yeah, the reason your 8 yo daughter has been having those headaches is because she's got a big old brain tumor." Medicine sucks.

I was actually thinking about this post when I saw a sweet 23-year old girl in the office complaining of one month of headaches. Sent her for CT. Radiology tech called the radiologist, radiologist called the office. Looks like GBM

Last night I got to tell a young mother with three grade school aged children that the back and hip pain that was keeping her bed ridden was caused by multiple pathologic fx's in her spine, pelvis, and hips. The shortness of breath was caused by a huge pleural effusion. Her new onset seizure disorder was brain mets. All coming from a gigantic breast tumor filling her entire right anterior chest wall.

Ok I gotta ask where is "__________ are belong to us" come from?

Originally Posted by Docgeorge

Ok I gotta ask where is "__________ are belong to us" come from?

http://www.planettribes.com/allyourb...ory.shtml#hist

45 y/o woman with long history of migraines, imaged normally 2 years ago by her neurologist comes in with a bad weekend of her typical pattern of migraines. The headache is actually gone by the time I see her in the ED. The husband complains that she is just not acting herself, although she can speak coherently to me in the ED. Nonfocal neuro exam. Go back and forth, whine about the utility of a repeat head CT to myself, and just bite the bullet.

On CT, a mass the size of a small lemon originating in the area of her thalamus with hydrocephalus. And I'm a hero for finding it, when I was not wanting to order that test in the first place. Not the first time I've been humbled to be cautious. Usually it's chest pain.

mike

Just think if you had missed it and someone else found it. It might have been you paying out $1 million for the lawsuit, but instead, you're now a hero to the family for finding it.

I was told at $1,000 each, you can order 1,000 CT tests for the same price as your $1 million lawsuit (which is the average money paid for missed head injury and tumors for patients presenting in the ED). I prefer to be more lenient at ordering CT's than restricting them for this very reason. No, it's not evidence-based medicine, but seriously, I would rather spend the money elsewhere.

(Yea, yea, a good doc can properly screen his patients. I don't want to hear it. )

Originally Posted by southerndoc

Just think if you had missed it and someone else found it. It might have been you paying out $1 million for the lawsuit, but instead, you're now a hero to the family for finding it.

I was told at $1,000 each, you can order 1,000 CT tests for the same price as your $1 million lawsuit (which is the average money paid for missed head injury and tumors for patients presenting in the ED). I prefer to be more lenient at ordering CT's than restricting them for this very reason. No, it's not evidence-based medicine, but seriously, I would rather spend the money elsewhere.

(Yea, yea, a good doc can properly screen his patients. I don't want to hear it. )

As a radiology resident:
As a radiology attending:

Originally Posted by mikecwru

45 y/o woman with long history of migraines, imaged normally 2 years ago by her neurologist comes in with a bad weekend of her typical pattern of migraines. The headache is actually gone by the time I see her in the ED. The husband complains that she is just not acting herself, although she can speak coherently to me in the ED. Nonfocal neuro exam. Go back and forth, whine about the utility of a repeat head CT to myself, and just bite the bullet.

Anybody who is supposedly "not acting right" according to somebody who knows him well gets a head CT. Most of the time it'll be normal, but a surprisingly significant percentage will have "interesting" pathology.

Originally Posted by mikecwru

45 y/o woman with long history of migraines, imaged normally 2 years ago by her neurologist comes in with a bad weekend of her typical pattern of migraines. The headache is actually gone by the time I see her in the ED. The husband complains that she is just not acting herself, although she can speak coherently to me in the ED. Nonfocal neuro exam. Go back and forth, whine about the utility of a repeat head CT to myself, and just bite the bullet.

On CT, a mass the size of a small lemon originating in the area of her thalamus with hydrocephalus. And I'm a hero for finding it, when I was not wanting to order that test in the first place. Not the first time I've been humbled to be cautious. Usually it's chest pain.

mike

nice story. i've been through some similar situations (though unfortunately i've never been hailed as a hero...).

the caution here is that you don't let this experience shape your clinical judgment for the future. you don't want to order a ct scan for every headache patient you see in the er (not saying that you would....). though in this case, a ct might turn out to be beneficial for treatment, in addition to nailing the diagnosis.

as a surgery resident i see attendings do things/order tests/etc that are not supported by evidence-based medicine. sometimes they catch things that would have gone by undetected. probably this is because during their careers they've had a number of near-miss cases like yours. there is no evidence-based substitute for experience and instinct.

the problem is that even if we practice the standard of care to the letter, we will still miss a small percentage of diagnoses. although this is not considered malpractice, missing a diagnosis while following the standard of care is still missing a diagnosis. and patients don't care about the cost of a ct, or the latest ebm paper... they care about getting better.

it's a fine line. in your case, you followed your gut instinct and ordered an expensive test that most experts would say was not essential. but by following your instinct, you diagnosed a tumor that otherwise would have gone undetected for a while longer. perhaps this is the best way to practice medicine. follow the standard of care generally, but don't hesitate to order a test when your instinct tells you so.

well anyway, nice job.

Originally Posted by Sessamoid

Anybody who is supposedly "not acting right" according to somebody who knows him well gets a head CT. Most of the time it'll be normal, but a surprisingly significant percentage will have "interesting" pathology.

Yes, but the not acting right was very vague and she was acting fairly normally in the ED. You can act weird in the throws of a typical migraine, although you could probably still pin down that that part is different from her typical pattern. All I was saying is that you could make an argument that a head CT was not warranted, at least emergently in the ED since she had a normal neuro exam for me (including no papilledema with easy to see discs non-dilated).

mike

2 years ago, my best friend and her fiance are in town for their wedding, best friend's mom works for my parents, and best friends dad is also a good friend of the family. My best friend and future husband had just finished meeting with the Pastor to go over some final details (wedding was two days away) and stopped home to find dad out cold on the floor snoring. They couldn't wake him up, so they call mom, who calls me. I tell them call 911 and then race over there with my jump kit. Friends dad ends up getting shipped to level 1 facility where the neurologist tells them in medical terms what has happened, I then have to translate to the entire family that their dad is not coming back. After a day of him surviving on machines, they unplug everything, and he passes away on the day he should have walked his daughter down the aisle. He was a healthy 50 yo with no hx, died of brain aneurysm. Absolutely sucks.

Last night I got to rescusitate a toddler the exact age of my son who drowned in a pool. I was so shook up I could barely see to tube him and its the first time I've cried after a shift in a long time.

I just heard from the PICU he's awake, eating, and "mad as hell"

made my day