Medicine Sucks

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Originally Posted by Hawaiian Bruin

I suspect she did, though I don't know what happened after she was airlifted out. I know this much: if I was in her situation, I would think that dying would be better than being kept alive.

Full thickness burns pretty much over her entire body, with charred skin coming off in sheets whenever she was moved. The only non-burned skin, eerily enough, was on her wrists under the rags they used to hog-tie her.

Dear God in Heaven. I don't think I'd want to live through that either. Did they catch who did it?

Originally Posted by Kittenmommy

Dear God in Heaven. I don't think I'd want to live through that either. Did they catch who did it?

I hope they did, and I hope they put up a fight. People like that forfeit their right to live, and I shed no tears for any and all of them being massacred.

Originally Posted by BlackSails

I hope they did, and I hope they put up a fight. People like that forfeit their right to live, and I shed no tears for any and all of them being massacred.

ITAWTC.

One thing that really sucks about EM is that you really can't devote a lot of time to a bad situation even when you want to. I had one of those unfortunately all too common situations in Vegas where one half of an elderly couple who are visiting just drops dead. So once more I have to tell some sweet LOL that her husband of 50 years is dead and she has to go back to the hotel all alone. She's 85 and clearly overwhelmed and she's gotta go back, spend the night (crying I assume) then get up, pack up their stuff, get to the airport and get home. Somewhere in there she's gotta make arrangements to get the body home and she's gotta tell the kids.

I really felt sorry for this one. I really wanted to call the hotel and see if the concierge could help her out some, call some family so she didn't have to, just try to make things easier. But by the time the code was over there were 9 charts in the rack and one was a STEMI. So I had to give the quickie, I'm so sorry for your loss speech and hurry off.

I bet if you asked all the EPs everywhere every single one of us wishes we could stop the new patients from rolling in just once in a while.

Originally Posted by docB

I bet if you asked all the EPs everywhere every single one of us wishes we could stop the new patients from rolling in just once in a while.

Just once in a while?

Originally Posted by docB

I bet if you asked all the EPs everywhere every single one of us wishes we could stop the new patients from rolling in just once in a while.

Absolutely. We now wear this fu*&'ng ASCOM phones on our hips to "improve communication". It seems it knows just when I'm in the family room giving "the talk" and finds a way to ring 15 times. I'd love to be able to hit the great pause button on life to be able to spend more time with families during those talks. I do the next best thing and 'overlook' the fact that my phone battery has mysteriously come out of the phone.

Take care,
Jeff

Kittenmommy, I had a patient in my residency clinic who survived been "torched" (her word, not mine) by her husband. She was constantly in and out of the psych hospital. She told me that she wished she had died. Her husband was released from prision early for good behavior.

Originally Posted by Annette

Kittenmommy, I had a patient in my residency clinic who survived been "torched" (her word, not mine) by her husband. She was constantly in and out of the psych hospital. She told me that she wished she had died. Her husband was released from prision early for good behavior.

Wow. Gotta love our justice system.

One of my good friends, who admittedly used to be on the heavy side: "I've been losing weight, man. I've lost 25 pounds without even trying!"

....

I suppose what sucks with a medical education is noticing the red flags.

Originally Posted by ForbiddenComma

One of my good friends, who admittedly used to be on the heavy side: "I've been losing weight, man. I've lost 25 pounds without even trying!"

....

I suppose what sucks with a medical education is noticing the red flags.

Oh dear.

Your good friend is in my thoughts. As are each of you here.

Folks--

Ouch. Things like these are why I went to law school instead of med school--I just couldn't handle the degree of human tragedy that was involved. (This is also why I opted to specialize in commercial/technological law instead of personal injury or the like--while I won't be able to defend any of you, after I graduate and pass the bar, I'd be glad to help you patent any useful medical things you invent.)

I haven't had much need of the EM department, but when I have, they've been most helpful, and they've done the best with what they've been allotted. Good eggs, virtually all of them.

Take care of yourselves, please. You deserve it.

Originally Posted by JustOneLawyer

while I won't be able to defend any of you,

Hey, at least you won't be suing us, either!

Take care,
Jeff

bump

So.... if you could go back, who would choose EM again? there's gotta be a reason you chose it in the first place? just curious... im considering EM

Originally Posted by jmp20

So.... if you could go back, who would choose EM again? there's gotta be a reason you chose it in the first place? just curious... im considering EM

Refer to the "Medicine is Awesome" thread, or whatever it was called.

Originally Posted by docB

One thing that really sucks about EM is that you really can't devote a lot of time to a bad situation even when you want to. I had one of those unfortunately all too common situations in Vegas where one half of an elderly couple who are visiting just drops dead. So once more I have to tell some sweet LOL that her husband of 50 years is dead and she has to go back to the hotel all alone. She's 85 and clearly overwhelmed and she's gotta go back, spend the night (crying I assume) then get up, pack up their stuff, get to the airport and get home. Somewhere in there she's gotta make arrangements to get the body home and she's gotta tell the kids.

I really felt sorry for this one. I really wanted to call the hotel and see if the concierge could help her out some, call some family so she didn't have to, just try to make things easier. But by the time the code was over there were 9 charts in the rack and one was a STEMI. So I had to give the quickie, I'm so sorry for your loss speech and hurry off.

I bet if you asked all the EPs everywhere every single one of us wishes we could stop the new patients from rolling in just once in a while.

That's a sad story DocB. But for the times you wish you could stop and console a distraught relative of someone you couldn't save, there are probably many more times you DON'T have to have that terrible talk because you saved a loved ones life.

There's no specialty that comes close to experiencing the ups and downs of humanity like emergency medicine. I couldn't imagine being a radiologist...

Originally Posted by Jabailya

Get real its a job, we do a job! Mechanics don't fret over who caused the problem they simply make a repair. Get over yourself............

Is that the attitude you want the attending physician to have when your dad has an MI or your daughter drowns?

I smell a troll.

I'm trying to do the right thing for a pt, but I'm being hamstrung by a stupid law! I have a young pt in a vegetative state after an anoxic event, seizure, and multiple strokes. Terry Schivo looked like a marathon runner compared to this pt. Pt doesn't register threat, has doll's eyes, only minimally withdraws from pain, and postures.

Because the pt didn't appoint a poa, a health care surrogate was appointed- family member. After much discussion and heart break, the family agreed to DNR. Well, because there is no poa, I have to have two physicians sign off that this pt has a "qualifying" condition- terminal, permanently unconcious, or incurrable/irriversible. Well, the neurologist thinks this guy is toast, but won't sign the form- thinks the CCM consultant who has been following the patient all along (5 months, now). The CCM thinks a DNR is appropriate, but doesn't believe the pt has a qualifying condition so won't sign the form.

I'm confused. How is the problem with the law? It sounds almost as though the problem is these two consulting MDs don't want to put their money where their mouths are. I'm probably oversimplifying... is the law the reason they won't sign and affirm what it sounds like they privately agree is appropriate?

Just had to share a little. My first time doing CPR was on a 9-year old female drowning victim. I was 15 at the time. Fortunately, I didn't have to tell the family.

We just had a little girl brought into our ER who was starved and beaten with an electrical cord. Bruises in all different stages of healing. "Fell down the stairs" for the bruising, and "we didn't want her to be fat" for the starvation, because "you know, there's a childhood obesity epidemic, and we don't want no fat baby."

11 cents...that's all I need...just 11 cents...well, 22, 11 for each, mom and dad. (At Walmart, 9mm ammo is 100 rounds for $11.00).

You can get a pretty decent claw hammer for around 11 bucks and its reusable.

Much more satisfaction than using a gun IMO.

Our place recently put in an EMR system. During slow periods on my rotations, I would go browse the ED roster for interesting cases that would be heading to the service I was on. For instance, when I was on renal I would look for ESRD's... when on neurosurgery I'd look for head or spinal traumas.

A couple weeks ago, I pulled up the file on a 3 y/o pt in the ED.

Chief complaint, according to the computer? "Rape kit."





I don't browse the ED roster on the computer anymore.

Ma'am, the reason your bright, normal 18 year old son has been sleeping a lot and not eating as much (and why he was minimally responsive this morning and his left pupil blown) is because there is a massive (6 cm + edema) "something" in his brain, smashing everything else.

Yeah, that went over well.

What I left out was that the radiologist's, the intensivist's, the neurosurgeon's and my own initial impression on seeing this poor kid's CT was "what the hell?..." I kid you not - I've never seen a non-trauma head that looked this bad come in off the street. Abscess? Cancer? Cyst? Damned if we know. But we'll find out.

Post craini, I heard it was most likely some sort of malignant glioma. Some sort of very aggressive, very devastating tumor.

There but for the Grace of God...

GBM is a MF!

Originally Posted by Chronic Student

GBM is a MF!

56 yo grandmother, nicest lady you could ever meet, full of energy and life hates hospitals (as most sane people do), active and aware, surrounded by family, healthy as a horse until she developed spastic extremity weakness, gait problems and trouble getting words out over the last few months.

Which, of course, guaranteed the diagnosis. We didn't need a biopsy. Hell, we didn't even need the MRI.

Too bad she wasn't a drunk driver who had killed a family of four. Then, it undoubtedly would have turned out to have been nothing.

Path is back. Grade 4 Glioblastoma, AKA GBM. Poor kid.

60-something yo guy w/ familial dilated cardiomyopathy s/p Heart transplant 5y ago, doing great, annual biopsy 1 month ago showed no rejection, admitted w/ back pain and dyspnea. CXR shows lobar collapse and mediastinal fullness. CT chest/abd/pelvis shows a 4cm spiculated mass in 1 lung, 5 ~1cm masses in the other, liver littered w/ goobers, entire T and L-spine riddled w/ mets, rt hemi-pelvis essentially nothing but mets. Stage IV NSCLC.

In the room next door is his 30-ish yo son for initiation of home dobutamine to try and bridge him to transplant (see familial above). Awesome-sauce.

Originally Posted by gutonc

60-something yo guy w/ familial dilated cardiomyopathy s/p Heart transplant 5y ago, doing great, annual biopsy 1 month ago showed no rejection, admitted w/ back pain and dyspnea. CXR shows lobar collapse and mediastinal fullness. CT chest/abd/pelvis shows a 4cm spiculated mass in 1 lung, 5 ~1cm masses in the other, liver littered w/ goobers, entire T and L-spine riddled w/ mets, rt hemi-pelvis essentially nothing but mets. Stage IV NSCLC.

Galloping tumours are a risk with transplants-and as you found, the person can go from 'well' to 'palliative' in mere days. My grandmother was 5 years s/p liver transplant and doing great; she was on the lowest doses of anti rejection drugs the transplant team had ever used-it was like her donor was an identical twin instead of an 18 year old boy.

She went from well (mild pneumonia in the bases but otherwise clear CXR, her typical spring 'cold') to lower right lobe of the lung gone, liver covered in so many tumours it looked like someone had strung a strand of pearls around and full lymphatic involvement in less than a month (~May 10-June 13) and was dead barely a month later-July 21.

We had been warned that cancer was a risk she was taking with the transplant and anti rejection drugs, but we had no clue how fast it could go.

The only blessing, if there was one, was that she had no pain; she lost her appetite and was very warm, but that was it. She stayed on her anti rejection drugs (doctors said it wouldn't matter either way), so her immune system did not try to fight the tumours.

If she were alive and facing the same situation now, would she consent to transplant? I honestly think she would; those five years were wonderful ones and her death by cancer was much less painful than the liver disease she had been dying of was (primary biliary cirrhosis). If I were in that position, needing a transplant? I honestly don't know what I'd do.

Originally Posted by RetiredTooSoon

Galloping tumours are a risk with transplants-and as you found, the person can go from 'well' to 'palliative' in mere days. My grandmother was 5 years s/p liver transplant and doing great; she was on the lowest doses of anti rejection drugs the transplant team had ever used-it was like her donor was an identical twin instead of an 18 year old boy.

Well, PTLD is a fairly not-unusal outcome in transplant patients (we do heart, kidney, pancreas and liver, never mind the BMT stuff at our institution so I'm far too familiar w/ the complications of solid-organ txplants) but a primary solid tumor is far less common. We all had our hopes on PTLD - throw some R-CHOP at him and get a few more years. Stage IV NSCLC on the other hand...dude qualifies for R-CHIP...
Roxanol (or Radiation Therapy)
Cocaine
Hawaii
Ice Ccream
Prednisone

Good news, 32 y/o diabetic with lupus with RLQ pain - your CT is negative for appy! However, we did find a rather large nodule at the base of your left lung on the abdominal CT - wait a minute, there's two.

So, we need a chest CT - where there are at least 7 nodules, bilaterally. Night sweats, tender cervical lymphadenopathy - yes. Weight loss, fevers - no. WBC 8K, though, with normal differential.

I feel drawn towards EM, but I'm not sure my emotions could take it. I was getting all choked up just reading this thread and I haven't seen the inside of an ER in 20 years.

WEll, these aren't your usual days if that makes you feel better.

Any thoughts on how attached/detached we should be when approaching these situations?

How do you "deal with" the intensity of these (hopefully rare) cases?

A few nights ago, 3 am..... Peaceful night in the ED when a squad rolls through the door with a 2 month old, grunting resp., glazed eyes, blood from nose, on blow-by oxygen. Dad "fell asleep" with baby on chest and awoke to find him not breathing well. Baby was intubated then coded. Worked the baby, got him back and shipped to the nearest peds hospital. Talked to the attending in the PICU and the EEG was "not promising" and the family was being investigated because their stories were changing and an anonymous phone call was placed to the hospital voicing abuse concerns.

Mom was in the ED by herself crying her eyes out while we tried to save her baby...these are the days that "medicine sucks."

This is in "Things I Learn..." format but for obvious reasons it's here instead.

Don't stay with your abusive boyfriend after he's beaten you time and time again thinking he'll change. He'll eventually kill you.

Originally Posted by docB

This is in "Things I Learn..." format but for obvious reasons it's here instead.

Don't stay with your abusive boyfriend after he's beaten you time and time again thinking he'll change. He'll eventually kill you.

I'm sorry, DocB.

My grandfather passed away a few months ago. He had a huge MI while on a cruise near Mexico for his and my grandmother's 60th anniversary. Airlifted back to a domestic hospital a week later in cardiogenic shock, and died a few hours after that in the cath lab.

When the interventional cards guy came out to tell us he had passed away, he had tears in his eyes and was quite upset. I was surprised that he still got that upset over something he likely has to do all too often. I don't know if that's a good thing, or a bad thing...maybe both?

1) couple months ago, 3 m/o male multiple extremity, rib, skull fx's tubed in the PICU. half-starved, **** suckle, and withdraws from all stimuli. got the fx's b/c mom "accidentally" bumped into a wall while holding him. uh huh. as if that weren't enough, mom is 19 y/o and dad is also the baby's grandfather. AWESOME. here's the clincher - the attorney for the family wants to know if it's possible the kid has osteogenesis imperfecta. right. ok. no f---ing way, moron, and my attending is about 2 sec from beating you with your own clipboard.

2) third child drowning this week and it's only tuesday. i f---ing hate summer, and i hate all those parents with pools and kids who can't swim.

Originally Posted by pdp2001

1) couple months ago, 3 m/o male multiple extremity, rib, skull fx's tubed in the PICU. half-starved, **** suckle, and withdraws from all stimuli. got the fx's b/c mom "accidentally" bumped into a wall while holding him. uh huh. as if that weren't enough, mom is 19 y/o and dad is also the baby's grandfather. AWESOME. here's the clincher - the attorney for the family wants to know if it's possible the kid has osteogenesis imperfecta. right. ok. no f---ing way, moron, and my attending is about 2 sec from beating you with your own clipboard.

I work in pediatric endocrinology, and we had to do a consult like that once..... CPS wanted us to evaluate the kid for OI, rickets, anything that might cause frequent fractures.... and I'm over here like "Hey, being beaten causes fractures! Had that occurred to you guys?" But then again CPS in this state couldn't find their ass with two hands and a flashlight.

Parents never went to do lab work or DEXA.... never followed up in the office..... gee, what a shocker.

-

Originally Posted by ForbiddenComma

Our place recently put in an EMR system. During slow periods on my rotations, I would go browse the ED roster for interesting cases that would be heading to the service I was on. For instance, when I was on renal I would look for ESRD's... when on neurosurgery I'd look for head or spinal traumas.

A couple weeks ago, I pulled up the file on a 3 y/o pt in the ED.

Chief complaint, according to the computer? "Rape kit."





I don't browse the ED roster on the computer anymore.

A few years ago I took a workshop with Roy Hazelwood- FBI Profiler (one of the originals) on Serial Sexual Sadists. Some you know, some you don't hear of---made the huge mistake of asking him about 'youngest rape victim'. Sometimes you don't want answers. I wish I could UNhear his answer. I just do NOT understand some people.

Originally Posted by leviathan

My grandfather passed away a few months ago. He had a huge MI while on a cruise near Mexico for his and my grandmother's 60th anniversary. Airlifted back to a domestic hospital a week later in cardiogenic shock, and died a few hours after that in the cath lab.

When the interventional cards guy came out to tell us he had passed away, he had tears in his eyes and was quite upset. I was surprised that he still got that upset over something he likely has to do all too often. I don't know if that's a good thing, or a bad thing...maybe both?

Sorry to hear about that leviathan.

If you're selfish enough to attempt suicide in order to gain attention, please please don't do so in front of your three little girls! It's difficult enough for an EMT and medic to treat a possible suicide, but it's all the more difficult when you can hear a 3-year old's voice telling the police that "mommy won't wake up"

Originally Posted by pdp2001

1) couple months ago, 3 m/o male multiple extremity, rib, skull fx's tubed in the PICU. half-starved, **** suckle, and withdraws from all stimuli. got the fx's b/c mom "accidentally" bumped into a wall while holding him. uh huh. as if that weren't enough, mom is 19 y/o and dad is also the baby's grandfather. AWESOME. here's the clincher - the attorney for the family wants to know if it's possible the kid has osteogenesis imperfecta. right. ok. no f---ing way, moron, and my attending is about 2 sec from beating you with your own clipboard.

We had one of these on Friday - not quite to bad, actually. Beautiful 2 month old girl with very young parents. The story was that the dad noticed a lump in his thigh. Dad thought that the lump was from her vaccines. X ray begged to differ and revealed a displaced femur fracture. Subsequent skeletal survey showed multiple healing rib fractures. Thankfully, the head CT was unremarkable.

Another good one - we monitor the 'non-transport' EMS calls for pediatrics in my town. The phone will ring in the doc's room and EMS tells us the story. If we feel that leaving the kiddo on site with parents is okay, we'll okay the non-transport. So the nice EMS dispatcher calls and tells me, "12 month old male whose father spanked him with a wire hanger on his back last night fell on his back today and cried. His mother got scared and called EMS. She wants to know if it's okay to take him to the ER in a private conveyance." Can we get a H&LL NO?!? I almost couldn't believe dispatch called to ask, but then I remembered that his departmental policy required it. I think he was as outraged as I was.

Originally Posted by cls4n6

A few years ago I took a workshop with Roy Hazelwood- FBI Profiler (one of the originals) on Serial Sexual Sadists. Some you know, some you don't hear of---made the huge mistake of asking him about 'youngest rape victim'. Sometimes you don't want answers. I wish I could UNhear his answer. I just do NOT understand some people.

I'm afraid to ask the answer Roy Hazelwood gave you. Especially since I think over in the Things I Learned thread, there's a six month old answer to that question.

Jesus Christ. The things people can do to one another. Especially the most helpless.

Originally Posted by Katydid

I'm afraid to ask the answer Roy Hazelwood gave you. Especially since I think over in the Things I Learned thread, there's a six month old answer to that question.

Jesus Christ. The things people can do to one another. Especially the most helpless.

Once when we were watching Law and Order, I remarked to Kittendaddy that I wasn't sure who sees more tragedy: a doctor or a police officer. Arguments could be made either way, IMO.

Originally Posted by Kittenmommy

Once when we were watching Law and Order, I remarked to Kittendaddy that I wasn't sure who sees more tragedy: a doctor or a police officer. Arguments could be made either way, IMO.

My brother's a corrections officer. The stories he's told about WHY people have ended up in his "care" are hair raising. And horrible. And will break your heart every time. People do some seriously f'ed up things to one another.

Originally Posted by Katydid

My brother's a corrections officer. The stories he's told about WHY people have ended up in his "care" are hair raising. And horrible. And will break your heart every time. People do some seriously f'ed up things to one another.

This is one of the many reasons why I prefer animals to people.

Originally Posted by Kittenmommy

This is one of the many reasons why I prefer animals to people.

No lie. And one of the many reasons I worry about my 14 year old daughter.