Things I Learn From My Patients

Darth Meatloaf said:

So, this is a thank you to everyone in the EM field, whether you be doctors, ambulance crews or anyone else. A thank you a long time coming (this happened @23 years ago, but I still think of it often) because There is no other place or way for me to do this.

I live in Wisconsin. My father was in Arizona just outside of Phoenix (for stupid reasins irrelivant to this post) and fell asleep at the wheel.

To illustrate the depth of my thanks, here is a list of his broken bones:

2-3 bones broken in each foot.
Both ankles
Left tib
Right tib/fib
Right patella (shattered)
Right femur
Right hip
Separated pelvic girdle
6 ribs
Right shoulder (required multiple pins to reassemble)
Right humerus
One bone in left forearm
Both bones in right forearm
Both wrists
Jaw (in 3 places)
Left cheekbone

Aside from the breaks, he had numerous internal injuries.

Flight for Life + Well-Trained EM crew = I still have a dad.


After scraping him off the road and piecing him back together, I'm fairly sure everyone involved needed a good laugh...









And after reading this thread, I am fairly sure that there were a few idiots around at the time to provide one.



I don't care if you are in Phoenix or not, if you were involved in that incident or not. Thank you all. Were it not for every one of you, there would be many many people without a loved one.

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I read this thread for the laughs, I post to it cuz I'm a know it all. Your heartfelt sincerity made me remember why I nurse in the ER....... Thank You

If you are worried about mixing crack and prescription meds for high blood pressure, by all mean, stop taking the BP meds. Of course, your doctors will be at fault when you have a stroke.

Don't mention the term "nodding off" to your junkie who is falling asleep while you talk to him. They will get extremely upset and demand to speak with your supervisor, state they want to file a police report against you, and try to file sanctions against your hospital. The patient told this to my attending after his sitter said he was nodding off all day.

Urban dictionary says that nodding means "the feeling of disorientation and loss of motor control while on heroin."

To make things more ironic, the pt had admitted to me that he shot 3 bags of heroin before EMS brought him in.

shirbat said:

Don't forget to be alert for the helpful tech who gives the restrained psych pt a lighter........ and when he and the stretcher catch on fire....... move him to another bed (foam smolders for DAYS)

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Where did this happen? We had an admission to our burn center a couple years ago from the exact same scenario!

Here's something I learned from someone who wasn't my patient, but might have wound up one of yours...

I work as a secretary in an office building on a hospital campus. Every day after work I take a walk around campus to get some exercise, since my job involves a lot of sitting. It's well-lit and easy and has never been a problem before.

Yesterday I nearly got hit by a guy who was kind of swerving around the road. I figured he was drunk, but he waved at me and said, "Which way is the ER?" Upon taking a closer look, I realized that he was doubled-over in pain and crying. This was a big black guy somewhere in his mid-thirties.

The ER was only a few minutes walk away and I didn't want him driving anymore, so I told him to wait there and ran over to the ER to get, hopefully, an EMT or a security guard or someone who could wheel over a stretcher and get this guy taken care of. This was easy enough, and we walked back over to the guy, who at this point had gotten out of his car and was lying on the ground, moaning and clutching his urgent care report.

Urgent care report included an abd. CT and x-ray showing appendicitis... EIGHT DAYS AGO.

So I learned that a) if you're diagnosed with appendicitis, don't take eight days to do something about it, and b) if you do wait eight days, don't drive yourself to the hospital, for Pete's sake, as you will run over the nice secretary who is SOCMOB.

I had a patient as a med student who drank bleach. Although she didn't really drink it, just gargled with it. She started with isopropyl to brush her teeth with, but ultimately decided that it wasn't killing enough germs. So she went with the bleach.

She'd lost 40 lbs over several months because she was terrified that her food would become "contaminated" with germs from her mouth. Only came in because she syncopized, and was severely dehydrated with a bunch of electrolyte abnormalities. The only way she would eat was to rinse with bleach and then toss the morsels to the back of her throat to avoid contaminating them. At least, when she tried to eat. First patient I've ever had that was overjoyed to have a dobhoff.

Really, a very sad case.

If you are an junkie angry that the triage nurse has not admitted yet (ahead of people with dislocated shoulders and concussions, bad chest pain, and severe bleeding, crushed ankles and severely infected wounds) because you have some normal dihrreah, It is always a good idea to go to the washroom, wipe a whole bunch of it on a towel, and come out to the triage volunteer(me) and wave a ****-smeared towel in his face..

that will get you ahead of the rest for sure!!!

shirbat said:

That's a really tough one if you've ever seen the EGD of a man who survived the drano ingestion. Turned out he TRULY didn't want to go to jail......

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On a similar note, drinking battery acid is a bad way to attempt suicide. It will pretty much liquify your stomach and small bowel, and you will grow weary of us after spending 9 of the past 12 months in our hospital.

He has survived long enough to restore his GI continuity, amazingly.

When the voices in your head tell you to put a paperclip up your urethra, make sure it's the smooth kind. That way it will take a 40+ minute conscious sedation and 20+ attempts with the urologist to get it out.

The urologist shoulda used a magnet.

PS Why couldn't she have found her vagina with the paperclip? The hole is so much bigger...

doctawife said:

When the voices in your head tell you to put a paperclip up your urethra, make sure it's the smooth kind. That way it will take a 40+ minute conscious sedation and 20+ attempts with the urologist to get it out.

The urologist shoulda used a magnet.

PS Why couldn't she have found her vagina with the paperclip? The hole is so much bigger...

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Because that would have made your life just that much easier...

My girlfriend just warned me to watch out for "some dude" whenever I leave church. I'd forgotten how much danger I was in.

I've never felt so vulnerable.

Depakote said:

My girlfriend just warned me to watch out for "some dude" whenever I leave church. I'd forgotten how much danger I was in.

I've never felt so vulnerable.

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You can stop "some guy" with a ballistic vest. He uses a gun. If you get beat up, it will be "two dudes" - always. Why? Because "one dude" could never kick your a$$. That takes two. But one guy can shoot you.

If you are scared my advice is to run up to everyone you see and get in their business. I never seen anyone jumped or shot who was "gettin' up in some dude's bidness". Nope, they are always "standing around, minding their own business". So I say, go on, get into everyone else's business. It may just save your life!

- H

dchristismi said:

I had a patient as a med student who drank bleach. Although she didn't really drink it, just gargled with it. She started with isopropyl to brush her teeth with, but ultimately decided that it wasn't killing enough germs. So she went with the bleach.

She'd lost 40 lbs over several months because she was terrified that her food would become "contaminated" with germs from her mouth. Only came in because she syncopized, and was severely dehydrated with a bunch of electrolyte abnormalities. The only way she would eat was to rinse with bleach and then toss the morsels to the back of her throat to avoid contaminating them. At least, when she tried to eat. First patient I've ever had that was overjoyed to have a dobhoff.

Really, a very sad case.

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Dude that's totally creepy. Seems to me she'd kill herself more easily with that bleach then the food. I've known some germaphobes too, but usually the extent of their germaphobicness goes to the extent of not eating out. i remember when I was an officer in the premed chapter of AMSA and we went to national convention and had to go to a restaurant for dinner cuz we didn't have food for the night. The guy who was president was totally looking uncomfortable having to eat out somewhere other then his house. Then we got pizza that day and he wouldn't let anyone else touch the pizza before he cut it cuz he was afraid of germs that much.

gujuDoc said:

Dude that's totally creepy. Seems to me she'd kill herself more easily with that bleach then the food. I've known some germaphobes too, but usually the extent of their germaphobicness goes to the extent of not eating out. i remember when I was an officer in the premed chapter of AMSA and we went to national convention and had to go to a restaurant for dinner cuz we didn't have food for the night. The guy who was president was totally looking uncomfortable having to eat out somewhere other then his house. Then we got pizza that day and he wouldn't let anyone else touch the pizza before he cut it cuz he was afraid of germs that much.

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That guy does realize that if he's going to be a doctor, he'll have to work at a hospital... you know, where all the sick people are, right?

I've always wondered why germaphobes were only afraid of everyone else's germs and not their own?

Cats are vicious animals that will hide your Clonidine from you. If you can't find said clonidine, cocaine is always a good substitute.

hurricanemd said:

Cats are vicious animals that will hide your Clonidine from you.

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Good to know! I'll have to keep an eye on the medicine cabinet now. Wouldn't want the cats hiding Kittendaddy's Singulair.

hurricanemd said:

If you can't find said clonidine, cocaine is always a good substitute.

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I... [*boggles*] I don't know what Clonidine is (I'll go look it up in a minute) but I can't imagine that cocaine would be an adequate substitute for too many prescription medications. Good grief.

Yoo Hoo is not an acceptable alternative to formula when feeding your 6 mo/o.

pingouin said:

Yoo Hoo is not an acceptable alternative to formula when feeding your 6 mo/o.

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Oh dear Lord.

Depakote said:

Oh dear Lord.

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Seconded.

Since this is your 5th baby in 6 years, I would assume that you would know that morning sickness is quite common, and that a little nasuea while you're pregnant does not require a trip to the ER.....AGAIN!!!!!!

docB said:

If you have presented, yet again, for your painin' vajaja try to avoid getting caught by the nurse servicing the gentleman who accompanied you to the ED with said vajaja. If you are unable to control your sexual urges despite your 10/10 vaginal pain and do get yourself caught by the nurse (who has worked the ED for 12 years, has a very strong stomach and STILL almost vomited at the sight) please refrain from bursting out of the room naked yelling at the doctor (who is thankfully unaware of what you're yelling about) that he had better not tell your baby's daddy what you have been doing.

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This vajaja is sounding an awful lot like just another "BO-gina."

docB said:

If you have presented, yet again, for your painin' vajaja try to avoid getting caught by the nurse servicing the gentleman who accompanied you to the ED with said vajaja. If you are unable to control your sexual urges despite your 10/10 vaginal pain and do get yourself caught by the nurse (who has worked the ED for 12 years, has a very strong stomach and STILL almost vomited at the sight) please refrain from bursting out of the room naked yelling at the doctor (who is thankfully unaware of what you're yelling about) that he had better not tell your baby's daddy what you have been doing.

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Oh my god. what is happening where you are?

First of all go take a dump on the floor in the corner of the room...then lay back down, minutes later, push out your dead baby.....baby daddy in the corner, comes stepping over poop wads asking the nurses and doctors 'yo, when can I hit dat again?"

EM_Rebuilder said:

First of all go take a dump on the floor in the corner of the room...then lay back down, minutes later, push out your dead baby.....baby daddy in the corner, comes stepping over poop wads asking the nurses and doctors 'yo, when can I hit dat again?"

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I'm still not sure I 100% understood it, but the imagery was amazing.

Go to ED with CC of stinky va-ja-ja ("it smells like something died in me") for several days but only now concerned and need to see a doctor because leaving for vacation tomorrow.
BTW - after period is over, how does one forget about a retained tampon? and NOT be embarrassed when doctor removes said tampon while patient mentions, "hey I wondered about that"

Yes, the ED is a fertile ground for the deep philosophical questions. Asking how is almost always as futile as asking why.

It is often more fun, however.

docB said:

I did recently give into curiosity and ask a patient "Sir, when the 911 dispatcher came on the phone and said 'THIS IS 911! wHAT'S YOUR EMERGENCY?' did you really tell her you were constipated?"

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And what was the reply?

docB said:

The patient said: "Well I told her that I been feelin' kinda bad and dat I hadn't movded my bowels in 3 days. She said they'd be sending the amboolance arounds to pick me right up."

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Good grief. I'm not sure who's dumber here; the patient for calling 911 for constipation, or the dispatcher for sending an "amboolance" over to bring him in for said constipation.

docB said:

Dispatch doesn't have a choice. Anyone who requests an ambulance gets one. The ambi crew doesn't have a choice either. No agency or EMS company wants the liability of not transporting someone so all patient contacts result in transport unless the patient refuses.

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Ah. I should've realized it was something like that. And why do I have the feeling that the local taxpayers were footing the bill for that guy's emergency constipation attack?

docB said:

Well the taxpayers pay for it if he has Medicare or Medicaid. If he's uninsured then everyone just eats the costs (ambulance company, hospital, me) and passes them on to other patients.

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Nice. And people wonder why health care is so damn expensive.

docB said:

I did recently give into curiosity and ask a patient "Sir, when the 911 dispatcher came on the phone and said 'THIS IS 911! wHAT'S YOUR EMERGENCY?' did you really tell her you were constipated?"

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Man that guys FOS!

-Mike

Apparently suicidal thoghts can be easily cured by a cheap, mass manufactured, turkey sandwich. Who knew?

Do you mean, as in "Give me a turkey sandwich or I'm gonna be suicidal or have CP ?"

-Mike

The time you spend in the ED watching your baby get another breathing treatment before being admitted for respiratory distress is "quality time" for rolling your cigarettes.

Apparently a college education (or the majority of one to be more precise) does not preclude one from being an utter *****. We had a girl (freshman) get plowed by a car on the road- basically a 4 lane undivided highway- next to campus as she was running back to get her flip flop that had came off during her initial drunken stumbling across the road. I was the first medically trained person on the scene (I was a couple hundred yards away and heard the accident and went to go have a look...BTW, I was sober in case you were wondering). The girl was dead before I got to her. One of the seniors here (apparently he was one of the bystanders) asked me the next day in class:
Him: "Why didn't you do anything for?"
Me: "She was already dead when I got to her. There was nothing I could do."
Him: "How did she die so quick?"
Me: "Well, I can't be sure, but I'm guessing from how she looked, that she landed on her head and broke her neck***. Either the neck injury or the head injury alone could have killed her. If you break your cervical spine, chances are decent you won't be breathing afterwards."
Him: "Cervical? So what did the car do? Hit her in the *insert common feline based reference for female genitalia here*?"


***- her neck was visibly angled in a way it was obvious her c-spine was fractured. She also had a massively depressed skull fracture

Dienekes said:

One of the seniors here (apparently he was one of the bystanders) asked me the next day in class:
Him: "Why didn't you do anything for?"

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I usually pretend to be a typical person just wanting to help and do not announce my medical training unless there's some sort of chaos for this reason.
"Why didn't you do anything?"
I'd feel like asking, "Why didn't *you* do anything?" But it was probably traumatic for the bystander and maybe they're trying to work it all out in their head.


Back on topic:

If a testicle is bothering you, just because you have plenty of practice in castrating cattle doesn't mean you can successfully remove your testicle.
Oh, you'll remove the testicle, and throw it in the trash, but the wound you left probably will get infected.

When urology takes you to the OR, make everyone uncomfortable by asking that your other testicle get removed so it doesn't eventually bother you either. After noticing the doc looking at you like you're crazy, tell them you're going to remove it if they won't.
Trust me, they'll believe you if you've already attempted on your own and will remove it for you.

Wackie said:

I usually pretend to be a typical person just wanting to help and do not announce my medical training unless there's some sort of chaos for this reason.
"Why didn't you do anything?"
I'd feel like asking, "Why didn't *you* do anything?" But it was probably traumatic for the bystander and maybe they're trying to work it all out in their head.


Back on topic:

If a testicle is bothering you, just because you have plenty of practice in castrating cattle doesn't mean you can successfully remove your testicle.
Oh, you'll remove the testicle, and throw it in the trash, but the wound you left probably will get infected.

When urology takes you to the OR, make everyone uncomfortable by asking that your other testicle get removed so it doesn't eventually bother you either. After noticing the doc looking at you like you're crazy, tell them you're going to remove it if they won't.
Trust me, they'll believe you if you've already attempted on your own and will remove it for you.

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My first thought was, "I would have gone the Patient Education route..."

Then I realized... "perhaps it is better that this guy stops breeding"

i'm a 2y med student and emt from graz, austria - somehow i found this thread via excessive google studies...

one thing i learned was that even if it isn't smart to cut off the cast you're wearing after an ankle fracture (which made trauma surgery put more metal in your foot than the terminator's) all by yourself - it is an even worse idea to use alcohol as a pain med, for it will not work as good on relieving the pain as it does on making you forget how stupid you were cutting off that stabilising cast in the first place. this will result in the self-removal of at least 9 casts within 3 weeks and after calling 911 at 2am because your foot hurts in an extremely annoyed EMT, who will choose the transport-route to the hospital by highest count of potholes in the road after he had to explain to you just why you can't take the bottle of "schnaps" with you to the hospital and then politely asked you to put those two cans of beer in your trousers back on the table...

another important lesson: if you're trying to kill yourself by jumping into a river, make sure nobody sees you - just in case you're not dead from the 7meter drop into the water and you'll have to swim ashore and try it one more time - bystanders might prevent you from jumping a 2nd time.

another thing i wouldn't recommend (i wasn't there personally): if you spend the weekend with friends on a metal-festival it is dangerous to pass out drunk if your friends know of the joy "decorating a drunk" can bring:
(wait for 8:38: glue + empty 5l beer cask + drunkfriends = helluva experience)

http://www.youtube.com/watch?v=PF8ItaOLy2k

Not my patient but I figured we could all learn from this...

how to change a tire

Although I think the part about him being not intoxicated has to be a misprint or out right fabrication

ERMudPhud said:

Although I think the part about him being not intoxicated has to be a misprint or out right fabrication

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Unfortunately, I know people who are just that stupid. It happens.