Medicine Sucks

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41 YO M brought in by EMS. Found down on the ground by coworkers who started CPR. Medics coded him for 25 minutes PTA. Vfib as initial presenting rhythm and throughout. Medics tell us patient had a heart cath with stent placement 1 mo prior. He gets to us and is still warm. Doesn't have that grey/mottled look that a true dead dead person looks like. Continue coding him. Checked with ultrasound, heart definitely still fibrillating. Tubed, EtCO2 of 35. We code and code and code. Epi, bicarb, amio, lido, calcium, mag, tPA, many shocks. Vfib -> Vfib -> Vfib. Eventually the vfib starts getting more and more fine until nothing is moving.

I've done plenty of codes before and usually don't have any problems calling it. But then again, rarely do I encounter someone I'm coding who is still warm, still apparently perfusing, and who has a damn good EtCO2 and heart motion on ultrasound. Not to mention much younger than many of the people I code. I just remember thinking "****, if this was 10-15 years from now, maybe I'd be able to put this guy on ECMO". I didn't want to give up.

Looked up his past records from our computer system after the fact. First MI at 33. This guy really drew the genetic short straw.
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toddler tortured and beat to chit by his parents, bilateral SDH, paralyzed, aphasic

toddler taken logging, tree fell on him, bilateral SDH, paralyzed

toddler left alone in pool, drowned, decorticate

full term w/late onset GBS meningitis / septicemia -> status epilepticus, DIC, shock

GBS meningitis -> horrible encephalomalacia -> withdrew care, somehow keeps breathing to live as a vegetable

Shoulder dystocia -> horrible HIE -> withdrew care, somehow keeps breathing to live as a vegetable.


3 fuking weeks on peds neuro and this crap. Don't understand how people can go into that field
 
Cytarabine said:
toddler tortured and beat to chit by his parents, bilateral SDH, paralyzed, aphasic

toddler taken logging, tree fell on him, bilateral SDH, paralyzed

toddler left alone in pool, drowned, decorticate

full term w/late onset GBS meningitis / septicemia -> status epilepticus, DIC, shock

GBS meningitis -> horrible encephalomalacia -> withdrew care, somehow keeps breathing to live as a vegetable

Shoulder dystocia -> horrible HIE -> withdrew care, somehow keeps breathing to live as a vegetable.


3 fuking weeks on peds neuro and this crap. Don't understand how people can go into that field
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wtf...
holy
 
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I don't miss pulling shifts at a tertiary care peds hospital. I'm not sure if this is the worst case I've ever seen but it's been what pops into my mind and discarded just as quickly when laypeople ask about things I've seen. 9yo brother and 12yo sister home alone during summer. Neighborhood teen comes over and takes the sister into her room while brother watches TV. Brother wonders where sister went and opens door into her room. 9yo walks in on teen raping sister, teen panics and accidently squeezes the trigger on the shotgun he's pointing at sister. I still remember pulling up the c-spine images on PACs and seeing where her mid and lower cervical spinal canal was studded with shotgun pellets.
 
Psai said:
wtf...
holy
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Forgot one - unsupervised toddlers riding an atv that rolled over

Arcan57 said:
I don't miss pulling shifts at a tertiary care peds hospital. I'm not sure if this is the worst case I've ever seen but it's been what pops into my mind and discarded just as quickly when laypeople ask about things I've seen. 9yo brother and 12yo sister home alone during summer. Neighborhood teen comes over and takes the sister into her room while brother watches TV. Brother wonders where sister went and opens door into her room. 9yo walks in on teen raping sister, teen panics and accidently squeezes the trigger on the shotgun he's pointing at sister. I still remember pulling up the c-spine images on PACs and seeing where her mid and lower cervical spinal canal was studded with shotgun pellets.
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Awful. Peds abuse/neglect is by far what I cope worst with in medicine, still trying to figure out a healthy way to do so
 
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Cytarabine said:
Forgot one - unsupervised toddlers riding an atv that rolled over



Awful. Peds abuse/neglect is by far what I cope worst with in medicine, still trying to figure out a healthy way to do so
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Fortunately I didn't have kids during that period of my life. There was a time when I barely felt it which was probably pathological. Now I try to give myself a little bit of time to grieve after telling the family and accept that once in a while for a couple of minutes on a random weekday afternoon when I'm home alone my mind is going to wander and its going to hurt. I also try and avoid reading anything that graphically describes harm to children, ie half of CNN's homepage.
 
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OK. Let's knock it off on the kids now. Time for the heroes of the silent screen.

70's yo gent comes in after his first syncopal event ever - all of a sudden got lightheaded, leaned on the wall, no head injury. Really minimal PMH, nice guy, nothing cardiac, ate normal food, weather is pleasant but not dehydrating. Exam normal. FWIW, San Fran rules completely negative. Feeling better. During the review of systems and meds he admitted to taking 2 ibuprofen earlier in the morning - little right sided headache, once in a while gets a headache, no WHOL. My spidey sense is singing things about getting a CT even though the forebrain knows they aren't a good screening tool in syncope and is getting grumpy. On CT, there's this funny little asymmetric divot in the right external capsule and it just doesn't look right. In fact, I could imagine it being an infarct with a tiny bleed. Radiology prints a vague read "maybe calcification around an old stroke, probably all chronic changes...", and when I pick up the phone to talk to them about the obviously required MRI, the radiologist refuses. He's decided that it's "nothing" and that if the patient is feeling better now, it should be done as an outpatient because in 10 years we won't be in a fee-for-service system and we need to save money, so in his estimation, I should discharge the patient. We had a little chat, and I got the MRI. And the official read ( by a different radiologist) was... blossoming hemorrhagic infarct. Blossoming. los flores pequeno de muerte.

Yes, I'm glad I picked it up. But what an absolute waste of my time and energy to deal with that horrific pushback from a self-proclaimed gatekeeper of the system who hasn't seen or evaluated the patient.

Now, before any radiologists feel defensive... I love you all. All except one. Ok?
 
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I personally get a little tick-ey every time I see a "young person with no identifiable risk factors" that comes down with the C-word.


Hate it. Every time.

Today, I spent a lot of time feeling my own abdomen. Buddy of mine told me in passing about a 42 year old with peritoneal carcinomatosis and a LLQ mass. Nicest guy ever; doesn't smoke or drink. Never had any indication to get a colonoscopy. Belly as big as a... whatever.


It gets to me. It gets in my head. It really does.
 
16 y/o girl BIBA, cc rape. Examination shows multiple tears and severe bleeding vaginally (was unrecognisable as human or female) and anally from violent penetration as well as various FBs including broken beer bottles, blood loss secondary to multiple contusions, more bruises than I've ever seen on one person, obvious severe dehydration and signs of starvation, barbed wire around arms, legs, groin and neck, powder burns from anally inserted sparklers, several cracked ribs... Multiple reconstructive surgeries required and lifelong psych care for PTSD and probable body image issues.
Two 15y/o boys were let off scot free due to police not giving a **** and 'Aspergers Syndrome'. Pt was informed and started crying; apparently both boys (from church!!!) had been stalking her for months before catching her. Started by tying her to a cross with barbed wire and using a tool box and anything else they could get their hands on to hurt her and rape her. She only survived by drinking water from a dripping pipe in the room where she was held for 10 days.
F*** this. Why are animals like those two allowed to breathe air when that poor girl suffers for the rest of her life?
Medicine sucks, and I'm not ashamed to say I cried for a long time when I got home that night.
 
elcollins95 said:
16 y/o girl BIBA, cc rape. Examination shows multiple tears and severe bleeding vaginally (was unrecognisable as human or female) and anally from violent penetration as well as various FBs including broken beer bottles, blood loss secondary to multiple contusions, more bruises than I've ever seen on one person, obvious severe dehydration and signs of starvation, barbed wire around arms, legs, groin and neck, powder burns from anally inserted sparklers, several cracked ribs... Multiple reconstructive surgeries required and lifelong psych care for PTSD and probable body image issues.
Two 15y/o boys were let off scot free due to police not giving a **** and 'Aspergers Syndrome'. Pt was informed and started crying; apparently both boys (from church!!!) had been stalking her for months before catching her. Started by tying her to a cross with barbed wire and using a tool box and anything else they could get their hands on to hurt her and rape her. She only survived by drinking water from a dripping pipe in the room where she was held for 10 days.
F*** this. Why are animals like those two allowed to breathe air when that poor girl suffers for the rest of her life?
Medicine sucks, and I'm not ashamed to say I cried for a long time when I got home that night.
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Been reading this thread a loooooooong time, and while I can't remember if it's the worst *ever* posted, it's certainly the worst in recent memory.

I'd say you win the thread, but with a story like this, no one wins.

-d

Semper Brunneis Pallium
 
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elcollins95 said:
16 y/o girl BIBA, cc rape. Examination shows multiple tears and severe bleeding vaginally (was unrecognisable as human or female) and anally from violent penetration as well as various FBs including broken beer bottles, blood loss secondary to multiple contusions, more bruises than I've ever seen on one person, obvious severe dehydration and signs of starvation, barbed wire around arms, legs, groin and neck, powder burns from anally inserted sparklers, several cracked ribs... Multiple reconstructive surgeries required and lifelong psych care for PTSD and probable body image issues.
Two 15y/o boys were let off scot free due to police not giving a **** and 'Aspergers Syndrome'. Pt was informed and started crying; apparently both boys (from church!!!) had been stalking her for months before catching her. Started by tying her to a cross with barbed wire and using a tool box and anything else they could get their hands on to hurt her and rape her. She only survived by drinking water from a dripping pipe in the room where she was held for 10 days.
F*** this. Why are animals like those two allowed to breathe air when that poor girl suffers for the rest of her life?
Medicine sucks, and I'm not ashamed to say I cried for a long time when I got home that night.
Click to expand...

What the ever-living f*ck.
 
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Maybe I just don't want to, but I have a hard time believing even the most lackadaisical of police departments not pursuing and prosecuting a teenage gang-rape and I have dealt with some frustratingly useless police departments...
 
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DeadCactus said:
Maybe I just don't want to, but I have a hard time believing even the most lackadaisical of police departments not pursuing and prosecuting a teenage gang-rape and I have dealt with some frustratingly useless police departments...
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Yeah, I cannot for the life of me believe that this story is true at face value.
 
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DeadCactus said:
Maybe I just don't want to, but I have a hard time believing even the most lackadaisical of police departments not pursuing and prosecuting a teenage gang-rape and I have dealt with some frustratingly useless police departments...
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Depressing but true. Have had several follow ups with them and they don't seem to care. Both perps are rich, which probably doesn't help...
 
elcollins95 said:
Source how? Can't break confidentiality.
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Something like this would typically make it to the newspaper. The details you've posted generally would too. I can't imagine a local newspaper NOT reporting on something like this or police not prosecuting despite "Asperger's syndrome." The names of the victims should be withheld from the papers given the fact that they are minors, thus there is no confidentiality issue with you posting a local news article. With how egregious your comment was and without anything else corroborating it, it sounds like hyperbole at best and trolling at worst.
 
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Assuming the above info is correct a simple google search didn't turn up anything except for the recent very sad case in India.

Like BoardingDoc said, if this did indeed happen in the US or Canada it would be all over the local news.
 
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alpinism said:
Assuming the above info is correct a simple google search didn't turn up anything except for the recent very sad case in India.

Like BoardingDoc said, if this did indeed happen in the US or Canada it would be all over the local news.
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Sorry guys, I'm not in the US or Canada. I'm horrified that a troll would do something like that, certainly is not me. So certainly think what you like of me, but I will not put myself or any of my patients on the line for the sake of an online forum. I came here to vent, wasn't expecting anyone to actually respond. If you want me to remove it I will, just didn't think people would ask for proof...
 
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elcollins95 said:
Sorry guys, I'm not in the US or Canada. I'm horrified that a troll would do something like that, certainly is not me. So certainly think what you like of me, but I will not put myself or any of my patients on the line for the sake of an online forum. I came here to vent, wasn't expecting anyone to actually respond. If you want me to remove it I will, just didn't think people would ask for proof...
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I don't think people are bashing you . It's unheard of here in the US for such a horrible act to occur with the police doing nothing. It doesn't matter how rich the family is. It would have gone viral and made national news. Sorry about your patient


Sent from my iPhone using SDN mobile
 
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sosoreal said:
I don't think people are bashing you . It's unheard of here in the US for such a horrible act occurring and police doing nothing. It doesn't matter how rich the family is. It would have gone viral and make national news. Sorry about your patient


Sent from my iPhone using SDN mobile
Click to expand...

Exactly.

No need to remove the post and you certainly have every right to vent.
 
elcollins95 said:
Sorry guys, I'm not in the US or Canada. I'm horrified that a troll would do something like that, certainly is not me. So certainly think what you like of me, but I will not put myself or any of my patients on the line for the sake of an online forum. I came here to vent, wasn't expecting anyone to actually respond. If you want me to remove it I will, just didn't think people would ask for proof...
Click to expand...
I believe you, OP, and agree it's a horrific, tragic story. Very sorry to hear it. Any chance you can give us an idea (roughly) what part of the world this is at least (e.g. UK or Europe, South America, etc.)?
 
On the patient side of things:
My grandpa passed away on December 31st. I was planning a party and had to explain to my friends why they had to buy the supplies.

The worst part though? His daughter's (my aunt's) birthday is on December 31st. I can't imagine what a s****y birthday present that is.
Thankfully he was 82 and we all knew it was coming so it wasn't a shock, but it was still difficult. The doctor was so nice, too.
 
elcollins95 said:
16 y/o girl BIBA, cc rape. Examination shows multiple tears and severe bleeding vaginally (was unrecognisable as human or female) and anally from violent penetration as well as various FBs including broken beer bottles, blood loss secondary to multiple contusions, more bruises than I've ever seen on one person, obvious severe dehydration and signs of starvation, barbed wire around arms, legs, groin and neck, powder burns from anally inserted sparklers, several cracked ribs... Multiple reconstructive surgeries required and lifelong psych care for PTSD and probable body image issues.
Two 15y/o boys were let off scot free due to police not giving a **** and 'Aspergers Syndrome'. Pt was informed and started crying; apparently both boys (from church!!!) had been stalking her for months before catching her. Started by tying her to a cross with barbed wire and using a tool box and anything else they could get their hands on to hurt her and rape her. She only survived by drinking water from a dripping pipe in the room where she was held for 10 days.
F*** this. Why are animals like those two allowed to breathe air when that poor girl suffers for the rest of her life?
Medicine sucks, and I'm not ashamed to say I cried for a long time when I got home that night.
Click to expand...


That's when you get one homeless person to find some other homeless people to beat the **** out of them.

And coming from a 3rd world country (although that's not what it used to mean), it is definitely easy to get away with this if you have the $ (or Rs) :(
 
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Met at guy this weekend that was a principal at an elementary school before this current job. Good dude. Told me about a second grader that had to watch Dad kill Mom. I'm not going to say anything else. It's getting to me.
 
Apollyon said:
Met at guy this weekend that was a principal at an elementary school before this current job. Good dude. Told me about a second grader that had to watch Dad kill Mom. I'm not going to say anything else. It's getting to me.
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:(
 
Holy crap, dudes. As an M4 applying into EM it's a little disappointing to know that the 'get home after a terrible case and stare at the wall being sad/angery for a while' type of reaction doesn't go away. I've gotta stay out of these threads.
 
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If it makes you feel any better, these are the worst stories in our personal graveyards. We all have them. They get softer around the edges with time, and over time, it also takes more to make you feel this way. But yeah, it still happens.

If it didn't, would we still be human? We may wear mental armor, but the breadth of human suffering is what we do. If it makes you feel better, go read the "things I learn from my patients" thread. Or, well, some of it. It's rather long. Far longer than this thread.
 
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What happened to DocB? Where is DocB?
It drives me nuts that people so crucial to a forum for so long can just disappear and no one even notices or seems to care. DocB was one of the best, if not the best posters or this forum for years. Did I miss something, or did he just disappear?
 
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Birdstrike said:
What happened to DocB? Where is DocB?
It drives me nuts that people so crucial to a forum for so long can just disappear and no one even notices or seems to care. DocB was one of the best, if not the best posters or this forum for years. Did I miss something, or did he just disappear?
Click to expand...
Yeah @docB is awesome (as are you @Birdstrike)! His profile says he hasn't been on SDN since mid last year (June 2016). Hope he's doing well wherever he is.
 
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On the advice of counsel, he's not posting.
 
I remember that too. Only half joking.
 
Birdstrike said:
What happened to DocB? Where is DocB?
It drives me nuts that people so crucial to a forum for so long can just disappear and no one even notices or seems to care. DocB was one of the best, if not the best posters or this forum for years. Did I miss something, or did he just disappear?
Click to expand...
A couple of years ago he asked to be retired as a moderator. At that point he just disappeared without public comment or explanation (which is, of course, his prerogative).
 
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