Things I Learn From My Patients

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Iron Man was hot. I'd sit through it while I was in labor too. What I don't get is why your resident was so angry. If I were him, I would have ran to the nearest computer and bought tickets to go see it the next day while I was post call.

I learned today that your resident is an unappreciative jerk.
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Me, being spoiled by the 3 page IM notes (and it was 3am), wrote down precisely what she said. My resident read over it and said, "What the hell is this, an L&D accept or a fcuking movie review?!?!"
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Wait, in this sentence is "IM" for Internal Medicine, or Iron Man?

CC: "The Giant Glowing Gadget in My Chest Cavity is Bugging Me a Little"
HPI: 42yo WM in 650-pound metallic battlesuit comes to clinic with intermittent tachycardia and SOB on exertion...

It sucks that you were spoilered on the movie, but I don't see the point of passing along the pain to the next poor sap. Medical training is miserable enough as it is; why be part of the problem?

But then again, at 3AM, I'm a good deal surlier.
 
Febrifuge said:
CC: "The Giant Glowing Gadget in My Chest Cavity is Bugging Me a Little"
HPI: 42yo WM in 650-pound metallic battlesuit comes to clinic with intermittent tachycardia and SOB on exertion... quote]

CXR reveals metallic shrapnel in atrial septum.
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New member here and thank you for all the work you do even if it's not appreciated the way it should be. I found this thread linked another message board in a thread about 'things you shouldn't put in your ***', which does seem to be a recurring theme here. 48 pages was a lot to read but worth every minute. I'm not a part of the medical world but hopefully I can make a decent contribution:

If you are a mildly disturbed redneck-type and your favorite hobbies are firewalking and guns what would be even better would be to combine the two. After throwing shotgun shells into a raging bonfire and then proceeding to repeatedly jump over it, don't get offended when everyone calls you a crazy mother*** and moves to put a good deal of distance and thick timber between themselves and you. Later when the nice medics are examining your new collection of leg wounds prior to taking you away, make sure to curse at them. It will definitely endear you to them.
 
If you have to play frogger, get the video game version. When you try to do the live action version you will end up fractured, head injured, and probably get an ex lap too (we have had 3 in just the last month or so). Cars are faster than you are. Heavier too.
 
Did the patient happen to be GC?
[YOUTUBE]http://youtube.com/watch?v=1IGEQTn-sUc[/YOUTUBE]
 
That calling EMS at 0234 in the morning for a "shrinking penis" unfortunately cannot be relieved even in the E.R. :idea:
 
never ever pleasure yourself with your own frozen poo.
 
Bugman said:
never ever pleasure yourself with your own frozen poo.
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I think what makes this so much worse is that this guy had to have the foresight and planning to put his own pooh in the freezer hours in advance.
 
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erin682 said:
I think what makes this so much worse is that this guy had to have the foresight and planning to put his own pooh in the freezer hours in advance.
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Nah, you can just use liquid nitrogen. You dip the poo and you have a few minutes to take care of business. Just make sure that the liquid nitrogen has evaporated from the fecal love log or your fingers might freeze to it.

Perhaps I've said too much.:p
 
docB said:
Nah, you can just use liquid nitrogen. You dip the poo and you have a few minutes to take care of business. Just make sure that the liquid nitrogen has evaporated from the fecal love log or your fingers might freeze to it.

Perhaps I've said too much.:p
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waaaaaaaaaaaaaaay to much. I am so happy Red didn't convince me to move to vegas. ;)
 
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docB said:
Nah, you can just use liquid nitrogen. You dip the poo and you have a few minutes to take care of business. Just make sure that the liquid nitrogen has evaporated from the fecal love log or your fingers might freeze to it.

Perhaps I've said too much.:p
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Now that's the kind of stuff they just don't teach you in med school.
 
Oh, the things you learn when taking a friend to the emergency room!

It's really not a good idea to start yelling at the triage nurse that you've got a Coke bottle inserted in a place where Coke bottles are not supposed to go, and dammit, you expect to have it removed RIGHT NOW. Not only will the triage nurse roll her eyes at you and tell you that you're not only not the first person to do that, you're not even the first one they've seen tonight, and you'll get seen as circumstances dictate, but that a laboring mother with the baby crowning is definitely more important than you? The rest of us will point at you, and laugh mercilessly.

Proceeding to start yelling then about how any woman can pop a kid out of her cooch any time, but you've got a G*DD*MN COKE BOTTLE IN YOUR *$$? Will definitely not win you friends and influence people. Wait, I take that back. People will definitely be influenced - to want to kick your @$$.

When they come to get you and take you back to exam, exclaiming, "FINALLY! Did that stupid b!tch who should have had a late term abortion get that damn kid out?" Will make the resident eye you with utter contempt. And, if the proud new father hears you? He may shove that Coke bottle farther up your @$$ with his foot.

Oh yeah...and upon hearing that? If the proud new father shoves that Coke bottle farther up your @$$? We never saw anything, we never heard anything, and we might help him.

I'm just glad that not only was my friend not having a stroke (just a nasty, nasty migraine, it was so bad she was slurring her words, forgetting her name, and generally exhibiting what even laypeople like myself think of as stroke symptoms), she didn't have to hear YOU snarking at her, dipstick. I heard what you said, and calling her a crackwhore was the wrong thing to say. She's never done drugs in her life, she won't even take a painkiller unless it's absolutely necessary. For you to call her a crackwhore? Be glad her hubby's in the Sandbox right now. He might have wiped the floor with you.
 
erin682 said:
I think what makes this so much worse is that this guy had to have the foresight and planning to put his own pooh in the freezer hours in advance.
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for me what makes it so much worse is that it wasn't a guy.
 
docB said:
Comment not really necessary.
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This does need more comment. What were they doing with those homemade blow torches? I won't lie, I've used bug spray in that capacity before. The article makes it sound like they were fighting with them or something, but we need more info.

Also, I fixed the link.
 
Bugman said:
for me what makes it so much worse is that it wasn't a guy.
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:wow: has she never heard of other ways or was this a straight psych eval or just normal for her?
 
I had a first in STD clinic today. Not only did the pt indicate was it painful to urinate and the discharge smelled bad, it also tasted bad. WTF?!!?
 
El Cheba said:
I had a first in STD clinic today. Not only did the pt indicate was it painful to urinate and the discharge smelled bad, it also tasted bad. WTF?!!?
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He's just being a proper scientist and using all of his 5 senses...:barf:
 
El Cheba said:
I had a first in STD clinic today. Not only did the pt indicate was it painful to urinate and the discharge smelled bad, it also tasted bad. WTF?!!?
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Did you tell her/him that dr's only used to taste urine, not discharge? And no, they don't anymore.
 
El Cheba said:
I had a first in STD clinic today. Not only did the pt indicate was it painful to urinate and the discharge smelled bad, it also tasted bad. WTF?!!?
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Wait til they tell you the really weird stuff. Such as, did you know that non-nutritive sweeteners are excreted unchanged in the urine? So that when they play, ahem, watersports, it tastes sweet?
Yeah, I didn't either. Then I had to go shower. For 4 hours.
 
One other thing I learned at summer camp many years ago: Should you want to leave four days early, the best way to arrange this is to take a really large hammer and whack your hand with it. The extra four days of freedom are totally worth the pain, trip to the hospital and inability to use your dominant hand for the rest of the summer.

From a bunch of posts early in the thread about the amazing patients people have seen from Philly, a few examples that might have wound up in the ER at some point from my experiences in that fine city:

If you are homeless, a great way to make friends and influence people is to assault random passerby. The police will totally believe your story that the person you attacked was wearing your suit and has stolen your identity.

Similarly, please do not listen to the voices (or your drugs, alcohol or whatever) when they tell you that you're a traffic officer. Standing in the middle of a busy intersection waving cars past you is a really bad idea. The Law of Inverse Value does not protect you from vehicles that weigh over a ton and are traveling at 30mph.

Trying to skate through city hall isn't too bright either. If the police don't stop you and you manage not to clip any pedestrians you'll be tripped up by the stairs at the west end, leading to you faceplanting the concrete.
 
Observerguy said:
One other thing I learned at summer camp many years ago: Should you want to leave four days early, the best way to arrange this is to take a really large hammer and whack your hand with it. The extra four days of freedom are totally worth the pain, trip to the hospital and inability to use your dominant hand for the rest of the summer.
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Shouldn't it be easier to wreck the nondominant hand with the hammer in the dominant hand?
 
This is from a few years ago when I worked in the ED as a PCT-

If you are a 15 y/o male and your parents tell you that your facial rash is an STD, please call 911 to be taken via ambulance to the ED for treatment.
When you are triaged, the charge nurse will ask you if you are serious. She will then proceed to lecture you on appropriate usage of 911.

Your story will then be spread around the ED staff, who will ALL laugh at you.

More recent story from when I floated to ED as helping hands:

Please, bring your 7 y/o daughter to our non-pediatric ED when there is another hospital, complete with a peds ED just a few blocks away (who are actually green for a change!). This is an especially good idea if it is 11pm, and your child fractured her arm earlier in the day. The docs and nurses LOVE to consciously sedate your child so that fracture can be reduced.

It's not that we don't like kids, it's that your child will end up being transferred to the other hospital if they need to be admitted. The only peds we do here is in the nursery (outside of the ED when people bring in their kids)
 
Don't do crack on your "cafeteria breaks" then come back and take your beta blockers.

I've had this three times intern year.
 
I learned this week that if you are 36 weeks pregnant, you should not smoke crack. You may very well go into labor. Although the delivery might be uncomplicated, the resulting code will leave you with bilateral pulmonary emboli, a stroke, and a myocardial infarction.
 
If you are an 85 year old guy who had bladder surgery 10 days ago and your urologist told you to come to the office today so he can take your foley out and you just can't get to the office today don't take the foley out on your own. If you do take it out on your own please spare me the details about how "it seemed caught on something" and how "it sure wasn't big like that when they put it in." And by the way, after you've pulled it out and seen the balloon on the end and you still ask me "Why do you think it's bleeding doc?" I will indeed think you are a *****.
 
Finishing up my trauma month here so I've learned a lot from my patients.....

I learned that if you are trying to burn a bunch of leaves in your lap using a magnifying glass and the sun you might just end up burning your twig and berries.... badly.
 
Dukes said:
Finishing up my trauma month here so I've learned a lot from my patients.....

I learned that if you are trying to burn a bunch of leaves in your lap using a magnifying glass and the sun you might just end up burning your twig and berries.... badly.
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Oh my.

Is it safe for me to stereotype your patient as a Virginia backwoodsy guy?
 
So that lends itself to the question, did he need the magnifying glass to find his twig and berries. If so, he was indeed focusing on the wrong thing.

I kill me!
 
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Was the guy naked? I'd think he'd find his pantaloons on fire before his twigs and berries were affected.

Just remember, these *****s keep you guys in business. Ugh.
 
I learned that post MVA dilaudid is nice!! It also makes the normally quiet person a little less inhibited. After the ED checked me for internal bleeding I informed them loudly that SOMEONE now owes me dinner. :D

I also asked for a LAP-BAND when the doc was trying to get consent for ORIF for compound fractures of my right tib/fib and my left humerus.

SO glad I was able to make them smile:D think they'll remember me when I apply for a job after rehab?
 
MaddieMay said:
Was the guy naked? I'd think he'd find his pantaloons on fire before his twigs and berries were affected.

Just remember, these *****s keep you guys in business. Ugh.
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Actually he was clothed, not sure what type of pants he was wearing though. I have a feeling this unfortunate 8 year old kid will not be a stranger to the trauma service in his lifetime.
 
I swear this is the best thread ever! I always love to sit around the lounge and listen/share stories and this thread is the next best thing. I'm a surgical tech and I've seen and heard my fair share of odd cases over the last 10 years or so.

1. Woman shows up in the ER with severe abdominal pain and leaking green fluid from her jay. She gets an exam by one of the ER docs and she is told that she has cancer and that the discharge is coming from a ruptured tumor. Gyn doc called to come down and take a look at said patient.

Upon exam by Gyn, she is told that she is pregnant and that the green discharge is mec, that the fetus is dead after using a Doppler and no heart tones. She is sent up to L&D to deliver her stillborn. The patient and her husband had been trying for years to conceive and finally gave up all fertility treatments a long time back. She had no idea that she was pregnant.

Up on L&D she is given vast quantities of narcotics while in labor, due to a non viable fetus. As the head is crowning, the father leaves the room and heads down to the lounge.

The OB delivering is a different doc due to shift change and as the head is coming out, he is looking at a 'dead' fetus who is looking back at him. He starts yelling at Laura {the RN} for suction, due to the expectation of a stillborn, a bulb wasn't placed on the delivery table. Once the baby is delivered, screaming and very much alive, Laura runs down to the lounge and grabs the dad while saying 'congratulations, you are a daddy!' He was obviously not impressed and had no idea what the hell Laura was talking about. He was on the other hand quite thrilled once he found out that his baby was alive.

2. A pool noodle belongs in a pool, not in your arse.

3. Make sure that you know where all those little torn off corners of your ketchup packets are at before you eat your burger. We very well might find one in your colon while we are repairing a hole in your colon from that buttscope that you had done earlier today.

4. When committing suicide in the woods using a razor blade to cut both wrists and ankles and you lose just enough blood to be unable to go out for help, just lay there for a few days and wait for some hikers to find you and your wounds chock full of happy maggots. Fixing your wounds in the OR with maggots tumbling out of your wounds is sooooo much fun.
 
I learned today that taking NSAIDS (Aleve) q30 min for pain is a bad idea as you will end up in the ICU with a massive GI bleed. Upon being transferred to the floor, you will return to the ICU after vomiting a cup of blood and dropping your pressure.
 
If you spill a box of .243 cartridges for your deer rifle on the lawn (of course while opening the door to your pickup truck), you should pick them up before the next time you mow the lawn. Shrapnel in the foot hurts.
 
If you are a frail 78yo suffering from Parkinson's, it's a FABULOUS idea to either:
a) go cycling, or
b) climbing ladders to fix the roof
either of these actions result in long admissions to the ICU to fix that rather large bleed in your brain, along with the fractures you have suffered to almost every bone in your body.
 
mepaRN said:
If you are a frail 78yo suffering from Parkinson's, it's a FABULOUS idea to either:
a) go cycling, or
b) climbing ladders to fix the roof
either of these actions result in long admissions to the ICU to fix that rather large bleed in your brain, along with the fractures you have suffered to almost every bone in your body.
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Remember that there is a Federal law that states that no one over the age of 60 is allowed on the roof unless they are on Coumadin.
 
docB said:
Remember that there is a Federal law that states that no one over the age of 60 is allowed on the roof unless they are on Coumadin.
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Totally OT and not at all EM-related but I had a primary care patient, 84, w/ new onset a fib at age 82, parkinson's and dementia who, after mulitple discussions w/ his wife, we decided not to put on coumadin (CHADS2 score ~1 million) because he was high risk for complications.

Unsurprisingly, he had a stroke, got admitted to the neuro service and started on coumadin (horse about 15 miles from the barn on that one) on d/c to rehab.

On day 1 of rehab, he falls while transferring from WC to toilet, gets a monster subdural and after a few days in the ICU unresponsive off sedation and on the vent, dies after withdrawal of care. Moral of the story...I don't really know but seriously...coumadin makes me angry.

I also just discharged a 25yo guy from the CCU w/ an EF of 10% and a 5cm LV thrombus on coumadin whose first question about post-discharge life was "when can I start racing motocross and skateboarding again?" He wasn't too excited about my "never" response.
 
docB said:
Remember that there is a Federal law that states that no one over the age of 60 is allowed on the roof unless they are on Coumadin.
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I'm Australian, we don't have such a sensible law over here. I've known my 84yo 4foot nothing Nana to climb onto the roof, despite the most logical of arguments.
 
mepaRN said:
I've known my 84yo 4foot nothing Nana to climb onto the roof, despite the most logical of arguments.
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and yes, she's on coumadin, along with several HTN meds.
 
...and that folks is why I stay so busy.

I would like to give my deepest thanks to the producers of coumadin, plavix and let me not forget alcohol, drugs and pure idiocy.

I like to think of myself as battling Darwin every day and trying to save those poor souls who did not know that driving a four wheeler while heavily intoxicated in the sand dunes at night at high speed without much light is not such a brillant idea!
 
I learned that letting your 5 yo kid ride around on an ATV without a helmet is really as bad an idea as it sounds.

But, fortunately, his mother (who was an emergency room nurse) was standing nearby, and was able to keep his c-spine nice and stabilized until EMS arrived.

(No, I don't know what she was thinking either.)
 
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