Things I Learn From My Patients

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Mike - the picture has made the archery rounds. Basic is amateur holding bow, sales clerk fitted too short of arrow, shish kabob hand.

So, idiot with too much money wanting the baddest toy, untrained sales clerk, unknown bow, likely unknown draw, too short arrow.

http://www.texasarchery.org/images/Overdraw/dangers.htm

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Turns out that the 80 year old former Marine with Alzheimer can kick the ass of the Orderly who is only six months out of the Marines.
/Second Hand story.
 
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It's fine and dandy if you enjoy some fisting now and then but don't have your partner do it so often your rectum is permanently dilated to the size of a fist. You will lose muscle tone to the point where you can only crap by a manual disimpaction.
 
It's fine and dandy if you enjoy some fisting now and then but don't have your partner do it so often your rectum is permanently dilated to the size of a fist. You will lose muscle tone to the point where you can only crap by a manual disimpaction.

I strongly suggest that you look up doubledickdude on reddit.
 
I found out the hard way don't skip three days out of seven days of your SSRI and NDRI or bad things happen.
/Paperwork mess up resulted in my prescription not being refilled and I figured I could go a few days without it. I was horribly horribly wrong.
//I'm a psychology student. I should know better.
 
I found out the hard way don't skip three days out of seven days of your SSRI and NDRI or bad things happen.
/Paperwork mess up resulted in my prescription not being refilled and I figured I could go a few days without it. I was horribly horribly wrong.
//I'm a psychology student. I should know better.



Some things you just have to learn the hard way....
 
I learned that it is absolutely acceptable to substitute your buddy's Lantus for your TID regular insulin dosing but need to be seen for a headache and burning feet with unknown cause....or after getting the crap beaten out of you by "2 dudes that knew how to fight" and having an MMA elbow/shoulder lock applied with resultant dislocation of both, don't follow the orthopods instructions that you were discharged with --- it's perfectly acceptable to take a shower without a non-slip surface, fall in the shower and head back to the ED for round 2......
 
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Please if you are sleeping with another man's wife and he comes home, don't jump through a sliding glass door filleting most of your anterior shin. While a cool experience for this resident, getting triaged to the "low acuity side" for "laceration" only to start arterial bleeding and becoming hypotensive 30 min later is not good for business. You should have learned to make better decisions when you were shot twice and ex-lapped...

On second thought, please do it again because it was the coolest thing that happened to me between a deluge of pelvic/back pain and toothaches.
 
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If you live in an area with a high crime rate, you might want to stay in good enough shape to run away from gunfire, otherwise the combinationg of "sprinting" and your obesity might lead to an open fracture of the tibia
 
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Do not take half of an 8 blister pack of OTC "Males Performance Enhancers" at a single time...no matter how great of a night is planned. This can lead to a really good imitation of a stroke/brain bleed...it gets even better when you start having coffee ground emesis while all this is going on, the history really, really says "Stroke-a-mundo"....and then your wife waits until your 16 year old daughter leaves the trauma bay we've got you in to let us know that you had munched these before going to work in anticipation.....doing this buys you a week long stay in the ICU complete with 3 nights of priapism only to be discharged on day 7 completely, stone cold normal......
 
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Do not take half of an 8 blister pack of OTC "Males Performance Enhancers" at a single time...no matter how great of a night is planned. This can lead to a really good imitation of a stroke/brain bleed...it gets even better when you start having coffee ground emesis while all this is going on, the history really, really says "Stroke-a-mundo"....and then your wife waits until your 16 year old daughter leaves the trauma bay we've got you in to let us know that you had munched these before going to work in anticipation.....doing this buys you a week long stay in the ICU complete with 3 nights of priapism only to be discharged on day 7 completely, stone cold normal......

HOLY CRAP! What the hell is in those things?!?
 
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"Them squirrels are g-- damn furry little alligators, boy. I'm tellin' ya, don't catch one on a bad day and feed 'em the kinda peanuts he don't want. He'll learn ya' a lesson. Quick. Real quick. Ha, I know that. Yaah."

That's what I learned from my patient today.
 
HOLY CRAP! What the hell is in those things?!?
According to Poison Control it contained things with hallucinogenic properties and wanna be steroids but we couldn't be sure.......good times....

In Psych ER I learned it's not a good idea to be disrespectful to an attending that you decide to try a double-leg takedown on --- Attending was a large, fit male who had wrestled in high school and college -- Psych ED patient bum rushes him and tries a double leg takedown -- before the aides could get there, the attending is rolling the patient up into an armlock -- patient proceeds to start screaming that the attending is a no-good, motherbleeping, stinking motherblanker, etc....attending then screams," Hey -- That's Dr. no-good, motherbleeping, stinking mother blanker!".....I laughed so hard my sides hurt....
 
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"Them squirrels are g-- damn furry little alligators, boy. I'm tellin' ya, don't catch one on a bad day and feed 'em the kinda peanuts he don't want. He'll learn ya' a lesson. Quick. Real quick. Ha, I know that. Yaah."

That's what I learned from my patient today.

I didn't realize you were still practicing! This patient sounds like someone I'd like :) My dad's doberman once caught and brought him back a squirrel. As soon as he let it out of his mouth, it scrambled up my dad and scratched the hell out of him then scurried off.

According to Poison Control it contained things with hallucinogenic properties and wanna be steroids but we couldn't be sure.......good times....

In Psych ER I learned it's not a good idea to be disrespectful to an attending that you decide to try a double-leg takedown on --- Attending was a large, fit male who had wrestled in high school and college -- Psych ED patient bum rushes him and tries a double leg takedown -- before the aides could get there, the attending is rolling the patient up into an armlock -- patient proceeds to start screaming that the attending is a no-good, motherbleeping, stinking motherblanker, etc....attending then screams," Hey -- That's Dr. no-good, motherbleeping, stinking mother blanker!".....I laughed so hard my sides hurt....

Sounds like I need some more grappling experience :D Couple years of boxing, but hopefully that skill never needs to be applied in the real world
 
I didn't realize you were still practicing!


"Just when I thought I was out, they pull me back in."

- Michael Corleone,
The Godfather: Part III.


I fully intended on being done with EM, for good. I left for a while. I did some work outside of EM but still in "Medicine" and carved out some new territory. Then EM said, "Hey, maybe this Birdstrike guy is not so crazy after all. Maybe he's on to something here." So they took EM and drew the borders just a little bit bigger so that new ground on which I stood lay within the borders of EM again. I didn't come back to EM. It followed me. Cryptic sounding? Yes, but very true and accurate.

The end result is that the work I did while "leaving EM" and continue to do, ended up in a round about and unexpected way, actually making the specialty better in a small, but very real and lasting way. It's weird, but very unexpectedly, I ended up making a (not huge but significant) positive contribution to EM, that will have a lasting effect after I'm gone that I never really thought would happen.
 
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Wh
"Just when I thought I was out, they pull me back in."

- Michael Corleone,
The Godfather: Part III.


I fully intended on being done with EM, for good. I left for a while. I did some work outside of EM but still in "Medicine" and carved out some new territory. Then EM said, "Hey, maybe this Birdstrike guy is not so crazy after all. Maybe he's on to something here." So they took EM and drew the borders just a little bit bigger so that new ground on which I stood lay within the borders of EM again. I didn't come back to EM. It followed me. Cryptic sounding? Yes, but very true and accurate.

The end result is that the work I did while "leaving EM" and continue to do, ended up in a round about and unexpected way, actually making the specialty better in a small, but very real and lasting way. It's weird, but very unexpectedly, I ended up making a (not huge but significant) positive contribution to EM, that will have a lasting effect after I'm gone that I never really thought would happen.

Why so cryptic Birdstrike? Give us a little detail so us young guns just starting residency can follow suit.. Or st least try to.
 
I learned that despite having just been stabbed in the chest immediately before walking in through the ambulance bay, nothing you say, including "I've just been ****ing stabbed!!!!" will keep the registration clerk from asking you all the required questions and you will only start getting medical attention when one of the residents happens to go see what the screaming is about and notices the 8cm knife wound in your right chest.
 
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wholeheartedly, post: 13859726, member: 278559"]If it's icy, stay off your roof. If you don't, you'll have a bone sticking out of your leg.

If you are having a good day.

If you are having a bad one you will be DOA after a blunt trauma arrest and 30 minute code en route to the department.

Gravity was discovered a long time ago but word of it apparently has not spread as widely as it should have.


Sent from my Z10 using Tapatalk
 
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Recently I learned that this forum provides a way to make that wait in the ER a little more entertaining.

I had to take my wife into the ER. After a turn through Triage, we ended up sitting in a far corner out of sight of the front desk. Shortly
afterwards a frequent flying seeker started a masters-level performance in the waiting room, after having her request for drugs turned
down. We couldn't see the patient, but there was absolutely no need to. This woman used every last argument ever mentioned on here,
and simply moved on to the next trick when the last one failed, like she was running a mental checklist:

• Operatic groans of pain (stopped as soon as she realized they weren't working)
• "But I'm sick"
• It's my kidneys/gall bladder/sciatica/allovermyalgia, and you just don't understand my pain
• I need the d medicine, cuz I'm allergic to everything else
• I had a script for the good D medicine, but I lost it. See, what happened was....
• I have a pain contract, but the doctor's out of town and I lost the number
• I came here from over 30 miles away, cuz the closer hospitals won't treat me for some reason
• I don't care what your records say about all those other visits under other names, this time the pain's the real deal
• Lemme tell you 'bout the accident. See, what happened was....
• Imma file a complaint
• My friend, she knows the hospital director, and she's gonna file a complaint
• You're racist, and discriminating against me (the doctor, the patient, and the two security guards standing by to throw her out were all
people of color)
• Imma get my lawyer, and sue all y'all up in here
• I'm not leaving till you treat my pain
• I'm not leaving without a taxi voucher
• I'm not leaving
• Don't touch me you freakin rent-a-cops, I'm leaving (does not move)
• I'm leaving, and if I die, it'll be your fault (finally leaves)

As the performance continued, I squinched lower and lower in my chair, stifling the chuckles with a massive face-palm. The wife asked
me what was going on. I had to explain that I had been playing "Frequent Flyer Bingo" in my head, and we had been listening to a
"winner" for the last 45 minutes.
 
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Recently I learned that this forum provides a way to make that wait in the ER a little more entertaining.

I had to take my wife into the ER. After a turn through Triage, we ended up sitting in a far corner out of sight of the front desk. Shortly
afterwards a frequent flying seeker started a masters-level performance in the waiting room, after having her request for drugs turned
down. We couldn't see the patient, but there was absolutely no need to. This woman used every last argument ever mentioned on here,
and simply moved on to the next trick when the last one failed, like she was running a mental checklist:

• Operatic groans of pain (stopped as soon as she realized they weren't working)
• "But I'm sick"
• It's my kidneys/gall bladder/sciatica/allovermyalgia, and you just don't understand my pain
• I need the d medicine, cuz I'm allergic to everything else
• I had a script for the good D medicine, but I lost it. See, what happened was....
• I have a pain contract, but the doctor's out of town and I lost the number
• I came here from over 30 miles away, cuz the closer hospitals won't treat me for some reason
• I don't care what your records say about all those other visits under other names, this time the pain's the real deal
• Lemme tell you 'bout the accident. See, what happened was....
• Imma file a complaint
• My friend, she knows the hospital director, and she's gonna file a complaint
• You're racist, and discriminating against me (the doctor, the patient, and the two security guards standing by to throw her out were all
people of color)
• Imma get my lawyer, and sue all y'all up in here
• I'm not leaving till you treat my pain
• I'm not leaving without a taxi voucher
• I'm not leaving
• Don't touch me you freakin rent-a-cops, I'm leaving (does not move)
• I'm leaving, and if I die, it'll be your fault (finally leaves)

As the performance continued, I squinched lower and lower in my chair, stifling the chuckles with a massive face-palm. The wife asked
me what was going on. I had to explain that I had been playing "Frequent Flyer Bingo" in my head, and we had been listening to a
"winner" for the last 45 minutes.

She didn't mention Press Ganey; that might have been the winner.
 
She didn't mention Press Ganey; that might have been the winner.

Based on her reaction to the news that the hospital was successfully tracking all her visits and the different names she used, I don't think this lady was that interested in adding to the records herself. Which may be why she was going with the "Imma tell the director on you" tactic.

As far as I'm concerned the lady bingo'd when she played the race card. Not only were the doctor, patient, and security all people of color, the hospital was located in a Northern Cal-Bay Area neighbourhood that's practically Diversity Central. Seriously, at this place you could be a blind, left-handed, transgendered Inuit with PTSD complications from your time working at Chuck E Cheese, and you could get counselling, treatment, and registration in your choice of support group before the toner even dried on the xerox of your insurance card....
 
Been reading this thread for years, just don't recognize the term.

Press Ganey is the scourge of physicians everywhere. The company uses statistically flawed patient satisfaction surveys and then charges hospitals a ton of money to collect and report the data. The evidence on the surveys is quite clear that they have zero to do with physician capability and may in fact even harm patients. Yet despite all of this negative information, hospital CEO's continue to clamor for Press Ganey scores and will hurt physicians who aren't on board.
 
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Press Ganey is the scourge of physicians everywhere. The company uses statistically flawed patient satisfaction surveys and then charges hospitals a ton of money to collect and report the data. The evidence on the surveys is quite clear that they have zero to do with physician capability and may in fact even harm patients. Yet despite all of this negative information, hospital CEO's continue to clamor for Press Ganey scores and will hurt physicians who aren't on board.

Thanks for the info. I'm not a medical professional, but lurk here because I enjoy this and several related threads and actually have learned things that I hope will make me a better patient to deal with. :)
 
If you're constipated and don't have an enema available, you can use an extra douche. But don't get distracted by your children's adorable dance routine while doing this, otherwise you might lose the douche nozzle up your butt and make me get a CT scan to find the douche nozzle. The douche nozzle will go up past the sigmoid and the douche nozzle will need to be surgically removed. It will also make me think that you might be a douche nozzle yourself. I said douche nozzle a lot tonight.
 
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If you're constipated and don't have an enema available, you can use an extra douche. But don't get distracted by your children's adorable dance routine while doing this, otherwise you might lose the douche nozzle up your butt and make me get a CT scan to find the douche nozzle. The douche nozzle will go up past the sigmoid and the douche nozzle will need to be surgically removed. It will also make me think that you might be a douche nozzle yourself. I said douche nozzle a lot tonight.

Wait.

So... Said person was giving themselves an enema (with improper equipment) while their children were in the same room and dancing in front of them?

Excuse me. I have to go throw up now.
 
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I'm not a medical professional, but lurk here because I enjoy this and several related threads and actually have learned things that I hope will make me a better patient to deal with. :)

You are awesome.
 
Wait.

So... Said person was giving themselves an enema (with improper equipment) while their children were in the same room and dancing in front of them?
when you gotta enema, you gotta enema

a little voice inside your head speaks to you...

tumblr_mz799ooxbm1rrl0mgo1_500.gif
 
Well, it's official now...

"In the adjusted multivariable model, a decrease in in-hospital mortality was strongly associated with an increase in blood alcohol concentration (adjusted OR = 0.83 per 100 mg/dl units change in BAC; CI 95%: 0.80, 0.85; p < 0.001). The direction of the dose response relationship was consistent across the stratified models, with the exception of patients suffering burns. The largest reduction of in-hospital case fatality rates by blood alcohol concentration was observed among patients suffering penetrating or severe injuries (Injury Severity Score ≥ 16)."

http://www.alcoholjournal.org/article/S0741-8329(12)00152-8/fulltext
 
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Well, it's official now...

"In the adjusted multivariable model, a decrease in in-hospital mortality was strongly associated with an increase in blood alcohol concentration (adjusted OR = 0.83 per 100 mg/dl units change in BAC; CI 95%: 0.80, 0.85; p < 0.001). The direction of the dose response relationship was consistent across the stratified models, with the exception of patients suffering burns. The largest reduction of in-hospital case fatality rates by blood alcohol concentration was observed among patients suffering penetrating or severe injuries (Injury Severity Score ≥ 16)."

http://www.alcoholjournal.org/article/S0741-8329(12)00152-8/fulltext

That's... super interesting
 
Well, it's official now...

"In the adjusted multivariable model, a decrease in in-hospital mortality was strongly associated with an increase in blood alcohol concentration (adjusted OR = 0.83 per 100 mg/dl units change in BAC; CI 95%: 0.80, 0.85; p < 0.001). The direction of the dose response relationship was consistent across the stratified models, with the exception of patients suffering burns. The largest reduction of in-hospital case fatality rates by blood alcohol concentration was observed among patients suffering penetrating or severe injuries (Injury Severity Score ≥ 16)."

http://www.alcoholjournal.org/article/S0741-8329(12)00152-8/fulltext
So if someone comes in with a penetrating wound, and their BAC isn't quite high enough, they should be given a "therapeutic dose" of EtOH? Lol
 
So if someone comes in with a penetrating wound, and their BAC isn't quite high enough, they should be given a "therapeutic dose" of EtOH? Lol
Yeah, what would it be, "a pint of Guiness PO, titrate to 1/patient IQ"?
 
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Yeah, what would it be, "a pint of Guiness PO, titrate to patient IQ"?

If you're titrating to patient iq you're going to have fairly thirsty patients. Same for number of teeth.

Now bad tattoos, baby daddies, hx of GSWs/KSWs, arrests, visits to the ER, obscenities towards staff....now were cooking with fire.
 
If you're titrating to patient iq you're going to have fairly thirsty patients. Same for number of teeth.

Now bad tattoos, baby daddies, hx of GSWs/KSWs, arrests, visits to the ER, obscenities towards staff....now were cooking with fire.
Sorry! See my edit (titrate to inverse of IQ; ie, 1/IQ of zero = infinite ETOH titration)
 
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Nurse! Get this patient 5 ccs of grey goose STAT!!
 
Nurse! Get this patient 5 ccs of grey goose STAT!!
Yes, but first things first Spinach Dip, you must deliver these orders properly, to establish your authority. Drop them with the proper Iggy Azalea rap flow, "Cup of Ace, cup of Goose, cup of Cris!" so everyone knows you're the "realest."
 
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If you're titrating to patient iq you're going to have fairly thirsty patients. Same for number of teeth.

Now bad tattoos, baby daddies, hx of GSWs/KSWs, arrests, visits to the ER, obscenities towards staff....now were cooking with fire.
that is mnemonickey (mnemoryffic?), in its own way...
bad tattoos, baby daddies, hx of GSWs/KSWs, arrests, visits to the ER, obscenities towards staff = BBHOG/KAVEROTS
 
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If you're titrating to patient iq you're going to have fairly thirsty patients. Same for number of teeth.

Now bad tattoos, baby daddies, hx of GSWs/KSWs, arrests, visits to the ER, obscenities towards staff....now were cooking with fire.

Call me dumb (you wouldn't be the first...today), but what is a "KSW"? I get the 'knife', but 'shot wound'?
 
Don't try to break and enter into a house undergoing fumigation. The poison gas works on you as well as the bugs and you'll be puking for hours.
/******* was lucky one of the neighbors notice the guy with no shirt going into the tent, and called the cops.
//As a side note I'm pretty sure I caught DocER on a reality show in the ER. It took place in a Las Vegas ER and it had a male doctor mention the Tooth/Tattoo ratio.
 
Based on her reaction to the news that the hospital was successfully tracking all her visits and the different names she used, I don't think this lady was that interested in adding to the records herself. Which may be why she was going with the "Imma tell the director on you" tactic.

As far as I'm concerned the lady bingo'd when she played the race card. Not only were the doctor, patient, and security all people of color, the hospital was located in a Northern Cal-Bay Area neighbourhood that's practically Diversity Central. Seriously, at this place you could be a blind, left-handed, transgendered Inuit with PTSD complications from your time working at Chuck E Cheese, and you could get counselling, treatment, and registration in your choice of support group before the toner even dried on the xerox of your insurance card....

I'll have to check with a professor but I'm pretty sure that the rates of PTSD amongst former workers at Chuckie Cheese are far higher then even soldiers who have seen heavy combat.
 
A bullet through both eyes does not a fun night make


Thumb typed from iPhone using Tapatalk
 
A bullet through both eyes does not a fun night make


Thumb typed from iPhone using Tapatalk
Seen that a few times. Gun to temple, just a little far too forward, clips both optic nerves, through and through but no brain hit as tract of bullet is 100% below anterior cranial fossa. Oops.

Thing learned: If you're going to shoot yourself, don't just clip your optic nerves, rendering yourself blind, yet completely awake and alive for the long haul.
 
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Seen that a few times. Gun to temple, just a little far too forward, clips both optic nerves, through and through but no brain hit as tract of bullet is 100% below anterior cranial fossa. Oops.

Thing learned: If you're going to shoot yourself, don't just clip your optic nerves, rendering yourself blind, yet completely awake and alive for the long haul.
Least you could do is pick up a Netter's before you kill yourself.
 
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