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Things I Learn From My Patients

Discussion in 'Emergency Medicine' started by docB, May 2, 2003.

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  1. Spinach Dip

    Spinach Dip Delicious with nachos

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  2. RespectTheChemistry19

    RespectTheChemistry19

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    3.5 L here. The EP and I had a grand old time laughing about that one.
    Last edited: Aug 10, 2014
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  3. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    Represent!

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  4. Spinach Dip

    Spinach Dip Delicious with nachos

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    So why do all urinals (hospital/nursing facility/etc) hold 1L? Is there a "super size" one available for those extra-special patients?



    /tangent
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  5. EmpericalNinja

    EmpericalNinja

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    Hello Folks.

    I'm not a med student, or anything like that in any field. But I've spent enough time in hospitals and Urgent Care over the years, to be thankful for doctors and the staff there, who are smart and know (most of the time) what's wrong with you.

    Let me just give you some of what's happened to me in my 27 years of life.

    First off, I am one of those unlucky folks who is allergic to Ibuprofen, Sulfa drugs, and Aspirin. Immune to Vicodin, and most....if not all regular cold medicines.

    So let's just have some fun going through my rather fun life.

    7 years old: Pneumonia and ear infection at the same time during the summer......not a fun summer......nor a fun rest of my life, because due to those two things I now no longer have a decent immune system.

    Also, come from a family background that has cancer and other unfortunate things in the background.

    Freshman year of college. IF after 3 days of coughing fits, and hacking, and other not pleasant things, you should have gone to the on campus health center to find out what's wrong with you; instead, wait until your dad comes to visit, dx's (He's worked around Hospitals enough as a sales rep that sells medical transcription devices and other assorted things) you with Pneumonia, and goes and gets you basic drugs to cure you......and be greatful, because your hallmates all but threatened to knock you out and take you to the E.R, even your R.A's roommate's girl at the time who was a medical student, DX's you as Pneumonia earlier in the week, and all but offers to take you to Urgent Care.

    I also had my wisdom teeth removed over christmas break that year, and was on Vicodin, and something else.....the Vicodin I stopped taking after day 2.5, because it wasn't doing anything for me, and I had become more or less....immune.

    Sophomore year of college. Punch through a glass panel on a door (accidentally with NO ALCOHOL INVOLVED) at 1 am in the morning because your housemates pulled a prank on you and you ran out of the house after them, only to have one of them close the door, and you, slightly sleepily knock on the window, not realizing how unstable it actually is. Hand goes through window, with you cursing, (which I rarely do) "ohhhh eff the door," folllowed by "OH EFFFF.....MY HAND." having them realize at that point, they may have screwed up. Have them help get your hand through the window part, with a very deep cut. Don't go to the E.R, instead, have a couple of them go to the all night safeway and get butterfly bandaids and neosporin, and keep your hand running under cold water. The next morning, go to class, with your hand bandaided up, and in a plastic bag (housemates idea), because based on their knowledge, your hand is fine. Go in to class, and have everyone stare at you as if you've grown a third eye. Have one of the Campus Security who is a student and in the class, who also dislikes you, look at you and ask what happened, say that an accident involving your house was all, and leave it at that. (find out later that he went and yelled at them). Come back from class and have your El Ed friend look at your hand ask what you did now, and if you need a ride to the E.R. Tell her you'll go have campus health services look at it later as you have class soon. Go back to your room, and have her IM you five minutes later and tell you that based on her Chem major roommate's advice that you need to go the ER. She'll offer to drive you up there (more or less threatening to take you if your refuse). Tell her you will go to Campus Health and have them take a look. Go to Campus health. Have them take one look at your hand, and immediately the nurse there says "uh.....hold on a second, I'm going to drive you to Urgent care." Go to Urgent care, have them take a look, and immediately have the Doctor ask if Alcohol was involved, when you tell him no, and he asks why you didn't go to the E.R, tell him that your housemates didn't think it was that bad. Have him again give you a skeptical look and inform you, that had the cut been any deeper or wider, you'd be facing tendon reconstructive surgery.....the cut was about 8/10th's away from the tendon. have them stitch you up, and then offer you Vicodin. Refuse and explain you're immune and it has no effect on you. Doctor and nurse look at you, like you're from another planet.

    Junior year. Same thing that happened freshman year.....only worse. starting with a fever, vertigo and neausa and not feeling hungry, on a tuesday night. DX yourself as food poisioning and ask the head of food services the next morning if anyone else experienced what you did, and he says no, then go around your business. that's wednesday. Thursday, still not feeling well, go to health services, have them take your temp (103.4) and say it's just a minor cold, and tell you to go on your way, you should feel better. Friday night, feel even worse then you did Thursday morning, and call your parents and the girl you're dating at the time, who both tell you to go the Urgent care. Go there, and find they're about to close, and have them ask if you can wait til tomorrow.....be polite and say you're not sure you're going to be alive in the morning. They give you the location of an U.C 30 minutes away that's open late. call up one of your friends and ask her to drive you to there, when you explain what you've got, have her tell you to wait where you are, she'll be there shortly. Go up to the other UC and have the doctor there take one look at you, take your temp (105.5) and immediately DX you as Viral Meningitis, have him inform you to go immediately to the E.R in your town where you go to school. Have your friend drive you back down, and go to the E.R, and check in, have the ER attending take one look at you and inform you that you do not have Viral Meningitis, because if you did, you've be bemoaning the fact that you're alive, and that you don't need a lumbar puncture. Instead inform you that you have a very bad case (also rare) of Pneumonia (when he finds out your history of seven years old) have him be a little less surprised. Have him put you on a few drugs, and then perscribe you some very heavy horse pills. a week later you're feeling better, and alive.

    didn't have any more problems in college, but after college:

    Two weeks after getting fired from your job, start having heart palpations that feel like a heart attack, go immediately to the Urgent Care and have them do an EKG on you. find out that stress heart attacks on a minor scale are possible. Also find out that you have an irregular heart beat where your heart beat beats 3 or so times at the normal rate, even though this is not an adverse affect on you. Find this part out again later a couple of months later when you go to join a weight loss program that does an EKG as well as a few other things.

    that's all I have that happened to me.

    One thing I did learn since working in retail, with fork lifts and all that is that when your foot/ankle gets run through with a fork lift blade, do not have the idiot spotter take off the person's shoe, because if that does happen, the foot'll swell up and said patient will end up having to have reconstructive surgery and have to walk with a cane for the rest of your life (27 years old this person is) because of the damage done.


    Once again, I am eternally thankful for doctors and nurses.
  6. EmpericalNinja

    EmpericalNinja

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    I should also say that some of these things I've read are kinda hilarious and sad at the same time. I actually understand a lot of these issues, as I have a lot of friends who are med or what have you. and I also watched a lot of House, Scrubs and other medical shows and understand better thanks to those shows and friends when someone says they have this and that.
  7. acceptmeplease

    acceptmeplease

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    Did I really just read all of that?
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  8. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

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    I totally agree. They will never admit it though. Just like no one will admit that our current "prescription pain medicine addiction crisis" was the utterly foreseeable and frequently warned about result of the "pain is under treated, oligoanalgesia, pain is the 5th vital sign and pain is what the patient perceives it as" movement of the late 90s.
  9. Birdstrike

    Birdstrike

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    Have you seen this?

    http://drwhitecoat.com/wp-content/uploads/Grassley-Feinstein-Letter-to-CMS-2014.pdf
  10. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

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    Yes. And I agree with it wholeheartedly (yes, that's now on the record, docB agrees with Sen. Feinstein about something). However the mess we are in now started before the advent of the patient satisfaction movement. It started with the JCAHO led movement to increase narcotic use in the 90s. There were even lots of studies finding that minorities got less narcotics than whites which implied "if you're not writing for narcs you're a racist." Patient satisfaction is gas on that fire to be sure but it started before this lunacy.
  11. Birdstrike

    Birdstrike

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    It's started before that. It started right here:


    Chronic use of opioid analgesics in non-malignant pain: report of 38 cases.

    Pain. 1986 May;25(2):171-86.

    "No toxicity was reported ...We conclude that opioid maintenance therapy can be a safe, salutary and more humane alternative to the options of surgery or no treatment in those patients with intractable non-malignant pain ..."

    http://www.ncbi.nlm.nih.gov/m/pubmed/2873550/
  12. TooMuchResearch

    TooMuchResearch i'm goin' to Kathmandu... Lifetime Donor

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    On the lead author, for us young ones that don't know the details:

    http://hcrenewal.blogspot.com/2012/12/the-king-of-pain-recants-pharmaceutical.html?m=1
  13. Birdstrike

    Birdstrike

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  14. JustSpeechless

    JustSpeechless

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    Apparently homeopathy doesn't cure liver cancer. Who knew?!

    I've never seen a liver that extends into the RIF before.
    RespectTheChemistry19 likes this.
  15. sb247

    sb247 wait...you mean I got in?

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    Probably wasn't diluted enough ;)
  16. Spinach Dip

    Spinach Dip Delicious with nachos

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    Or he took so many doses it reduced the overall effectiveness.
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  17. Perrin

    Perrin sittin in the morning sun

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    Reminds me of this skit.

    Evisju7, Birdstrike, johnamo and 2 others like this.
  18. Ceke2002

    Ceke2002 Patient Zero

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    One from a while ago...

    If you have enough lung capacity to give a running commentary, that is loud enough for the entire department to hear you, on how you're having trouble breathing then you're not actually having trouble breathing (that and the fact that your pulse ox hasn't dropped below 95% in the four hours plus you've been here). As for why that other person (ie me) is getting 'special treatment' (extra pillows, warm blankets, magazines to read, cups of tea), it's called having manners, you should try it some time.
  19. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

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    If my patient education must begin with "Don't take random pills you find in the street." you may be beyond my ability to help you.
  20. Birdstrike

    Birdstrike

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    That's where you're like..."You know what? Just forget it. Thanks for coming in, Sir. Pleased have a blessed day. And please don't forget to remember 'DocB' was the one who hooked you up with the free turkey-sando and blanket that you pulled over your head for 6 hours. Good bye."

    :)
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  21. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

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    I like it but it's missing something. Oh yeah. Here we go:

    That's where you're like..."You know what? Just forget it. Thanks for coming in, Sir. Please have a blessed day. And please don't forget to remember 'DocB' was the one who hooked you up with the free turkey-sando and blanket that you pulled over your head for 6 hours. So please rate me highly at the survey kiosk on your way out the door and if you ever get an HCAHPS form remember that the correct answer is "Always." Good bye."

    I knew all that scripting would come in handy.

    PS - For all the students and residents who read that and are thinking "Survey kiosk? Scripting? What is he talking about?" just don't worry about it. Ignorance is bliss and you will miss it soon enough.
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  22. Cytarabine

    Cytarabine

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    No benzo/narco discharge goodie bag? Are you even trying to keep your PG competitive?
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  23. Spinach Dip

    Spinach Dip Delicious with nachos

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    Please note: If you are an 80yo lady with advanced osteoporosis and a couple rods in your back DON'T fall off your deck.

    The result might be the obliteration of one of the bones those rods was attached to (T1?), and a bunch of screws and bone chips occupying the region of your body that used to be your back. Also, you will have a titanium rod sticking out the back of your shoulder.

    Somehow, your spinal cord will remain patent and you will be writhing in pain and begging for pain meds (which you will receive in abundance) while the ED docs call every orthopod and neurologist in the state to figure out what to do with you.

    Lastly, your Xrays will make it into the "holy crap did that really happen?" files of a dozen physicians. Immortality: achieved.
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  24. scummie

    scummie

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    If you are in the ED already and don't feel like waiting, feel free to call 911 while in the waiting room so you can be transported to another hospital.
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  25. Birdstrike

    Birdstrike

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    Yes! This is the classic, Holy Grail of passive aggressive behavior. And we've all seen it. I love it! And that person, never, never, is actually sick, right? Ah...and God just looks down, smiles and shakes his head.
    Last edited: Sep 6, 2014
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  26. jdh71

    jdh71 si vis pacem, para bellum

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    I've gotta know what the first guy you got a hold of said about it when you tried to explain it on the phone.
    Last edited: Sep 6, 2014
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  27. Perrotfish

    Perrotfish Has an MD in Horribleness

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    No matter how screamingly psychogenic a behavior, at least one patient will always have managed to die after they exhibited it.

    Remember this story? http://www.nbcnews.com/id/19207050/...oman-dies-er-lobby-refuses-help/#.VA0Wz8J0xOw
  28. Birdstrike

    Birdstrike

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  29. mohi

    mohi

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  30. Birdstrike

    Birdstrike

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    It doesn't all have to be "overshadowed by doom." You will have lots of good times along the way. Remember, people are much more likely to post about a bad day or frustrating patient encounter, than a good one. They come here to dump the bad, so that they can discard it, walk away, and leave it here. But that doesn't mean the positives aren't happening. They are, but you have to open your eyes to them. Most people don't make a conscious effort to deposit them here. They keep the good ones for themselves. Although, I identify with nearly all of the dark humor on this thread, I've made the point to write about a few of the good encounters, and about a few of the positive things patients have taught me. I'm grateful, for what my patients have taught me. If you haven't read them, here's just a few:


    Humility, from "Tony the Doorman."

    Laughter, from "Lighterman."

    Surprise, from the lady with "Some Serious Constipation."

    Resilience, from "An Amazing Little Girl."

    Gratitude, when "Blown Away."


    It's there, you just have to choose to see it.
  31. DeadCactus

    DeadCactus SDN Lifetime Donor Lifetime Donor

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    "Don't take random pills you saw someone else vomit up."
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  32. EM Doc to be

    EM Doc to be

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    LMAO! That is too funny.
  33. Birdstrike

    Birdstrike

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    What?! Why not?!



    Lmao
  34. dudeliness

    dudeliness hi

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    I love it! I've been prowling this thread for a while and somehow I've never seen your blog. Thanks so much for sharing. Lighterman cracks me up!
  35. Birdstrike

    Birdstrike

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    Thank you. It's not my blog, though. I just guest post on it sometimes. It's owned by a guy that goes by "White Coat" (different than White Coat Investor on the SDN EM forum). The posts that have "By Birdstrike MD" are mine, and all of mine are SDN EM Forum posts first, before going on the blog. A few have been reposted by Kevin Pho, also, FWIW. All the others (90%) are by White Coat. Thanks again
    Last edited: Sep 8, 2014
  36. RespectTheChemistry19

    RespectTheChemistry19

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    *shudder*
  37. Pons Asinorum

    Pons Asinorum "Please see your attached ERAS token..." Moderator Emeritus

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    Thought I'd wandered into the Veterinary forum for a minute...
  38. exi

    exi EM, home of the cool kids

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    Are you sure you didn't?
  39. Birdstrike

    Birdstrike

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    Large animal psych ward.
  40. exi

    exi EM, home of the cool kids

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    Mooooooooooo.
  41. Birdstrike

    Birdstrike

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    Exi. You're mooing again. Did you take your Haldol?
  42. Spinach Dip

    Spinach Dip Delicious with nachos

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    Well, humans are just one species of primate (minus some hair and plus some needlessly complex social norms).
    Last edited: Sep 12, 2014 at 5:12 PM
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  43. Spinach Dip

    Spinach Dip Delicious with nachos

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    Don't worry. I told him he didn't have to take it today.

    Oink. Oink.
  44. Mr Roboto

    Mr Roboto +Throckmorton Bronze Donor

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    Saw a patient a few months back that was mooing, on all fours, pretending to chew cud.

  45. exi

    exi EM, home of the cool kids

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    As Uncle Bird said. I do some f*cked up stuff when I'm off my meds.
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