Things I Learn From My Patients

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VA Hopeful Dr said:
Ah, but vending machines require you to put in money before they give you candy.
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:laugh: You are absolutely right. I better rethink my analogy. You truly have a grasp on what the ER is about.
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If you are 7 months pregnant you should limit rather than increase the number of foreign objects you insert into your vagina.

And to the nurses in L&D: While a vaginal laceration is not technically a complication of pregnancy you shouldn't boot it back down to the ER. That patient will do much better in L&D with L&D nurses and an OB/GYN than down here in a bed in the hallway and me.
 
Febrifuge said:
In a strictly wilderness-medicine kind of way, mind you, wouldn't this be a half-decent temporary measure to fight a raging yeast infection?
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It might... but, this lady was just doing it for some sexual reason known only to her.

Where on earth do these patients get these ideas anyway?
 
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IdiotBoxen said:
It might... but, this lady was just doing it for some sexual reason known only to her.

Where on earth do these patients get these ideas anyway?
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These forums
 
IdiotBoxen said:
It might... but, this lady was just doing it for some sexual reason known only to her.

Where on earth do these patients get these ideas anyway?
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Ahhh, I see. Another sexual practice that not even Dan Savage has a name for yet.

(I nominate "yo-play.")
 
Last night, I learned that if you're sufficiently septic, the thermister placed in your bladder as part of your Foley can still register 40 degrees C even when your groin is packed with ice.
 
So we get this unresponsive, apnic guy in by ambulance. Unknown history. EMS couldn't get him intubated because he's covered in the thick, red liquid (not blood) and it's also in his oropharynx. I get him all sucked out and tubed and a little later his friends show up and teach me a lesson. If you're out partying and your buddy drinks too much then decides to shoot smack for the first time and then collapses do not try to "amp him out of it" by pouring several cans of Red Bull down his throat.
 
docB said:
So we get this unresponsive, apnic guy in by ambulance. Unknown history. EMS couldn't get him intubated because he's covered in the thick, red liquid (not blood) and it's also in his oropharynx. I get him all sucked out and tubed and a little later his friends show up and teach me a lesson. If you're out partying and your buddy drinks too much then decides to shoot smack for the first time and then collapses do not try to "amp him out of it" by pouring several cans of Red Bull down his throat.
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What a way to either a) die or b) find yourself after being given naloxone. You know you've f***** up your life when... 🙄
 
I disagree, if there is anywhere that mullets belong, it's on children. Perhaps until the age of 10.
 
In honor of TILFMP big 2 year anniversary I think we should haul up some of the funniest posts from the past. The first one I'll nominate is:
pikachu said:
If you have sex with a girl, and your frat brother tells you right after you come downstairs that she has herpes, pouring bleach all over your privates will not take care of ANY of your problems!
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I still laugh at this one. I imagine this idiot frantically running around the house with his pants around his ankles looking for some caustic liquid to pour on his privates. Great fun! :laugh:
 
I've learned that no matter how old my patients are, they will still try to hit on me, even as a nursing assistant:

Her: "Doctor, doctor, take a look at my chest."
Me: "I'm not a doctor, and I won't look at your chest."

----

During a bed bath...
Her: "What do you think of these big melons?"
Me: "I think you can take over from here."
 
If you are two frail, little 79 year old men and you fly into Vegas from out of town, rent a car and start driving out to Nye County (about 60 mi west of Vegas) to go to the brothels to "get some" and you have a minor car crash don't ask the nurse, the doctor and anyone else you can stop in the hall if the hospital has a shuttle bus to the whorehouses for you. We don't.
 
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If you're a hypochondriac who believes that your spleen has spontaneously ruptured inside of you w/o trauma, you will not be seen faster by any health-care professionals by threatening the triage nurse with a fork you stole from the cafeteria. However, you will see the hands of a cop grab you from behind and drag you into the back of their cop car.
 
if you are a malingering/drug seeking patient new to our E.D. do not
1. show up in the company of our 4 biggest frequent flyers
2. change your complaint 3 times before being seen from dental pain to back pain to headache
3. state you have nothing for pain at home, not even tylenol, immediately before you.....
4. drop a bottle containing > 100 vicodin out of your pocket on the floor, all of which fly all over the room as you shout" they are just vitamins, I swear!!!"

when the provider recognizes them as vicodin and calls you on it you did make the correct decision by asking " can I just leave now ?"
answer "yes"
( huge note in chart describing incident with our directors famous underlined and highlighted phrase " NO NARCOTICS EVER WITHOUT EVIDENCE OF GRAVE INJURY")
 
Smoking while on your oxygen mask is on might not be a good idea.
 
If your lower back pain is serious enough for you to come the ED in the middle of the night, you probably should not be recieving oral favors from your girlfriend while lying in the ED bed. Especially when the only thing seperating your bed from the nurse's station 5 feet away is a curtain.

The best was that when the attending, 2 nurses, resident, and medical student barged in on them, the gf didn't even notice and continued her search for the magic robitussin. 😍

The dude saw the audience and pushed her off. By the way these weren't teens in case you were wondering, I'm talking people in their 50s. 😱
 
Points for creativity in dealing with long waiting times in the ED.
 
docB said:
Don't stick things in your rectum. A good general rule. Should you break this rule be sure that you are not a 14 year old boy who has swiped your mom's vibrator. ...
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AAAAHHHH Who is more embarrassed, the kid or his Mom??
 
Svetlana117 said:
Some strange things in some strange places...

Pt brought in from Psych hosp for unexplained fever. Did a KUB as he was tender in his abd. Guess what we found... a blade and a small pencil.

No he didnt swallow these. It was in his bladder. The guy had inserted it up his urethra.. Dont think about it guys...True story, I swear..
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How? I want to know how? The pencil... okay, I can see how. But the blade?? I have this ungodly need to understand how someone can do this and still keep his parts in .. place.
 
It doesn't matter how much blood, pus, vomit or processed vomit you have on your scrubs. It doesn't matter that your eyes are beet red from lack of sleep (or crying over the 15th stupid consult). It doesn't matter that you are snoring standing up. People will get very indignant when you don't give them sympathy for not having a day off for a holiday!

A volunteer (volunteer!) was whimpering to me in the elevator that she was so tired because she had to work two Saturdays this month, and now on Memorial day! She didn't like my reply of "sounds like a light schedule" for some unknown reason.
 
If you slam the end of your finger off in a steel door at 2 in the morning, you may NOT leave the ED for a cigarette and a "samwich," and I will not be bringing you a cigarette to smoke in here (but please, continue asking me every 5 minutes, maybe I'll change my answer). The weary hand surgeon (conveniently located two rooms down with the man who shot himself in the hand. cleaning his gun. at 2 am.) will eventually tire of arguing with you (we can reattach your finger, but you can't eat beforehand, etc) and let you go home, after stitching up what's left.
Could you really be hungry enough to forego the tip of your finger?!?
 
FrauBlucher said:
If you slam the end of your finger off in a steel door at 2 in the morning, you may NOT leave the ED for a cigarette and a "samwich," and I will not be bringing you a cigarette to smoke in here (but please, continue asking me every 5 minutes, maybe I'll change my answer). The weary hand surgeon (conveniently located two rooms down with the man who shot himself in the hand. cleaning his gun. at 2 am.) will eventually tire of arguing with you (we can reattach your finger, but you can't eat beforehand, etc) and let you go home, after stitching up what's left.
Could you really be hungry enough to forego the tip of your finger?!?
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The hand surgeons I've worked with wouldn't bother reattaching this anyway. Most thumbs, kids' amputations, and multiple digits (other than DIP) on the dominant hand we'll consider reattaching, but just the tip of a single digit? Nope--he gets the end tidied up and closed, nothing more, especially if he smokes.

On the other hand (no pun intended) 2 am does seem like an excellent time for many people to get an urge to have a few drinks and break out the circular saw for some late night carpentry projects. These NEVER end well...
 
Nitropaste makes terrible toothpaste but if you land on your face when you syncope you might not have any teeth left to brush anyway
 
I know this thread has usually been the spot for joking observations about the people we see but last night I saw something that reinforced to me how easily even the most innocent or trivial thing can still cost you a loved one.

I saw a three year old boy who had fallen asleep with mom and dad. Dad woke up and saw the child with a noose of mom's long hair around his neck. The kid was purple, not breathing, and flaccid. Dad called 911 while trying to untangle the kid. Couldn't untie the hair so he ended up cutting big hunks of it off with a pocket knife. By the time EMS arrived the kid was loose, breathing, and crying. By the time I saw him he was alert and acting normal not even crying any more but his whole face was covered in petechia and he had some of the nastiest looking ligature marks around his neck I've seen in a while. Mom and Dad on the other hand were crying their eyes out as they realized how close they had come to losing their son. Life is short. 🙁
 
docB said:
Don't make your 3 year old boy wear a mullet. Do I have to call child protective services?
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This goes along with not piercing your 4-6 month old infants ears and giving them hoops. They like to grab things, especially earrings.
 
AzMichelle said:
How? I want to know how? The pencil... okay, I can see how. But the blade?? I have this ungodly need to understand how someone can do this and still keep his parts in .. place.
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Gives new meaning to dysuria.
 
Apollyon said:
Please don't shoot yourself in the head. Besides killing yourself, you'll ruin my night, too.
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I disagree. Please don't mess around with pills, hanging or cutting yourself. Those are weenie ways then almost never succeed. Bullets and buildings are the only way to go.
 
docB said:
I disagree. Please don't mess around with pills, hanging or cutting yourself. Those are weenie ways then almost never succeed. Bullets and buildings are the only way to go.
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Well, if you're going to do it, do it right. A 9mm to the temple will leave you both nonsalvagable (including blood gushing out of both entrance and exit wounds) and yet, lingering for a LONG time before you expire.
 
Apollyon said:
Well, if you're going to do it, do it right. A 9mm to the temple will leave you both nonsalvagable (including blood gushing out of both entrance and exit wounds) and yet, lingering for a LONG time before you expire.
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True. That's why we as a specialty need to educate the public about proper techniques. We could advertise testaminials like "Kurt Cobain knew that large caliber weapons work best." or we could use a slogan like "In the mouth stupid!"
 
This sort of lends credence to the guy I saw my last week back there, who put a .22 in his mouth... and then punched a hole through his cheek with the bullet. Pretty much cauterized, too. He said it wasn't a real attempt, just a "cry for help."

Poor guy. Bipolar sucks. There's enough sanity left in the tank to know things are way wrong.
 
Febrifuge said:
This sort of lends credence to the guy I saw my last week back there, who put a .22 in his mouth... and then punched a hole through his cheek with the bullet. Pretty much cauterized, too. He said it wasn't a real attempt, just a "cry for help."

Poor guy. Bipolar sucks. There's enough sanity left in the tank to know things are way wrong.
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I'll second that, I had a buddy at work who used a shotgun in the mouth, the kick was too strong to control, sooo instead of heading into the brain the buck shot went out through his face, leaving him with a mess for the plastics guy to take care of.

I say hang yourself, it works everytime if the rope holds and the jump is far enough. The rope not breaking is easy enough, just buy good rope, and have it attached to something sturdy.
 
we had a guy shoot himself outside of a hospital entrance in the neck, midline just below the chin. so of course people ran out and resuscitated him... ended a C2 quad w/ a trach and all that mess... now he's just living his life away in some SNF. if he at all wanted to die or wanted attention then, he surely wants to die now and gets plenty of attention!

lesson learned: shoot for the brainstem if you really mean it!
 
No, no, really do it right. A former medic on my old volley squad burned out. So, he stole a 1/4 stick of dynamite from a construction site and put it in his mouth with the fuse lit. Very effective... messy, but effective.

🙁

- H
 
You have no idea how stupid you sound telling the cops that you don't want to press charges and that you really love him anyway while I sew up your lacerations and set your broken bones.
 
It doesn't matter that you've only done cocaine "twice, and in the beginning of my pregnancy," and it doesn't matter that the second time wasn't your fault because your "baby daddy tricked" you. The bottom line is, the baby daddy is a bad man.
 
I've learned that it's ok to call an ambulance at 3 in the morning to take you to the emergency room for a bleeding mole on your abdomen, which you picked at while drunk at home. It is also ok to wait almost 3 whole minutes after being put into the room to sign out AMA, because no one rushed into see you immediately.
I'm glad the tax payers footed the bill on that one. I wouldn't want to burden him with the bill, you know, with his bleeding mole and all.
 
Jeff698 said:
Call me obsessive, but if you're gonna do it, do it right (although I'm pretty impressed with the crossbow). Maybe we should print out flyers with the following instructions:

1) Take the ENTIRE bottle of Tylenol,
2) Wash it down with bleach,
3) Jump off tall bridge over fast moving river,
4) Shoot yourself in the head with a shotgun on the way down.

That ought to do it.
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Over the years I have come to realize that some people are not meant to go. Had a 23 y/o female that went out in the desert (Phoenix) where really nobody should have found her and OD'd on a huge variety of drugs. *Just* at the point where she had gone long enough to cause a great deal of brain damage some kids shooting cactus found her and wouldn't you know it. They were boy scouts that knew CPR. Now she doesn't have enough working brain cells to finish the job.

Had a 40-some y/o police officer that sat down in his livingroom after getting his 2nd grade daughter off to school and decided to shoot himself in the head. He realized that his wife would never be able to clean the couch so he moved to the bathroom. He sat in his bathtub and was going to shoot himself and suddenly realized he *just* finished redoing the bathroom and really didn't want to mess it up. So he moved to the kitchen, he hadn't yet redone his kitchen. He sat down on the floor and shot himself in the temple. The bullet exited the other side of his head where blood coagulation prevented him from bleeding out. His 2nd grade daughter came home to find Daddy laying on the kitchen floor.

Today he doesn't remember why he wanted to kill himself. His family never forgave him for letting his daughter find him that way and they haven't seen him in 10 years. That's okay, he doesn't realize it's been that long.

Had one patient that was a paranoid schizophrenic. He *really* wanted to die, the universe didn't seem to agree.

He drank 120cc of 100mg/ml Thorazine, that didn't work.

Next time he injected 20cc Insulin IV, that didn't work.

Next time he shot himself in the head with a gun. The bullet lodged nicely in the back of his skull, that didn't work.

Next time he jumped in front of a train. He lost both arms and a leg, that didn't work.

He's now a 42 y/o who will spend his days in a SNF. He doesn't have enough working body parts to finish the job.

Some people just aren't meant to go.
 
docB said:
So we get this unresponsive, apnic guy in by ambulance. Unknown history. EMS couldn't get him intubated because he's covered in the thick, red liquid (not blood) and it's also in his oropharynx. I get him all sucked out and tubed and a little later his friends show up and teach me a lesson. If you're out partying and your buddy drinks too much then decides to shoot smack for the first time and then collapses do not try to "amp him out of it" by pouring several cans of Red Bull down his throat.
Click to expand...

But... Red Bull's not red, so I wonder why the liquid was.
 
docB said:
True. That's why we as a specialty need to educate the public about proper techniques. We could advertise testaminials like "Kurt Cobain knew that large caliber weapons work best." or we could use a slogan like "In the mouth stupid!"
Click to expand...

As a suicide counselor, I have to take ever client seriously who says, "I'm thinking about swallowing this whole bottle of Tylenol." In reality, I want to say, "Please don't. You're going to get sick and I'm going to have a lot of paper work to fill out."
 
deuist said:
As a suicide counselor, I have to take ever client seriously who says, "I'm thinking about swallowing this whole bottle of Tylenol." In reality, I want to say, "Please don't. You're going to get sick and I'm going to have a lot of paper work to fill out."
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And the taste of N-acetylcysteine is extremely unpleasant!
 
Sessamoid said:
And the taste of N-acetylcysteine is extremely unpleasant!
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Yummmm... smells as good as it tastes!!
 
AzMichelle said:
Some people just aren't meant to go.
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My worst is a girl we pulled out from under a train. Rookie medics turned green on the scene, puking everyewhere; nothing went right on the call. I had to get off the truck company with my Lt. to take care of the patient. We pulled her out, immediate surgical cric for massive maxofacial injury. We arrive at the trauma center, giving report "This is an unknown 20 to 30 year old female who we pulled from under a train..." As we are moving the patient from our cot to the hospital cart an ED nurse says "Oh, it's Sally". She knew the patient. How? From the scars on her wrists. Turns out this was her 13th suicide attempt. 1 by OD, 10 by cutting, including some tendon and nerve damage (serious cuts - chica wasn't playing) and now her SECOND TIME UNDER A TRAIN!!! Yep, she had been released from rehab six weeks prior after a 12 month course of hospitalization and PT after being pulled from under a train one town over from ours.

Some people aren't meant to go, but she was. She died two weeks later in the ICU from sepsis.

- H
 
FoughtFyr said:
Some people aren't meant to go, but she was. She died two weeks later in the ICU from sepsis.
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My mum always said "you can achieve anything if you put your mind to it, and stick at it."
 
Tractors + old men = Death

ATVs + young men = Death

Bicycles + children without helmets + cars = Death
 
Tractors + old men = Death

recent case....tractors plus old men plus coumadin= bloody(survivable) mess.....
was more concerned about the epistaxis and multiple dental fxs than the open ankle fx.....and he drove himself in.....
 
Seaglass said:
Tractors + old men = Death

ATVs + young men = Death

Bicycles + children without helmets + cars = Death
Click to expand...

Nah, it's not death, it equals a peg and trach, and a long fulfilling life of q 2 hr rolls.

mike
 
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