Christmas Patients

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The Knife & Gun Club

The Knife & Gun Club

EM/CCM Attending, Finally.
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Good morning, Mrs Smith? It’s Dr Knife calling from the ER at Community General. Is “John smith” your son? Yea? I’m sorry to tell you this, but John overdosed on heroine this morning. We put a breathing tube in to help him breath, but he threw up into his lungs and has a really bad infection. His brain was without oxygen for a long time, we don’t know how much damage was done.

I promise we’ll take good care of him.

This was officially my first year actually working Christmas Day.

Man, it was a special kind of grim. On the plus side leadership bought us some fantastic catered Chinese food.

Anyone else have any good Christmas/holiday stories? Both epic saves and depressing venting are welcome.
 
Thanks for working x-mas. This was the first year in awhile I haven't worked it. And I'm OK with it as I always feel like the grim reaper's messenger when I work the holidays....last x-mas I got to diagnose 2 extremely nice pts under the age of 50 with cancer and tell a 3rd pt in his early 60s that his cancer, thought to be in remission, was back and had metastasized everywhere. And I still vividly recall x-mas the year before where I had to tell a 30-something yo pt they had cancer...and being pulled out of the room in the middle of breaking that news to go code a pt who died in front of their entire extended family at x-mas dinner.
 
Worked Christmas night one year and found stage 4 colon cancer in a guy about my age (too young). Was losing weight, having progressive symptoms of mets impinging on his spinal cord, and came to see me with horrible back pain and acutely worse SC compression symptoms after the primary NP failed to realize the symptoms weren't due to "prostatitis" over the last several months (not that this would have led to much difference in ultimate outcome). Merry Christmas, guy. Just terrible. Will never forget this one.
 
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Christmas is always bad because the truly sick still come in and you can’t push away how horrific it is like a “normal” day. You don’t forget your bad Christmas Day cases.
 
Fetal demise at 20 weeks. Falalalala
 
EMhawkeye said:
Fetal demise at 20 weeks. Falalalala
Click to expand...
Wife had an IUFD at 37 weeks on labor and delivery. Had to push with the lady to deliver her dead baby on Xmas. Broke her pelvis in the process.
 
Was this a teen? I never call family for this.
 
BAM! said:
broke her pelvis? is that a thing?
Click to expand...
Yea actually not unheard of in OB patients, especially if it’s a small lady and a big baby. In this case she had DM1, so the baby was huge >10lbs.

Went into DKA on the labor floor.

On a lighter note, watching a cadre of gynecologists attempt to manage DKA was very entertaining. The frantic 3am phone call went something like “hey this lady is in like um in like DKA or something. Is that bad? Should we call someone? Her pH is like, like REALLY low”
 
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The Knife & Gun Club said:
Yea actually not at all uncommon in OB patients, especially if it’s a small lady and a big baby. In this case she had DM1, so the baby was huge >10lbs.

Went into DKA on the labor floor.

On a lighter note, watching a cadre of gynecologists attempt to manage DKA was very entertaining. The frantic 3am phone call went something like “hey this lady is in like um in like DKA or something. Is that bad? Should we call someone? Her pH is like, like REALLY low”
Click to expand...
Source on that?
 
VA Hopeful Dr said:
Source on that?
Click to expand...



jkms.org

Incidence and Risk Factors of Symptomatic Peripartum Diastasis of Pubic Symphysis

Yoo JJ, et al. J Korean Med Sci. 2014 Feb;29(2):281-286. https://doi.org/10.3346/jkms.2014.29.2.281
jkms.org jkms.org

Looks like around 1/400, but not a ton of literature on the topic.

You’re right a better phrasing would be “not unheard of” rather than not uncommon. A big place doing few thousand annual births a would see a handful every year. Also a seems to be more “pelvic ring injury” where you separate your diaphysis or SI joints rather than true fracture.

Edited my original post.
 
The Knife & Gun Club said:
jkms.org

Incidence and Risk Factors of Symptomatic Peripartum Diastasis of Pubic Symphysis

Yoo JJ, et al. J Korean Med Sci. 2014 Feb;29(2):281-286. https://doi.org/10.3346/jkms.2014.29.2.281
jkms.org jkms.org

Looks like around 1/400, but not a ton of literature on the topic.

You’re right a better phrasing would be “not unheard of” rather than not uncommon. A big place doing few thousand annual births a would see a handful every year. Also a seems to be more “pelvic ring injury” where you separate your diaphysis or SI joints rather than true fracture.

Edited my original post.
Click to expand...
OK yeah I was thinking like "broken bone" type stuff. That is a known complication (and we c/s is done on big babies).
 
Been off service this month on an ICU rotation, mainly with COVID patients. Yesterday was my last day, thank GOD! Lost track of how many death certificates I filled out.

December of my OMS-3 year was also ICU. I'll never forget watching the monitor go from sinus, to brady, to sine wave, to asystole while hearing the family cry and "Rockin' Around the Christmas Tree" was playing, it was surreal.

But, on the bright side: Managed to get a couple extubated and on the way to discharge, got what I wanted for Christmas, had a good mid-year eval.
 
The Knife & Gun Club said:
Yea the colloquial “she broke her pelvis” doesn’t necessarily equate to actual broken bones.
Click to expand...
Unrelated, but I had a transfer pelvic diastasis injury that was read by the outside radiologist as a "sprung pelvis".

I have never heard that terminology before, but apparently it is accepted.
 
CajunMedic said:
Been off service this month on an ICU rotation, mainly with COVID patients. Yesterday was my last day, thank GOD! Lost track of how many death certificates I filled out.

December of my OMS-3 year was also ICU. I'll never forget watching the monitor go from sinus, to brady, to sine wave, to asystole while hearing the family cry and "Rockin' Around the Christmas Tree" was playing, it was surreal.

But, on the bright side: Managed to get a couple extubated and on the way to discharge, got what I wanted for Christmas, had a good mid-year eval.
Click to expand...
I really don't like playing XMas carols in the hospital. I mean, if someone requests music therapy that's cool, but keep that **** off the PA please.
 
Jabbed said:
Unrelated, but I had a transfer pelvic diastasis injury that was read by the outside radiologist as a "sprung pelvis".

I have never heard that terminology before, but apparently it is accepted.
Click to expand...
In my understanding getting "sprung" precedes the pregnancy.
 
WilcoWorld said:
I really don't like playing XMas carols in the hospital. I mean, if someone requests music therapy that's cool, but keep that **** off the PA please.
Click to expand...
AhderIaBLuHcOFO-800x450-noPad.jpg
 
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