Medicine Sucks

[PsyDGrrrl]

My brother's a corrections officer. The stories he's told about WHY people have ended up in his "care" are hair raising. And horrible. And will break your heart every time. People do some seriously f'ed up things to one another.

Same goes for the things that corrections officers do to the inmates in their care.

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[deleted109597]

Same goes for the things that corrections officers do to the inmates in their care.

You watch too much television. As many corrections officers abuse inmates as parents abuse children. Doesn't make it right, but it doesn't happen all the time either.

 

[ZincFingers]

55-ish yo admitted to the psych ward for anxiety.

Upon questioning, the current attack was provoked by a "bull****" court case.

Upon further questioning, it appears the pt's daughter took exception with time he spent alone with his grandson.

And upon even further questioning, the pt's son who does not speak to him turns out to have a pretty good reason for not speaking to him.

Sometimes medicine sucks... because you have to sit there appearing empathetic, when all you're thinking about is how the psych ward windows are reinforced so you can't throw your own patient through them.

 

[Katydid]

Same goes for the things that corrections officers do to the inmates in their care.

Yes, because of course all corrections officers brutalize inmates. You watch too much TV.

 

[Katydid]

55-ish yo admitted to the psych ward for anxiety.

Upon questioning, the current attack was provoked by a "bull****" court case.

Upon further questioning, it appears the pt's daughter took exception with time he spent alone with his grandson.

And upon even further questioning, the pt's son who does not speak to him turns out to have a pretty good reason for not speaking to him.

Sometimes medicine sucks... because you have to sit there appearing empathetic, when all you're thinking about is how the psych ward windows are reinforced so you can't throw your own patient through them.

There are times when it's a pity that murder is illegal.

 

[Kittenmommy]

There are times when it's a pity that murder is illegal.

This.

 

[PsyDGrrrl]

You watch too much television. As many corrections officers abuse inmates as parents abuse children. Doesn't make it right, but it doesn't happen all the time either.

Not from what I've heard from corrections officers and other people that worked in prisons, as well as what I've seen from my patients.

 

[GatorEM]

Not from what I've heard from corrections officers and other people that worked in prisons, as well as what I've seen from my patients.

And I'm sure those incarcerated patients of yours are model citizens and have never done anything to harm another human being. Not that it effectively rationalizes this type of behavior, but it definitely helps put things in perspective. I guess I have a little more tolerance toward unfair treatment of a criminal compared to that of an innocent person of child. I once heard that some crazy states even opt to kill their convicted murders... Now that's not nice.

 

[Katydid]

Not from what I've heard from corrections officers and other people that worked in prisons, as well as what I've seen from my patients.

Oh yes, and the prisons are FULL of people who really didn't do it, and the "real" killer/molester/burglar is out there SOMEWHERE.

Inmates lie. They lie about their crimes, they lie about mundane bullcrap, they lie about big stuff.

Do inmates sometimes get brutalized? Sure. Usually by other inmates, sometimes by corrections officers. Does it happen all the time? Hardly. Inmates like to self-harm, hoping to get someone else into trouble, or to get out of something.

Corrections officers have a tough job. They have to deal with the dregs of society on a regular basis. They're spit at, have feces and urine thrown at them, have other bodily fluids flung at them, they're threatened on a daily basis, and hell, inmates try to kill them. It's too bad you'd prefer to think the worst of them.

 

[PsyDGrrrl]

Oh yes, and the prisons are FULL of people who really didn't do it, and the "real" killer/molester/burglar is out there SOMEWHERE.

Inmates lie. They lie about their crimes, they lie about mundane bullcrap, they lie about big stuff.

Do inmates sometimes get brutalized? Sure. Usually by other inmates, sometimes by corrections officers. Does it happen all the time? Hardly. Inmates like to self-harm, hoping to get someone else into trouble, or to get out of something.

Corrections officers have a tough job. They have to deal with the dregs of society on a regular basis. They're spit at, have feces and urine thrown at them, have other bodily fluids flung at them, they're threatened on a daily basis, and hell, inmates try to kill them. It's too bad you'd prefer to think the worst of them.

I recommend reading "The Lucifer Effect" by Philip Zimbardo so that you may better understand some of the dynamics that create these behaviors, regardless of whether people who work as corrections officers are "good" or "bad" guys.

 

[PsyDGrrrl]

And I'm sure those incarcerated patients of yours are model citizens and have never done anything to harm another human being. Not that it effectively rationalizes this type of behavior, but it definitely helps put things in perspective. I guess I have a little more tolerance toward unfair treatment of a criminal compared to that of an innocent person of child. I once heard that some crazy states even opt to kill their convicted murders... Now that's not nice.

My incarcerated patients (or rather, in between incarcerations) are seriously mentally ill, so I guess you wouldn't consider them model citizens regardless of what they do, would you?

 

[Squad51]

My incarcerated patients (or rather, in between incarcerations) are seriously mentally ill, so I guess you wouldn't consider them model citizens regardless of what they do, would you?

PsyD - you simply aren't likely to find a sympathetic ear from those who work in the ED. Especially those of us with "prison units" in our EDs.

But back to the thread - "I'm sorry ma'am but that blood is not in your 3 yo daughter's urine, it is coming from her torn posterior faschette". Even worse, our SANE nurse will discover her 7 yo brother did it. So who has been touching / teaching him?

{And when they catch that individual PsyD - I really don't care what the guards or other prisoners do to them, mentally ill or not.}

 

[Pharmavixen]

Oh yes, and the prisons are FULL of people who really didn't do it, and the "real" killer/molester/burglar is out there SOMEWHERE.

Inmates lie. They lie about their crimes, they lie about mundane bullcrap, they lie about big stuff.

Do inmates sometimes get brutalized? Sure. Usually by other inmates, sometimes by corrections officers. Does it happen all the time? Hardly. Inmates like to self-harm, hoping to get someone else into trouble, or to get out of something.

Corrections officers have a tough job. They have to deal with the dregs of society on a regular basis. They're spit at, have feces and urine thrown at them, have other bodily fluids flung at them, they're threatened on a daily basis, and hell, inmates try to kill them. It's too bad you'd prefer to think the worst of them.

At the jail where I have worked for eleven years, the vast majority of abuse/harm is perpetrated by inmates against other inmates. The guards generally vent their frustrations by yelling and swearing.

Jail is boring much of the time. People are playing cards, or watching TV, or talking on the phone, while the guards do crossword puzzles. Ex-inmates like to play it up as if it were more harrowing than a Soviet gulag or an ongoing episode of "Prison Break." But most of the time, nothing happens.

And if anybody lies more than inmates, it's the lawyers who represent them.

[/thread drift]

 

[EM2BE]

Sweetest lady (when you know something will be wrong) came in for high blood sugars - also from another country, just came to visit her family. Got admitted for the inc glucose and possible PE workup in the end. Ends up no PE, but has a huge (slightly <20cm) uterine mass which is already metastatic and with further questioning has already had major weight loss. Hopefully can get back to the homeland to be around family before it gets too bad.

 

[GoBuckeyes913]

A few nights ago, 3 am..... Peaceful night in the ED when a squad rolls through the door with a 2 month old, grunting resp., glazed eyes, blood from nose, on blow-by oxygen. Dad "fell asleep" with baby on chest and awoke to find him not breathing well. Baby was intubated then coded. Worked the baby, got him back and shipped to the nearest peds hospital. Talked to the attending in the PICU and the EEG was "not promising" and the family was being investigated because their stories were changing and an anonymous phone call was placed to the hospital voicing abuse concerns.

Mom was in the ED by herself crying her eyes out while we tried to save her baby...these are the days that "medicine sucks."

I tried not to read this thread for personal reasons, obviously didn't work.
The quote above unfortunately reminded me of the most disturbing thing I've seen: 10 month old brought in by EMS bludgeoned, unresponsive, apneic. Neighbor saw mother throwing baby around the house, against walls (**** I dont even want to say anymore), called 911. Hallucinating drug mother says she "didn't want the baby anymore", so she beat up her child and was going to stage it as some sort of freak accident so she could get money to pay for her drug habit. Baby coded, we weren't able to revive. Balled my eyes out in the bathroom, wasn't the same for about a week.

40 yo male in MVA brought in as trauma, hit from the side by a semi that crossed over the median coming from the opposite direction (driver fell asleep). He ended up with contusions and abrasions... but his wife, 10 yo son, 6 yo son, and 2 yo daughter were DOA. I've never seen a man cry the way he did. Cried when I got home.

When I was in college, my significant other of 3 years and I were helping a friend move. It was a nice area. We were walking out to the parking lot where we had just had dinner, when a mugger approached us at gunpoint. Gave him our money, but apparently that wasn't enough, and he shot my love, point blank in the chest. Didn't bother to shoot me or our friend, not sure why. Only wondered a million "whys". Nothing I did mattered. No pressure in the world wouldve stopped that bleeding .45 through the aortic arch. DOA. Still have the ring put away that he was going to give me 10 months down the road on a surprise trip to Australia.


...Medicine sucks

 

[bravotwozero]

When I was in college, my significant other of 3 years and I were helping a friend move. It was a nice area. We were walking out to the parking lot where we had just had dinner, when a mugger approached us at gunpoint. Gave him our money, but apparently that wasn't enough, and he shot my love, point blank in the chest. Didn't bother to shoot me or our friend, not sure why. Only wondered a million "whys". Nothing I did mattered. No pressure in the world wouldve stopped that bleeding .45 through the aortic arch. DOA. Still have the ring put away that he was going to give me 10 months down the road on a surprise trip to Australia.


...Medicine sucks

Wow, that is horrible. I am so sorry to hear that. I can only imagine what a nightmare that must have been.

 

[doctawife]

When I was in college, my significant other of 3 years and I were helping a friend move. It was a nice area. We were walking out to the parking lot where we had just had dinner, when a mugger approached us at gunpoint. Gave him our money, but apparently that wasn't enough, and he shot my love, point blank in the chest. Didn't bother to shoot me or our friend, not sure why. Only wondered a million "whys". Nothing I did mattered. No pressure in the world wouldve stopped that bleeding .45 through the aortic arch. DOA. Still have the ring put away that he was going to give me 10 months down the road on a surprise trip to Australia.


...Medicine sucks

Holy crap, I'm sorry.

18 year old male presented with 3 weeks of headache, right sided, associated with nausea/vomiting, better when sitting up. Maternal family history was positive for migraines. The pain responded to Motrin and rest. I scanned his head pretty much for CYA purposes (CYA = cover your @ss). I mean, really, how many times have I scanned someone for 'new headache' in the pedi EC and gotten a positive results? Never... until this kid. 4cm brain tumor.

Mother cried, father cried and patient teary.

 

[docB]

I'm sorry to have to tell you this but after you put your brother to bed drunk (again) last night he must have vomited in his sleep (and/or stupor). His brain and heart didn't get enough oxygen for several hours. The paramedics put a tube into his lungs to pump oxygen into him and we gave him many rounds of powerful heart stimulating drugs and electricity to try to get his heart to beat again. Nothing worked and I'm sorry but he died.

I know he was only 30 but his brain and heart were without oxygen for too long.

I know it's Christmas but it doesn't change the facts.

No there's nothing else we can do. He arrived here 3 hours ago and I called the code about 30 minutes later. I understand that you didn't think he was that sick but it would have been nice if you'd have realized this was bad when the medics tubed him in his bedroom and carried him out doing CPR. Then you might not have waited until after breakfast to come in and see him.

I'm don't know how you should tell his children (5 and 8) but the social worker, nurses and I can help you with that.


That was yesterday morning. Too busy to post it until now. I've gotta get next Christmas off.

 

[leviathan]

I'm sorry to have to tell you this but after you put your brother to bed drunk (again) last night he must have vomited in his sleep (and/or stupor). His brain and heart didn't get enough oxygen for several hours. The paramedics put a tube into his lungs to pump oxygen into him and we gave him many rounds of powerful heart stimulating drugs and electricity to try to get his heart to beat again. Nothing worked and I'm sorry but he died.

I know he was only 30 but his brain and heart were without oxygen for too long.

I know it's Christmas but it doesn't change the facts.

No there's nothing else we can do. He arrived here 3 hours ago and I called the code about 30 minutes later. I understand that you didn't think he was that sick but it would have been nice if you'd have realized this was bad when the medics tubed him in his bedroom and carried him out doing CPR. Then you might not have waited until after breakfast to come in and see him.

I'm don't know how you should tell his children (5 and 8) but the social worker, nurses and I can help you with that.


That was yesterday morning. Too busy to post it until now. I've gotta get next Christmas off.

Sorry to hear about that, docB. I went to a cardiac arrest (as a paramedic) as well, and the poor guy was down in the basement in an awkward spot to work on him. He was without resuscitation for 4-6 minutes (what felt like that long) to get him upstairs where we could work on him. Unfortunately he didn't make it, in spite of getting a pulse back for awhile after 6 rounds of epi. Probably better off as his pupils were fixed and dilated before we had even got on scene.

 

[pedidoc]

Working in the PICU forces you to develop relationships w/ families over a long period of time. What kills me is when they bring in pictures and put them all over the room. It really gives you the idea that you know them and you can make them into real people.

Saddest case I had was a two year old who choked on a piece of kiwi while older sister was watching her. Mom and dad two houses away. Pt came into the unit intubated from the ER. Massive brain hypoxia. Hung on for three days. Watched as we disconnected all of the ventilator tubing and IV poles so that mom could hold him while he died. I sobbed in the bathroom.

Even in the PICU, I think there's still some stigma w/ women appearing weak for crying. I don't know how the attending was so rational and able to give directions.

I know I chose to go into peds and that for the most part, it was a really good decision, but sometimes when you look at your kids it just makes you sick to think of other parents' suffering. It's difficult to explain the rationale that says that you are willing to put up with the pain of watching that for the tradeoff that you sometimes can help them get better.

 

[Kittenmommy]

Even in the PICU, I think there's still some stigma w/ women appearing weak for crying.

I think seeing a doctor cry humanizes him/her. Sometimes doctors can come across as unfeeling or unemotional.

When we had to euthanize our cat Jellybean, the vet who had been treating him all those years (and who did the euthanization) stood out in the lobby with us sobbing and hugging. IMO, being unafraid to show emotion like that makes him a stronger person, not a weaker one.

And I feel the same way about the female vets who've cried with us over our cats. It makes me feel that they care as much about our "kids" as we do, and that they're as sad as we are when we lose them or have to let them go.

 

[njac]

I think seeing a doctor cry humanizes him/her. Sometimes doctors can come across as unfeeling or unemotional.

When we had to euthanize our cat Jellybean, the vet who had been treating him all those years (and who did the euthanization) stood out in the lobby with us sobbing and hugging. IMO, being unafraid to show emotion like that makes him a stronger person, not a weaker one.

And I feel the same way about the female vets who've cried with us over our cats. It makes me feel that they care as much about our "kids" as we do, and that they're as sad as we are when we lose them or have to let them go.

agreed. my beloved Toridog is 10 and has CKD. my vet also has her "once in a lifetime dog" who is the same age - and going through the exact same things. It actually helps when she calls me with bad news and she cries with me. I think it helps solidify that you really have done everything that you can, and the families can see that it upsets the doctor too.

 

[Kittenmommy]

agreed. my beloved Toridog is 10 and has CKD. my vet also has her "once in a lifetime dog" who is the same age - and going through the exact same things. It actually helps when she calls me with bad news and she cries with me. I think it helps solidify that you really have done everything that you can, and the families can see that it upsets the doctor too.

I'm sorry about your Toridog. We've gone through kidney issues with cats too, and it's heartbreaking when there's just nothing more you can do for them.

 

[njac]

I'm sorry about your Toridog. We've gone through kidney issues with cats too, and it's heartbreaking when there's just nothing more you can do for them.

thank you. as of her last labs (3 months ago) we were in a good place - SCr down to 2.5 from 3.5 and albumin creeping up to 2.3. But her K was still 5.8 and her urine protein was still 3+++. I've refused to do SC fluids because she does. not. do. needles. and frankly we're ok with it. She is still wild and fun (we found it on incidental lab work for a dental procedure, she's asymptomatic other than getting up to pee in the night) so we'll see where it takes us.

but thank you. I do love the silly dog

 

[Kittenmommy]

thank you. as of her last labs (3 months ago) we were in a good place - SCr down to 2.5 from 3.5 and albumin creeping up to 2.3. But her K was still 5.8 and her urine protein was still 3+++. I've refused to do SC fluids because she does. not. do. needles. and frankly we're ok with it. She is still wild and fun (we found it on incidental lab work for a dental procedure, she's asymptomatic other than getting up to pee in the night) so we'll see where it takes us.

but thank you. I do love the silly dog

It's impossible not to love them, isn't it?

We were doing SC fluids with Jellybean, but Kittendaddy is a needlephobe and I just about died when the vet was trying to teach us to do it at home and I could see the needle hitting resistance as he punctured Jellybean's skin. So we took him back to the vet twice a week and let them deal with it.

One morning we came downstairs and found Jellybean hiding behind the kitchen trash can, and we just knew that that was the end. We took him to the vet, and sure enough he had a mass developing in his abdomen. But his kidney values were great!

 

[Newmanium]

I think seeing a doctor cry humanizes him/her. Sometimes doctors can come across as unfeeling or unemotional.

When we had to euthanize our cat Jellybean, the vet who had been treating him all those years (and who did the euthanization) stood out in the lobby with us sobbing and hugging. IMO, being unafraid to show emotion like that makes him a stronger person, not a weaker one.

And I feel the same way about the female vets who've cried with us over our cats. It makes me feel that they care as much about our "kids" as we do, and that they're as sad as we are when we lose them or have to let them go.

Little off-topic... stick to just the poignant stories of the ER?

 

[Doomydoom]

At my high school we have a class where we can do rotations at a couple of the hospitals here.

Today some of our students had their first day in the ER. To welcome them, a baby that had had scalding hot water poured on it...by its mother.

 

[Jwax]

Do you guys ever get a little misty when you start in telling these folks the news? I know I do. I used to think it was unprofessional. I've decided that it helps to communicate the seriousness of what I'm saying and that I care. I can't really help it anyway so maybe that's just a rationalization but it helps. It always happens when I tell parents about kids.

That was yesterday morning. Too busy to post it until now. I've gotta get next Christmas off.

I gotta say, Vegas EM has been in my short list for residency programs... but your 4 years of stories makes Vegas seem extra awful. Probably all the better for training purposes... but I cry easy. As an MSII, I think I've done my fair share of choking back the tears to not look like a jacka$s med student, but maybe I shouldn't.

My first code to witness was as a pre-med while shadowing at the ER. A ~30 yo WM came in for overdosing on aspirin? tylenol? and alcohol. Had been at the home alone for several hours before a family member found him unconscious. They were running him up for an MRI? CT? Not sure... but he coded on the machine. The EM doc and I went up there til they called it. Then we went back to to tell his parents and siblings. The dad ripped his cell phone into pieces at his grief. The doc and the nurse were both blinking back tears and I was having to wipe them from my face. Leaving the hospital that day was the first time I wanted to get out of medicine b/c who on earth would submit themself to this kind of life?

Second patient I watched die was a L.O.L. who came in short of breath. I was a pre-med then, too, so I can't remember what was wrong. I think it was CHF. I was standing by her hand while they were pumping drugs & yadda yadda. She reached out and took my arm, looked at me, and said "I don't want to die." Shortly thereafter, she went hypotensive and crashed. Still makes me sick to my stomach to think about.

Now I've seen enough people die that I can't really remember them all. Most of this has been in my spare time of following docs at the ED or trauma surgery. I can't wait to see what sad stories I will see when I actually start clinical rotations in July.

 

[docB]

I gotta say, Vegas EM has been in my short list for residency programs... but your 4 years of stories makes Vegas seem extra awful. Probably all the better for training purposes...

Vegas has some real problems when it comes to health care. The best way to sum it up is that there have not been enough doctors for the growing population for decades so the docs that are here are very overworked and have become reluctant to deal with anyone who is at all complex. They are very reliant on the EDs for lots of primary care roles. Consequently people here have lots of barriers to getting care and tend to be very sick by the time anyone does anything. This is a problem everywhere but it’s particularly bad here.

Now I've seen enough people die that I can't really remember them all.

That is a point that everyone in medicine reaches eventually. It’s a kind of rite of passage. It’s not good but it is a fact.

 

[Jwax]

Vegas has some real problems when it comes to health care. The best way to sum it up is that there have not been enough doctors for the growing population for decades so the docs that are here are very overworked and have become reluctant to deal with anyone who is at all complex. They are very reliant on the EDs for lots of primary care roles. Consequently people here have lots of barriers to getting care and tend to be very sick by the time anyone does anything. This is a problem everywhere but it’s particularly bad here.

Hmm thanks for the heads up. I figured Vegas = lots of interesting trauma; not so much Vegas = excessive primary care in the ED. Well, I wonder if an overworked ED is a better place to train than an underworked one. You've got a better chance of seeing everything, but you end up not getting to really dissect and understand why each move is made in each step of the game. Hopefully I'll get to do a month out there in 4th year and then I'll be able to decide which end of the spectrum Vegas lands on.

Sorry for going off topic...

 

[kajunman]

4 kids 16 and 17 years old, driving to a high school basketball game they are playing in get in a roll-over MVC.....all good kids, one has all ready been offered full rides a 4 different SEC school.

two wearing seatbelts walk out of ED with very mild abrasions....other two are ejected, one had a skull fractrue but should recover fine......other is brought in in full arrest....work him for awhile but apparent from the start he is dead.

worse thing about this was walked out of the department to see the 200-300 kids and adults having a prayer service in the parking lot.

wish the news would say the ones that lived had on seatbelts instead of talking about the basketball stats of the kids in the crash.

 

[dmitrinyr]

Holy crap, I'm sorry.

18 year old male presented with 3 weeks of headache, right sided, associated with nausea/vomiting, better when sitting up. Maternal family history was positive for migraines. The pain responded to Motrin and rest. I scanned his head pretty much for CYA purposes (CYA = cover your @ss). I mean, really, how many times have I scanned someone for 'new headache' in the pedi EC and gotten a positive results? Never... until this kid. 4cm brain tumor.

Mother cried, father cried and patient teary.

I had a similar case when I was a medical student. 25 y/o male with no PMhx presents to ED with 2 weeks of nagging HA after his family convices him to get it checked out and he doesn't have a PMD to go to. HA is frontal, was a 3/10, intermittent and does not really get better with OTC pain pills. After sitting in the waiting room for probably 3-4 hours, pt was seen by me (a 4th year student at that time). HA did not sound like a SAH, but did not sound like a migraine either as it did not run in the family and pt had no auras, photosensitivity, common triggers. I convinced my attending to do a head CT (it was more of a CYA move) and guess what we found... midline frontal mass 5 cm in diameter. That poor guy stayed in that room a few hours as he was seen by neurology and neurosurgery consultants and still no one really told him what was going on. Which of course left me to tell him that most likely he has a malignant tumor in his brain from which he will probably die soon (all of this being done over a language-line as my Spanish is not good enough to explain the severity and details of this problem). What sucky fortune that his wife just had their second child.... medicine sucks.

 

[rhan101277]

I just wanted to post and say that I thank everyone for what they do. I just started in EMS, but for the clinicals I had in the ER they go through alot. Here is hoping that my patients reports to ER nurses and doctors sound as educated as I hope they are.

 

[146233]

Community ED -> Burn Center transfer a year or two ago.. 16y/o girl ditches school to hang out with her 24 y/o boyfriend at her mother's apartment in Chicago. They smoke some weed, fool around, and then watch TV. He later decides to take a nap and tells her to turn the TV down. She refuses a few times (neighbors heard them argue).

About 2 hours later, mom comes home to her daughter still smoldering on the couch after the boyfriend doused her with lighter fluid and set her on fire. Mostly full-thickness burns on 80+% of her body. ...because he couldn't sleep.

 

[JeetKuneDo]

Community ED -> Burn Center transfer a year or two ago.. 16y/o girl ditches school to hang out with her 24 y/o boyfriend at her mother's apartment in Chicago. They smoke some weed, fool around, and then watch TV. He later decides to take a nap and tells her to turn the TV down. She refuses a few times (neighbors heard them argue).

About 2 hours later, mom comes home to her daughter still smoldering on the couch after the boyfriend doused her with lighter fluid and set her on fire. Mostly full-thickness burns on 80+% of her body. ...because he couldn't sleep.

Wow, that is messed up...

 

[ForbiddenComma]

20 yo M with dyspnea. SVC syndrome. CT from a trauma a year and a half ago was negative.

New CT shows a big ol mass obliterating his mediastinum. Some sort of NH lymphoma. It's laughing off everything oncology is throwing at it. They told us to watch for tumor lysis... what a joke! His K barely budged.

And CT a year and a half ago was clean. FFS. This tumor is not fooling around.

 

[Midwest Medic]

48 y/o mother of 2 young girls with a h/o breast CA. Had bilateral masectomy, chemo, radiation, was node negative on axillary dissection. Just had reconstructive surgery a few months ago. came in with constipation for last 1 week. CT of abdomen and pelvis shows multiple mets to colon and 4-8 mets in lungs. Got to tell her and her family thre great news with the daughters in the room.

 

[Apollyon]

3 y/o mauled by a German Shepherd. From a distance, looked like he was bald; nope, it was his skull - rather beige - not pearly white. From about 1cm above the eyebrows, scalped. The balance of the material on his head was just hanging behind him, with only the ears to hold it up. Huge gash on R side of face, smaller on L. Remains of forehead are sagging downwards. EOMIs intact, though.

ENT on facial call - immediately in. Thought it would just go back together, but, no - tissue loss at the vertex - about 4cm x 4cm square. Not even periosteum left, so would be an exposed plain bone. Recovered tissue looks like a chewed piece of meat; can't be used. Plastic surgeons in town can't handle it. Airlifted to Carolinas, where they have a peds plastic surgeon.

 

[telenurse]

2003 My Aunt died pulmonary fibrosis
2005 My Uncle died small cell lung cancer.
2006 Another Aunt died pulmonary fibrosis
2007 My father died Large cell Neuro-endocrine carcinoma
2008 My favorite Uncle died,
We have a history of carcinoid, pancreatic tumors, and colorectal cancer, and another uncle who died from Neuro-endocrine cancer, and other malignant endocrine neoplasms.

My father recieved his dx and I found out he was terminal on my birthday.

My sister has suddenly developed a large goiter, with nodules and calcifications.. After the u/s, her surgeon decided to skip biopsying the nodes and go straight for surgery. She's having a thyroidectomy, and we should have the results of her pathology back on my birthday.

It frakkin sucks, autosomal dominant inherited familial syndromes...

 

[ZincFingers]

2003 My Aunt died pulmonary fibrosis
2005 My Uncle died small cell lung cancer.
2006 Another Aunt died pulmonary fibrosis
2007 My father died Large cell Neuro-endocrine carcinoma
2008 My favorite Uncle died,
We have a history of carcinoid, pancreatic tumors, and colorectal cancer, and another uncle who died from Neuro-endocrine cancer, and other malignant endocrine neoplasms.

My father recieved his dx and I found out he was terminal on my birthday.

My sister has suddenly developed a large goiter, with nodules and calcifications.. After the u/s, her surgeon decided to skip biopsying the nodes and go straight for surgery. She's having a thyroidectomy, and we should have the results of her pathology back on my birthday.

It frakkin sucks, autosomal dominant inherited familial syndromes...

I'm sorry. Genetic syndromes are a bitch. Only a small fraction get a fancy name in the medical textbooks.

Today we saw a thin-as-a-rail, nonsmoking, nondiabetic, otherwise healthy early-50s woman who needed a CABGx3 because of multivessel CAD. On top of the calcified aorta (AAA in her near future), shot carotids (CVA city), clogged iliacs, you name it, she got it. Despite living a medically blameless life. Nothing she could have done differently to prevent this. When God was handing out the arteries, she drew the model designed by the lowest bidder. In med school, they group this sort of thing under the mushy header "multifactorial" which doesn't mean much of anything except "we have no treatment, no cure, and no idea why it's happening to begin with."

 

[DrJosephKim]

Do everything you can to mitigate your risk. Lifestyle has a huge impact on the prognosis of several of these types of conditions.

 

[leviathan]

I'm sorry. Genetic syndromes are a bitch. Only a small fraction get a fancy name in the medical textbooks.

Today we saw a thin-as-a-rail, nonsmoking, nondiabetic, otherwise healthy early-50s woman who needed a CABGx3 because of multivessel CAD. On top of the calcified aorta (AAA in her near future), shot carotids (CVA city), clogged iliacs, you name it, she got it. Despite living a medically blameless life. Nothing she could have done differently to prevent this. When God was handing out the arteries, she drew the model designed by the lowest bidder. In med school, they group this sort of thing under the mushy header "multifactorial" which doesn't mean much of anything except "we have no treatment, no cure, and no idea why it's happening to begin with."

I'm assuming cholesterol is normal / no hx of FHC?

 

[Makati2008]

Today I had a young woman come into the ER where I work and she had committed suicide. The family threw her in the pick-up truck and drove her ten miles to the hospital and when we got her in the ER I saw a small entry wound from a bullet in the temporal region....to make matters worse she did this at her family's gravesite over a relative she was close to grave. To make this fXXXed up thing worse is I know the family personally. I coded this very young person as deemed appropriate with the consultation from the attending and called it when appropriate. When I went to tell the family the bad news it broke my heart to hear her grandmother say-"Makati save her I know you can save her" I very literally just felt like someone kicked me in the family jewels.

MEDICINE SUCKS!
I hope you all have a better day/night than me.

 

[Stitch]

Two cases completely unrelated but of course happen at the same time. And at shift change, with just me, a fellow and one other attending.

8 year old asthmatic in status. Parents smoke and had run out of albuterol. Getting worse at home, and mom finally called EMS. Kid deteriorated in transit and they had to tube him (I HATE tubing asthmatics). He was so tight they could barely bag him, but no pneumo. Arrested on arrival and despite a lot of time coding, couldn't bring him back.

And as he arrived, another EMS team brought in a 12 month old unresponsive into the other resus room. She was 'just found that way' at home. Tubed on site and arrived with an IO and getting chest compressions. Pupils fixed and dilated by my exam with some bodily bruising. Turns out dad has had allegations of child abuse in the past, but no hard evidence. Until now. Autopsy pending. I hope they go for the death penalty.

 

[ZincFingers]

I'm assuming cholesterol is normal / no hx of FHC?

Indeed so.

I wish this weren't the only time I've seen this. Last time was on neuro. 55 yo male, again thin as a rail, never smoked, no HTN, works out, works as an important music instructor at the local university, no hx of a familial syndrome or anything else. L carotid occluded > 95%; R carotid 100%. Presents with amaurosix fugax. Initially admitted to cards for angina. Cards, neuro, vascular, and IR all fighting because nobody wants to take him. I got to witness some dramatic interservice debates. (The IR guy here is legendary for being hardcore but even he didn't want to get involed.) Seriously... the guy was just plain hosed. Even a CEA would buy him only 6 months before a reocclusion. wtf were we supposed to do? wtf was HE supposed to do?

In the end, they just d/c'ed him because I guess nobody wanted to be liable for the inevitable. I hope he got a CEA at a different facility... he was lost to followup.

 

[Apollyon]

Not one, not 2, but 3 fetal demises today. No healthy pregnancies.

First was a surprise, and was over before pt even knew she was pregnant. Second had to go to the OR for emergent D&C. Third, the worst. Intelligent, clean, NICE (so you know the worst is going to happen) young black couple. She's 21, G1P0. Just found out she's pregnant 3 days ago. Ecstatic. Starts bleeding today. No pain. HCG is 29K, 12w6d by dates. They coordinate. My bedside U/S shows IUP, no heart tones. I tell the patient that, more than likely, it is my technique that is the problem. Formal U/S, no heart tones - "likely demise" per rads.

Were she a lazy, scummy, leechy baby factory, would be home free.

 

[thanecyan]

MS0 here.

These stories are depressing but inspiring.

 

[ZincFingers]

15 year old AA girl, nicest family you could ever meet, churchgoing, so you know she's in for it. DM1 with a glc around ~500, presenting with lethargy. Ok, I've seen worse... at least I have until her venous gas came back at a pH of 6.76.

My attending got the news before I did... no wonder he was giving the mom "the talk" when I came by to check up on her. I was like, dude, a blood sugar of 500 isn't the end of the world. Little did I know.

 

[bravotwozero]

15 year old AA girl, nicest family you could ever meet, churchgoing, so you know she's in for it. DM1 with a glc around ~500, presenting with lethargy. Ok, I've seen worse... at least I have until her venous gas came back at a pH of 6.76.

My attending got the news before I did... no wonder he was giving the mom "the talk" when I came by to check up on her. I was like, dude, a blood sugar of 500 isn't the end of the world. Little did I know.

What is the significance of a 6.76 venous gas pH? What sort of conditions are you looking at?

 

[dchristismi]

That would be the "A" in DKA.

And 6.76 is pretty darn acidotic. A young-un like her will probably pull through, but no guarantees. Gramps, not so much.