Medicine Sucks

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The law of inverse value again...

45 y/o healthy cardiologist, home alone studying for recert boards. Going inside from his deck, opens the door, and the wind catches it - blowing him over the edge, 15 feet to the ground. Has to crawl about 100ft before anyone sees him.

Burst high lumbar fracture with retropulsion into the cord. Fortunately, motor maintained, and just some numbness. NeuroSx will do a reconstruction (instead of a fusion) later today.
 
Dear God...

Every one of our nightmares to have a colleague roll in as a trauma.

(I have cared for colleagues, but never like that.) Prayers to his family.
 
We get a patient in L&D triage, G1P0, complaining of ctxs. Diagnosed in early labor, sent home. On the way home with husband, hit by drunk driver running red light. Husband is okay. After hours in the ED/Surg, external fixation of both legs, comes up to L&D to deliver her baby, which of course had died, since they are such great people.

The OB techs had to support her legs while she pushed and cried and delivered. It was horrible. Afterwards she goes to another unit, and the drunk driver is on the same unit, two doors down. Fortunately (or unfortunately) the staff figures it out and moves him before the dad learns who he is and kills him.

------------------------------------------------------------------------

20yo G1P0 is driving to work, stops at light. Her abusive ex-boyfriend has been following her and pulls her out of the car, makes good use of his fists, pulls her around by the jaw, kicks her... after being cleared in ED, gets admitted to deliver her IUFD. Horrible.
 
The last two weeks have blown for me.

2 year old 'walking funny'. MRI shows gigantic midbrain tumor.
6 year old, no PMH, AMS: ruptured AVM... not doing well.
6 month old, 'fell off the couch'. old skull fracture, multiple new and old bleeds.



gah.
 
- found this site through a link to the "TILFMP" link (from the "customerssuck" website- similar concept as that sillier thread, but with people acting extra-tragicky over even lower-import stuff, like "I seen it on teevee! I know yous has it!") ...




Not in a medical profession at all, but, hey, have visited medical professionals a lot since I was born (6 weeks early in the 70's, and of course a bunch of follow-up health issues- thanks for helping me survive!), and just wanted to add to the people thanking everyone here profusely for being the kind of person that can and does do this on a daily basis. My God, thank you and thank you again. 😍


I know from experience that there ARE people who suck/ get burned out/ otherwise shouldn't be dealing with patients (heh- impatients?), but most medical professionals like the folks here deserve all the thanks we can give.


... and also, now I need to find a medical center of some sort to send pizza to... 😀



(... man, I work in a store/ drugstore, and I wish more people would realize, that... overall, if they're in good enough shape to BE there buying expensive drugs, they're freaking lucky to be alive... I am SO glad I don't work in the actual pharmacy part... people bitching about the lady writing a check taking too long, and her daughter comes back in a few minutes later and apologizes... APOLOGIZES... because her mom is out of it, because her husband of over 40 years - the apologetic lady's dad- just died and she's barely starting to be able to function in public... and the guy in line behind them is bitching because he can't buy his newspaper fast enough while he chats on his cellphone... and the guy behind him is just sad because he didn't get to the front of the line in time to buy his adult diapers before he needed them... and this is just dealing with the*survivors*. Again, I salute you.)
 
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35 yo F with no medical problems, 2 young children and a primary seizure. CT at outside hospital showed ugly looking 3.5 cm brain mass. They got transferred to me so neurosurg could see them. I gave her the usual "We'll get you in and get the neurosurgeons involved and they'll figure out how to best figure out what this is and what to do about it." Naturally they're freaking out. They kept asking "But doctor what do you think this is?" I had to keep saying "We don't know yet but we'll find out." That's what you have to say because they don't want to hear what I really think it is.
 
docB said:
35 yo F with no medical problems, 2 young children and a primary seizure. CT at outside hospital showed ugly looking 3.5 cm brain mass. They got transferred to me so neurosurg could see them. I gave her the usual "We'll get you in and get the neurosurgeons involved and they'll figure out how to best figure out what this is and what to do about it." Naturally they're freaking out. They kept asking "But doctor what do you think this is?" I had to keep saying "We don't know yet but we'll find out." That's what you have to say because they don't want to hear what I really think it is.
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"Tissue is the issue" - learned that at Duke from the heme/oncs. I live by that.
 
I’ve been losing sleep over this one. 5yo found daddy’s .40 cal. Accidental GSW to the head. Dad carries the kid into the ER in his arms freaking out as you’d expect. Triage nurse (isn’t this case every triage nurse’s worst nightmare right behind the pregnant woman with the little hand waving at you?) runs the kid to the code bed. We’re not a trauma center or a pediatric hospital. My partner was actually the first to the room and I was about a minute behind. He was getting the airway stuff together and calling for the drugs.

The thing that has been getting to me is that the kid was still moaning “Daaaaaddy. Daaaaaddy.” Other than the moaning he was not really doing anything else that was purposeful. I was looking at the wound, side of the head. I thought at first it might have been just a glancing blow but I moved some hair and clot and there was grey matter coming out. About then the moaning stopped and the kid’s resp rate started to drop so my partner called for the RSI and I held C spine. When I held C spine and pulled a little bit I could feel that the whole back of the head was soft and unstable and blood and brains started to run down over my hands.

Tube went in well and I started calling the trauma center while my partner took the kid to the CT scan. We didn’t have a receiving hospital or an ambulance immediately available so we felt that getting a head CT rather than doing nothing was reasonable. The CT was bad as expected given the brain matter oozing out of the wound and the unstable skull. The bullet path had obliterated most of the temporal lobe and was still in the skull. It was becoming more and more apparent that this was an unsurvivable injury.

We grabbed an ambulance that was dropping off and had them truck the kid up to the trauma center where he died within a few hours.

We’ve all seen the GSWs and the kids and the kids with GSWs, even the ones that don’t make it. But I keep hearing that kid moaning “Daaaaaaaady.” The visual and tactile stuff hasn’t bothered me anywhere near as much as that. I have a 4 year old. It’s been waking me up at night. It pops in when I’m not distracted. I was eating dinner with my family yesterday and my wife nudged me and said I was staring off into space. She asked what I was thinking about. There’s a topic you can’t bring up at dinner, especially with your kids.

It’s interesting how with fire, police and EMS there is CISD (Critical Incident Stress Debriefers) even when you don’t need them but not for Emergency Medicine. In EM when you have a really bad case that ties you up and messes you up all you get is a full rack and everyone else is pissed off because the waits are too long.
 
docB said:
We’ve all seen the GSWs and the kids and the kids with GSWs, even the ones that don’t make it. But I keep hearing that kid moaning “Daaaaaaaady.” The visual and tactile stuff hasn’t bothered me anywhere near as much as that. I have a 4 year old. It’s been waking me up at night. It pops in when I’m not distracted. I was eating dinner with my family yesterday and my wife nudged me and said I was staring off into space. She asked what I was thinking about. There’s a topic you can’t bring up at dinner, especially with your kids.
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All I can say is, *hugs*. 🙁
 
I'm not going to devalue talking through tough cases with someone, anyone to get it off your chest. But from what I understand CISD has not been shown to improve measurable outcome (ie rates of PTSD etc). So not sure that pushing the ED towards a model where a lot of time and money is spent on formal debriefing would be the best thing.

But I would advocate having some protected time to talk with colleges about the stresses of the job and vent. I think this happens a lot in med school and residency, I've had several rotations where once a week we got together with a faculty member and talked about things we've been struggling with on the rotation. Maybe attendings could use a similar venue, say once a month have a get together to vent.
 
jbar said:
I'm not going to devalue talking through tough cases with someone, anyone to get it off your chest. But from what I understand CISD has not been shown to improve measurable outcome (ie rates of PTSD etc). So not sure that pushing the ED towards a model where a lot of time and money is spent on formal debriefing would be the best thing.

But I would advocate having some protected time to talk with colleges about the stresses of the job and vent. I think this happens a lot in med school and residency, I've had several rotations where once a week we got together with a faculty member and talked about things we've been struggling with on the rotation. Maybe attendings could use a similar venue, say once a month have a get together to vent.
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It would be nice if there was some way to avoid walking out to the full rack and the whole crowd of "Do you know how long I've waited?" jerks. But that would cost $$$ so won't happen.
 
docB said:
I’ve been losing sleep over this one. 5yo found daddy’s .40 cal. Accidental GSW to the head. Dad carries the kid into the ER in his arms freaking out as you’d expect. Triage nurse (isn’t this case every triage nurse’s worst nightmare right behind the pregnant woman with the little hand waving at you?) runs the kid to the code bed. We’re not a trauma center or a pediatric hospital. My partner was actually the first to the room and I was about a minute behind. He was getting the airway stuff together and calling for the drugs.

The thing that has been getting to me is that the kid was still moaning “Daaaaaddy. Daaaaaddy.” Other than the moaning he was not really doing anything else that was purposeful. I was looking at the wound, side of the head. I thought at first it might have been just a glancing blow but I moved some hair and clot and there was grey matter coming out. About then the moaning stopped and the kid’s resp rate started to drop so my partner called for the RSI and I held C spine. When I held C spine and pulled a little bit I could feel that the whole back of the head was soft and unstable and blood and brains started to run down over my hands.

Tube went in well and I started calling the trauma center while my partner took the kid to the CT scan. We didn’t have a receiving hospital or an ambulance immediately available so we felt that getting a head CT rather than doing nothing was reasonable. The CT was bad as expected given the brain matter oozing out of the wound and the unstable skull. The bullet path had obliterated most of the temporal lobe and was still in the skull. It was becoming more and more apparent that this was an unsurvivable injury.

We grabbed an ambulance that was dropping off and had them truck the kid up to the trauma center where he died within a few hours.

We’ve all seen the GSWs and the kids and the kids with GSWs, even the ones that don’t make it. But I keep hearing that kid moaning “Daaaaaaaady.” The visual and tactile stuff hasn’t bothered me anywhere near as much as that. I have a 4 year old. It’s been waking me up at night. It pops in when I’m not distracted. I was eating dinner with my family yesterday and my wife nudged me and said I was staring off into space. She asked what I was thinking about. There’s a topic you can’t bring up at dinner, especially with your kids.

It’s interesting how with fire, police and EMS there is CISD (Critical Incident Stress Debriefers) even when you don’t need them but not for Emergency Medicine. In EM when you have a really bad case that ties you up and messes you up all you get is a full rack and everyone else is pissed off because the waits are too long.
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Holy crapola. I even lost some sleep last night thinking of this story, esp since I have a 3yo boy at home. The thought of losing a child just sends shutters down my spine......Oh man, some sad stuff we see in our line of work....
 
docB said:
It's interesting how with fire, police and EMS there is CISD (Critical Incident Stress Debriefers) even when you don't need them but not for Emergency Medicine.
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I talked to a Medical Director for an EMS company about this once. At the end of the conversation, neither one of us had been able to figure out why this was the case.

As a cop, we were always offered to attend... sometimes required... CISD's after severe death cases (usual, run of the mill stuff never was). This was especially true for 'unexpected deaths' - if you can call them that.

The doctor said all he was ever offered was to take time to visit the chaplain, talk to the counselors if needed, and detour a couple patients to another physician while he gained his bearings. His belief was that the overall opinion of the community was a doctor who can't handle a death in an E.R. is weak. However, a cop, ems, or fire member who can't handle death is human.

He stated, "just because I've got two letters after my name that you don't doesn't mean it makes it any easier to hold a dead child." So true. A life is a life.
 
DoctorMedic said:
doc i'm sure your hospital pays for counselors/therapists/cisd if you ask for it
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Actually they don't. To the hospital I'm a contractor, not an employee. If I tried to see a counselor on someone else's dime it would have to go through my group's work comp.

The real point is that I don't even care about the counseling. I think that walking out of a mess like that into a rack full of charts and an ED full of hornets is just bad. Does anyone really think that they can pick up the next chart and deal with it with the same mental acuity as they would normally?

CopToPharm said:
He stated, "just because I've got two letters after my name that you don't doesn't mean it makes it any easier to hold a dead child." So true. A life is a life.
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That's a good quote.
 
docB sounds like it could be something to bring up with your group. set up some sort of policy. the biggest problem is there are only so many physicians in ED's especially community that have 1 or 2 physicians on at once. Not easy to get another doctor in there so quick, but there are usually numerous police, fire, EMS on duty and their jobs aren't as constant as a physicians usually. Having worked EMS (Earn Money Sleeping) the ED docs near me always had more to do than we did.
 
DoctorMedic said:
docB sounds like it could be something to bring up with your group. set up some sort of policy. the biggest problem is there are only so many physicians in ED's especially community that have 1 or 2 physicians on at once. Not easy to get another doctor in there so quick, but there are usually numerous police, fire, EMS on duty and their jobs aren't as constant as a physicians usually. Having worked EMS (Earn Money Sleeping) the ED docs near me always had more to do than we did.
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I think docB is well aware of the staffing limitations of his ED. Actually, I think he's the medical director or some such title.
 
docB said:
I’ve been losing sleep over this one. 5yo found daddy’s .40 cal. Accidental GSW to the head. Dad carries the kid into the ER in his arms freaking out as you’d expect. Triage nurse (isn’t this case every triage nurse’s worst nightmare right behind the pregnant woman with the little hand waving at you?) runs the kid to the code bed. We’re not a trauma center or a pediatric hospital. My partner was actually the first to the room and I was about a minute behind. He was getting the airway stuff together and calling for the drugs.

The thing that has been getting to me is that the kid was still moaning “Daaaaaddy. Daaaaaddy.” Other than the moaning he was not really doing anything else that was purposeful. I was looking at the wound, side of the head. I thought at first it might have been just a glancing blow but I moved some hair and clot and there was grey matter coming out. About then the moaning stopped and the kid’s resp rate started to drop so my partner called for the RSI and I held C spine. When I held C spine and pulled a little bit I could feel that the whole back of the head was soft and unstable and blood and brains started to run down over my hands.

Tube went in well and I started calling the trauma center while my partner took the kid to the CT scan. We didn’t have a receiving hospital or an ambulance immediately available so we felt that getting a head CT rather than doing nothing was reasonable. The CT was bad as expected given the brain matter oozing out of the wound and the unstable skull. The bullet path had obliterated most of the temporal lobe and was still in the skull. It was becoming more and more apparent that this was an unsurvivable injury.

We grabbed an ambulance that was dropping off and had them truck the kid up to the trauma center where he died within a few hours.

We’ve all seen the GSWs and the kids and the kids with GSWs, even the ones that don’t make it. But I keep hearing that kid moaning “Daaaaaaaady.” The visual and tactile stuff hasn’t bothered me anywhere near as much as that. I have a 4 year old. It’s been waking me up at night. It pops in when I’m not distracted. I was eating dinner with my family yesterday and my wife nudged me and said I was staring off into space. She asked what I was thinking about. There’s a topic you can’t bring up at dinner, especially with your kids.

It’s interesting how with fire, police and EMS there is CISD (Critical Incident Stress Debriefers) even when you don’t need them but not for Emergency Medicine. In EM when you have a really bad case that ties you up and messes you up all you get is a full rack and everyone else is pissed off because the waits are too long.
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I'm sorry, DocB. I read about this in the local news and have had such a hard time thinking about it.
 
You made me cry. We have all seen some pretty horrible things in this job and part of the reason posts like yours take our breath away is that we know it could have just as easily been us standing in your shoes. I really feel you pain regarding the drama seekers filling up the rest of the ED with nonsense. It is impossible to put on your game face like nothing happened after such a traumatic ordeal and deal with "Do you know how long I have been waiting for my completely nonemergent, chronic complaint?" The last few nights I have needed to give more referrals to the Jerry Springer Show than I care to mention. It sucks when reality slaps you hard in the face, but never seems to touch the people that need that slap the most. My heart goes out to you and everyone touched by the tragedy.
 
I know even for myself it never outweighs all the bad we see, but at least trying to remember some of the good we do helps to get us by. A big part of medicine people don't even think about is all the stuff we have to deal with everyday. And after a while it takes a toll on all of us. Hence doctors high usage of drugs/alcohol and high divorce rates. Wish you all the best.
 
So I get called out to triage to see if a kid with burns needs to be seen by the main ED or by trauma.

It's an 8 week old with 3rd degree burns across his abdomen, around to the back, into the groin/perineum, and circumferential along one arm. The family is wailing and crying, except for mom who seems pretty unconcerned and is reading a magazine. The burns on the kid are clearly not new because there's a strong purulent odor coming from them, the skin has become leathery in areas and there are small patches of faintly healing skin in some of the less burnt areas.

The mom claims it happened when she put the kid into his bath. She didn't think anything was wrong until she took him out at the end of the bath and his skin started peeling. And that was 2 days prior to bringing him to the hospital. Of course, the story mom gives is inconsistent with the burn pattern. But the timeframe is. So whatever she did to the poor kid, she waited two days before bringing him in to the hospital.

The kid is screaming in pain from the burns, and surely had been doing so for the past day. There was barely a dry eye during the evaluation back in the trauma room both from hearing the kid crying out and from anger at the mom.
 
31 y/o male, a friend, and his 2 y/o daughter take off to Home Depot to get paint for the new baby's room (wife is 32 wks pregnant). Freak storm comes out of nowhere and has 98mph winds. A branch breaks from the tree and smakck the car on the roof and lands on the 31y/o head, dead instantly. 2y/o in back is not harmed, neither is the friend. The family hears that he was just pulled from a car and all rush to our ED. Wife is obviously upset and wants to know where her husband is as he was just put in the rig. Got to tell her that he just died. Family takes the daughter to another room to be away from the mother through her initial shock. I go to examine the daughter since she was in the car, and all she kept saying is "Me no boo-boos, daddy has boo-boo, help him, daddy ok?" Toughest thing that I have had to do so far...
 
Midwest Medic said:
31 y/o male, a friend, and his 2 y/o daughter take off to Home Depot to get paint for the new baby's room (wife is 32 wks pregnant). Freak storm comes out of nowhere and has 98mph winds. A branch breaks from the tree and smakck the car on the roof and lands on the 31y/o head, dead instantly. 2y/o in back is not harmed, neither is the friend. The family hears that he was just pulled from a car and all rush to our ED. Wife is obviously upset and wants to know where her husband is as he was just put in the rig. Got to tell her that he just died. Family takes the daughter to another room to be away from the mother through her initial shock. I go to examine the daughter since she was in the car, and all she kept saying is "Me no boo-boos, daddy has boo-boo, help him, daddy ok?" Toughest thing that I have had to do so far...
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Tough one man. Sorry. The kid's voices stick with you.
 
Blah... Just intubated a kid in the PICU who had the summer of a lifetime traveling to china to see his dad, and hitting just about every historic in the far east. They stopped by to visit family on the east coast before returning home. Kid got a rickettsia infection and has been slowly deteriorating for the past few weeks, and now he’s got ARDS to deal with. Naturally the family is amazingly supportive, caring, and understanding. ... not my favorite prognostic indicator.

Medicine sucks, peds blows 🙁
 
About 3 months ago, get an EMS call for possible hanging. Get to the residence and see this 10 year old kid laying on the sidewalk with family all around. Turns out his sister wanders up to his bedroom and finds him hanging in the closet. Family then proceeds to carry him outside...not really sure why... On scene less than 5 minutes. Boarded, tubed, and worked him all the way to the hospital...called soon after we got to the ER. Makes you really wonder what can be so bad in a ten year old's life to make him want to kill himself.

About a week prior to that my partner & I (BLS crew) get a call for a patient who fell. We get there and family member says "i don't think he's breathing". Patient turns out to be pulseless and apneic - DNR, end stage lung cancer. Just got home to go into hospice but was doing perfectly fine. Turns out he was the father of a friend of my partner. The first time I had to tell a family that their loved one had died.
 
Please don't put boiling soup down on the table in front of your 3 year old. Genital burns are quite painful. It was so sad seeing that little girls face as she was lying there in the trauma bay naked with her legs up so we could wrap her in wet gauze. She was more scared than in pain at that point after the morphine. And you feel bad for the parents. It was pretty clear that it was an accident but you know they're gonna get put through the CPS ringer.
 
I had two pedi burn patients this month. One was a 2 yo who spilled a pot of hot coffee over her. Similar story to DocBs and she was so scared. The second was an 8 mo old who rolled off his parents bed in the middle of the night onto a radiator. 2nd and 3rd degree burns to his hand, scalp and ear. Horrible.
 
beanbean said:
I had two pedi burn patients this month. One was a 2 yo who spilled a pot of hot coffee over her. Similar story to DocBs and she was so scared. The second was an 8 mo old who rolled off his parents bed in the middle of the night onto a radiator. 2nd and 3rd degree burns to his hand, scalp and ear. Horrible.
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I've seen a few of these unfortunately. The 'worst' (most frustrating) was a family who had been told that a humidifier might help the baby's congestion. Mom couldn't afford one, so she boiled water and put it in a pan beside the couch to humidify the room. The kid rolled in. The CPS investigation basically decided she was stupid and not malicious, but still. At some point stupid should become a crime.
 
Stitch said:
I've seen a few of these unfortunately. The 'worst' (most frustrating) was a family who had been told that a humidifier might help the baby's congestion. Mom couldn't afford one, so she boiled water and put it in a pan beside the couch to humidify the room. The kid rolled in. The CPS investigation basically decided she was stupid and not malicious, but still. At some point stupid should become a crime.
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Those kind of cases are always tough. I know usually the parents aren't at fault and either careless or plain stupid but can CPS take the child away if lets say the parents are stupid and just keep repeating the same stupid mistakes and indangering the child? I would assume so but I'm just curious if you guys seen examples of this.
 
dmitrinyr said:
Those kind of cases are always tough. I know usually the parents aren't at fault and either careless or plain stupid but can CPS take the child away if lets say the parents are stupid and just keep repeating the same stupid mistakes and indangering the child? I would assume so but I'm just curious if you guys seen examples of this.
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It depends on the state, but in general yes. My overall feeling is that children in this country are treated like property, but repeat dangerous stupidity can result (eventually if the child survives) in taking the kid away. It's still difficult though, as those with bleeding hearts always want to give 'one more chance.'

Although I did read about one case in the mid west where they asked the court for mandatory sterilization. 😱
 
16 y.o. M playing in street with his friends. Caught a stray bullet in the left chest and brought in coding. Cracked his chest, but his great vessels were shredded. Had to tell mom and sister that he didn't make it.

Last month, I had a 20 something guy come in with his parents complaining of neck pain. Neck films show some lucencies. CT reveals probable clastic mets/primaries in the c-spine and bilateral lung fields. The family wanted me to tell them exactly what it was, but I had to defer to further workup. Happy Halloween man.
 
God looks out for drunks and idiots. A buddy of mine suffered several cracked vertebrae in a car accident (not driving) while drunk. He refused care on scene, taken to the PD with the guy who was driving (drunk), went home a few hours later and collapsed trying to walk up the stairs. Spent the next 3 weeks in the hospital and next 3-4 months in a back brace.

Worst case for me so far was 18M, GSW to head. Playing russian roulette as a joke, thought gun was unloaded. Blew his brains out in front of cousins and brother. Dad brings him in by car, still got a heartbeat and pressure but satting around 40 and dropping fast. Eyes bugging out and brain popping out the right temple. After leaving the trauma room I'm waiting by the ambulance entrance watching the docs prepare their talk for the parents in the family room and the cousins/brother walk out. Soaked in blood head to toe, looking like they saw a ghost...which given 5 more minutes, they did. Dad was sitting on a stretcher outside the trauma room covered in blood with a bunch of cops questioning him about the gun. Obviously in shock, all he could say was he was watching maury povich and his son would never shoot himself on purpose.
 
Jlaw said:
Worst case for me so far was 18M, GSW to head. Playing russian roulette as a joke, thought gun was unloaded. Blew his brains out in front of cousins and brother. Dad brings him in by car, still got a heartbeat and pressure but satting around 40 and dropping fast. Eyes bugging out and brain popping out the right temple. After leaving the trauma room I'm waiting by the ambulance entrance watching the docs prepare their talk for the parents in the family room and the cousins/brother walk out. Soaked in blood head to toe, looking like they saw a ghost...which given 5 more minutes, they did. Dad was sitting on a stretcher outside the trauma room covered in blood with a bunch of cops questioning him about the gun. Obviously in shock, all he could say was he was watching maury povich and his son would never shoot himself on purpose.
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Those always seem to come in POV. Then the car becomes a crime scene outside the ED. Ug.
 
Worst night of my brief medical career recently:
Had to tell three different people they had cancer in one night. Only one had a history of it, but 25 years remote. Of course I hedged, but it was a pretty obvious call in all three. They all took it well, but after the third one I wanted to curl up in a corner. Sucks
 
csmmedic said:
Privately owned vehicle. Used to mean any non-emergency vehicle in most contexts.
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Ah, thanks. I figured it had to be something like that.

DocVirk said:
Worst night of my brief medical career recently:
Had to tell three different people they had cancer in one night. Only one had a history of it, but 25 years remote. Of course I hedged, but it was a pretty obvious call in all three. They all took it well, but after the third one I wanted to curl up in a corner. Sucks
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I'm sorry. *hugs*
 
bad one today working over on the peds side.

8 y.o. female at the the boys and girls club doing her homework after school when some one fired off a rifle round at the building....round went through exterior wall...internal wall and hit her in the head....arrived with GCS 15, telling us her home address and mother's name and number....small wound over right temple...At first we all though it was just a graze wound....withing 10 minutes left upper extremity lost all function....ct showed bullet in the head....

over next 20 minutes pt decompensated became confused then combative....was intubated....

neurosx placed EVD....herniated...non operative.
 
I would really appreciate it if you all take care of yourselves, cause you seem to be the kind of doctors that really care about others. So for your sanity's sake first, family's second, and your patients third, do something to help you channel this pain in a healthy way. By the way, writing about it and sharing your feelings is great 👍, you are already on the right track. I think also sharing with your peers at work will be great. This might help some drop the macho image, and share their feelings. Additionally, you have so much in common. Take some days off when you can and focus on yourself and your family. Find a hobby that you like..(hey as you can see, I dance, dance dance as if there is no tomorrow..).
I am 100% for seeing a counselor if you can, but you can do these things on your own.
Sorry if I butted in :laugh: but :laugh: you all seem to be nice and we (lay people) do not want to lose you.
Good Luck
 
The Law of Inverse Value strikes again. Just started my CCU rotation yesterday and am on call today. Admitted two patients from the emerg, one a 62 year old chain smoking extremely hostile noncompliant vasculopath who has been on long term disibility since 1981(!)with CHF, DM and uncontrolled HTN (can't afford the meds - but smokes 2 packs a day and drinks a 24 of beer on the weekends) who will probably do reasonably well once he is cathed despite leaving the department frequently to smoke and drinking gallons of water while waiting for his bed to be ready.
The other is a bright, friendly polite 23 year old who just started his first real job since graduating university, active, fit, presents with SOB since 1 month, coughing up pink frothy sputum for 3 days, chest film shows a right lower lobe pneumonia and a large heart. Heart rate on presentation was 135. Echo shows a dilated cardiomyopathy and an ejection fraction of 20%. He's been working all month despite not being able to walk up more than 4 stairs without having to stop to catch his breath, and really wouldn't be in the emerg bothering us except his mother is a little worried about him.
Augh!
M
 
5 month old with massive intracranial hemorrhage. Mother had a psychotic break and threw him off a balcony, went down the stairs, picked him up and threw him off again. Many witnesses. Mother was also completely naked when doing this. Spoke with the aunt who said when she left them to go to work, everything was completely normal. Some things in this world are WTF.
 
quagmire223 said:
5 month old with massive intracranial hemorrhage. Mother had a psychotic break and threw him off a balcony, went down the stairs, picked him up and threw him off again. Many witnesses. Mother was also completely naked when doing this. Spoke with the aunt who said when she left them to go to work, everything was completely normal. Some things in this world are WTF.
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OMG, that poor baby. Sounds like Mom has serious problems aside from a psychotic break, and should maybe be institutionalized.

Poor, poor baby. Why does it seem that people who shouldn't have custody of a goldfish have the ability to pop out kids like a dog does puppies, and people who would be awesome parents have infertility issues? Why? It's not f'ing fair.
 
What are you talking about? A psychotic break is about as serious as mental problems get, and would explain her violence and symptoms. And yes, people who throw their baby off balconies while naked during a psychotic break tend to spend some time talking with psych.
 
I just read through this whole thread, and I'm sitting here with tears in my eyes from all the heartbreaking stories. I like to think that I'll remember every patient that dies under my care, but already after a few years some of the stories are starting to blur together.

Some stick with you forever, though...

We had an nurse at our hospital who was a single dad of a two-year-old son. Grandma often brought the son by the hospital to see his dad since they lived just up the street, and a lot of us residents/nurses etc had met the kid. So one summer night, when I was on trauma call, this nurse and his son were walking past the hospital after his shift was done. Dad let go of his son's hand for a second, the kid fell off the curb into traffic. An oncoming car ran him over. This guy came running into the ED with his son in his arms, screaming. Massive head trauma, unstable vitals. We obviously did everything - intubation, head CT - despite the fact that the kid's head was essentially crushed. Dad was just standing in the corner of the trauma bay, covered in blood and brain, crying. I don't think there was a dry eye in the ED. I went to the bathroom and sobbed for a good forty-five minutes after it was all over.

Last year I was at our pediatric affiliate, sewing up a facial lac in the ED. In the room next to me, the ER docs were evaluating a 16-year-old kid who had leg pain for a couple weeks. He'd been seen at an outpatient clinic a couple times, told it was "growing pains" or maybe a pulled muscle, but it wasn't getting better and now he was having some low-grade fever and chills. He seemed like a really nice kid, polite, athletic, wanting to get this taken care of before basketball tryouts next week. I hadn't even finished suturing the lac next door before the kid had a PEA code. It took a solid day of workup after his admission to the PICU to get the answer - massive tumor lysis syndrome from lymphoma, there was tumor in pretty much every major organ. We got called to put in a dialysis catheter later that night. I think he lasted all of about twelve hours before he died. I cried that time, too.

Nice gentleman came into the ER while I was moonlighting last week - severe lower abdominal pain, tachy, hypotensive. He knew something was wrong, even though he was a "pretty healthy guy". "Don't let me die, doc", was the last thing he said before he coded. We actually got back vitals long enough to diagnose him with a pulsatile abdominal mass, and rushed to the OR. I cried while he died with my hands in his open abdomen trying to get a cross-clamp on the aorta. He had a free intraperitoneal rupture. It sucked.

There are days when I really think I should just quit this and open up a bar...
 
Had a woman transferred to our hospital due to HELLP. Previously healthy, G1, had prenatal care without incident until that day. While over in labor and delivery, she suddenly became aphasic and flaccid on the one side. Rushed to CT to find IVH. BPs never went over 160 measured. Stat section.
I was in the ICU, saw her that morning with absent corneals. Ordered definitive study. Later, I had to tell her mother she was brain dead and that no intervention was useful.
Then go home to hug my pregnant wife.
 
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