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Discussion in 'Emergency Medicine' started by docB, Oct 12, 2004.
Wow...that is tough. I'm sorry to hijack the thread, but what risk factors did they have?
One had recently driven a long ways.
The other two nobody knows. Healthy young people.
Really tough situations...sucks for their families
Bad night = time to resurrect this thread again.
Palpable abdominal mass in 25 month old with "less urine than usual, intermittent abdominal pain." Mom had no idea it was there. I just happened to feel it, and it wasn't exactly an easy abdominal exam.
CT with 8cm malignant-appearing retroperitoneal mass and contralateral lymphadenopathy. I was hoping it was just a lot of poop, or maybe a big spleen, or a perfed appy/abscess. Anything but this.
First time I've ever admitted someone to the peds onc service at Academic Children's Ivory Tower directly from my lil' ED.
Having The Talk was awful. Of course, it's a lovely family and an adorable kiddo. Ivory tower now thinking its a neuroblastoma...
Definitely one of those "once I walk in the room, nothing will ever be the same again" moments.
1. Dead kids
2. Young adult trauma deaths
3. New-onset CA
Least favorite things about EM. I hate walking into the pt/family room knowing I'm about to destroy their lives.
I found even worse than walking in to tell them bad news is having to repeat it several times until it sinks in or they understand the gravity of the situation. I just spent 30 minutes trying to explain to someone they had cancer this past week. Sadly, even though I used the word cancer multiple times, I'm fairly certain it still didn't sink in.
Had my first "you have leukemia" talk with the politest, loveliest 50 year old woman ever who was just concerned about her fatigue the last month.
And this thread reminded me of the time I got to tell 2 families that their 18 year old children had just died in a car accident. I didn't have the heart to tell the 19year old driver what had happened to his girlfriend and best friend as he was being admitted for relatively minor injuries.
Bumping this thread up with some good news...
I've been following the Bond Family's blog since it was posted and thought I'd share that the wife (with stage 4 breast ca) reports her breast, bones, and liver are all clear. The brain mets have disappeared except for 1 lesion - which is shrinking. I can't find the post, but I believe the husband (stage 3? colorectal) has no signs of cancer after surgery/chemo/radiation.
Treating domestic violence patients is depressing. Treating the spouse of a colleague for domestic violence really sucks.
Had a SIDS a few days ago. It is absolutely terrible, I was moonlighting and I had to tell the newly wed parents... I started crying when I was telling them... this is why I absolutely hate emergency medicine sometimes.
Sometimes I wish that certain diseases and illnesses (Cancer, AIDS, SIDS, etc) just didn't exist.
5 month old 1st Nations girl brought in because she was "a little pale". Haemoglobin of 45. Gone to the paeds oncology unit 400 kilometers away with leukaemia. Cutest little girl you could ever see, with lovely concerned parents and grandparents in tow.
My first 3 codes as an EMT were under the age of 24. All while being a 18 year old EMT.
My 4th was my medical director. I live in a small town, he was the doctor on call that night, they call him because he had a patient to come see. He starts talking gibberish on the phone and they call the ambulance. We get there, hes talking to us except for periods of silence when his internal defibrillator was going off. He codes, we roll up to the ED, they work him for 40 minutes and call it. He had been my personal doctor and role model since I was a kid.
Fast forward to this year, I was working as a paramedic and I cross cover the ER. One of the other small services comes in with a 13 month old code. Rigor and dependent lividity. We work it, pop in an IO, intubation was impossible, we didn't try for very long, she was just too far gone. Then the family comes soon behind, thats always the worst when you hear the wailing of the family members when they come in. The mom held the baby from 7:00am until noon when they came to take her for autopsy.
We find out that she had been seen for bronchiolitis that Friday in our clinic, she still was having some trouble breathing, so mom and dad were taking turns sitting with her. Dad sat up with her until 2am and finally felt comfortable going to bed and heard her on the monitor when he fell asleep. They woke up at 6am to find her dead.
I was looking through her EMR and she had just started talking and was really developing.
Needless to say, that took a few beers to get over.
Not EM, but one that got to me a while back.
Mild MR early teenage male admitted to inpatient psych through court system after flaying a cat and attempting to sexually molest a peer. Happened a while following his being forced to smoke pot by two older men then repeatedly raped. Sat in on his OT assessment.
On NYE had a couple hit by a drunk driver, husband ejected and DOA, wife arrive quite stable but pretty bruised up. Kept her separate from the husband for a bit until a nurse, not knowing she was standing right outside the patient's room said, "has anyone told that girl from car crash that her husband died?"
Not the way you deliver that news.
had a mother bring her 3mth old in that had been hit by a falling rock. full arrest, got him back for a few minutes than he went south and was circling the drain...CPR infront of the mother for 30mins and 7 rounds of meds because he was her only child, the father had split and she couldn't have anymore.....i felt like the grim reaper...its the first time i actually cried in the toilet the whole time i've been practising.
the reason i could never do peds oncology!
*hugs you so tight*
thanks.....lest to say thats been the hardest thing i've ever experienced in my career so far. i got drunk that night down at the local watering hole!
had to tell a mum and dad today their daughter has a retinoblastoma re-occurrence and will lose her eye
Jesus. *hugs you more, hands you bottle of wine*
Medicine sucks when you have an extremely sad case but can't talk about it (particularly in this medium, even if you don't use identifiers) because you know it's going to go to litigation.
Sorry, DocB. That really sucks.
30 yo F
28 weeks pregnant
Blood alcohol 390
Happy Mother's Day.
Happy mothers day:
New onset intractable hip pain.
Ovarian mass with lesion in R hip. .
1. Dead kids
2. Informing family of (young) trauma victim's death
3. Child-hood SA
4. New onset CA (especially with mets)
I always hate the cases where I ask one of you awesome people "please tell me (s)he has a history of cancer...please".
Just had a case where the lady had a several month hx of early satiety, abdominal fullness, presenting with a few days of N/V. CT with probable ovarian Ca and omental/peritoneal mets....also with an endometrial primary too.
"I" had one like that last year, born 1978. Had her C-section in her ICU-bed, lingered for >4 weeks of ARDS, never really met her (perfectly healthy) child.
All the while reminding me of my girlfriend, I might add.
One room down from her: gentleman (teacher, I think, or math professor) with the same problem, same time. He made it though, barely.
I thus want to disembowel all those smartasses you meet online who love to tell you how swine flu didnt' even exist and was just a hoax or something. With a wooden cooking spoon.
i was doing my Mission rounds a couple of weeks ago doing checks on the soon to be mothers and ended up delivering a stillborn baby boy
I know you just came in for a little cough and shortness of breath that is probably related to the wildfire out near your house... but...
Diffuse and extensive mediastinal lymphadenopathy with tracheal compression in a 16 year old honors student is a hard bit of news to deliver. Rads thinks it's lymphoma - too extensive to be any of the other anterior mediastinal baddies.
She asked me if it was hereditary. Oh, yeah, because her dad, who is barely holding it together at this point, is a Hodgkin's survivor. And he knows exactly what his baby is up against.
Shipped her to the children's Mecca, and hoping for an update in the next few days.
This sort of negated the rush from the earlier patient who brought in the dead Crotalid after a dry bite. He got lucky. Really lucky. She didn't. Or hell, maybe she did, but we just don't know it yet.
Sorry about the rough day. How frequently are people actually able to bring the snake in? I've thought about it, and it just seems like the opportunity would infrequently present itself unless the person is in the middle of yardwork or carrying a pistol
80-ish y/o guy falls at home due to ?syncope vs slip. EMS called. Admitted to ICU.
Grandson rushes to hospital to see him, and gets in a wreck and dies on the way.
Initial patient made it out on time for his funeral
Now I ALWAYS tell family over the phone, "Take your time, you getting here quicker will not change what is going to happen"
Ug. That's awful.
And usually a shovel is the weapon of choice. Long handle, chop snake, voila = dead snake. At least, that's how it's supposed to happen.
Oh, and ideally, the snake is dead when it's brought in.
In my family we use the lawn mower. Kind of hard to pickup the pieces but very effective.
lol, poor snake....80% of bites are dry bites anyway.... i would be more worried about someone washing the bite than killing a snake, bringing it in and having a doctor identify the snake wrongly....i'm the resident snake go to person...i know all species
I've decapitated several rattlers with my shovel, samurai style.
One time I pinned one by spearing it with the tip of the shovel, and then my dad beat the heck out of it with a baseball bat. It was one of our closest father son bonding moments.
80% dry maybe down under, but, with copperheads and cottonmouths here, it's about 20-25% dry hits (actually, mark that crotalids - I'm posting on my phone and it's a pain to go back).
Two pediatric patients brought in Code 3 for asystole? Back to back?
Yeah, glad I got to do that the last hour of my shift.
20mth old brought in today full arrest after falling in the family pool and drowning because the gate was open due to renovations.....eesh, got her back to sinus tach on the ventilator and in PICU but i had to tell her parents they will have to make a decision in the next few days whether or not to continue lifesupport....diffused brain activity and a GCS of 5 at the time of PICU admission. parents called me every name under the sun...so glad i took those acting classes! lest to say i found a empty room on my break and lost it...my own cousin died from drowning in 1997 and she was the same age!
Had a family that reacted to a death really inappropriately. Screaming, running around the ER into other patient rooms, refusing to stay in the consult room. There's appropriately upset and this wasn't it. It just drains you to deal with that.
I felt like it forced me to be extra harsh because they started screaming "No. It's not true. He's still alive. You're lying. You've got to go back and do something else!"
I had to forcefully say "No. He really is dead. I'm sorry but there's nothing else to do. We did everything and it didn't work. I'm sorry but he's dead."
I wish people understood that acting like that isn't a declaration of your love for the deceased. It just alienates you from the people who tried to save him.
Reading this stuff really puts life into perspective. This is just horrid stuff.
I've had a few of these too but they are so rare they'd easily be traced back to the patients. Horrible things. The worst feeling is knowing there's nothing else you can do.
Oh God. That really sucks. Hard enough to lose the patient but to have the family flipping out and disrupting the whole department (not to mention accusing you of lying - who would do that anyway) just makes it that much worse. Hope your month gets better from here,
Triple GSWs at once. Mother and 2 sons. Both sons died. Mother still alive and intubated. Will be horrible to give the news to her. I thought I was going to be the one to tell her, but I think the ICU team told her today. I will find out tomorrow when I'm back. (I'm on trauma)
The holidays are tough. When I do things with my family I find myself thinking about cases where there is a family member who isn't there anymore. There's something about this job they never tell you or you just can't comprehend until you live it.
i feel like the grim reaper....found 8 cancers in last 3 shifts.
I was called to intubate a woman with platelets of 2 and a plummeting GCS in the ICU couple weeks ago. Watched her herniate in front of my eyes while I threw the kitchen sink at her and arranged transfer to a neurosurgery capable hospital. She was only a little older than my wife and had a 9 year old girl at home.
3 year old sent for 2nd sexual assault exam in life. One is bad enough. Poor kid. And it was obvious something had happened too.
Sad. Really sad.