The Case of the Bleeding Ear Takes a Bizarre Twist

[Birdstrike]

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Did I tell you the one about the kid with the bleeding ear, and how it just takes a turn for the bizarre? Well...

My shift is over and I'm ready to head out the Emergency Department door. When I walked in 12 hours ago, the department had 20 waiting patients. I look up at the monitor and after 12 hours of trying to wrestle the department under control, not only is it not under control, now we're 25 patients deep in the weeds. My partner Dr. Jim looks at me and says, "Get out of here. Don't even think about staying late. You can't save the world." With me leaving, the department will drop to single coverage with Jim taking the reins alone the rest of the night. Despite his words, the dejected look on his face reads, Help! It's going to be a long and grueling overnight shift for Dr. Jim.

I look up at the monitor and it says, "Ruptured eardrum." That's easy, I think to myself. I'll stay late and see at least one more patient to help out. I walk in the room and it's a 16-year-old girl, in a green and white basketball uniform, with her mom and dad, who looks like he could be a retired football linebacker. "I got hit in the ear with the ball. I can't hear at all, and my ear's bleeding. This is the second time, it's happened. Last time I couldn't play basketball for a week," she says.

"Okay, let's take a look," I say. I put a couple of drops of peroxide in the ear to soften up the dried blood. Hmm? There are no bubbles. I clean out the ear and…what is that smell? Do I smell raspberry jelly? I clean out the ear more and look at the ear drum. It's perfect. There's no rupture and no laceration in the canal. Her ear is completely normal.

"I won't be able to play this weekend, will I?" she asks. "Just put me on the injured list this weekend, and we're good to go," she says with a bubbly smile. Being that she's 16, and still a minor I ask her parents if she and I can talk in private for a minute. They say okay, I have a female nurse come with me, and we close the door. "Did you put something in your ear?" I ask. “Like raspberry jelly or something, to make it look like blood?"

"Yes," she says, looking deflated. She then confesses that she doesn't want to go to the tournament and concocted the whole story to have a reason to be injured, so she could go to her boyfriend's party, instead. I thank her for her honesty. "Can I go now?" she asks.

I discharge her and on the way out the dad comes back in, "Doc, she faked it didn't she? I know she doesn't want to play in the tournament." Without speaking, I gave a half nod. He smiled and walked out. Even though I was dog-tired after working 12 1/2 hours and staying late, I finished the shift a little lighter, with a simple case where no one died, no one bled out, or inappropriately demanded narcotics.

A week later prior to a shift, our ED director Dr. Bob comes to me and says, "Hey Bird, how've you been? I've got some good news, bad news and ugly news. Which do you want first?"

“None of it," I answer.

"Okay, the good news." Then, with the phrase no ER physician ever wants to hear, "Remember that kid you saw last week? The one with the bleeding ear.....(read more)

 

[BF2BC EMT]

No comment here..... They should sue the jelly company as well.

 

[ILEMres]

Did I tell you the one about the kid with the bleeding ear, and how it just takes a turn for the bizarre? Well...

My shift is over and I'm ready to head out the Emergency Department door. When I walked in 12 hours ago, the department had 20 waiting patients. I look up at the monitor and after 12 hours of trying to wrestle the department under control, not only is it not under control, now we're 25 patients deep in the weeds. My partner Dr. Jim looks at me and says, "Get out of here. Don't even think about staying late. You can't save the world." With me leaving, the department will drop to single coverage with Jim taking the reins alone the rest of the night. Despite his words, the dejected look on his face reads, Help! It's going to be a long and grueling overnight shift for Dr. Jim.

I look up at the monitor and it says, "Ruptured eardrum." That's easy, I think to myself. I'll stay late and see at least one more patient to help out. I walk in the room and it's a 16-year-old girl, in a green and white basketball uniform, with her mom and dad, who looks like he could be a retired football linebacker. "I got hit in the ear with the ball. I can't hear at all, and my ear's bleeding. This is the second time, it's happened. Last time I couldn't play basketball for a week," she says.

"Okay, let's take a look," I say. I put a couple of drops of peroxide in the ear to soften up the dried blood. Hmm? There are no bubbles. I clean out the ear and…what is that smell? Do I smell raspberry jelly? I clean out the ear more and look at the ear drum. It's perfect. There's no rupture and no laceration in the canal. Her ear is completely normal.

"I won't be able to play this weekend, will I?" she asks. "Just put me on the injured list this weekend, and we're good to go," she says with a bubbly smile. Being that she's 16, and still a minor I ask her parents if she and I can talk in private for a minute. They say okay, I have a female nurse come with me, and we close the door. "Did you put something in your ear?" I ask. “Like raspberry jelly or something, to make it look like blood?"

"Yes," she says, looking deflated. She then confesses that she doesn't want to go to the tournament and concocted the whole story to have a reason to be injured, so she could go to her boyfriend's party, instead. I thank her for her honesty. "Can I go now?" she asks.

I discharge her and on the way out the dad comes back in, "Doc, she faked it didn't she? I know she doesn't want to play in the tournament." Without speaking, I gave a half nod. He smiled and walked out. Even though I was dog-tired after working 12 1/2 hours and staying late, I finished the shift a little lighter, with a simple case where no one died, no one bled out, or inappropriately demanded narcotics.

A week later prior to a shift, our ED director Dr. Bob comes to me and says, "Hey Bird, how've you been? I've got some good news, bad news and ugly news. Which do you want first?"

“None of it," I answer.

"Okay, the good news." Then, with the phrase no ER physician ever wants to hear, "Remember that kid you saw last week? The one with the bleeding ear.....(read more)

Tell me the group you work for so I can make sure I never work for them. wow. insane.

 

[emergentmd]

This has to be a joke. No way this happens.

 

[Cinclus]

Wow. Unbelievable. Almost...🙁

 

[ActionFigure]

this sounds more like a case of $h!* parenting

 

[Arcan57]

I appreciate the point you're trying to make Bird, but you're getting increasingly heavy-handed in your stories. One of the things I find beautiful about EM is that there's no need for embellishment. The absurdity we see doesn't require dramatic license. You're writing fiction (and you're almost always a compelling read) based on actual events for an audience that's used to non-fiction. Nothing wrong with that, but it makes it harder to have a useful discussion about how to fix things when your opposition is the boogeyman.

 

[Birdstrike]

I appreciate the point you're trying to make ...

Just to clarify, the point I was trying to make with this post was, well....nothing. That's right, there was no point. It's just a story.

...you're getting increasingly heavy-handed in your stories.

I'm not sure what this means. I'm not sure how a 1000 word patient story is "heavy handed."

One of the things I find beautiful about EM is that there's no need for embellishment. The absurdity we see doesn't require dramatic license. You're writing fiction...

If you are going to spend the three minutes reading one of my patient "stories" please do so with the assumption they are fiction. That's right, fiction. 100% made up. (Or is my imagination really that good?) To write a "story" based on a real patient, fact for fact, finding for finding, detail for detail can't be done. It's a HIPAA violation (and boring as s--t). You know that. I'd be stupid to do so. There's a HIPAA disclaimer on every post. That being said, there is only as much "truth" as you ascribe to a story or a post. To the extent it reminds you or a reader of something or someone you've seen, encountered or experienced, is the extent to which the post is "true." To the extent that a post, or a "story" seems fictional, implausible or embellished based on a reader's own experience, is the extent to which it is.

Was House of God "true" or was it "fiction" or was it something entirely different? I don't know, but I loved reading it. By the way, I'm not a "writer," have no training as a "writer" and have never earned a penny from any post I've ever made. I have no desire to be considered a writer and as such, nothing I've ever posted or will ever write can hold a candle to writing such as the House of God.

My last post on the "Amazing Little Girl" got comments that ranged from "wonderful" on KevinMD and "nice" and "interesting" on SDN, all the way to a "clumsy little piece of fiction" on KevinMD.

Which is it?

It's all of the above, and everything in between, I suppose.

...it makes it harder to have a useful discussion about how to fix things when your opposition is the boogeyman. ..

Awe come on. Do you really think anything I write has the ability or power to help or hinder anyone's desire to "fix things," whatever those thing are you are hoping to fix?

Let me set the record straight. I am under no delusion that anything I write or post on the internet is going to "fix" anything. Neither am I under any delusion that anything I post matters enough to prevent anyone important from actually fixing something that's fixable. I'm not in business to "fix" "things." That's a job for much more important people.

...you're almost always a compelling read

For someone who is randomly posting stuff on the Internet no different than everyone else on here, I take this as a compliment. I suppose it's cool that you care enough to read what I post and comment. So, I give an honest, thanks.

 

[Taxguy]

Just to clarify, the point I was trying to make with this post was, well....nothing. That's right, there was no point. It's just a story.




I'm not sure what this means. I'm not sure how a 1000 word patient story is "heavy handed."



If you are going to spend the three minutes reading one of my patient "stories" please do so with the assumption they are fiction. That's right, fiction. 100% made up. (Is my imagination really that good?) To write a "story" based on a real patient, fact for fact, finding for finding, detail for detail can't be done. It's a HIPAA violation (and boring as s--t). You know that. I'd be stupid to do so. There's a HIPAA disclaimer on every post. That being said, there is only as much "truth" as you ascribe to a story or a post. To the extent it reminds you or a reader of something or someone you've seen, encountered or experienced, is the extent to which the post is "true." To the extent that a post, or a "story" seems fictional, implausible or embellished based on a reader's own experience, is the extent to which it is.

Was House of God "true" or was it "fiction" or was it something entirely different? I don't know, but I loved reading it. By the way, I'm not a "writer," have no training as a "writer" and have never earned a penny from any post I've ever made. I have no desire to be considered a writer and as such, nothing I've ever posted or will ever write can hold a candle to writing such as the House of God.

My last post on the "Amazing Little Girl" got comments that ranged from "wonderful" on KevinMD and "nice" and "interesting" on SDN, all the way to a "clumsy little piece of fiction" on KevinMD.

Which is it?

It's all of the above, and everything in between, I suppose.



Awe come on. Do you really think anything I write has the ability or power to help or hinder anyone's desire to "fix things," whatever those thing are you are hoping to fix?

Let me set the record straight. I am under no delusion that anything I write or post on the internet is going to "fix" anything. Neither am I under any delusion that anything I post matters enough to prevent anyone important from actually fixing something that's fixable. I'm not in business to "fix" "things." That's a job for much more important people.



For someone who is randomly posting stuff on the Internet no different than everyone else on here, I take this as a compliment. I suppose it's cool that you care enough to read what I post and comment. So, I give an honest, thanks.

Fair points. Please keep writing. I find your stories enjoyable to read. Perhaps one should think of them as Bible stories: some element of truth, but lots of other stuff too.

 

[Zanegray]

Fair points. Please keep writing. I find your stories enjoyable to read. Perhaps one should think of them as Bible stories: some element of truth, but lots of other stuff too.

Bird.... in case you missed it Taxguy just compared you to the author of the Bible... you know... God.

 

[Birdstrike]

Bird.... in case you missed it Taxguy just compared you to the author of the Bible... you know... God.

After a sharp rebuke by Arcan, Taxguy compares my prose to that of THE CREATOR himself (and also his apparent tendency to embellish, LOL). How could I miss that? Taxguy gets it (and I get that he was trying to be funny).

👍 Taxguy!

But...sometimes truth is stranger than fiction:

Have you never stayed late for a shift and have that last easy case just blow up in your face and seriously regretted it? Have you never had a patient fake an injury or illness for secondary gain? Have you never seen child in the ED that was a victim of horrendous psychosocial drama and all of a sudden it's you who's suddenly expected to fix it? Have you never been stung by that line, "Remember that patient you saw?" Have you never had an utterly ridiculous patient complaint? Have you never felt that admin had their backs more than yours?

So where's the "truth" and where's the "fiction"? All of a sudden it starts to blend together after all. I don't care that Arcan thought my post was stupid (okay, maybe a tiny bit), but anything I post here or anywhere else is just for the heck of it anyways; there's nothing riding on it whatsoever. It has been quite interesting, though, seeing posts go up here, then on Whitecoat's blog, then on KevinMD.com (huge audience on that site) and seeing such drastically different reactions. One audience thinks a post is stupid, and another loves it and it gets read 8,000 times. I can't explain it. I'm surprised anyone cares to read any of it, to begin with. It's been interesting, to say the least.

I'm no different than anyone on this site: I'm just a guy that wastes time posting crap on the Internet for the heck of it. Why a few guys with blogs want to put the stuff I post on their site is as much a mystery to me as anyone else. The most surprising thing, is that anyone really cares, one way or another.

So where's the "truth" and where's the "fiction"?

 

[Arcan57]

After a sharp rebuke by Arcan, Taxguy compares my prose to that of THE CREATOR himself (and also his apparent tendency to embellish, LOL). How could I miss that? Taxguy gets it. (I'm still not quitting my day job).

👍 Taxguy!

The issue was I was thinking of you more as a John Stewart type but you're actually going for a Mark Twain vibe. Your clarification clears up some cognitive dissonance. Carry on...

 

[Birdstrike]

The issue was I was thinking of you more as a John Stewart type but you're actually going for a Mark Twain vibe. Your clarification clears up some cognitive dissonance. Carry on...

John Stewart? I'm not nearly that good.

Mark Twain? Nothing I ever write will be read, mentioned or payed attention to, 100 years after I'm gone, like Twain. I'm certain of that.

If you really want to know how and why I take the time to write and post the stuff I do, let me explain.

I've experienced (as I'm sure you all have, too) and seen many things in my time as a physician that have impacted me profoundly. Some of the things I've seen, done and experience still affect me and I am reminded of years later (I know, I should just "get over it!" right?) For some reason, it feels therapeutic to put these cases and experiences in print, in some form (it really doesn't take long to write a two to three page post). So what I do, is write down fact for fact, experience for experience what I've been through or seen and how it affected me. I literally write this stuff down for myself, just for the hell of it, when I have a spare 5 minutes, and hit "save". But in that form, a patient cases or "story" is not publicly shareable. So what I do later, is I run back through what I've written and first, change enough so that if posted, it does not violate anyone's privacy, patients and co-workers. (There are actually 18 things that legally must be changed or deleted [ http://cphs.berkeley.edu/hipaa/hipaa18.html ] to be HIPAA compliant). Then, once "technically" compliant with HIPAA, I read through the post again, to make sure it fits my own "sniff test" of, "Is there any person that, despite the deletion of names, places, identifiers, etc, can read this and say, 'That's me!'?" Naturally, some of the stuff is so bizarre and unique, I have to change and distort things further and drastically, to pass that test. Some of the best stuff I want to write about is so bizarre, unique and therefore identifying, I just haven't found a way to modify them enough to make them postable, without losing the essential nuggets of truth. Pretty soon, you have something essentially fictional, and therefore HIPAA compliant ( and certainly not fit for JAMA or the Annals) BUT, the final test is that it has to evoke the same emotion, experience, essence and TRUTH (there's that word, again) of that which has made it hang around within my head for so long. The last rule is that I'm never looking to be scientific or educational.

(I don't know, is that "art"?)

So, why post these "stories," or "cases" or whatever they are, and why not just keep them private on my hard drive? I think there is a severe lack of this sort of expression in the world of Medicine. Most of what people write and blog about is either profoundly cerebral and career obsessed (boring!) or just open bitching about their plight and gloomy future as a doctor (boring!). If even one person reads a post of mine and feels that it reminds them of something they've been through, or entertains them, or makes them feel someone else has gone through what they've gone through, or "gets it" where they're having trouble finding anyone admit they "get it," then I supposed it's served a purpose beyond me just writing "therapeutically". The worst case scenario is that they what I've written is ignored, is a total bore, and fades quietly into cyberspace until I come along and push "delete," some day. I'm fine with that, in fact sometimes I'd prefer that. Second worst case scenario is that a post irritates someone. That's inevitable, and I'm okay with that, but it's never the intention. I've found even the most innocuous post will annoy someone if read by enough people. Best case scenario is that people read a post and like it. I'm cool with that, too. I don't do it to be "known," and that's why I remain anonymous. If some of my posts come off as "amateurish," that's because they're written by, well, an amateur (I've never been paid for one, but that's not to say I wouldn't). The advantage I have, is that very few "professional" writers have seen and done what I (and you) have done. And when I'm out of things to post or write about, I'll be done.

 

[Procyon]

Can someone explain what Press Ganey is to me? For some reason I'm reminded of when I worked in a grocery store back in high school, and if I wasn't ringing up a certain amount of items per minute they'd get all upset. haha

 

[Arcan57]

Can someone explain what Press Ganey is to me? For some reason I'm reminded of when I worked in a grocery store back in high school, and if I wasn't ringing up a certain amount of items per minute they'd get all upset. haha

Google is a thing and available through the same browser that got you here. If you have a specific question that hasn't been asked and answered in the multiple threads that have related to PG on this subforum, please feel free to ask.

 

[docB]

I tried searching it and on SDN I got a lot of hits that assume knowledge of it. On Google I got a lot of opportunities to hire Press Ganey which is not helpful either.

So for the sake of those who don't know:

Press Ganey (AKA PG) is a consulting company that will (for a fee) survey ED patients to assess for patient satisfaction. There are other companies that do this as well, e.g. Gallup. These surveys are of dubious value for several reasons including questionable statistical validity and sampling bias. Most importantly there are many reasons why "customer satisfaction" is not a beneficial goal and may cause long term harm in EM. Nevertheless these surveys are frequently used against EPs and EM groups by hospitals.

 

[WilcoWorld]

In my opinion, anyone who has cause to ask about Press Ganey should be made familiar with the article, The Cost of Satisfaction, in which higher satisfaction scores were shown to correlate with higher mortality.

First, do no harm.

 

[Birdstrike]

Can someone explain what Press Ganey is to me? For some reason I'm reminded of when I worked in a grocery store back in high school, and if I wasn't ringing up a certain amount of items per minute they'd get all upset. haha

You apparently understand it more that you realize.

 

[Procyon]

Haha, thanks for explaining, guys. 👍

Birdstrike, fwiw I like your stories. They're insightful and interesting for a guy considering EM. 🙂

 

[Birdstrike]

Haha, thanks for explaining, guys. 👍

Birdstrike, fwiw I like your stories. They're insightful and interesting for a guy considering EM. 🙂

Thanks. 👍