Things I Learn From My Patients

[ISR]

Sub thread:

Things I learned from my attending:

If you page the attending twice and call his office, and he doesn't return your phone call for over 90 minutes, it is almost certainly your irresponsible behavior that resulted in his patient delivering her baby 8 weeks early. Stupid intern!

Also, never, EVER document that you called him three times, because that increases his liability and you get your a$$ chewed for an additional 10 minutes.

I LOVE being an intern!

Well of course it can't be the attending's fault! After all, you did only page him twice, and called him once. Didn't you know you have to page 'em every five minutes repetatively?

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[sddoc]

That's right... my bad. What's the punishment for that anyway? 50 lashes?

 

[Depakote]

Also, never, EVER document that you called him three times, because that increases his liability and you get your a$$ chewed for an additional 10 minutes.

Silly intern, will you ever learn?

 

[8744]

Silly intern, will you ever learn?

Right. Make it a habit never to screw anybody over. If you have to document something jsut write "Attending was paged at 2030" and leave out the editorial comments.

 

[Apollyon]

Right. Make it a habit never to screw anybody over. If you have to document something jsut write "Attending was paged at 2030" and leave out the editorial comments.

Putting down each time someone was paged is not an editorial comment, and is definitely the right thing to do. I've documented paging someone 5 times without response.

 

[Sweet Tea]

What I learned from my patient this morning:

When you wake up drunk and find yourself in the ED with blood streaming down the side of your head, the correct response is not to rip out your IV, rip off your clothes, and go streaking down the hallway. This move quickly buys you 4-point restraints.

 

[beyond all hope]

Don't help if you do it five times.

If the chart is seen in a courtroom, you will be expected to move up the food chain after a reasonable period of time if the condition is serious enough.

Paged intern 1230
intern 100
Paged junior 115
Paged attending and junior 130
Paged cheif of surgery 145
etc

If you paged the intern five times and the patient dies from mesenteric ischemia because he didn't get opened by surgery, you're probably not off the hook. If you went up the ladder to the cheif and no one got back to you, it will seem that you acted in the best interests of the patient to get a specialist down as soon as possible.

 

[Apollyon]

Don't help if you do it five times.

The case I refer to was 4 calls to the cardiology attending, then to the fellow in the CCU, whom I directed that this patient would be admitted when I didn't hear back.

I learned a lesson as an intern when the surgery consult person that day was actually a PA, and was absolutely dragging her feet. When she finally DID come down, she became pallid and diaphoretic after I told her the attending had already come and gone, having stuck his finger in the colostomy and breaking up the stool. That's because the attending that day was the Chairman of the Department of Surgery (the "king of kings", because all surgery are divisions under the department at Duke).

What's right is right, and I'd rather be right than popular.

 

[ISR]

I learned a lesson as an intern when the surgery consult person that day was actually a PA, and was absolutely dragging her feet. When she finally DID come down, she became pallid and diaphoretic after I told her the attending had already come and gone, having stuck his finger in the colostomy and breaking up the stool. That's because the attending that day was the Chairman of the Department of Surgery (the "king of kings", because all surgery are divisions under the department at Duke).

What's right is right, and I'd rather be right than popular.

Besides...that look of PURE PANIC on her face had to have been priceless!

 

[Paws]

What's right is right, and I'd rather be right than popular.

A surgery attending told me that if I paged the intern and did not hear back after several tries, then to page the resident, the fellow and the attending - in that order. She told me, that I would in no way be penalized and that the attending would be very interested in learning that the people working below them were not doing their job. She said, when a patient's life is at stake and something is critical, go up the ladder until you get the help.

I think either way you're sort of screwed, but I would rather piss people off for a good cause than because I sat on my hands and let a patient situation get out of hand all alone. It's scary either way, but what else can you do?

 

[Wackie]

Is this the right place to ask patients why on earth they decide it would be a good idea to move around in bed with a hip fracture? I thought she said her pain was a 10/10.

If I was a 10/10, I'd be absolutly still and would shoot anyone who tried to move me. It's been seven hours since I saw her and I can still hear her wails in my head.

 

[Taaki]

A surgery attending told me that if I paged the intern and did not hear back after several tries, then to page the resident, the fellow and the attending - in that order. She told me, that I would in no way be penalized and that the attending would be very interested in learning that the people working below them were not doing their job. She said, when a patient's life is at stake and something is critical, go up the ladder until you get the help.

I think either way you're sort of screwed, but I would rather piss people off for a good cause than because I sat on my hands and let a patient situation get out of hand all alone. It's scary either way, but what else can you do?

I am so far from a doc that it's not funny, only a paramedic student, gotta start somewhere But I do agree, patient advocacy is taught at all levels of healthcare. Patient care comes first. You want a comfortable working environment, but not at the expense of a patient.

 

[Depakote]

Is this the right place to ask patients why on earth they decide it would be a good idea to move around in bed with a hip fracture? I thought she said her pain was a 10/10.

If I was a 10/10, I'd be absolutly still and would shoot anyone who tried to move me. It's been seven hours since I saw her and I can still hear her wails in my head.

 

[ISR]

I learned tonight that if you decide you need to remove your pubic hair for a "cleaner, fresher feeling" becasue your girlfriend "didn't like it in her face" the best way to do that is to cover your most intimate parts with lighter fluid then set it afire to "flash burn all the hair. I thought it'd be easier than using a razor."

When the guy was asked why he didn't just use a razor, he said, "I always get razor burn on my chin, and come on. Do you really want that down there?"

I guess 3rd degree burns requiring E&G is the better alternative???

 

[doctawife]

Well, at least he was putting his privates near her face and not her reproductive bits. 'Cause then he might have bred, and that would be a tragedy.

 

[Apollyon]

I learned tonight that if you decide you need to remove your pubic hair for a "cleaner, fresher feeling" becasue your girlfriend "didn't like it in her face" the best way to do that is to cover your most intimate parts with lighter fluid then set it afire to "flash burn all the hair. I thought it'd be easier than using a razor."

When the guy was asked why he didn't just use a razor, he said, "I always get razor burn on my chin, and come on. Do you really want that down there?"

I guess 3rd degree burns requiring E&G is the better alternative???

I kid you not - one of my roommates in military college used to regularly trim his pubic hair with a lighter. One of the more amazing times was when it was self-sustaining. I have to tell you - seeing someone's crotch on fire is surreal. We even got a picture of it (he put his hand over his package so they would print the picture), but a roommate that quit before he got drummed out by the Honor Court took it with him.

 

[docB]

I learned tonight that if you decide you need to remove your pubic hair for a "cleaner, fresher feeling" becasue your girlfriend "didn't like it in her face" the best way to do that is to cover your most intimate parts with lighter fluid then set it afire to "flash burn all the hair. I thought it'd be easier than using a razor."

When the guy was asked why he didn't just use a razor, he said, "I always get razor burn on my chin, and come on. Do you really want that down there?"

I guess 3rd degree burns requiring E&G is the better alternative???

Yeah, that's just stupid. Every time I did it I got all these ingrown hairs.

 

[Orthonut]

I kid you not - one of my roommates in military college used to regularly trim his pubic hair with a lighter. One of the more amazing times was when it was self-sustaining. I have to tell you - seeing someone's crotch on fire is surreal. We even got a picture of it (he put his hand over his package so they would print the picture), but a roommate that quit before he got drummed out by the Honor Court took it with him.

oh, DGIH, I think I went to the same school, (either that or they ARE breeding)

 

[Wackie]

Things I learned...

It is entirely not bad form to complain of a decreased appetite, and when the doctor comes in, to dive behind your bed, falling onto the floor as you do so, to hide the large bag of skittles (all of which are rolling all over the floor) you've been munching on while waiting.
A walk on the rainbow...

 

[dogbone65]

When you climb into a tree with a chainsaw to cut a limb off a tree.....do not stand on the limb you are cutting as you will end up with a c-spine fracture and quadraplegia.

 

[EctopicFetus]

When you climb into a tree with a chainsaw to cut a limb off a tree.....do not stand on the limb you are cutting as you will end up with a c-spine fracture and quadraplegia.

NO JOKE? Funny but clearly also sad..

 

[katrinadams9]

It is possible to get your blood sugar up to 1197 if you stop taking your insulin long enough.

 

[docB]

It is possible to get your blood sugar up to 1197 if you stop taking your insulin long enough.

Yes. But you should have phrased it as "Don't quit taking your insulin. You'll end up in the ER with a blood sugar of 1197."

I should also add that if the EP who is on is Dr. Norris you'll be getting your insulin bolus delivered by roundhouse kick.

 

[Dr. Will]

.

 

[The White Coat Investor]

If you are the son of the hospital chaplain, and your European girlfriend has a history of genital herpes, don't lick her down there, even if you don't see any sores at the time. You won't like the results.

 

[katrinadams9]

Yes. But you should have phrased it as "Don't quit taking your insulin. You'll end up in the ER with a blood sugar of 1197."

I should also add that if the EP who is on is Dr. Norris you'll be getting your insulin bolus delivered by roundhouse kick.

LOL. Thanks for the suggestion.

 

[DropkickMurphy]

From one of my nurse friends today: "It's not right to point out that 'Pumbaa' means 'warthog' in Swahili after standing idly by and letting a new mother give her child this as his middle name."

 

[DropkickMurphy]

NO JOKE? Funny but clearly also sad..

We had a guy who had been ordered to NOT cut down a tree- not sure WHY but the state department of natural resources ordered him not to....maybe it was a rare species or something. He basically told them to go f--k themselves and then after they left proceeded to take a chainsaw to the aforementioned tree....which promptly fell on him, killing him instantly. It basically folded him in two, crushed his skull and ripped his spine out of his back (THE ONLY TIME I have ever seen a compound spine fracture in an otherwise intact body). To make it even funnier, my partner looks at me and goes "He's dead right?"

 

[MirrorTodd]

We had a guy who had been ordered to NOT cut down a tree- not sure WHY but the state department of natural resources ordered him not to....maybe it was a rare species or something. He basically told them to go f--k themselves and then after they left proceeded to take a chainsaw to the aforementioned tree....which promptly fell on him, killing him instantly. It basically folded him in two, crushed his skull and ripped his spine out of his back (THE ONLY TIME I have ever seen a compound spine fracture in an otherwise intact body). To make it even funnier, my partner looks at me and goes "He's dead right?"

Now that's irony.

 

[DropkickMurphy]

The funny thing was that I looked at him and go "You're kidding right?" to which he responded (with a look of abject shock on his face) "I'm not sure...." It took me a couple of seconds to realize what I was looking at.....it's just not something you see every day.

 

[BKN]

We had a guy who had been ordered to NOT cut down a tree- not sure WHY but the state department of natural resources ordered him not to....

Apparently a species that turns vicious when attacked.

 

[DropkickMurphy]

Apparently a species that turns vicious when attacked.

I believe it was a cousin of Charlie Brown's kite eating tree.

 

[EM2BE]

From one of my nurse friends today: "It's not right to point out that 'Pumbaa' means 'warthog' in Swahili after standing idly by and letting a new mother give her child this as his middle name."

I guess that mom didn't get enough Lion King reruns in...the warthog was named Pumbaa...maybe it's just me, but I think if I saw that correlation, I'd check it out further before naming a kid.

 

[Quine]

I take it that 'fall out' = prolapse?

'cuz while it's (thank god) a very small and specialized fetish subculture, I imagine there's good money to be made as a "pink sock" adult website model.

Never forget the lube, kids.

Apparently rectal prolapse can also be involved in reproduction.

"When I finish, I have used two pair of pink socks to make four gametes, each with two autosomal chromosomes and one sex chromosome, "X." I set the "eggs" ..." quote from google search result.

I just had to know.

 

[DropkickMurphy]

I guess that mom didn't get enough Lion King reruns in...the warthog was named Pumbaa...maybe it's just me, but I think if I saw that correlation, I'd check it out further before naming a kid.

Yeah, but any person who would consider naming their kid after a cartoon wild pig probably would not know what correlation is if it jumped up and bit them on the ass.

 

[allendo]

Yeah, but any person who would consider naming their kid after a cartoon wild pig probably would not know what correlation is if it jumped up and bit them on the ass.

Maybe she was naming him after her favorite pair of kicks! It's that puma nature baby!

 

[dogbone65]

NO JOKE? Funny but clearly also sad..

Nope...really happened about 8 years ago...had him as a patient in sicu....twas pretty funny

 

[Quine]

Thread seems to have stagnated, so I'll start it up again.

No matter how long your nose has been bleeding, it will stop before the paramedics arrive. It will start back up when you return from the ER.

 

[kate_g]

Not a case I had any involvement with whatsoever, but it's in my neighborhood so I thought I'd contribute. Note down toward the end of the article that the man was about to become yet another "foreign object in rectum" case for one of you. But he did you the service of extracting the object himself, presumably while still naked, right there on the street. (Hopefully the medic on the fire truck could at least provide a wet-nap.)

What I learned? That you should never carry a concealed weapon when you're out for some public indecency, of course, because the former is a felony charge while the latter alone would have been a misdemeanor...

http://www.contracostatimes.com/mld/cctimes/community/15914427.htm

Naked man arrested after pulling awl from rectum
By Karl Fischer
CONTRA COSTA TIMES

A police encounter with a naked man near the El Cerrito BART station turned into an arrest on suspicion of carrying a concealed weapon Thursday.
Passers-by called officers about 7:50 a.m. to report that a naked man was lying on a tree stump beside the Ohlone Greenway path, exposing himself and masturbating.
Police saw 33-year-old John Sheehan and arrested him on suspicion of indecent exposure.
Officers led him to the nearest street, the 2000 block of Kearney Avenue. Before putting Sheehan in the back of his car, Sgt. Paul Keith asked him if he had anything on him that police should know about.
Sheehan replied that he had hidden a screwdriver in his anal cavity, Horgan said.
Unsure about what to do, police called for a fire engine. Firefighters quickly decided that an emergency room would be better equipped to deal with the situation.
Sheehan interceded before an ambulance was called.
"When he heard what they were talking about, he said, 'Hey, don't worry about it. I can do it,'" said El Cerrito Detective Cpl. Don Horgan.
Mindful that a 6-inch metal awl wrapped in black electrical tape could be used as a weapon, officers kept their weapons trained on the 33-year-old.
Sheehan went quietly afterward, without explanation.
Sheehan was paroled from state prison last week and listed an address in Pittsburg, Horgan said. Police booked him into County Jail in Martinez on suspicion of parole violations, indecent exposure and one felony count of possessing a concealed weapon.

 

[MirrorTodd]

Not a case I had any involvement with whatsoever, but it's in my neighborhood so I thought I'd contribute. Note down toward the end of the article that the man was about to become yet another "foreign object in rectum" case for one of you. But he did you the service of extracting the object himself, presumably while still naked, right there on the street. (Hopefully the medic on the fire truck could at least provide a wet-nap.)

What I learned? That you should never carry a concealed weapon when you're out for some public indecency, of course, because the former is a felony charge while the latter alone would have been a misdemeanor...

http://www.contracostatimes.com/mld/cctimes/community/15914427.htm

Naked man arrested after pulling awl from rectum
By Karl Fischer
CONTRA COSTA TIMES

A police encounter with a naked man near the El Cerrito BART station turned into an arrest on suspicion of carrying a concealed weapon Thursday.
Passers-by called officers about 7:50 a.m. to report that a naked man was lying on a tree stump beside the Ohlone Greenway path, exposing himself and masturbating.
Police saw 33-year-old John Sheehan and arrested him on suspicion of indecent exposure.
Officers led him to the nearest street, the 2000 block of Kearney Avenue. Before putting Sheehan in the back of his car, Sgt. Paul Keith asked him if he had anything on him that police should know about.
Sheehan replied that he had hidden a screwdriver in his anal cavity, Horgan said.
Unsure about what to do, police called for a fire engine. Firefighters quickly decided that an emergency room would be better equipped to deal with the situation.
Sheehan interceded before an ambulance was called.
"When he heard what they were talking about, he said, 'Hey, don't worry about it. I can do it,'" said El Cerrito Detective Cpl. Don Horgan.
Mindful that a 6-inch metal awl wrapped in black electrical tape could be used as a weapon, officers kept their weapons trained on the 33-year-old.
Sheehan went quietly afterward, without explanation.
Sheehan was paroled from state prison last week and listed an address in Pittsburg, Horgan said. Police booked him into County Jail in Martinez on suspicion of parole violations, indecent exposure and one felony count of possessing a concealed weapon.

Not related to Cindy Sheehan is he? What a weird coincidence that would be.

 

[ssquared]

This thread is so funny, I just had to contribute (nope, not a doc, just a lowly premed, but this did happen to somebody I personally knew)

It's always a good idea to do backflips off the roof of your house into the bushes below. And when one of the branches of the bush goes straight up your anus, cuts clear through the intestine, and punctures your stomach, just go to the bathroom and pass out so your dad can find you soaked in blood a few hours later.

Oh, and once you've healed from surgery, go to a parking lot and try to throw a molotov cocktail. Expect hold the thing upside and light your arm on fire, and while trying to put out said fire, break both of your ankles.

(I've got more, too. I went to high school with a bunch of kids who had absolutely no common sense.)

 

[Wackie]

This thread is so funny, I just had to contribute (nope, not a doc, just a lowly premed, but this did happen to somebody I personally knew)

It's always a good idea to do backflips off the roof of your house into the bushes below. And when one of the branches of the bush goes straight up your anus, cuts clear through the intestine, and punctures your stomach, just go to the bathroom and pass out so your dad can find you soaked in blood a few hours later.

Oh, and once you've healed from surgery, go to a parking lot and try to throw a molotov cocktail. Expect hold the thing upside and light your arm on fire, and while trying to put out said fire, break both of your ankles.

(I've got more, too. I went to high school with a bunch of kids who had absolutely no common sense.)

Darwin failed us.

 

[Orthonut]

I kid you not - one of my roommates in military college used to regularly trim his pubic hair with a lighter. One of the more amazing times was when it was self-sustaining. I have to tell you - seeing someone's crotch on fire is surreal.

Um, Apollyon PT'd me, and upon discovering we both went to the same aforementioned military school, I can verify that yes, this does occur and more shockingly sober cadets do this and male cadets aren't the only ones that "trim" this way

 

[KNightInBlue]

No idea if this is true but a friend of mine sent this to me -



"In retrospect, lighting the match was my big mistake. But I was only trying to retrieve the gerbil," Eric Tomaszewski told bemused doctors in the Severe Burns Unit of Salt Lake City Hospital. Tomaszewski, and his homosexual partner Andrew "Kiki" Farnum, had been admitted for emergency treatment after a felching session had gone seriously wrong.
"I pushed a cardboard tube up his rectum and slipped Raggot, our gerbil, in," he explained. "As usual, Kiki shouted out 'Armageddon,' my cue that he'd had enough. I tried to retrieve Raggot but he wouldn't come out again, so I peered into the tube and struck a match, thinking the light might attract him."
At a hushed press conference, a hospital spokesman described what happened next. "The match ignited a pocket of intestinal gas and a flame shot out the tube, igniting Mr. Tomaszewski's hair and severely burning his face. It also set fire to the gerbil's fur and whiskers which in turn ignited a larger pocket of gas further up the intestine, propelling the rodent out like a cannonball."
Tomaszewski suffered second degree burns and a broken nose from the impact of the gerbil, while Farnum suffered first and second degree burns to his anus and lower intestinal tract.



I think the funniest part is the cue they had for each other - "Armageddon"..........you'd think "STOP!" would suffice, but no................"ow!....ow!!!........OW!!!!.......ARMAGEDDON BEE**IIITCHHHHH!!!"

 

[Febrifuge]

Urban legend. http://www.snopes.com/risque/homosex/gerbil.asp

As to "armageddon," you mean you've never heard of the concept of the "safe word?"

Bummer.

 

[Miami_med]

If you have a seizure disorder and are not taking your meds, it is always a good idea to do your work while standing on chairs. Make sure that a solid history of subdural bleeds that have already left you with numbness and other mild deficits doesn't deter you from participating in this sort of activity again.

 

[DropkickMurphy]

Darwin failed us.

Hell, it's part of our jobs to interfere with the very processes he described......that's what is sad.....

 

[The White Coat Investor]

No told bemused doctors in the Severe Burns Unit of Salt Lake City Hospital. H!!!"

Not only is there no Salt Lake City Hospital, but there is no "Severe Burns Unit" in the city either. The university hospital has a burn unit, but I don't think anyone ever called it the "Severe Burns Unit" while I was there.

 

[ferreed]

From one of my nurse friends today: "It's not right to point out that 'Pumbaa' means 'warthog' in Swahili after standing idly by and letting a new mother give her child this as his middle name."

My apology for the thread-hijack, but I thought a little Swahili might add something here. Pumbaa doesn't actually mean 'warthog' in Swahili, but is instead a verb root that means foolish, dim-witted, careless, etc. Great name for a kid!

This has got to be the most amusing thread in the history of the internet. Thanks to all who have posted stories!

 

[em4me]

Gotta love the ED...the seclusion rooms...the suturing that becomes a therapy session exploring why alcohol and many things such as driving, moving furniture, and/or screaming "bring it on" to a giant group of equally drunk frat boys who will re-arrange your anatomy do not mix.

My humble lesson? Don't swallow the inedible. This poor guy decided (while drunk of course) there was no time like the present to fix things with his wife/girlfriend/female love. He felt that alcohol+anger+jewelry would win her back...she stormed out. Best way to seek revenge? Hit her? Threaten to take the kids? Nope, swallow the jewelry (helped it down with more alcohol apparently) and let it sit in your GI tract for weeks (nice XR I must say) while developing profound abd. pain. I wish I knew what the results of our surgical consult were but this gives a new addition to the differential dx for epigastric pain.