Things I Learn From My Patients

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Another lurker who has been following this thread for a while. I'm not a medical professional, but am married to one who worked as an EMT in San Francisco. Lots of good things to learn there...

1) If you're at the office and experiencing extreme SOB and faintness, there's really no need to tell someone about your corset fetish before the EMTs roll in with the oxygen and the shears.


2) If you've gotten your throat slashed while SOCMOB and have successfully contacted 911, go ahead and speed up the hemostasis thingy with a bit of exercise. Make things exciting for the dispatcher by running around while bystanders attempt to update your location every two minutes. Do this until the EMTs give up trying to find you, and simply wait for you to fall over from blood loss. Um...tag, you're it?


3) If you're a gangbanger who's decided to "represent" at a public event like Carnivale or Cinco de Mayo, a good way to get the cops' attention is to fall over while SOCMOB, with no obvious cause. Cops and medics will surround your unconscious body so they can check you thoroughly for bullet holes. They'll start laughing when they can't find any. Bystanders will join in the fun once everyone realizes you've given yourself heat stroke by wearing ALL your gang colors--including the hat w/ bandanna underneath, oversized pants, puffy starter jacket, and 5 pound sneakers--in 95 degree weather.
 
If you take your 60-lb Lab-mix and your 80-lb German Shepherd out into your very large backyard to play, they will ignore the large open space and, instead, choose to play close to you. So you shouldn't be at all surprised when the two of them run into you at the same time (at full speed) knocking your small self (less than 5' tall) to the ground. Nor should you be surprised at the sound of your ankle breaking. The same ankle you'd broken less than two years earlier. And no health insurance. Again.

At least this time, I could place some of the blame on my dogs and not on my own clumsiness. 😀
 
I learned from experience (don't want to repeat it, thanks) that when you are in urgent care, and have been shot full of Stadol because you are likely passing a kidney stone and the doctor wants to do diagnostic testing without you writhing in pain, you are going to be the entertainment for the rest of the waiting room in the lab.
 
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If you're having abdominal cramping and vaginal bleeding roughly a month after your last period, you should go to the ED to have it checked out. Because, well, you can never be too sure.
 
You should always carry "medicated" Chap-stick with you because if you're deathly allergic to bee stings, and you're stung by a bee, you can just take it out of your pocket and rub it on the sting. This will be life saving. Why? Because "its got medicine in it".
 
If you vigorously scrub or scratch your highly vascularized sacral tumor eroding through the skin because it itches and stinks (and I bet it does so I sympathize), it will also bleed...a lot. Like a 4 unit transfusion amount (14 point Hct drop - 36 --> 22).

The second time you do it, you will buy yourself some mitts and another transfusion.

The 3rd time you do it, your choice is go home and leave us alone or enjoy some arm restraints while we apply pressure and transfuse another 3 units...3rd time in the last 3 days.

No...seriously...it's your call. Let us know which way you want to play this.
 
Some tribes in Vanuatu and Solomon islands implant marbles (the glass ones) under the skin around the base of the penis or somehow into the glans itself. This is not widely known, even on the web, and it certainly makes for some interesting x-rays. I learnt this (like all me colleagues) during the A&E rotation when we get one such x-ray to interpret. We use the pidgin term 'marbolo' to refer to these. there's a couple of fun stories associated with these:

One such patient who came in to have one removed gave a perfect opportunity to prank a visiting urologist. Our own uroligst, who was familiar with the case, showed the x-ray to the visitor, and asked for his opinion on the two perfectly round opacities superimposed on the urinary bladder. on inspection these were two very hard lumps above the base of the penis. The visitor was quite flummoxed and the best he could come up with was 'some sort of weird metastasis'. Anyway, they went to operate, and the visitor reportedly freaked out when he took out the marble, providing much hilarity for the locals.

Another such patient had it in his glans, got it surgically removed because he was getting married to a local lady who was unfamiliar with the custom, even though they had had sex already w/out problems. Anyway, 3 weeks after the nuptials, the wife comes in to inquire the possibility of getting the marble put back in!

TL;DR: small, hard sperical masses which are radiopaque may be subcutaneously implanted marbles.
 
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JR Klein said:
My dad had just awakened from heart surgery and noticed a tube coming from his man-parts. Still pretty zonked-out from the general anesthetic, he yanked it out. He didn't feel any pain (or so he claims) but there was some blood.
Click to expand...

During my paramedic ER clinicals I got to know a very nice, demented male frequent flyer who would become convinced that his foley was what was making him unable to pee, and would yank it out, balloon and all. Again and again.

I realized the other day that most of my really good ER stories involve the penile misadventures of old geezers.

Still working my way through all of the old posts on this thread, but here's something I learned from a patient last week (I'm a paramedic working as an ER Tech, I hope it's ok to share my stories!):

If you've been banned from buying iodine at all the local stores, go to the ER and have your floozy stuff iodine swabs down her pants. Make sure you do this in the room right next to the nurse's station, with the door and curtain wide open. When caught by the ward clerk, explain that you TOTALLY thought that they (and the food from the staff breakroom we found in the patient belongings bag you had) was included in your ER stay.

The real stumper was why they went for the swabs when there was a big bottle of the stuff right next to them on the same shelf. 😕
 
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When I was a Paramedic student years ago. I learned that Viagra has the same effect in a 2 year old, as it does in an adult.....Was working the ER at a rural hospital about 60 miles from the big Children's Hospital when an ambulance rolled in with a critical peds. Mom starts filling us in on his diagnosis, Rx meds etc. When she said Viagra, the whole room stopped: MD, 3 nurses, respiratory, the ambulance crew, and myself. She very politely explained why and what condition and finished with "Yes, before you ask, it does have the same effect"
 
I mentioned this thread to one of the nurses I work with, and she reminded me of how a patient (well, his wife) taught us how to murder your significant other and get off scot-free.

1. Take control of all health related matters. Deal with his pills, Drs. appointments, everything. Don't tell your husband what he's taking or when he should be taking it. Just hand him various pills and a water glass at various times of the day.

2. Leave on a 2-week vacation to visit your sister.

Seriously, this guy had NO idea what he took, who his doctors were, WHERE the pills were kept in his house, nothing. He didn't even know his wife's cell phone or any other way to get hold of her. We did a number of mental status assessments on him, he was completely with it, just was completely helpless (and swelling up like a balloon because he hadn't taken his Lasix in 3 days.)

If one of his neighbors hadn't come over to return a borrowed power tool and seen how badly this guy was doing and called EMS, I'm pretty sure he would have just kept on ignoring his deteriorating health and croaked within a few days.
 
This one is from one of my shifts as an MS3 at a very busy inner city ED.

I learned that after getting stabbed it's probably a good idea to check if the knife was actually pulled out. This 18 YO girl came in 1 month after her pimp stabbed her thigh, because the stab wound is now a huge ulcer and it's also draining pus.

What do we see on CT? Well wouldn't you know it, the knife!! All 12 inches of it, with handle and everything, came to rest somewhere between her hamstrings, completely invisible to the outside, and she was walking around with this for a month, so check your stab wounds people!! yikes 😱
 
If you go to the beach for a BBQ with your wife and 3 kids, make sure you drink a lot of alcohol and then when its time to go, make sure you load the BBQ (hot coals and all) into the bed of your pick-up truck. Then, proceed to load your family into the truck and get behind the wheel.
Once you get on the freeway, act surprised when your unsecured, still burning BBQ falls over in the bed of your truck, only noticing the smoke and flames when other drivers begin to honk and motion for you to pull over. After you pull over, unload your family from the truck and go take a closer look at what is happening while your children and wife are screaming.
As soon as you realize that the plastic lining in the bed of your truck is actively burning, it is a really good idea to try to "save the truck" by removing the hot BBQ and scraping out the molten plastic with your bare hands. Also, make sure you aren't wearing any type of shirt while you do this.

When a highway patrolman arrests you and brings you to the ER for your circumferential burns on 8 out of 10 fingers including bilateral thumbs and various other burns to your wrists, arms, and abdomen, state that you "got off easy" because the burns are too severe to feel any pain and then make jokes to the arresting officer that "thank god I've been drinking! It takes the edge off!" The officer might not find that funny and will instead lecture you about how lucky you are to still have a family after a dumb stunt like that 🙁

He ended up spending some time at a specialty burn center and then I'm pretty sure he spent some time in the hoosegow for his DUI and reckless endangerment. Hopefully those kids are safe from his further antics.

Unbelievable stupidity.
 
Hoser said:
I learned that jail is better than the ED because "at least they f***in' feed you there!"
Click to expand...

I learned sometimes the opposite is true, and people will swallow batteries to come hang out in the ED for awhile. Cool x-rays ensue.
 
If you frequently visit the ED due to your non-compliance and get intubated three times in one month by the same resident, don't be surprised to discover that your vocal chords are stretched out like a well used hooker and that the 9cm ET tube easily passes into your trachea. You'll cause the resp therapist to exclaim, "What size tube is that?!" while connecting the ventilator. If you come in again next week, I'm using a garden hose.
 
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It is all right to complain that your pain meds did not make you 'loopy' enough.

This incident was actually kinda cute for me. My friend had his wisdom teeth pulled and was upset that the pain meds he got didn't make him feel all silly and 'out of it' like they do for characters on TV. He didn't actually complain, but if he could form a legible sentence I'm sure he would have 😀
 
I learned last shift that if you need to test out your new 3-lead EKG cables, be sure to choose a pt to hook up to the monitor who is in for something that at least might be vaguely cardiac.

Otherwise you'll discover significant ST elevation in leads II and III on the person who just came in for a bleeding hemorrhoid, and the doc will yell at you because he thought that pt was going to be a quick in-and-out and he'd get to go home on time.
 
From my volunteering days at a local community hospital on the border of upper middle class suburbia and the ghetto...

If you come in high on heroin, with track marks up your arms, legs and portions of your neck, screaming for thirty minutes that "MAH STOMACH HURTS... GIMME DA MORPHINE" it perfectly okay to then grab an innocent volunteer's hand and demand he brings you a turkey sandwich or you will sue the hospital. Needless to say, she was a very frequent flyer. No one knew her real name, either.

Also if you are a 250 lb woman, and you come in swinging at EMTs, police officers, attendings and the chief of EM, you're going to hit with the benzo hammer, whether "your friend Mr. Obama" will shut down the hospital or not.

EDIT: One more good one...

If you're diabetic and come in with a glucose number >400, go ahead and finish your soda (non-diet, of course)...
 
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Young woman presents in active labor. There's a radio on in the background playing 'sexual healing'

Woman: "Could someone PLEASE turn that off?!?"

Doctor: "You don't like this song?"

Woman: "This SONG is why I'm HERE!"
 
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It is not a good idea to come to the ER for narcotics, receive a full work-up for nothing in particular, and after being discharged, proceed to steal a CVC kit so that your ex-nurse, druggie girlfriend can insert a central line for convenient drug use.

Natural selection doesn't always work, apparently.
 
If you're trying to be a competitive college athlete, spring for a real personal trainer. Don't respond to one of those road-side "boot camp" billboards. They will have you do >250 weighted squats. You might come to realize this was a bad idea when your legs swell up like balloons, you can't walk any more, you end up in rhabdo with a CK>190,000, and you end up with bilateral thigh fasciotomies. Bummer. Otherwise healthy kid. Going to be a while before you play sports again.
 
Me, interviewing pt: So, what caused you to need a lung transplant?
Pt: Pulmonary fibrosis.
Me: Oh, so you had IPF [idiopathic pulmonary fibrosis]?
Pt: No, no, not idiopathic. I didn't have that kind.
Spouse: God no. If he had that IPF he'd be dead by now.
Me: OK. So what caused your pulmonary fibrosis?
Pt: Nobody knows.
 
Zits, no matter how annoying, are not medical emergencies. pt arrived at the ED at 0200 because a pustule on her upper back needed i&d. couldn't wait until the clinic opened i guess.

clearasil: $8
EM visit: ~$800

Clearly the latter option is the best.😀
 
A few from fellow ER patients/bystanders over the years...

Pain is a legitimate allergy.

If your friend has just been bought in priority one after an Ecstasy overdose, it's perfectly acceptable to shout in his ear, and interfere with the equipment he's hooked up to, because you think it's funny when all those bells go off.

If you're in hospital with multiple fractures to your jaw and cheek after being on the wrong end of a piece of wood, please go ahead and have your friend swing past your dealer's place, and then courier several preloaded syringes of Heroin to you. After all, those stingy Doctors aren't giving you anywhere near enough Morphine for you to catch a decent buzz. 🙄
 
I'm retired from the military. That means I have access to military hospitals when necessary.

I developed an eye infection over a weekend at Knob Creek Gun Range, and one of our party was an active duty Naval Aviatohr (I learned this is the proper pronunciation). So I had him drive me to the ER at Ft Knox, 15 minutes away.

I learned that if you're waiting in the ER, you should complain every five minutes about how you have terminal cancer, and shouldn't have to wait four hours for your headache, and engage everyone in the waiting room in conversation.

I learned that if your fellow Soldiers bring you in with a migraine (a different patient), you should spend an hour waiting, then decide that maybe you can come in during regular hours.

I learned that everyone waits until 2100, when there's only one doc on duty, to get sick, stub toes, fall down stairs, etc.

I learned that a two year old with an ugly sounding fluid cough gets triaged and treated in three minutes, and I'm glad.

I learned that after a four hour patient wait, when led back to treatment, the reason for the delay will resolve as a man on a gurney with O2 and IVs who's probably in worse shape than the rest of us.

I already knew that a good description (awoke Friday with what felt like an eyelash under upper lid, that wouldn't dislodge, sensation faded and returned Friday evening, awoke with crusty secretions this AM, discomfort and pain returned 6 hours ago) makes diagnosis of conjunctivitis and Rx of Moxifloxacin drops very easy for the Attending.

And I observed that being patient doesn't slow one's treatment down at all. The longer it takes, the better your chances of survival.
 
If you take your child to the ED to get stitches in her forehead it might be a good idea to forego the balloon they give her for being so good as she might be looking up at it in the parking lot and trip over one of the cement blocks and land on the stitches she just got busting them wide open.

My question: Does this put the child to the back of the line again or does she get to go right in? lol
 
When coming in for your stat read KUB, be sure to explain to your x-ray tech in excruciating detail how two weeks ago you swallowed a tooth from your partial plate and ever since then you have been crapping in a spaghetti strainer and mashing it through with a fork.

Do you really need the tooth back after that? Or the spaghetti strainer?
 
An inhaled condom is definitely something you should have your doctor take a look at.

This one's from Pubmed:

"A 27-year-old lady presented with persistent cough, sputum and fever for the preceding six months. Inspite of trials with antibiotics and anti-tuberculosis treatment for the preceeding four months, her symptoms did not improve. A subsequent chest radiograph showed non-homogeneous collapse-consolidation of right upper lobe. Videobronchoscopy revealed an inverted bag like structure in right upper lobe bronchus and rigid bronchoscopic removal with biopsy forceps confirmed the presence of a condom. Detailed retrospective history also confirmed accidental inhalation of the condom during fellatio."

:laugh:
 
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Wow..been a long time since I've been here. Got floated a while back. I've learned that if you are arguing with your husband, and he says he IS REALLY LEAVING this time, don't stand in front of the car. Then don't scream out obscenities about his manhood, and what you did with his nearest and dearest friends while he was in the sandbox. He will take off forgetting to put the car in reverse, essentially pinning you between 2 cars and darn near amputating both, yep both of your legs. Luckily the hamstrings and the vastus lateralus weren't completely severed in both legs, and ortho was able to pin the femurs back together. Heck, she didn't have to go to the SICU. Then threaten to go AMA when staff feels it's just not such a good idea to have hubby stay in the room overnight.
 
I have been a lurker for some time now and i finally decided to add 2 of my stories
1) If when hiking through the Mojave desert you find a gila monster, do not pick up said reptile to "bring it home as a pet because it needed rescuing" while it was minding its own business. Said reptile will in fact bite you and latch on and not let go resulting in EMT's who will not want to touch you because they do not also want to get bit. (I was the EMT not the idiot)
2) EMTs are NOT for horses, dogs or any other furry animal. When we get there we will NOT transport your precious Fluffy to the ER vet or the actual ER because they are for PEOPLE.

Not that i hate animals quite the contrary, I decided i would much rather work with them than all of the people out there that need to be fed to banthas.
 
You're a hyperglycemic noncompliant diabetic hoarder lying in a pool of your own urine and feces, and I have a family member with power of attorney for you standing ten feet away (not that I need him):

"Ma'am, can you tell me what day of the week it is?"
"It's Not Going to the Hospital Day!"

Really? Could've fooled me!
 
An important lesson: If you aren't getting noticed, start doing summersaults down the corridors.

And when you crash into a wall based on your many summersaults, complain about the quality of care.

Yeah, we should have been careful about putting that wall there...
 
We now present an episode of Silly Intern Theatre... Tonight's silly intern will be played by Depakote:

We find our Silly Intern going to see an adolescent male complaining of a subjective feeling of trouble swallowing.

Silly Intern: *solicits HPI, PMH, does physical exam*

The only findings our silly intern seems to find is bilateral painless cervical lymphadenopathy. HPI unremarkable except for CC. No hx of bleeding. Mucus membranes pink, no hx of fever/chills, no hepatosplenomegally.

Silly Intern to Dr. Attending: Can you look at this kid? The only thing I can find on him is painless lymphadenopathy I want to make sure he doesn't have ALL? Should I get a CBC?

Dr. Attending: Let me look at him.

*Dr. Attending enters room*

Patient's mom: Oh, his sister just had strep... can you check him for that?

Silly intern: *had not asked about sick contacts* :smack::bang::boom:
 
Advice to my drunken, and rather challenged before drinking, neighbor and his friends:

Do not get so drunk that you can not walk properly, and deliberately go into a completely unlighted back yard full of professional painter's gear

If so dumb, do not get up, and head further back, towards the blackberry briar patch.

If you make it this far, and are female, do not, then, undo your pants, and attempt to urinate with your back to the brambles a mere few inches from you.

If you do all of this, and end up with your pants and dainties around your ankles, pinned by multiple thorns, your torso well captured by more thorns, by all means, solve this problem by thrashing about in the dark. Then pull the drunken male that comes to your "rescue" when you scream into the brambles with you.

By all means, if you are said male, struggle a bit, yourself, then carefully remove your cell phone from your pocket, and call 911, placing it on speakerphone so you can understand and be understood.

And do not mention that the girl (a bar girl met that night) has a packet of meth in the pocket of the trapped pants, which falls out when the pocket liner tears, while a cop is assisting in pulling you out.


Last night was kind of interesting.
 
Me to patient-"man why did you take 20 ecstasy pills tonight?"
patient-"things just got out of hand"
me--"uummmm.....ya think?"


Me-"so your entire tricep is torn off--why are you jumping metal fences at 3:30 in the morning?"
patient-"I was running from the po po. I don't know WHY they don't put back entrances to apartment complexes for that reason"

chief complaint-"I get real sleepy when I'm at work x 1.5 YEARS" (yes this was an emergency room vist)

me-"Tell me about your chest pain"
patient-"well, I let the devil sit on my chest yesterday, and his head is still in my chest and I would like it out today. It hurts real bad when I pray to jesus to quit smoking cigarettes.".........psych consult anyone?

theres many more and I've only been in ER for 4 months....LOVE it 😀
 
The ED is the ideal place to come on Friday night with your complaint of dry chapped lips for 4 years.
Complain bitterly and repeatedly about your long wait while the ED staff deal with a 55MPH roll-over with 2 unbelted teen-age passengers and their hysterical families and about 40 other fairly unwell people (in a small double coverage shop that provides care for 140,000+ people - the next emerg even close to our size is 2 hours away, everything in between is tiny - like 3 rooms or less tiny). Finally leave at 1 am - wish I could do the same - without being seen. Probably registered the next night too.
 
If you wish to trim your toenails, perhaps you should seek a slightly more precise implement than a machete.
 
The best time to mow the lawn is at night, while intoxicated. And if something more pressing requires your attention, don't turn off the riding-mower, just go ahead and step off.

Resident: What drugs do you use?
Pt (very insulted): I don't use drugs, I used to use drugs!
Resident: When was the last time you used drugs?
Pt: I smoke some marijuana and used some cocaine last night.

If you come into the ED to get a prescription for pain pills because of your cracked molar, be sure to come in drunk and mention that your tooth has been like that for 4 years. That way it won't be obvious what you're really there for.

If you already have one baby, are sexually active, and don't use condoms or birth control, please do not freak out when the physician tells you that yes, its very possible that you could be pregnant.
 
- If you're French, have a cough and need cough syrup, perhaps you should try and get help translating the name of the medication before purchase it. Buying a bottle of Eucalyptus Oil and treating yourself and your husband won't make you feel any better. On the plus side, as an attending paramedic, it was the best smelling vomit and diarrhoea i've ever come across!

- If you're on methadone for substance abuse, and find your needle fixation is strong, it's probably not a good idea to inject suboxone because your friend told you it was "the good ****". You'll end up vomiting the Chinese you ate all over your apartment. Oh, and don't ask the paramedics for morph to make you 'feel better'. You ain't getting any!

- If you're spending a few days at an outdoor music festival camping and your toe hurts after you crushed it, don't wait a week to present to the medic tent. Because then we'll have to do a local, remove your toenail, and find 20 maggots in there.

- If you're a 16 year old female, don't sleep in the same bed as your grandmother. Not only is this weird, but when we get called to treat her because she feels as though she has "snakes slithering all over", we'll find she's in uncontrolled AF. Then when you tell us you feel weird too, we'll pop the monitor on and find you're in uncontrolled AF as well. If I didn't know any better, i'd think it was contagious!

- If you're a new student, and wonder why your partner can terminate seizure activity with a sternal rub, well, welcome to the world of pseudoseizures!
 
When you punch your buddy in the tooth and cut your hand by all means glue it shut and don't tell anyone for 2 days...
 
If you have central DI (and know about it), you should probably refrain from not drinking water when it is hot. And also refrain from not using your DDAVP. Because you will continue to lose free water, and then you will come to the ED with a sodium of 178 and a chloride of 150.
 
Coming in with a STEMI, getting sent to the cath lab, promptly eloping after you are stented (without scripts) because they wouldn't let you go smoke is a great way to insure you'll be coming back in with chest pain every few days (oh and of course, on return to the ER just sign out AMA because "they didn't do anything to fix me last time").
 
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Just volunteering at an ER currently, so I haven't seen all that much. I do have one to add though.
If you are in the psych hold room in the ER and want out, don't let the combination code on the door stop you. Just wait until a nurse opens the door, and knock her out of the way to run down the hall. You certainly won't be conspicuous running down the hall in nothing but a hospital gown and socks with a nurse running after you. There is, after all, no chance that she or one of the 30 other hospital employees you have to pass to get to the door will tackle you before you make your escape. After all, when you are strapped to a gurney in 4-point restraints and sedated, it will be much easier to escape, I am sure.
 
If you absolutely must comfort your boyfriend in the ER because he's so scared of needles (despite his vast array of tattoos) please don't do it by giving him a handjob. If you can find no other means of getting him to behave rationally during his visit please at least stop doing it when I walk into the room to talk to him.
 
After spending several evenings reading through all of these posts, good, bad, funny and horrific. I have to say that all of you who do this work are amazing. I spent several years in the military as an infantryman,and a trained combat lifesaver. (basically someone trained just enough to put their buddies guts on his chest or splint a broken limb while prepping him for transport)
This has caused all sorts of hilarious stories but I will limit myself to just two.

I learned that if you have some medical training,you can actually instruct helpful bystanders on how to prevent someone from slipping further into shock,while in shock from a broken collarbone.

I also learned that when it is your son with a broken arm,complaining that his arm hurts and that it clearly has a non protruding fracture,that all medical training will go right out the window,and your contribution to the situation will be to insure that your son places said arm on the table to prevent it from moving while calling 911,and that when the wonderful EMT's arrive,that one of them will end up spending the entire time keeping you from flipping out and panicking while his partner fixes your son with a painkiller before both transport him to the ER.

Just about Every time I see my son swinging a bat or playing video games or doing any of the other hundreds of things he wouldnt have been able to do if not for those EMT's I feel thankful for them,and people like them.

You all are doing jobs that most people could never manage to handle. So while you all definitely dont hear thank yous as much as you all deserve...know that alot of us out there realize if not for you guys,people we care about wouldn't be around....

And I am totally ordering pizza delivered the next time I have to go to the ER for the people working there.
 
I learned the other day that you can be so drunk that after losing control of your van you can get yourself tossed out of the passenger window, only to be hit by your van. then when asked by the police if the van is yours get excited that you own a van!
 
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