Things I Learn From My Patients

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Here's a couple lessons I've learned in the past (very busy) week.

1. If you do meth, but are so broke you can only buy the cheapest stuff in town, dont be surprised when it makes you violently ill 2-3 days a week. Sure, go to your local ED every single time this happens. They wont recognize you and put you on a "therapeutic wait" in the "waiting room" (such an apt name!) before taking you back so the third-year med students can pump you full of antiemitics and send you away again.

2. However, if you have a previous cardiac history and you say to the person at the front desk, "I think I'm in Afib right now", you will get a wheelchair and immediate entrance, even if they have to put you on a stretcher in the hallway.

3. Coming in for your back pain x5yrs will not get you dilaudid immediately. You can say you are allergic to asprin, advil, tylenol, and every other drug imaginable... but when you answer "yes" when the doctor asks if you are allergic to hydromorphone, carfentanil, and acepromazine, it doesn't help your case very much.



EDIT: I just realized that I implied there's different "qualities" of meth. Oh... the things we dont mean to say...
 
HI, I'm not a med student but I am taking a certificate course to become a medical transcriptionist so I may be transcribing some reports on the activities of Some Dude, Two Dudes, and That B**** come next summer. If I see any good ones I will hopefully remember to come here and share them with you.

And on the subject of Krokodile, I recently saw a picture of a guy's hand who suffered severe gangrene apparently due to that drug, the tip of one of his fingers apparently just broke clean off. Ick.

Anyway, thanks for giving me the opportunity to practice my comprehension of medical terminology, and a number of laughs, including 2 or 3 incidences when I had to go lie down for a minute because I was laughing too hard. Honestly, some people should not be allowed to breed. Sorry you guys are kept so busy dealing with the people from the shallow end of the gene pool in addition to the people who get injured or sick from no fault of their own.
 
Apparently, some patients think it is fine to rip off the adult diaper and urinate on the bed, the floor, and the wall. SHE didn't want to "bother" her nurse with help getting up to the potty chair. Our observation "stroke" patient who needs "help" walking had plenty of strength to turn around in the bed, lift her bottom up, and arc her urine over her head board.

Thank heavens that this patient was not mine but belonged to another nurse in the unit.
 
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Today I learned that if you say you've been vomiting for a week straight and can't stand to think of food, and are now claiming to be to weak to walk to the bathroom, we should not read anything into the french fry lodged in your butt crack when we roll you for the bedpan.

Perhaps it has been there a while. Did we ever think of that, hmmmmmm!?
 
Note to self: going into the men's bathroom, crushing a urinal cake into powder, and snorting it, is not an effective way to get high.

It is, however, an effective way to strip the mucosa from your nose, give you a case of chemical pneumonitis, a touch of blood poisoning, and get you a mandatory psych hold.
 
Spinach Dip said:
EDIT: I just realized that I implied there's different "qualities" of meth. Oh... the things we dont mean to say...
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Reminds me of an interaction I witnessed a couple months ago between a patient and my attending:

"I'm sorry doc, I think I did too much heroin..."
"Well, how much is too much? (thoughtful pause) Wait a minute, let me clarify: any non-zero amount of heroin is too much. How much did you use this time?"
 
Today, I learned that it is not a good idea to pick up random silver rings that you find lying on the ground and place them on your finger. When it gets stuck, and the swelling impedes your progressively more desperate attempts to remove it, you may become so desperate that you let your cousin 'sterilize' a razor blade with his lighter and cut your finger open in hopes that 'letting out the blood' may reduce the swelling enough to get the ring off.

Also, wait four days to come into the ED after this.
 
JediZero said:
Today, I learned that it is not a good idea to pick up random silver rings that you find lying on the ground and place them on your finger. When it gets stuck, and the swelling impedes your progressively more desperate attempts to remove it, you may become so desperate that you let your cousin 'sterilize' a razor blade with his lighter and cut your finger open in hopes that 'letting out the blood' may reduce the swelling enough to get the ring off.

Also, wait four days to come into the ED after this.
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"Well, the important thing is that you're here now for us to take care of this."
 
Don't beat on your girlfriend infront of witnesses for "not getting my dinner on the table fast enough", she may shoot you in the chest in self defense. Also list her as your emergency contact when you come in to the hospital.
 
MackandBlues said:
Don't beat on your girlfriend infront of witnesses for "not getting my dinner on the table fast enough", she may shoot you in the chest in self defense. Also list her as your emergency contact when you come in to the hospital.
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MackandBlues said:
Don't beat on your girlfriend infront of witnesses for "not getting my dinner on the table fast enough", she may shoot you in the chest in self defense. Also list her as your emergency contact when you come in to the hospital.
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So, he was still able to breathe and talk when he arrived at the ED?

Sounds like she needs to work on her aim.
 
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So kid in one genius episode figured out if you work on your baseball slide on ice, it won't be pretty. I will grumble about having too many boys who encourage blatant stupidity while waiting to get your new cast. Thankfully, it is his right arm and he's left handed.

However, waiting for release, I will sing Hallelujah for having only one girl. Grandma to be was very convinced that her 14 year old daughter was having the next virgin birth. I'd say maybe the kid hid the pregnancy quite well - however as said child has a baby already, I would suspect the virgin birth concept is totally ruled out. Apparently not. Must have the purse stealing, Bible corner reading at 2 am Jesus as the father.

Orthopedic doctor was happy that I knew, and made sure kid knew, that he can't have morphine or codeine or their related drugs. By now, this is third hand - Great Grandfather was in Switzerland when he got hurt and he was given desomorphine (it was legal there in early 30s apparently) and had a nasty reaction. Grandfather had the same reaction to morphine, as did my father. I'm not as sensitive, but morphine is not happening. So, it's suspected my kids will react the same.

Apparently, the desomorphine can be the drug part of the zombie lizard drug. Yay. Nasty short acting morphine mixed with gasoline, sounds delightful!

Snarky question - if one makes the lizard drug with ethanol containing gas, would they get drunk also?

Second snark - why do we always run into the crazies at the ER. Did I miss information about flash mobbing the ER? I want on that list so we can avoid hospital then. I know I was really fidgety and shaky when I had to get Reglan injected. Apparently, my jitters aren't uncommon then. But, I felt like a crazy fool, but I couldn't hold still then.
 
There is much we can learn from our patients--plenty of it serious, plenty of it comedic.

But, when given the opportunity, I think we should all try to learn from our experiences AS PATIENTS OURSELVES.




For example, yesterday I learned that:

1. If you have a migraine, haven't eaten since last night, and are tired from sleep deprivation, don't make it all worse by suddenly going into afib.

2. If you disregard the first, make sure you have to "sit down" in the main lobby of a major teaching hospital. This will ensure a quick response and get you several bystanders in white coats just itching to take charge of the situation, and a gaggle of med students all looking on in rapt horror/fascination.

3. When you do syncopize (syncopate?) be sure it is in the middle of all the boring questions (What's your name? Are you diabetic? Do you do drugs? etc). This will turn the nurses and doctors away from all that nonsense so they can focus on what's really important--finding the biggest damn needle in the whole ED to stick in your arm. (On the upside, I think I got at least one of those pesky questions right. I think it was the one about my name.)

4. Decide to wake up in the middle of a head CT. I mean 5 seconds through a 10 second scan. Move so much that the scan is ruined and the CT tech has to come over and put a big strap over your forehead to "remind you to not move"... Oh ecstasy, thy name is restraints and tight spaces... and large doses of radiation.

5. It is possible for a pulse-ox to go from 93 to 100 in the space of 10 seconds. Also, it is possible for the number to drop to 89 without everyone running to your room like its on fire. (Yes, I was bored and on opiates... And it gave me a great idea for a new contest you can all have at your next Christmas party: Pulse-Ox Limbo! How low can you go... without falling over?)

6. Sometimes, a liter of NS, a touch of morphine, and a couple hours of bed rest are the perfect cure.




But let's get serious for a second... I don't know how you guys do what you do day in and out. Dealing with all the attention seekers and drug abusers and just plain idiots...

Deep down, I love you guys. I love the fact that you're there to take the wheat AND the chaff, and give all of them the treatment they need. I love that you were there for me and gave me the best care possible (even though I wasn't aware of it at the time), and that you will still be there if I need you again.




Hugs.


And have a Merry Christmas.
 
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If you are a military man who enjoys inserting objects into your urethra, remember that a dogtag chain may tangle, impeding your attempts to remove it.
 
Another who found this from a link who first must say thank you. I have been to the ER in Vegas many times as a youngster (they new my mother by name and always asked which son it was this time) and who's life was saved at UMC after a being stabbed while stopping a robbery.

Which brings me to my "if you are a police officers and the man whom just stopped the bad guy is telling you the finger jammed in his chest is there to stop the bleeding from the punctured lung, DO NOT I repeat DO NOT demand he pull it out. When he tells you NO he got my lung, do not proceed to jerk his hand away. When you end up with a face full of blood please do not at that point start FREAKING OUT and screaming you don't have aids do you?(happened 1990ish early in the aids scare) Your only response will be I told you he got my F'n lungs you idiot!"

Now if that isn't enough please don't try to kill that person who is now going into shock by telling him to put his head between his legs. You will only piss him off for trying to drown him in his own blood and really piss off the EMT when he arrives to the injured yelling to get the F'n idiot who is trying to kill you away from you. You will be shoved and told to get the f'k away from him and no I don't care if you got blood in your mouth get the f away.

It is funny now and gets better (ICU, Morphine and flowered shower curtains, deomons saying they are coming to get you and waking up DEAD, flat lined on the monitor, electrodes came off) but the people that took care of me except the cop did an amazing job. As proficient and professional as NASCAR pit crew. I do pray I never get a chest tube and a catheter at the same time EVER again though. So thank you for all you do..

P.S. I am still on page 20 🙂
 
G8P7 with NO prenatal care at 38(?) wks (confirmed via 3rd trimester u/s!) shows up so she can have her baby.

The real story is the 10in long vagina tattoo on her forearm that reads "juicy" at top and bottom. After evaling the pt I asked my nurse to repeat her bp and check out her arm.

She said "in 20 years, I never ..."


Sent from my iPhone using SDN Mobile
 
jumperjohn said:
As proficient and professional as NASCAR pit crew. I do pray I never get a chest tube and a catheter at the same time EVER again though. So thank you for all you do..
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I had someone (a nurse?) say to me: "there's only 2 things worse than a foley sticking out of your d*ck: having one pulled out while your awake, and having one put in while your awake."
 
I learned from my patient's mother today that our x-ray machine was defective. It's a good thing she told me, too- we almost diagnosed her daughter with a 50% pneumothorax, and we would have had to put a chest tube in her, so thank goodness she was there to let us know what the real problem was- faulty ER equipment. She told me she could just go home, the tachypnea/wheezing/desaturation would just resolve on its own.
 
JediZero said:
I learned from my patient's mother today that our x-ray machine was defective. It's a good thing she told me, too- we almost diagnosed her daughter with a 50% pneumothorax, and we would have had to put a chest tube in her, so thank goodness she was there to let us know what the real problem was- faulty ER equipment. She told me she could just go home, the tachypnea/wheezing/desaturation would just resolve on its own.
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And in things no one ever says, "CPS FTW".
 
😱Lesson: If you are playing on the trampoline with your brother, do not continue to bounce whilist having him in a headlock.

Story: It may be funny, but when he's unable to lift his head up and he's an an obtuse angle... that's alright he can sleep it off. In fact if you are the father of this individual, wait 2 days to present. Then, since it's not an urgent issue, come to the local urgent care. Have the EMT come, peak at the xray and take over neck stabilization at that, excrutiating angle.

Then leave the doc diaphoretic, shivering, with perioral/distal numbness and tingling. :nailbiting:

My only explanation -he was born with a bungie cord.

Leave the xray in the pile for overread... for every 2nd reading doc for the next week... :bookworm::prof:
 
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Today I learned that females of the H. sapiens species can be highly territorial.

For example, if one female has claimed rights to copulate with a specific male, that male may not copulate with any other female. Period. End of story. If he does, that may be grounds for the aggrieved female to fill both the offending male and female (whilst still in the copulatory embrace) with two barrels of birdshot.

Dont worry. Both will survive, plus or minus a few scars and minor body parts (eyes, ears, fingers, testicles, etc).

If it was buckshot, it woulda been a simple double homicide and the surgery residents would have never had the chance to look at the xrays and say "HOW MANY are there!?!"
 
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huh, just came here from quora where some member posted a link. i would say its a well of fun knowledge. thats really interesting to know what to expect from people ... 🙂
 
Today I heard the following conversation at the check-in/triage corner of the local (smallish) ED:

Receptionist: Can I help you?
Woman: Yes, I'm here to pick up a patient.
R: Name?
W: Joe Smith.
R: ... The computer says he was discharged 4 hours ago.
W: Huh? He just called me and said he was in room 8.
R: Well, according to this he's not here.
W: That's wrong. I dropped him off 4 hours ago.
R: Well I'm afraid I can't help you then.
W: Can I go back and look for him? He should be in room 8.
R: Ma'am, there's no one in room 8.
W: Can I at least go back and look?
R: Sorry, you can't go back there.
W: So what do I do?! Just stand here and wait, while he sits in room 8 waiting for me?!
R: Uhm...



They eventually got a nurse to go look in room 8. Guess what.... Joe was right there where he said he'd be.

Lesson of the day: sometimes the hired help is the problem.
 
Today I learned that if the emergency department refers you to a dentist for a dental abscess it's smarter to go to the internet. On the internet you can learn that applying rubbing alcohol to the painful tooth will cure your dental problem. Then when you apply so much rubbing alcohol to the tooth that you poison yourself and return to the emergency department your tooth no longer hurts because you are in repertory arrest.
 
Saddleshoes said:
Today I learned that if the emergency department refers you to a dentist for a dental abscess it's smarter to go to the internet. On the internet you can learn that applying rubbing alcohol to the painful tooth will cure your dental problem. Then when you apply so much rubbing alcohol to the tooth that you poison yourself and return to the emergency department your tooth no longer hurts because you are in repertory arrest.
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👍
 
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Saddleshoes said:
Today I learned that if the emergency department refers you to a dentist for a dental abscess it's smarter to go to the internet. On the internet you can learn that applying rubbing alcohol to the painful tooth will cure your dental problem. Then when you apply so much rubbing alcohol to the tooth that you poison yourself and return to the emergency department your tooth no longer hurts because you are in repertory arrest.
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I can see where he's coming from. I mean, I also hate dentists. But, oh the other hand, is avoiding a dentist worth being intubated and on a vent for a couple days......

Hmmm... I'll have to think about that one....
 
Spinach Dip said:
I can see where he's coming from. I mean, I also hate dentists. But, oh the other hand, is avoiding a dentist worth being intubated and on a vent for a couple days......

Hmmm... I'll have to think about that one....
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...at least while intubated the extraction/I&D is safer than undergoing procedural anesthesia in the dental office. of course, that's if you can find a dentist who will come into the hospital. d=)
 
Daiphon said:
...at least while intubated the extraction/I&D is safer than undergoing procedural anesthesia in the dental office. of course, that's if you can find a dentist who will come into the hospital. d=)
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Im sure the OMFS residents would love to have a crack at it.
 
When having only cat napped for a total amount under 6 hours in 98 hours, when you take your normal Ativan dose and see no improvement, when your doctor tells you to take another dose (thus a total of 2 mgs in 45 minutes) in addition to your Soma, gabapentin and Ultram to stop the visible back spasms - you will sit on the floor and fall asleep hard enough that the lovely hospice nurse calls down to the ER to get you treated as you aren't waking up to her.

A nasty sternal rub will wake you up, but being flat on your back makes the spasms worse. Two bags of fluids and better pain control, along with a required 4 hours of sleep, fixed that.

I'm the bad patient, I'm very sorry. I will nap in the quiet room more.

The waiting for death sucks. My mom is not there anymore, mentally (breast and lung cancer, mets in her brain, bones and lymphatic systems), but her body is too stubborn to quit already. Day 8 starts in 2 hours of the exact same. Remind me why we can't euthanize dying humans one more time and I may hit. I know I can't, I don't have to like it. Terminal is terminal, DNI/DNR, no chance of recovery, I don't think they can adequately control pain now. I'm not sorry about blowing up at the extreme Catholic chaplain who said it's a sin to kill a parent. That's not my Mom anymore, she's already gone. I don't want my 33rd birthday without her, but I don't have that option, so I got mad and rude
 
If you have plenty of money from some sort of annuity that you can't talk about, perhaps there are better things to spend it on than heroin, needles, more heroin, and more needles.

However, once you decide to pick up the habit, it would be best if you continue it for 30-40 years without major incident. This way, when you are in a motor-vehicle-v-pedestrian accident and are brought in with a concussion and delirious, there will not be a single vein on your body into which can be inserted an IV.

An ED attending (with a little bit of a chip on his shoulder, maybe) will decide to start looking for veins in unorthodox places. Eventually he will find one. Bad news for you, its on the side of your...er...male organ.

But that's not the end of the story! Oh there's more. 'Cause when you regain a certain amount of feeling in your body, you will decide you do not like the position of this IV. This will lead to you trying to pull it out. However, you will find that it has been attached to your skin quite well. You will eventually get the IV out, but in the process obtain a rather horrible looking asymmetric degloving injury that will make even the most hardened urologist shake his head.

Also, you will sue the hospital as soon as you are released.
 
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Okay, compound bow shooters are on a drive to get as much velocity as possible. Bow geometry, lighter arrow shafting--aluminum became fiberglass became carbon fiber. If you shorten the arrow, and use an "overdraw" rest that protrudes inside the limbs a couple of inches, you can use a shorter, lighter, faster arrow (remember, they're using the sharp head for trauma, not mass or energy like a bullet). Then that bow has counterbalances and all kinds of other crap on it. He probably uses a mechanical release button on the string as well-a grip handle with a hook. It's more "consistent," but is another gadget.

So I'm assuming this guy had 2-3" of overdraw and a short arrow, and drew a bit too much, slipped off the rest, and either his release or fingers also slipped as the tension went all screwy, and drove the arrow down and forward.

We were discussing if it's safer to cut the arrow in several sections to disattach him for transport, or if one should just hacksaw his $800 bow to teach him a lesson as well.

I shoot a real longbow with wood shafts, preferably bodkin points for historical accuracy. It won't win any technical awards, but it will severely hurt something's day at 200 yards, and it would be very hard to shoot myself.
 
MikeWilliamson said:
Okay, compound bow shooters are on a drive to get as much velocity as possible. Bow geometry, lighter arrow shafting--aluminum became fiberglass became carbon fiber. If you shorten the arrow, and use an "overdraw" rest that protrudes inside the limbs a couple of inches, you can use a shorter, lighter, faster arrow (remember, they're using the sharp head for trauma, not mass or energy like a bullet). Then that bow has counterbalances and all kinds of other crap on it. He probably uses a mechanical release button on the string as well-a grip handle with a hook. It's more "consistent," but is another gadget.

So I'm assuming this guy had 2-3" of overdraw and a short arrow, and drew a bit too much, slipped off the rest, and either his release or fingers also slipped as the tension went all screwy, and drove the arrow down and forward.

We were discussing if it's safer to cut the arrow in several sections to disattach him for transport, or if one should just hacksaw his $800 bow to teach him a lesson as well.

I shoot a real longbow with wood shafts, preferably bodkin points for historical accuracy. It won't win any technical awards, but it will severely hurt something's day at 200 yards, and it would be very hard to shoot myself.
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This is why I still use a recurve.

Is it possible the bow belonged to someone else and the owner could have had a shorter draw?

Sent from my Nexus 7 using Tapatalk
 
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That's possible. But you should check your draw length before drawing.

It's not that it's a compound, though that...compounds the problem, with string letoff. It's that he used an overdraw shelf so he could use an arrow inside the draw length.

It would be almost impossible to have that problem with a real bow, and just do enough exercise you can hold 68 pounds at full draw:
 
JediZero said:
Today, I learned that it is not a good idea to pick up random silver rings that you find lying on the ground and place them on your finger. When it gets stuck, and the swelling impedes your progressively more desperate attempts to remove it, you may become so desperate that you let your cousin 'sterilize' a razor blade with his lighter and cut your finger open in hopes that 'letting out the blood' may reduce the swelling enough to get the ring off.

Also, wait four days to come into the ED after this.
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I did this in high school. My friend's dad cut the ring off with a small bolt cutter. Good times
 
Hey, not all compound lovers are idiots. I've got itty bitty T Rex arms. I can't get a strong enough draw to deer hunt without a compound bow.

However, I routinely throw people off the range for extreme modifications which are 99.99999% of the time stupid and dangerous. If the T Rex girl can bring down a deer and four coyotes in a day with a stock compound and outdated fiberglass arrows, you need to work on your skills not on the biggest and baddest toys you can find.

I did threaten the pompous jerk if he kept trying to use dangerous modification crap, I was taking my unmodified baby and aiming towards the brain that shouldn't be used. Granted, I doubt there was much, if any target there, but at 6 feet, I won't miss.

Seeing more recurves thanks to Hunger Games.
 
Today I learned that if you're drunk, but the bar is only a couple of miles from home, you should turn left onto a major thoroughfare, and leave your lights off for discretion (at 8:45 PM). Ignore the three vehicles flashing headlights and flashlights at you. When you run over the concrete median four blocks later, throw sparks all over and lose a tire, you should swerve over it, across two lanes, into a professional building parking lot. Ignore the guy with the cell phone following you. Get back on the road, drive another mile, turn into the Lowe's parking lot, go around the Lowe's, back onto another major street, into your apartment complex, park in your space and pass out.

When the police arrive, you should insist you were not drinking, have no idea how the tire failed, or what caused all the damage to your car. (Actually, it's entirely possible he doesn't remember.)

Bonus points if your wife comes out and wails, "But he can't go to jail again!"

No injuries, luckily. Just damage, hilarity and alcohol poisoning.
 
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