Things I Learn From My Patients

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strega42 said:
Just wanted to add one from a medical transcriptionist...

When you are diagnosed with fibromyalgia and IDDM, and you are out of methadone, by all means don't bother your doctor. Just dissolve your muscle relaxants in tap water, and inject them with your insulin needles.

Certainly the ER docs, pulmonologist, cardiologist, and infectious disease specialists will be astounded by this new method of pain relief.
Click to expand...

Finally one I can top. When I was a third year medical student we had a guy on our IM service who ground up a Fentanyl patch, mixed it with water and injected IV. I don't remember the outcome, just the story from admission...
 
1. When you are tired of hanging out at the jail - please try to hang yourself. When it doesn't work, try again the next week, and the week after as well. When the 3rd year med student has seen you 3 times in 3 weeks, it's time to try another method.
2. Same jail, different guy... please stop picking your varicose veins until they bleed, then come in and complain because you haven't lasted to your vascular office appt and the other guys make fun of your ted hose.
3. GSW to occiput, midline - is kind of hard to self inflict... 'specially when same guy was put back together after scrotal GSW the year prior.
4. When your spleen "ruptures while you were just sitting on a bar stool, minding your own business" and you are writhing in pain, confessing to all your outstanding warrants, don't get mad and threaten the doc on call seeing you (Rheum - which made it even funnier), because he will call the cops to let them know how sorry you are about your misdeeds and when you are getting released.
5. Please don't come into the ER at 0200 on a Sunday for "vaginal bleeding for the last 124 days" - when your appointment is 0830 on Monday.
6. People who get dragged by cars by their arms tend to deserve it - especially when they have the talent of working the c-collar up over their face by wiggling their jaw repeatedly while alternating screaming obsenities and crying. This gains you street cred. Then tell the big, muscled ER nurse that "you know why he's so mean, you must have slept with his girlfriend."
 
Don't come to the ED at 0100 having not passed a bowel movement in two weeks. What made you wait this long before seeing a doctor in the first place? And second, are you sure that you can't wait another 7 hours until the walk-in clinic opens?
 
Wow you guys are the cure for depression! Some of theses stories are extremely funny!

Why don't you guys (The true ER docs/nurses on here) create a booklet with theses true funny stories and sell it and use the money to help out the cost of this site? I would buy it in a heart beat! (Just please accept paypal!) Even know I'm not a doc or nurse. It would be my way of supporting this awesome site.
 
Anuwolf said:
Wow you guys are the cure for depression! Some of theses stories are extremely funny!

Why don't you guys (The true ER docs/nurses on here) create a booklet with theses true funny stories and sell it and use the money to help out the cost of this site? I would buy it in a heart beat! (Just please accept paypal!) Even know I'm not a doc or nurse. It would be my way of supporting this awesome site.
Click to expand...

A book about our experiences would be very funny. Unfortunately, I don't think that it will happen for three reasons:

1. The SDN is a non-profit website. It already generates more than enough revenue from advertisements and donations. The webmaster is trying to come up with ways to use the excess funds.

2. There is a book called Emergency which gives many of the same user-submitted stories. Crazy patients aren't unique to just our hospitals.

3. Some of the stories from this website have already been published. I have a doctor calendar that tells a new joke or tale every day. Some of the material is pulled and credited right off of here.
 
deuist said:
A book about our experiences would be very funny. Unfortunately, I don't think that it will happen for three reasons:

1. The SDN is a non-profit website. It already generates more than enough revenue from advertisements and donations. The webmaster is trying to come up with ways to use the excess funds.

2. There is a book called Emergency which gives many of the same user-submitted stories. Crazy patients aren't unique to just our hospitals.

3. Some of the stories from this website have already been published. I have a doctor calendar that tells a new joke or tale every day. Some of the material is pulled and credited right off of here.
Click to expand...

Hi there Deuist.

I understand that SDN is a non profit website. We could use the money for more bandwidth, etc. more the better. Since this site gets plenty of hits off of the advertisement (according to you) and the webmaster is wanting to come up a way of using the excess funds. Why not make this community bigger by developing a Non profit org that helps people to get medical care? We can use the extra money to help those who cannot afford medical/denture care, just a thought.

Thank you for recommending me this book. I will search around for this book.
 
When I volunteered in an ED, this was my favorite line of questions/answers with teenage females:

1. Is there any chance you could be pregnant? No.
2. Do you take birth control? No.
3. Do you have unprotected sex? Yes.
4. When was your LMP? 3 months ago.
5. Now, let me ask you again, is there any chance you could be pregnant? No, I told you that already.

:laugh:
 
HIANMI said:
1. Is there any chance you could be pregnant?
Click to expand...

Yep. This question is about as useful as "what is your pain scale?". That one is pure evil. It seems solely designed to make me spend more time dictating why I didn't treat the 10/10 pain in the patient busy skipping around the ER.

Grrr.

Take care,
Jeff
 
Yeah the is there any chance you are pregnant is my favorite as well because regardless of the answer they are getting a UCG. Of course at the crap hole im doing my sub-i I had a 73 y/o that the cath lab thought needed a ucg.. Go figure what do i know I am just an m4.
 
EctopicFetus said:
Yeah the is there any chance you are pregnant is my favorite as well because regardless of the answer they are getting a UCG. Of course at the crap hole im doing my sub-i I had a 73 y/o that the cath lab thought needed a ucg.. Go figure what do i know I am just an m4.
Click to expand...

heee. i guess it's like ny lotto: hey, you never know...
 
Anuwolf said:
Hi there Deuist.

I understand that SDN is a non profit website. We could use the money for more bandwidth, etc. more the better. Since this site gets plenty of hits off of the advertisement (according to you) and the webmaster is wanting to come up a way of using the excess funds. Why not make this community bigger by developing a Non profit org that helps people to get medical care? We can use the extra money to help those who cannot afford medical/denture care, just a thought.

Thank you for recommending me this book. I will search around for this book.
Click to expand...

The book is available off of Amazon for about $3 used. Some of the ideas that Lee (the webmaster) has thrown around include an SDN conference, a scholarship, or profit-sharing for the biggest contributors---the last idea that was quickly shot down.
 
Bandwidth... a conference would be cool as well. Scholarships would be cool, the only thing is I dont know if there is enough $$$ to make a difference.

How about a scholarship where the winner pledges to give back $1000/yr to SDN once they have completed all training. Over time it could pay for itself.
 
deuist said:
I already donate enough money to SDN.
Click to expand...
I meant the scholarship winners... not you... Assuming the scholie was a full ride
 
Quote:
Originally Posted by edinOH
A couple of things I learned yesterday...

Chest tubes apparently hurt a hell of a lot less than I&D of a 4 cm abscess on your ass. This 26 yo guy was crying like a baby from the minute the betadine touched his ass. It only got worse with the lido and the knife. What a puss.



I wouldn't discredit abscesses so quickly as minor. I had one on my shoulder that got so bad I couldn't even bear the pain of shirt in contact with it one morning and therefore went to a clinic to get it drained. The actual drainage (even with lido) was the worst pain I've ever experienced, and I had to get the FP to stop halfway through to give me a breather as I almost passed out due to that pain. Then again, I never made a peep though through the whole thing; just shut my eyes, clenched my jaw, and waited for it to be over.
Click to expand...
Lev is right. This is a rather humorous thread. But, once you are in Practice, especially if you have your own patients, rather than just those who wander into the ED, a little Empathy for those in pain goes a long way.

Not all people in pain have caused their own damage to their Mu receptors. Pain itself can do this. Please, let's not forget we are treating human beings. Even if they have more tattoos than teeth...... 🙂 They are still humans. That's why we went into this field. Right?
 
AMA is against medical advice.. which is when someone leaves when a doc thinks they need to stay..
Click to expand...
Or Advanced Maternal Age, in OB. (Meaning any pregnant woman over the age of 35.)
 
Doc Zuzu said:
Lev is right. This is a rather humorous thread. But, once you are in Practice, especially if you have your own patients, rather than just those who wander into the ED, a little Empathy for those in pain goes a long way.

Not all people in pain have caused their own damage to their Mu receptors. Pain itself can do this. Please, let's not forget we are treating human beings. Even if they have more tattoos than teeth...... 🙂 They are still humans. That's why we went into this field. Right?
Click to expand...

stop_sign_MD.jpg


Just stop it.
 
Hello. Non-medico here; I actually came across this thread from a similar thread in the pre-pharm forum. (Non-pharm too: I'm an Rx delivery driver for a pharmacy.) Still, thought you might enjoy a bit from a 'customer' viewpoint.

See, my wife --- type 2 diabetic, some blood pressure problems --- has been chosen by the Lord to be the football in a game called "Stump The Doctors." If there's an adverse reaction to something, and it's really obscure, well... That's my wife's role in the universe: to suffer that adverse reaction.

Case in point:
Wife was getting violently ill every three weeks, like clockwork: yakking up bile, febrile, muscle weakness. Off to the ER we go. She would be held overnight, tested for this 'n' that, instructed to discontinue all meds for 72 hours, liquids only for same, then soft foods. Come back if there are still problems.

So... She'd come home, follow instructions, and be just fine. Would contact her GP and told to continue with her normal meds regimen. 2½ weeks later, back to the ER.

After about six months of this gig, she happened to draw the same ER doc she'd seen the first time; he remembered her. After looking at her recent history, he instructed the lab to test for everything, no matter how unlikely. By gum, test for prostate cancer: test for everything and anything.

The result: my wife had potassium poisoning. 😕

Buh-hunh? It took some work, but they finally figured it out:
It was her BP medication. A side effect so rare it wasn't even indexed was the cause. Apparently, the BP med prevented her body from correctly processing potassium in her blood stream. The potassium would build and build, until it hit a critical mass and she'd get sick. This reaction would only occur in 1 of 180,000 patients, which meant it never got mentioned in the normal info sent out.

So yeah, that's my wife's role in this existence: Stump The Doctors. It's her role to keep y'all on your toes, even though she really wishes it wasn't. 🙄
 
Doc Zuzu said:
Lev is right. This is a rather humorous thread. But, once you are in Practice, especially if you have your own patients, rather than just those who wander into the ED, a little Empathy for those in pain goes a long way.

Not all people in pain have caused their own damage to their Mu receptors. Pain itself can do this. Please, let's not forget we are treating human beings. Even if they have more tattoos than teeth...... 🙂 They are still humans. That's why we went into this field. Right?
Click to expand...

The people that wander into the ED are my patients, just like the anxiety ridden soccer moms are your patients in your clinic. The only difference is, that I have some clarity, and enough honesty, to admit that some of my patients are degenerates. Please don't speculate that emergency physicians are less empathetic than internists, etc ("real doctors"); we treat everyone, including the people that those other doctors turn away.

Your soapbox is creaking. Get off of it before it breaks.

mike
 
Doc Zuzu said:
Or Advanced Maternal Age, in OB. (Meaning any pregnant woman over the age of 35.)
Click to expand...

Wow, really?!? Cool, I guess we should have the moderators move this thread over to the OB forum now.

😛

Get over yourself, this is the EM forum. AMA is "against medical advice", not "advanced maternal age", not the "American Medical Association", not even the "American Music Awards" nor the "American Muslim Alliance". Given that your other post...

Doc Zulu said:
Lev is right. This is a rather humorous thread. But, once you are in Practice, especially if you have your own patients, rather than just those who wander into the ED, a little Empathy for those in pain goes a long way.

Not all people in pain have caused their own damage to their Mu receptors. Pain itself can do this. Please, let's not forget we are treating human beings. Even if they have more tattoos than teeth...... They are still humans. That's why we went into this field. Right?
Click to expand...

...shows a complete lack of the laid back attitude needed to practice emergency medicine, don't even bother getting over yourself, just leave. Go back to to your soccer moms on Wisteria Lane, I'm sure that someone is overdue for their prescription for "Mother's Little Helper"...

😎
 
docB said:
The thing about abscesses in the ED is that the majority of the ones I I&D are on people who have hypersensitized their Mu receptors so horribly painful to them is regular life to the rest of us. Regular abscesses on normal people can be done at a PMD's office or urgent care.
Click to expand...
For the record, mine was done at my family physician's office, and I don't have hypersensitized Mu receptors as far as I'm concerned. I've taken what other people would consider "painful" experiences on many occasions; for example, breaking bones, dislocating my finger, etc, which weren't as painful as that drainage. Sometimes, certain things can be more painful than would normally be expected, and this was probably one of those times.

Ultimately, I wasn't crying or vocal at all during the procedure, but I hope my FP didn't mock me later on when I asked him to stop and give me a breather for a few seconds before he continued draining it. Pain is pain.
 
Yeah there was a study done and it showed that the most painful procedure done on males in the hospitals is a foley insertion. Obviously other things would hurt more but we end up giving them pain meds and we dont for foleys... just a thought..
 
EctopicFetus said:
Yeah there was a study done and it showed that the most painful procedure done on males in the hospitals is a foley insertion. Obviously other things would hurt more but we end up giving them pain meds and we dont for foleys... just a thought..
Click to expand...

A buddy of mine told me a story years ago, that, when we were interns, when he was rotating over at Mt. Sinai (NY), there were these minor grand rounds, and they were talking about my friend's patient (whom he himself - my friend - had put the foley in) - part was radiology, and the rads resident was intoning, "the foley is in the prostate" - which couldn't be fun.

This all came back to me a few weeks ago when we had a patient transferred in - chief warrant officer in the US Army with the 82nd who had a jump accident (head, not lower), tough as nails guy - who was periodically screaming in pain from his groin, saying, "it's this tube in my joint!". The EMS folks (two petty officers 3rd class) say that the foley was checked before they left. There's less than 100mL of urine in the bag. We DC the foley, and give the guy a urinal, and he puts out >300mL urine.

Moral of the story? Tube in whizzer =/= good times.
 
I remember when I was at the funny farm a medical nurse threaten to incert a cath. if I wouldn't urinate into the cup 🙁 It's not like I wasn't cooperating, I just didn't needed to go at the time! I know how painful that could be, hell my mother told me all about it when she was at the hospital.
 
whoa....waht's going on here? the spirit of the thread deteriorates before my eyes!
speaking of eyes, a recent lesson:

if you crash your car into a horizontal pole that penetrates your maxilla, the trauma surgeon may be forced to pop out your eyeball to release the hematoma behind it. if you consult ophthamology for guidance on how to handle the eyeball dangling out of the head attached only by it's lateral rectus, they may leave a note stating only "recommend atropine drops." that's why they get paid the big bucks!
 
MeanDean said:
Hello. Non-medico here; I actually came across this thread from a similar thread in the pre-pharm forum. (Non-pharm too: I'm an Rx delivery driver for a pharmacy.) Still, thought you might enjoy a bit from a 'customer' viewpoint.

See, my wife --- type 2 diabetic, some blood pressure problems --- has been chosen by the Lord to be the football in a game called "Stump The Doctors." If there's an adverse reaction to something, and it's really obscure, well... That's my wife's role in the universe: to suffer that adverse reaction.

Case in point:
Wife was getting violently ill every three weeks, like clockwork: yakking up bile, febrile, muscle weakness. Off to the ER we go. She would be held overnight, tested for this 'n' that, instructed to discontinue all meds for 72 hours, liquids only for same, then soft foods. Come back if there are still problems.

So... She'd come home, follow instructions, and be just fine. Would contact her GP and told to continue with her normal meds regimen. 2½ weeks later, back to the ER.

After about six months of this gig, she happened to draw the same ER doc she'd seen the first time; he remembered her. After looking at her recent history, he instructed the lab to test for everything, no matter how unlikely. By gum, test for prostate cancer: test for everything and anything.

The result: my wife had potassium poisoning. 😕

Buh-hunh? It took some work, but they finally figured it out:
It was her BP medication. A side effect so rare it wasn't even indexed was the cause. Apparently, the BP med prevented her body from correctly processing potassium in her blood stream. The potassium would build and build, until it hit a critical mass and she'd get sick. This reaction would only occur in 1 of 180,000 patients, which meant it never got mentioned in the normal info sent out.

So yeah, that's my wife's role in this existence: Stump The Doctors. It's her role to keep y'all on your toes, even though she really wishes it wasn't. 🙄
Click to expand...
See, this is the type of problem that drives us crazy and clogs the ER. If your wife has ongoing problems with exacerbations of her chronic diseases then her PMD should be dealing with this stuff. If she does get sick enough to merit an ER visit I'm not playing "stump the doctor" with anyone. I'm getting the basic stuff going and calling the PMD to admit and work it out. The ER is not the place to deal with the 1:180K zebra reaction. Having said that "potassium poisoning" should have been caught on the first test any doc would order on a vomiting diabetic. This shouldn't have required anything close to every test in the book.
 
OK, here's a fun one.

If you decide to build a pipe bomb, never try to weld the cap on after the gunpowder is inside the pipe. If you do, don't be surprised if you get an explosion a little sooner than you had anticipated. 😱

At least the guy wore a welder's mask and limited his injuries to his torso. Safety first. That's what I always say! 🙄
 
sddoc said:
OK, here's a fun one.

If you decide to build a pipe bomb, never try to weld the cap on after the gunpowder is inside the pipe. If you do, don't be surprised if you get an explosion a little sooner than you had anticipated. 😱

At least the guy wore a welder's mask and limited his injuries to his torso. Safety first. That's what I always say! 🙄
Click to expand...

Some people aren't that lucky and manage to blow up couple of fingers 🙁

http://nobombs.net/brucel/Explosiveinjury5.html take a look (WARNING! GRAPHIC picture)
 
Sorry man, I try to avoid looking at trauma as much as possible. Seen enough of it in real life. That graphic pic warning just made me laugh cuz ED's get a lot of trauma, so it seems ironic to me that there needs to be a warning about graphic stuff on the Emergency medicine forum.
 
MirrorTodd said:
Sorry man, I try to avoid looking at trauma as much as possible. Seen enough of it in real life. That graphic pic warning just made me laugh cuz ED's get a lot of trauma, so it seems ironic to me that there needs to be a warning about graphic stuff on the Emergency medicine forum.
Click to expand...

I've placed warning tags on it simply because other people who are not in the medical field can be warned about it. Not everybody here has a strong stomach to handle theses type of pictures 😀
 
docB said:
See, this is the type of problem that drives us crazy and clogs the ER. If your wife has ongoing problems with exacerbations of her chronic diseases then her PMD should be dealing with this stuff. If she does get sick enough to merit an ER visit I'm not playing "stump the doctor" with anyone. I'm getting the basic stuff going and calling the PMD to admit and work it out. The ER is not the place to deal with the 1:180K zebra reaction. Having said that "potassium poisoning" should have been caught on the first test any doc would order on a vomiting diabetic. This shouldn't have required anything close to every test in the book.
Click to expand...
Never work for Kaiser Permanente, DocB: You're blessed with too much common sense. IMHO, engaging in such rationality will only gum up the sprockets at a Kaiser facility. 😀
 
docB said:
Don't come to the ER to ask a doctor about penis enlargement. Just don't.
Click to expand...

"enlargement, huh? Let's see it.....

yep, you're sure need one. Too bad I'm the wrong guy. Good thing you waited 15 hours for this advice, huh?"

Take care,
Jeff
 
After downing a bottle of lithium and a bottle of risperdol telling the doctor, "I wasn't trying to kill myself - I was just trying to make my blood taste bad so the vampires wouldn't eat me." is not going to get you out of a trip to the psych ward. In fact, it will probably get you locked in a higher security ward than otherwise would have been the case.


On the other hand, when doctors tell you they have to put something in your neck for dialysis screaming, yelling, crying and fighting anyone who tries to touch you while insisting that they are lying to you and bringing you to be eaten by vampires WILL in fact convince them to use a vein in your leg instead. When this happens, it is a BAD idea to try to sit or stand to get to the bathroom.
 
RoryJarrah said:
After downing a bottle of lithium and a bottle of risperdol telling the doctor, "I wasn't trying to kill myself - I was just trying to make my blood taste bad so the vampires wouldn't eat me." is not going to get you out of a trip to the psych ward. In fact, it will probably get you locked in a higher security ward than otherwise would have been the case.
Click to expand...
How do you know that this won't make human blood unpaletable to the vampires. I think you're being overly judgemental. 😉
 
docB said:
How do you know that this won't make human blood unpaletable to the vampires. I think you're being overly judgemental. 😉
Click to expand...

I think they'd sleep in their little coffins all night as well as all day.

and we certainly wouldn't want to be judgemental on SDN
 
RoryJarrah said:
After downing a bottle of lithium and a bottle of risperdol telling the doctor, "I wasn't trying to kill myself - I was just trying to make my blood taste bad so the vampires wouldn't eat me." is not going to get you out of a trip to the psych ward. In fact, it will probably get you locked in a higher security ward than otherwise would have been the case.
Click to expand...

Oh come on! Anybody should know that the best way to keep the vampires from biting you is to take an OD of garlic! Or better yet find couple of skunks.. make them scared and have them spray you all over your body. I'm sure those vampires wont even go near your door, It will also keep the vampires who are dressed up as doctors/nurses from coming at you too. Damn! I should make a special perfume to keep the vampires away. I'd be filthy rich! 🙂
 
Awesome thread, don't let it die!

If you're a huge guy, by all means forcefully grab the hair of the tiny female paramedic that has come to help your friend, and don't let go. The cops really love this and don't feel at ALL protective of their helpful, unarmed friends. Chances are, they won't cause multiple fx's to your forearm. IF they do, said paramedic will still feel REALLY great about helping you out...
Not me but one of the gals I work with!
 
From a surgery rotation...

When you are waking up from anesthesia after undergoing surgery for the several deep stab wounds your fellow inmate inflicted on you with your own knife, feel free to kick the resident in the chest--he definitely deserves that for putting the tiny foam straps around your wrists.
 
blake2go said:
👎 👎 Being that you are so heartless,why did you not just kill her yourself? Poor mixed up KID wanting to die,failed, and had to meet you,no doubt people like you,are the reason she wished to leave in the first place. Perhaps with your weapons no how,you might take yourself out and then We would not have to deal with you!
Click to expand...


We are not heartless people, we too go home in tears. Humor is a way for us to get through the traumatic things we have to deal with every day. It may seem heartless to other people, but it is one of the few things that helps us keep our sanity in a profession where violent death is prominent.
 
Apollyon said:
If you are 21, and had a head-on MVC with no restraints or airbag, and bent/broke the steering wheel, and you remember nothing since being at the Waffle House at 0400, since you are stoned on pot, and have only a non-displaced nasal fracture (without septal hematoma) and a minimal tongue lac to show for the whole thing, don't fret over 1. the needle for anesthesia or 2. the two Vicryl sutures I put in your tongue, as far as cosmesis goes. Face it, if you get dumped 'cause your tongue has a scar on it, she ain't worth it.

I did learn today, though, "a piece of corn" (if the tongue lac is bigger than that, you sew it). Since this guy's lac was 2/ to biting his tongue, he had to have his tongue protruded when this occurred, and I can only picture this dude reclining, enjoying his buzz, with his tongued sticking out (?), until the accident.
Click to expand...


I can top that one. I had a family member have a nail go through his tongue, while still connected to the 2x4. Better yet? It went through his tongue from the bottom up!!! Now tell me how that happens? LOL :laugh:
 
Please bear (bare?) with me. This was written for another blog that I have where the majority of people are not in the medical field.


Large angry man enters the ED, with police assistance. Large angry man has been doing multiple drugs, and drinking mouthwash. For those inexperienced alcoholics mouthwash is apparently a very cheap drunk. Large angry man is not fat, but solid muscle. He was in police custody because he attempted to stab a bus driver, what a wonderful guy. Anyways, we needed to obtain a urine sample from this kind gentlemen. So I recruit the help of a male coworker. Now I have to hold this patient up while my coworker holds the urinal and assists with the male urinating process. This patient was having none of it, yet he kept screaming that he had to pee. So we try a different route, called a condom cath. This is a device that fits over the penis and collects the urine through a tube into a bag, very clever. Off we go. I, being a very strong female (laugh here), am in charge of holding this mans arms down while my male coworker attempts to place this condom cath. So this disoriented patient, who is drunk and high is lying supine on the cot, naked from the waist down. He is smiling at me, totally oblivious to the other male presence in the room, and telling me that I am his "white chocolate" and that he would like to "eat me", great. My coworker starts the task of applying the condom cath, the patient gets a little curious and looks down to see what is up (excuse the pun). Seeing a man attempting to roll a condom onto his penis he FLIPS OUT. Now my coworker is attempting to calm the patient down by telling him "don't worry man, it's just a condom". Men, help me out here. If you were completely bombed and being held down how would you respond to a man hovering over you telling you "don't worry man, it's just a condom". ROFLMFAO!!!!!!! This is still one of my favorite stories.
 
Bear. Bare means naked or lacking the normal furnishings.
 
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