"Things I learn" & "Medicine Sucks" discussion thread

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In regards to old guys and ladders....


Several years ago, my great-grandmother recruited a bunch of guys from the senior citizen center to repaint her two story house. The local paper ran an article on it.

There were 9 or 10 people, the baby being "only" 65. My great-grandmother was 78 at the time...and going up and down the stairs and ladders just like the guys. No one was hurt, and the house looked really spiffy when they were done!
 
AznTrojan said:
not an ER story.. but i have a good one from non-trauma surg..

when you get tired of vaginal or anal sex.. try transverse colon.. there are individuals out there who will pay 1000 bucks a pop to screw a colostomy patient (yes.. the colostomy).. more amazingly is there are prostitutes who sell their colostomy..
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We had a gentleman brought in for a psych eval for pimping his colostomy site, the staff christened him "the Colostatute". :laugh: :laugh:
 
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docB said:
Your patient base must be more "cerebral" than that of FoughtFyr. I'm still cracking up about that bit he posted (paraphrasing) "The prison must be required to have at least one guy who jams pencils into his urethra."
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We have a gentleman from the local prison that will insert ANYTHING into his urethra... paint chips, pieces of his mattress, paper. Most times the urologist has to go in. We care convinced that he is trying to bankrupt the state one FB at a time.

Then again he is in good company. We also have a man that castrated himself with a length of string and a rusty razor blade...

To top it off, another inmate who has a hx of cutting and ingesting razorblades just swallowed 14 (all taped together). I wish I had the image of the CXR. Priceless.
 
My dad was the plant manager at a chemical plant for a number of years, and I heard a few...

1. If you're unscrewing a plug in a high-pressure tank, you should make sure it's empty. Further, if it starts hissing loudly, you might want to reconsider your theory that it's empty. If you continue to loosen said plug, which is a hunk of iron about the size of your fist and weighs about 10 pounds, once it reaches the end of the threads, it will be ejected with enough velocity to enter through your chest and exit through your back. That was the only Darwin award candidate at the plant.

2. If you come to work drunk, and the tank that you're pumping concentrated sodium hydroxide (extra-strong draino) into is overflowing into the retaining wall, you're correct to reverse the pump. However, when the tank gets down to the "full" line, you should either at least turn the pump off or close the valves, or preferably both. It's a bad idea to just pull the disconnect levers on the hose, which will spray you with the chemical and nearly kill you. Somehow the guy avoided going blind even though he got it in his eyes.

3. If you're leaning on a truck with your hand, which contains several of the tanks from the first story sitting on railroad rails, you should pay attention to what's going on. Should one of the tanks start to roll, it will squish the ends of your fingers right off.

One of the chemicals at the plant was chlorine gas. Apparently, if you breathe it a bit, you can get a bit high off it. Keep in mind that this same gas was used as a chemical agent in WWI. No, I don't get it either. Ammonia gas, on the other hand, will just burn the living $#!7 out of you. That stuff is f$cking nasty.
 
One of the chemicals at the plant was chlorine gas. Apparently, if you breathe it a bit, you can get a bit high off it. Keep in mind that this same gas was used as a chemical agent in WWI. No, I don't get it either.
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Chlorine burns like hell in such minute amounts, I can't imagine someone getting a good enough whiff to get any kind of highness out of it unless they're also getting pulmonary edema.
 
loveoforganic said:
Chlorine burns like hell in such minute amounts, I can't imagine someone getting a good enough whiff to get any kind of highness out of it unless they're also getting pulmonary edema.
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Unless they're getting minor oxygen deprivation off of stuff that's reacted with the chlorine already and is therefore marginally less volatile, I really can't figure that out either. :confused: I suppose if you really really dilute it you just get a "pleasent" public pool smell...
 
Speaking of which, I heard a story about a guy who all his chlorine tabs for the pool were stuck together after a long winter in the garage. So he puts them in the microwave to "soften them up." Yeah, chlorine gas ain't good for you.
 
jbar said:
Speaking of which, I heard a story about a guy who all his chlorine tabs for the pool were stuck together after a long winter in the garage. So he puts them in the microwave to "soften them up." Yeah, chlorine gas ain't good for you.
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brilliant
 
Chlorine and Caustic (sodium hydroxide) are wonderful chemicals. We make both of them along with the pool tabs where I work. It doesn't take but a little bit of chlorine gas to let you know it's time to get out! We don't have too many inhalations among regular employees, but we have hauled out a lot of contractors in the ambulance, with lots of puking and other bodily fluids being expelled!
 
jbar said:
Speaking of which, I heard a story about a guy who all his chlorine tabs for the pool were stuck together after a long winter in the garage. So he puts them in the microwave to "soften them up." Yeah, chlorine gas ain't good for you.
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People are brilliant. Wonder how long his home was uninhabitable.
 
jbar said:
Speaking of which, I heard a story about a guy who all his chlorine tabs for the pool were stuck together after a long winter in the garage. So he puts them in the microwave to "soften them up." Yeah, chlorine gas ain't good for you.
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I think it was posted in this very thread... :laugh:
 
Quite possible, its a long thread. I never said I saw the patient.
 
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Apsaras said:
If your kid is running a fever for a week, it's obviously cheaper to call EMS in when he spikes a 104.4 fever than to just bring him into his PCP. Bonus points when it's all our fault.
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During residency I had a floor nurse who was obsessing about a kid's fever being 'too high'. I kept saying it didn't matter so she finally calls me and asks snottily 'Well what temperature would you care about, Dr. Stitch? At least leave me parameters.'

I wrote the following order: please notify house officer should child spontaneously combust secondary to fever.

It did not go over well. But she wanted parameters!
 
Stitch said:
During residency I had a floor nurse who was obsessing about a kid's fever being 'too high'. I kept saying it didn't matter so she finally calls me and asks snottily 'Well what temperature would you care about, Dr. Stitch? At least leave me parameters.'

I wrote the following order: please notify house officer should child spontaneously combust secondary to fever.

It did not go over well. But she wanted parameters!
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Reminds me of one of my favorite ScutMonkey cartoons:
http://theunderweardrawer.homestead.com/burnbabyburn.html
 
Stryker One said:
Linky no worky.:(
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Looks like they got boingboinged! I'll look and see if they have a mirror site or something... otherewise it'll recover in a couple of days when the blogwatchers go away :D
 
jbar said:
What are you talking about? A psychotic break is about as serious as mental problems get, and would explain her violence and symptoms. And yes, people who throw their baby off balconies while naked during a psychotic break tend to spend some time talking with psych.
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What *I* want to know is what led to her psychotic break. Was she self-medicating for serious mental illness?

And I hope she spent some time talking with psych, rather than just being thrown in jail. Some people really have genuine issues and should be in a hospital for them. Some people are liars, who are just trying to get out of trouble (the name Susan Smith comes to mind).

I still feel sorrier for the baby than her.
 
MediCane2006 said:
There are days when I really think I should just quit this and open up a bar...
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I don't know how you all do it. I really don't. You all deal with some really horrible situations, and I for one am grateful you do.
 
Been gone for a while, had to post though. Been stuck in the PICU, and have been learning lots of things. For example:

If you are the intellegent charge nurse that you think you are, by all means, put your worst nurse with your sickest patient. This will only result in 50 pages for the on call resident that evening, eliminating any possibility of sleep. And, they will include the wonderful page involving "That patient you wanted me to restrain, well, I wasn't paying attention, and he pulled his Quinton out". I will not be in a good mood the rest of the night.

Later on that evening, when the patient is now intubated, paralyzed, and sedated after head CT findings, don't bother to tell me you are holding up the repeat STAT head CT the neurosurgeon wants because you are not comfortable with him going now, even though the sleep deprived resident is willing to go down with the patient. When the now severely irritated resident asks the rockstar charge nurse why this is happening, go ahead and tell him that the nurse isn't comfortable, and that an MRI would be better anyway (because we all know that if we are worried a patient is unstable, an hour in a tube, out of sight is much more reassuring than 5 minutes in plain sight). Oh, and by the way, I know the charge nurse only mentioned MRI because the radiologist, who was unaware of the patient's clinical status, mentioned follow up with MRI. Ugggggggh.

And, if that wasn't enough, there's more. If you are now a different charge nurse, please ask during rounds for this sedated, intubated, paralyzed patient if we can change his (home dose) seroquel from 5 pm to 9pm (I guess we are worried about him having a psychotic episode while in a medically induced coma without any motor neuron capability?). And then, when the resident tells you that it doesn't matter when we give it, and usually is given at night merely because it is sedating (you know, in awake patients not using a machine as a diaphragm), please respond with "No, it works better at night for the next day. I know, I do psych nursing as well." I will bite my post call, sleep deprived, venom filled tounge rather than sarcastically asking "Well, why don't we just give it in the morning? Are we worried it's going to make him sleepy?"

10 more days. :mad:
 
Katydid said:
What *I* want to know is what led to her psychotic break. Was she self-medicating for serious mental illness?

And I hope she spent some time talking with psych, rather than just being thrown in jail. Some people really have genuine issues and should be in a hospital for them. Some people are liars, who are just trying to get out of trouble (the name Susan Smith comes to mind).

I still feel sorrier for the baby than her.
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i don't know if this is necessarily something we should be blaming the mom for doing (i.e. self-medicating, stopping meds, etc.) when this really could be postpartum psychosis or a first schizophrenic break, something that just happens without much in the way of forewarning. either way, sucks for both. I mean, imagine realzing you suddenly just went crazy as a new mom and killed your kid and have to live with that the rest of your life while not crazy?
 
It wasn't post-partum. Speaking with the aunt, the mother was very concerned about taking care of her child and had even taken that day off work that day to be with her son, who'd had an episode of vomiting the night before. There was a previous psych history, but it had been stable for many years. It was just :( .
 
Love this thread. I'm an RN student in Canada, last rotation was on ortho surgery. We recently switched to these biodegradeable urinals, bedpans, etc. they can last for 6 hours once they have been used. (maybe you can see where this is going)

ortho patient total L knee replacement. Foley catheter removed by RN student at 0800 per orders. Pt is given biodegradeable urinal. Day proceeds as normal, pt insists that he hasn't been able to urinate yet. Later in the day, RN student enters pt room to find urine seeping out from bedside cabinet. Pt hid used urinal because "I thought my urine smelled funny, and i didn't think you'd let me go home". turns out the new urinals do not quite last 6 hours and the gel packs you put in them to solidify the urine have a peculiar smell.

I spent 20 mins cleaning up the urine and then another 20 hunting down maintenence to sanitize the floor and cabinet. If your hospital decides to go green, by all means, protest.

The other problem of course is that you can't see the colour of the urine in the urinals.:mad:
 
quagmire223 said:
It wasn't post-partum. Speaking with the aunt, the mother was very concerned about taking care of her child and had even taken that day off work that day to be with her son, who'd had an episode of vomiting the night before. There was a previous psych history, but it had been stable for many years. It was just :( .
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Oh, that's just AWFUL. Poor woman. Poor baby. It's just sad all the way around.
 
Dr.McNinja said:
Had a woman transferred to our hospital due to HELLP. Previously healthy, G1, had prenatal care without incident until that day. While over in labor and delivery, she suddenly became aphasic and flaccid on the one side. Rushed to CT to find IVH. BPs never went over 160 measured. Stat section.
I was in the ICU, saw her that morning with absent corneals. Ordered definitive study. Later, I had to tell her mother she was brain dead and that no intervention was useful.
Then go home to hug my pregnant wife.
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Oh my God. I can tell you, from the perspective of non-medical person, nobody ever thinks that pregnancy will be anything but "normal", and that the baby will be perfect.

When something like this happens, that's just a kick in the teeth. I'm so sorry for her family.
 
rmbsstock said:
You know, it would have been much better for everyone if she got help way before this happened. I don't blame her if she was that sick but I blame the people around her that should have done something and/ or admitted her to a psych ward. As for now, trust me its easier for her to stay psychotic and in prison rather than have to live with what she has done to her baby.
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I completely understand. And it's much easier for everyone around someone who has mental illness to ignore the issue, and whine about how harrrrd it is to get that person help.....than to do the work and try to get them help.

And yes, it's work. It's an uphill battle to have someone committed involuntarily. There's a lot of legal wrangling involved. There's a lot of resistance from someone who is mentally ill to get help quite often. But, when someone needs help....they need help!

I feel bad for both this woman and her baby. When she is told what she's done, well, it's going to be bad.
 
WakeMedHeel said:
SIDS deaths are impossible too. Had a 6 month old come in, who was obviously dead. We worked on him for a while but we knew he had been dead for a while...finally called it and went and got the mother. I stayed in the room with her, the pain and grief she was experiencing must have been unimaginable. I could literally feel it. My wife was 8 months pregnant at the time and I had a rough time with the rest of that shift. I decided not to tell her and I never have. Probably never will either.
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I had a 17 week fetal demise when my wife was ~20 weeks. It really got to me but of course I couldn't talk to my wife about it. You just carry that stuff around until it wears off.
 
docB said:
I had a 17 week fetal demise when my wife was ~20 weeks. It really got to me but of course I couldn't talk to my wife about it. You just carry that stuff around until it wears off.
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I honestly don't know how doctors (and veterinarians) cope with all the tragedy they see. I really, really don't. :(
 
rmbsstock said:
I wonder sometimes why we are surprised to have child molesters among us, or criminals, when on many occasions we become part of the system that creates them!!
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I am really thinking about unsubbing to this discussion. But then I remember that ignoring it doesn't make it go away. :(
 
Stitch said:
But she wanted parameters!
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I love ICU nurses. First call is a nurse asking for a levophed order. I ask for the blood pressure and she tells me that the art line is running 120s/90s pretty consistently. I ask her why she wants it and she states that the neuro consult note wanted the nicardipine drip to be titrated to keep SBP between 140-160. Educational time spend there.

Second levophed request was for a patient who, when awake, would stay around 110 systolic, but when asleep was 90s/50s, making his MAP dangerously close to 65, which is FULL RED ALERT PANIC LEVEL. Sometimes I'm happy an ICU nurse isn't watching me sleep, cause I would get woken up a lot apparently.
 
docB said:
If your very elderly mother is forced to live in a nursing home so she can have round the clock care to manage her brittle diabetes it's probably not a great idea to take her out of said nursing home and bring her to Vegas for the holidays without any of her medications. If that's beyond you you might at least want to know what medications she's supposed to be on or even what types of medical problems she has.

You see, if you fail in those measures, your mother will wind up in the ER in florid DKA with a glucose of >1200, pH of 7.13, renal failure, hyperkalemia, sepsis, altered mental status, etc. If I seem frustrated when you answer all of my questions with "I don't know.," even easy questions like "Can she usually talk?" you will understand. If you're lucky I might not even explode all over you and tell you outright that you've killed her with your stupidity.
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Sometimes, I'm really suprised at how stupid some people are. Especially when it comes to common sense and the health and well-being of their loved ones.
 
docB said:
If your very elderly mother is forced to live in a nursing home so she can have round the clock care to manage her brittle diabetes it's probably not a great idea to take her out of said nursing home and bring her to Vegas for the holidays without any of her medications. If that's beyond you you might at least want to know what medications she's supposed to be on or even what types of medical problems she has.

You see, if you fail in those measures, your mother will wind up in the ER in florid DKA with a glucose of >1200, pH of 7.13, renal failure, hyperkalemia, sepsis, altered mental status, etc. If I seem frustrated when you answer all of my questions with "I don't know.," even easy questions like "Can she usually talk?" you will understand. If you're lucky I might not even explode all over you and tell you outright that you've killed her with your stupidity.
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That's someone who should be exploded on, and told outright that they killed their own mother with their stupidity.

I'm guessing it was, "I'm going to take MY mother wherever *I* want to, and her doctor be damned!" Along with a subconscious, "And if she dies, her life insurance will pay out, and I'll get my inheritance."

Of course, with my mother-in-law, the latter was actually a conscious thought, when they moved her father home from the nursing home. I honestly think that sped up his eventual demise, but what do I know. He was just away from 24 hour care, and nurses and a floor doctor who knew his condition....that's all.
 
Apollyon said:
If you're putting tape - the big, 2 inch cloth tape - onto a dressing over a butt boil that's been I & D'd, do NOT put the tape on the anus. That's not skin, that's mucosa. 1. it will hurt like hell when the patient is going about their life (MUCH worse than the incision site), and 2. when the tape comes off, it will take "DNA laden tissue" (a/k/a "rectal mucosa") with it. On the flip side, the patient will get almost instant relief.
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*bum clinches in sympathy*

Ow! I can damn near literally feel the pain from that. Is it bad when you can just feel your own butt clench in sympathy?
 
Not even in the medical field (I'm a desk clerk in a hotel), but I had a few shining examples of brilliance from my guests to share:

-If you (male in late teens) think you're being way cool by opening Christmas presents with a knife during your family get-together, please remember to cut away from your body. Aside from needing stitches in your hand, you will bleed all over my nice clean floor and make my coworker ill.

-Telling the desk clerk that you're having chest pains will instantly alarm her and make her offer to call 911. Replying with "mm, no, I think I'll take a bath and eat something first" will lose you all sympathy.

(Note: There was nothing wrong with her, physically. She was just PITA that kept bugging the staff for a hundred various reasons because she wanted attention.)

-When the lady at the desk tells you and your friend (both 14 y/o males) to quit running, she is not being mean. If you don't listen to her, your friend will shove you while you're running to the pool. You will slip and strike your knee on the tile border of the wall, which will then shatter and give you a nasty gash. You will then go into shock, and your friend will be traumatized at the sight of you lying on the floor with blood pooling around you.

(I'm not sure if he went into shock from the pain or blood loss, as I only got a glance at him before I hurried to the phone to call 911, but he was paper white and twitching. Poor kid needed fourteen stitches.)
 
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Also not in medical field, but I have plenty of co-workers that have surely taught their physicians some valuable lessons.

If you have a mild stroke and the doctor that treated you in the emergency room suspects that it might have been caused by your current birth control (which does cause seizures and strokes in a small number of women) it is okay to keep taking it until you finish what you have left, because this clearly cannot happen again. It's a rare side effect, after all, and it would be a waste of money not to take the rest. In addition, you can go ahead and stop taking your stroke-preventing medications because they make your period heavier than normal and you haven't had another stroke, so you obviously don't need them anymore. In fact, you didn't have a stroke at all, because people who have strokes end up with "their arms all curled up" and you know this because somebody in your church had a stroke, a "real" stroke, and that's what happened.

If you then have another stroke two months later, one that is more severe, that means that the first doctors to see you obviously had no idea what they were talking about because you wouldn't have had another one if they had fixed you right the first time. Your arm being curled up is a reaction to the medications your new doctors have given you and you should stop taking them. You don't need to see a neurologist per your discharge instructions. These doctors just drug you up, and the drugs don't even work.

Thankfully, her family and friends were quite forceful about her seeing a neurologist and taking her meds. She hasn't had another stroke since the last one and she finally stopped taking that birth control.
 
If you're a woman, significant movement just as you're about to get a rectal exam is a bad idea. The physician's finger may end up somewhere that neither he, nor you, want it to.
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Yeah, during my M3 year I heard the words "wrong hole! wrong hole!" when trying to DRE an obese woman with an overabundance of hemorrhoids. The resident stood in the corner trying to stifle laughter.
 
dchristismi said:
Yes, I know your baby was perfectly fine when you brought him home, but little babies can get really sick, really fast.

6 days old. Normal pregnancy, normal delivery... now hypothermic, hypoxic, hypotensive and hypoglycemic. And oozing from every needlestick.

Plt 11.
INR of 6.
Ph 6.9
Hgb initally 13. Lab called with a repeat as the chopper crew was wheeling the baby out: down to 4.

I never, ever want to watch fulminant DIC in a baby ever again. There wasn't a damn thing we could do. (And yes, we threw everything and the kitchen sink at this kiddo.)

Baby didn't make it.
Medicine sucks.
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:(
Disseminated HSV?
 
That was high on my list, especially given the bloody tap, but cultures are growing Gm- rods from blood and CSF now.
 
This one is from my dad who is a radiographer:

Back in the 80s he had X-rayed an old lady who was complaining of severe pain and irritation in her throat. After developing them he was stunned to find 9 needles stuck in her oesophagus.

Turns out her sewing needles were getting rusty so she'd asked her daughter to store them in oil. Idiot daughter stored them in her cooking oil. The old lady had cooked using the oil and ended up swallowing nine of them with her dinner

I'm still not sure how u can swallow 9 needles and not notice them.
 
docB said:
If you are a 75 yo with a history of brain tumors, seizures, hemiplegia and DVTs for which you take rat poison don't climb up ladders. Jeeze this is so common and stupid. What is wrong with these people?
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Goddammit, these young whippersnappers aren't telling me what to do!
 
Stitch said:
During residency I had a floor nurse who was obsessing about a kid's fever being 'too high'. I kept saying it didn't matter so she finally calls me and asks snottily 'Well what temperature would you care about, Dr. Stitch? At least leave me parameters.'

I wrote the following order: please notify house officer should child spontaneously combust secondary to fever.

It did not go over well. But she wanted parameters!
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This reminds me of a similarly snide conversation I had with a pediatrician many years ago regarding an infant in respiratory distress.

"Precisely when would you like me to be concerned, Doctor?'

If I put emphasis on "Doctor," it usually means I'm unhappy with said physician. Oh well, at least the guy finally came in and saw the kiddo.
 
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