Category Archives: Hilarity Ensues
A few thoughts from the last week of work
- I both love and hate the new work schedule. 12 six hours shifts are exhausting. Feels like all you do is work and sleep. But then we get four days off at the end of it…. which is pretty baller.
- Did a conscious sedation on a patient so we could relocate he mangled thumb. She had a pretty profound reaction to the propofol, taking a good 15 minutes to come back to acting like her normal self. At one point during her altered period she looks me dead in the eyes “Sir… you suck….balls!” Hilarious.
- I was expecting it to be quite in the ED over the labor day weekend. Instead it’s like all the nutter’s came out to play at once. We had 5 1:1′s going at once. It’s a 24 bed ED!
- I had one patient who was particular grumpy. I asked him why. Apparently it was raining pretty hard, so when the ambulance pulled up, they just laid on the horn until he opened the door. And when he did, the driver got on the PA and hollered “Get in the back of the truck!” So he did, and he was pissed about the lack of door service. No idea if it’s true or not.
And of course, the learning curve was steep as always. A couple of pearls and rules of the road from this past week
- “Two-fers are never sick, unless it’s poisoning, usually of the carbon monoxide variety” (A two-fer is a two for one patient room, usually two related kids in one patient room)
- Give a miligram of ativan to anyone with a complaint of seizure and alcohol is in anyway involved, even if not seizing. Cuts down on repeat seizures, admissions, mortality & length of stay.
- PE’s and EKGs – S1Q3T3 is actually pretty rare. The most common EKG finding in PE is non specific T wave changes. Then, inversion of T waves in the anterior leads.
And finally, what’s an ED shift without a little humor. There is one attending who drinks a two liter of soda every shift. When he was off seeing another patient, the other attending dermabonded the cap shut (skin glue with the strength of rubber cement). After a few moments of struggling the first attending simply shouted “GOD DAMMIT” and stormed off, only to reappear 15 seconds later with an 11 blade scalpel in hand and quickly decapitated his bottle of soda.
(not how Officer Rainbow earned his name)
The last two days of the rotation were spent with a suburban EMS department. They all assure me it was not normally this slow, but we got two calls in two days, one of them being the sugar bomb mentioned in the last post. So needless to say, we spent a lot of time sitting around the fire house. But everyone else was slow as well, so crews all over the surrounding townships gather at this one firehouse when things are slow and just shoot the breeze. There were loads of stories being swapped, more than I could possible remember. Frat house humor was in full effect, and the women were representing themselves just as well as the men at dishing out the rips.
Medic to police officer walking into the house: “Hey it’s officer rainbow!”
Police: “Officer rainbow, what are you talking about?”
Medic: “The way you respond to calls, you know, you like to show up after the storm”
Medic 1: “Yeah, I don’t want kids. They are sticky, smelly, they cry, they want to be held-”
Medic 2: “What do you mean? That sounds just like your typical friday night”
Medic 1: “You know that f*#cker is at home, pureeing his twinkies, so he can get them past his lap band”
My favorite story of the two days was this. For whatever reason, there is a black, 8 inch, suction cup dildo in the firehouse. “It’s not gay when it’s within the walls of the station” as it was explained to me. It’s a favorite prank and firehouse tradition, to suction cup the penis to the side of firetrucks housed in the other stations. If the truck leaves the station with the dildo firmly attached, the new station now possess it and must keep it in their station until they can return the prank on another house.
(if you are seeing this post, you’ve successfully made it to the new site)
Around 7pm last night we started tracking the cumulative BAL (blood alcohol level) of the patients coming into the ED. 80-100 is legally drunk (depending on where you live). We were over 1100 when I left at midnight. Any guesses on the final number?
Warning: This next tale is not safe for work or the squeamish.
This 30 something year old gentleman came in complaining of blood in his semen. Both him and his girlfriend were present in the room upon walking in. Looking at the patient I said “How can I help you tonight?” His girlfriend jumped right in “I blew my boyfriend last night and when he came, I thought it tasted funny so I spit it out and it had blood in it. We had just had anal sex, so I think that might have had something to do it”. Stunned at the fact that she had volunteered all this, without actually being asked or addressed, and hoping that there had been a shower in between said acts, I did the best I could to get through the rest of the history and physical. As I was walking out the girlfriend interjected “You know doc, we could do another trial right now, just to see if he’s cured.” ”No! that won’t be necessarily, just relax for a few minutes and let me put in a few orders” So I left, presented the patient and when I saw the attending coming back from the room laughing, I could only imagine. “Apparently they snuck into the bathroom and he is now fully cured of his complaint, and they are going to leave. Make sure you document that there was a “test of cure” “.
This elderly woman came in by ambulance and the paramedics stopped by the desk to give us a quick report. The home health nurse had called the patient just to check up on her, but while they were talking, the nurse thought that the patients speech was sounding slurred, so out of concern for a stroke, she drove over to the patients house. When she arrived, she found the patient unresponsive, so started to perform chest compressions, after calling 911 to report a code blue.
What had actually happened, is that the nurse called the patient while she was brushing her teeth, getting ready for bed. The reason her speech sounded slurred was because she had a toothbrush in her mouth. When the nurse arrive, the patient was actually sound asleep in bed. Assuming the patient was dead, not in fact asleep, the nurse started to perform chest compressions…. for 15 minutes… before the ambulance arrived. When the paramedics arrived and started to manipulate and poke and prod the patient, she quickly “recovered” to her normal and full state of health. Another life saved.
There is one ICU attending that stands out from the rest, Dr. Smith. She is very tough, very demanding, expects excellence from those around her at all times. The senior residents had warned us about how tough she can be, that she had been known to make a few residents break down in tears on a few occasions. I know that I myself was very intimdated, if not afraid of her, when we started out this past fall. But now, having gotten to know her a bit better, I actually really enjoy working with her. She IS tough, IS demanding, but I also know it’s making me a better doctor. Things she has scolded me for in the past, are things I didn’t get wrong the second time around. By nit picking our notes each morning on rounds, we learn what we need to be looking out for, to be aware of, what information we are missing out on. I can see how people might take her criticisms as personal attacks, but when you view it as her trying to make you better, suddenly it’s not such a big deal, and then when you realize that there is this dry sarcasm underlying most things she says, her criticisms actually start to become quite funny, especially when you can play off them and get a laugh out of everyone, including her, on rounds.
She is equally tough on the rest of the staff, nurses and aids alike, and some of them may not appreciate her criticisms for their constructive nature as well as some others are able to. I say all this to set up this next little story. About 4pm one afternoon, this patient comes up from the ED, bradycardic to the 30′s, pretty much obtunded. I dropped a cortis into her internal jugular ( basically a huge needle in her neck) and she didn’t flinch once during the whole process. She was stabilized and what not by the time I left that night, resting peacefully. I come back the next morning and even before I get to the unit I hear a loud voice booming down the hall. Upon entering, I hear calls, at the utmost top of voice volume coming from the room where the obtunded patient was the night before. “DOCCCCTOOOR! NUURRSSE! THE LIGHT IS BLINKING! THE RED LIGHT IS BLINKING! THE RED LIGHT IS BLINKING!” I walk up to the overnight intern, “What happned to the obtunded lady in that room from yesterday, did she pass or get transferred out?” “Dude, that IS her. She has been screaming about that damn light since 4am non stop”. ” WHY IS THE LIGHT BLINKING? DOCCCTTOOOR IS THERE A FIRE? NUUURSE! I SEE PEOPLE WALKING BY MY ROOM, DON”T FORGET TO EVACUATE ME!”
Apparently her mental status had improved a bit since I left the night before. The patient was in no apparently distress now, just a bit delirious, which was not entirely different from her baseline from what we were told. If you have never worked in medicine, there are few things more distracting and frustrating that a patient repeatedly calling for help when they have nothing that actually needs help with. The patient had been redirected and reoriented multiple times since 4AM, to no avail. 2 of ativan and 5 of haldol didn’t touch her one bit. She wasn’t complaining of anything other than the blinking light, but the second you walked out of the room “DOOOCTTOOOOR! NUUURRRSSEEE!” So the nurses thought it would be kinda funny to try to get her to call for Dr. Smith specifically, as a way of getting a little revenge for all the times Dr. Smith had been tough on them. Imagine what it would be like to have someone shouting your name over and over and over at the top of their lung. So every time they went into the room to see the patient, they would remind her that her doctor was Dr. Smith. And before long the patient was repeatedly calling ” DOOOCCCTOOOR SMIITHH! THE LIGHT IS BLINKING. DOOOCTTTOOR SMITHMAN! DOCTOR SMITHMAN! HELP ME DOCTOR SMITHMAN” And it WAS pretty funny….for a while…but when the patient was STILL shouting it 12 hours later…the joke had worn just a bit thin. And by then Dr. Smith had gotten the patient to learn all of the residents names as well, as her own form of payback. At one point I was dropping another central line on a patient on the far side of the unit, only to hear my name being boomed from the opposite end. Everyone was relieved when psych finally made it by and recommended 5 of haldol Q20min, which brought her voice down to a nice conversational level. Thankfully she was finally transferred off the floor before my next shift.