Burned Out and Without Interest

After being on the overnight on the "fall back" night and working an extra hour I just don't care about my current patient. She has "cotton-mouth in-and-out for a few hours" and her face "feels like it's stretching". Also, for about thirty minutes she feels like she's "floating when she walks". On top of this the poor thing has the "nervous jiggers". My differential diagnosis is "Not sick. Don't care. Here's your work excuse."

Eating a Gun

Pronounced a patient dead in the field who had put a large caliber pistol in his mouth and pulled the trigger. By a quirk of this particular case the deceased was brought to our hospital briefly before being transported to the medical examiner in a nearby town.

This guy's face looked like a Halloween mask. His right eye was out of the socket and kind of hanging by the optic nerve. His head was no longer connected to his neck as the bullet had disrupted the atlanto-occipital joint, and he was a sickly pale yellow color. Hard to miss with the barrel in your mouth.

CSI: Small Town USA

A new one on me. Delivered the bad news to a wife that her husband had died of an apparent heart attack. She didn't cry. She told me that she could handle it and that they had, in fact, just redone their wills three days ago. She then asked me if I knew which mortuary in town to contact regarding cremating her husband as that was what he wished. She then told me she would probably move to Florida and that she and her husband had no family in the area and therefore no one to contact.

I asked the charge nurse who accompanied me to the meeting if she had any weird feelings about the interview and she nodded yes. After conferring we decided to call the police.

I find it hard to believe that this woman offed her husband (he definitely was a set up for a heart attack), but then she told me that she had been in the medical field and I surmised that if she had the desire she certainly had the knowledge to kill him with the medicines he was already taking.

Just another day at the office. An autopsy will be performed.

Another Welfare Baby Success Story

Had a 20 year old patient lie her way past our triage system last night. She was tired of waiting to be seen so told the triage nurse that she was 3 months pregnant and having heavy vaginal bleeding and abdominal pain. She was evidently quite vocal in triage and given the complaint was brought straight back to be seen.

Per Emergency Medicine philosophy this girl had an ectopic pregnancy until proven otherwise. I took our portable ultrasound machine right into the room after ordering some essentials from nursing. I didn't see anything in the uterus so I was even more suspicious of an ectopic.

Rather urgently we proceeded with the workup but some things did not make sense. Her vital signs were not abnormal, and if she was hemorrhaging it was not evident on cursory exam.

The pregnancy test then came back negative and we ramped down a bit. I figured she had miscarried and delivered the bad news. She wasn't upset. We did a pelvic exam and there was no blood. Curious indeed. She did, however, have a yeast infection and trichomonal vaginitis.

Then her concern turned to how we would treat her pain and the picture changed even further. I told her that I would be happy to treat her pain while she was in the ED but all of a sudden she had to go. She had to have her full treatment for the yeast and the trichomonas because she couldn't afford medicines due to her young child at home and lack of job. No problem, we treated both there.

A few minutes later the nurse came to tell me the patient had pulled out her IV and was bleeding on the floor and would not allow us to bandage the arm. The patient wanted out and wanted answers.

I walked into the room to see blood all over the floor.

Me: "Ma'am you are bleeding all over the floor and creating a health hazard, if you do not sit down and let us bandage your arm I will have to have you escorted off the property."
Patient: "It's a hospital, there's supposed to be blood on the floor."
Me: "No there's not."
Patient: "This hospital sucks, you killed my grandfather."
Me: "It's time for you to leave."
Patient: "I'm going to sue you and all the nurses... You fucking assholes."
Me: "Ma'am, I want you to realize that you had a complete workup here tonight and we have treated every problem we found... Knowing that you do not have insurance and have no money you just got a lot of free stuff by lying. I challenge you to go to the grocery store and demand food for free."

WAIT FOR IT!!!

Patient: "That's exactly what I do... I'm on food stamps."

I mean, can you forgive me for being speechless? I had security escort her off the property.

New Worst Name Ever

I guess I can't tell you the real name that has now taken it's place on my "worst names of all time list" which I maintain here at work in a secret book. I keep the patient sticker and put it in the book for later discussion and proof of the name. As you can see from a prior post I already met a toddler with the name of "Lestat". Well the other night I met a woman with a name which would be the equivalent of "Thankgsving Day Breeze" or "Valentines Day Kiss". Sorry I can't print the real one but I don't want her harassed. She is already exhibiting all the wonderful character you would expect from a child raised in a family that would give them a name that would get them teased for the rest of their lives.

Be Mean and Nasty

Never fails. Had the nicest patient the other day... She works 6 days a week and has most of her life. She didn't have medical insurance and I'm not sure why... She works for a local businessman and has for years. She came in as a referral from an outside clinic with a diagnosis of GI bleed. She certainly looked pale and anemic and I thought she was simply a GI bleed. She was thankful to me and her nurses for nothing really... We were simply doing our jobs. She was cheerful and nice even when I mentioned that while I thought she might have a simple GI bleed due to using too much motrin that her blood count was a bit high for her appearance and that other diagnoses like leukemia or lymphoma would have to be considered.

She was admitted with a presumptive diagnosis of GI bleed. Talked to her the other day... She has metastatic colon cancer and with treatment probably 2 years to live.

She's still cheery and optimistic. God bless her. If she'd cursed us up and down and spit on people she probably wouldn't have had anything terminal. That's the rule.

A Difficult Legal Question

What to do what to do?

You are a horribly ill though relatively young quadriplegic who recently signed a DNR/"Comfort Care Only" form and are in fact sick again with a very resistant bacterial infection. One problem, you are now suicidal.

Do I allow your prior wishes regarding the end of your life to be followed as they were written when you were not suicidal, or do I treat you against your stated wishes as you are now suicidal and can not make a decision regarding withholding current treatment?

"Sorry sir, we can't allow you to die because you want to, but as soon as you don't want to anymore then you can die."