Tuesday, August 24, 2010

Not an ER Patient

For those of you out there who are EM Docs or ER Nurses or Midlevels or clerks... Brace yourselves... What you are about to read may induce convulsions.

I've been kinda mum on my new job... Still working the kinks out, but I really like it. As a government physician I get to take care of some active-duty folks. They are a basically healthy population, and, strangely enough, this means that when they come to see me they generally really have something wrong with them.

So check this out and maybe it will give you a little hope in these dark times... this guy is one of many wearing the uniform.

Me: Hey, how can I help you today?

Pt: Well doc, you know, I had my ACL repaired a few years ago and I noticed that I can't seem to break through the barrier to get back to being in really good shape.

Me: Okay, give me an example.

Pt: Well, before my ACL I was winning all the two mile PT runs and could run 12 with the fastest guys. Now to run twelve miles I'm kinda coming in in the middle of the pack... I'm very frustrated and I wonder if there's anything I can do better? My knee still hurts a bit, especially after twelve miles.

Me: Well, we can look into some physical therapy, but it sounds like you are doing that naturally... it might be worth another MRI to see how the operative site is healing and see if you may have chondromalacia or something similar. But, to tell you the truth, running twelve miles, in and of itself, is not something many people can do... Why aren't you okay with what you can do now?

Pt: Well, in two years I'm going to be going to a special school for a _____ selection. I want to start now in getting as prepared as I can be for this school.

Me: Uhh... Ummmm... There was one?

I chose ER medicine to take care of sick people. More and more, I took care of the worried well or the hurried well or the 'agenda' patients. I go to a job to take care of healthy people, and THEY, they are the ones who end up having real problems. This guy had been running on a meniscal tear. He should do well after the surgery. He is, well, motivated, to do well and he's got your back.


  1. Can I get an "Ho-ah" for this man?

  2. My ex, a civilian FM resident, was just rotating at a military facility and was presenting to an attending. She gave some basic demographics and a chief compliant before her attending stopped her and asked what the patient's mental health diagnosis was. Turns out the patient was 53 and a Private. Things can't be all that different for you.

  3. I don't think I've run 12 miles in my entire life...

  4. Sorry, I'm not American and I don't understand this part of the exchange:

    Pt: Well, in two years I'm going to be going to a special school for a _____ selection. I want to start now in getting as prepared as I can be for this school.

    Me: Uhh... Ummmm... There was one?

    I get the point of the thing, of course, and I'm kind of impressed that he could run 12 miles on a meniscal tear given that I couldn't run 12 miles on my healthy knees, I'm just curious as to what that part means. There was one what?

  5. dear Emma,
    sorry, it's a quote from an old silly movie "stripes", and the point was simply that I didn't know what to say.

  6. Actually, I bet most of you could run 12 miles if you work up to it. I used to go beyond that on long weekend runs. Marathon runners do double that, occasionally, and there are lots of them out there. And then there are the ultra marathoners.

    Now ... running 12 miles fast and in full gear ... that is a different story! I have a feeling that was part of the training runs.

  7. PeggyU,
    I meant 12 miles in the Cummulative Tense, i.e. if God made us with Odometers that only counted running miles, mine would be lucky to be in double digits, like my 3rd Arm.
    Now if we had odometers that counted time spent jerking off....

    Frank "There's more where that came from" Drackman

  8. Dude...a meniscal tear made you feel like this guy was really sick and made you feel bad for him? You need to get back to the trenches and take care of sick people. Don't you remember the codes, the young that you saved....and now you are worried about a meniscus?

  9. I think his more piercing memories are of billing codes.

  10. anon,
    the point is that the same patient in the ER would have demanded dilaudid and immediate surgery and when i didn't produce it for him he would have complained and then i would have had to write an apology letter. that's it. and yes, i remember the codes and the 'young that i saved'... so what? i don't miss is, i don't miss the family conferences to deliver bad news, and my sense of 'owing' my skills to the less fortunate has been beaten out of me long ago. i have ptsd from the ER... you go do it if it's so great, or continue doing it if you are already, and God bless you, but i'm done.

  11. Jeeezus 911,
    Are you go'in all "commercial dog" on us?!?! I feel like I might accidentally call you Happy Hospitalist one day.

  12. yup,
    completely sold out like REM, U2, the Peppers, and Jimmy Buffet. laughing all the way to the bank... at least... that's the plan... after all the tens of dollars start just rolling in. i'm just proud i figured out how to write the html to make three collumns... don't get me wrong... i had a 'how to guide', but it was still the hardest thing i've done since i had my cock shortened... and now i'm starting to sound like drackman, who has, as far as i can tell, not sold out.

  13. OK, so this thread is getting some vintage, so I'll throw out a Not An ER Patient query.

    Eldest stepboy, 17, has had a post nasal drip thing going now, for two weeks. Mom accidentally bought a benadryl generic, two weeks ago, when she was supposed to get a sudafed generic, so she is a bit irritated with me for not having made the correct replacement purchase. However, this is obviously not a cold. It acts like an allergy, but he gets no relief when at school, during the day. He feels better, or thinks so, when he sneaks out of the house where I hide, in the garage, but I don't see a real improvement. I see/hear him snorting, and blowing out here. This is CONSTANT, all day, all night.

    This is chronic and incessant. He snorts with every breath and can't sleep. He is usually still awake at 2 or 3 in the morning when I get up, then he collapses for an hour or two before I get him up for his 5:25 am bus.

    I assume we have to get in touch with his father (on his insurance) and arrange a primary visit, followed by a referral to an allergist. He's concerned about that, because he anticipates an allergist visit as involving lots of needles. I don't have a problem with that, as the needles won't be stuck in me and I can torture him by carrying nails in a pocket and slipping them out, pointing at them, when his Mom isn't looking.

    However, am I missing something that a pseudo-parent should be spotting, for a kid that isn't snorting coke?

  14. -what color is the stuff coming out of his nose?
    -did you take a temp?
    -other aches and pains?

    Have you had this horrible hot muggy weather all summer in your area?

  15. dear CJ,
    may be time to get him looked at. an oddball that can act like allergies but is not is vasomotor rhinitis. steroid spray along with antihistamine usually clears it up. would be less suspicious than you of cocaine or drug abuse but you are there and i'm not... cocaine would cause a dry nose... withdrawal from same would cause the opposite. of course, if he's huffing inscticide that would do it as well. seriously, vasomotor rhinitis is worth looking in to, but it should clear with time.

  16. CJrun
    dont wanta be a meany, but if I'd complained about a runny nose when I was a kid, I'd have gotten an Effin BLOODY BROKEN NOSE, and if I'd told my Dad it would have been even worse...
    But if you have to have a Chemical Solution, try some OTC Zyrtec.
    and who the F gets up at 5:25am to go to school??, I mean, I get up that early, but only cause it's the one time I can look at Porn without bein interrupted a million times.

    Frank "the only Stupid Question is the one you just asked" Drackman

  17. Running is addictive. And awesome. Runners don't get overuse injuries because we're dumb, or don't feel pain, but because we are too insanely addicted to stop.

  18. Typical reason to consult an ER doc ...runny nose. Strikes me funny CJ you would ask, after all.

  19. Thanks folks. It's still a problem, after a few days of trying Claritin. I guess we'll try the OTC Zyrtec. He doesn't wake up at 5:25, that's when the bus arrives. He stupidly tried to get back to the house at 5:24 for a tissue, this morning, and missed the bus. He's not huffing, or using any drugs, he's just had this weird condition for two weeks, plus, now we have to keep trying things.

    After trying Zyrtec, I guess it will be time to go to the doctor, but, as I said, this was NOT an ER patient!

  20. Sort-of interesting:

    After trying Zyrtec for a few days, with no relief, we took him to the Pediatrician. Regular exam and when she asked him to say, "Ahhhh," she then said, "Oh My God!! You gotta see this!"

    He had an inflamed Uvula that was so bad it double normal size and had ulcers on it! I guess the kid was really sick, but just had no other outward symptoms apart from the nasal drip.