WORD OF THE DAY #2

BLOOD CLOG

​​When I was a kid, I had a hard time remembering the word volleyball. I would always have to pause before saying it, and would run through a **volleyball or bolleyball** street fight in my head. Over the years, the b dropped away, and volleyball was correctly adopted into my vernacular. That same process doesn't appear to be the case with everybody else. 

Blood clog. This is another term that I hear all the time in the ED.
"My doctor sent my in because he said I might have a blood clog."
"It hurts, but not the same as the time I had a blood clog."​
And so on. ​

One fine day, I approached a patient ​in a hallway stretcher who had come in with a chief complaint of leg pain. 
Dr.Z: Hi there, ma'am. What can I do for you today? 
Patient: Well, I thought I had a blood clog in my leg, but I just went to the bathroom and it came out of my vagina, so I think that I'm okay now.
Dr.Z:  Right. 

So go ahead and add blood clog to your vocabulary. It's safer than a blood clot, and apparently you don't need blood thinners as part of your treatment. Just a vagina. ​

LIAR LIAR

LIAR LIAR​

Every day that I'm at work, somebody is trying to pull one over on me. And when I say somebody, I mean that about a quarter of the patients that I see are trying to feed me some sort of BS in order to get one thing or another. This is the battle that we, as emergency physicians, must face on a daily basis. ​

Some days, the battle is a terrible, frustrating, angering experience that leaves you mentally drained and searching for your He-Man comforter by the end of the day. Let me give you an example: ​

Dr. Z: So what brings you into the hospital today, Mr. 'Obviously On Dope and Reeking of Booze and Cigarettes and Barely Able to Stay Awake While Talking to Me?' 
Patient: Well, I was at work the other day (Lie#1), and I lifted something heavy (Lie#2), and my back has really been hurting me since then. It just gets worse and worse every day! 
Dr. Z: I see. What kind of pain medication have you tried taking at home? 
Patient: My girlfriend (Lie#3) had some left over Percocet (Lie#4) that I tried, and that seemed to work. 
Dr. Z: Uh huh. Okay, well let's do an examination and see what we can find. 
........
Dr. Z: It looks as though it's just a muscle strain. I think that you should be okay to go back to work tomorrow, and I'll prescribe you some good pain medication in the meantime. 
Patient: What are you going to give me, Doc? I'm allergic to Tylenol (Lie#5), I'm allergic to ibupofen (Lie#6), I'm allergic to codeine (Lie#7), and tramadol doesn't work either... (Lie#8)
Dr. Z: Well I see here the last time that you were in the hospital you were treated with ibuprofen and you didn't experience any allergic reactions. Let's try a really strong type of ibuprofen. That should do it! 

Every day. EVERY DAY I have to deal with these people. Sometimes, however, the trickiness is fun, and I don't mind it. Like today, for example. I was taking care of a 21  year old female in a local college Life Sciences program. She was in a room with three of her friends, and all of them were lively, full of smiles, and a nice break from the monotony of a Fast Track shift filled with abscesses and ankle sprains.

Patient: I hurt my ​back during sex a week ago. I think I just pulled it, but I've been having trouble bending over. 
Dr. Z: Well, after my examination, and the type of injury that you described, I agree - it's likely just a muscle strain. I'll make sure to prescribe you something that will take care of the pain, but won't make you drowsy, as I'm sure you've got a lot of studying to do. 
Patient: About that, Doc. I have been in a lot of pain this week, and I haven't really had a chance to... 
Dr. Z: You need a doctor's note? 
Patient: (All of her friends laughing) Yes. 
Dr. Z: What exam did you miss today? 
Patient: Biology. How did you know? 
Dr. Z:  It's hard to believe, I know, but I was once 21 and in university. I lived in a Fraternity - you don't think that I had friends who had this little exercise down to a T? 

Everyone left smiling, laughing, and happier than they were when they got to the hospital - including me. I also got a reminder of how great it was to be 21. Then I remembered my beat up and rusted out 1993 Honda Civic, cramming for midterms, and living on Ramen, and was glad that I was no longer 21. 

HOMELESS. DRUNK. HILARIOUS.

HOMELESS. DRUNK. HILARIOUS. ​

​Typing away at my computer one dreary Saturday night, trying desperately to catch up on my charting before the next wave of patients hits, I'm startled by some screaming at the far end of the ER.  I look to my right, and I see something that is pretty much the norm - a homeless man making a scene. He's a patient of the other physician that I'm working with tonight, and I'm filled in on a little bit of the action. The guy is absolutely obliterated, and was found face down in the middle of the street with his left eye swollen shut, a bunch of abrasions to his face, and no recollection of what had happened. So, like I said before, pretty much the norm. 

He's wearing a rigid cervical collar and a Canadian tuxedo - stone washed jeans and jean jacket - and he's wearing it well. He's coupled his tuxedo with one old boot, no shirt, and a scraggly grey beard that is matched in length and shabbiness only by the ring of 10 inch long hair that encircles his bald spot (a la Hulk Hogan circa 2008).  Maybe 130 pounds soaking wet. ​ The amount of shirts that he is wearing matches the amount of teeth that he has remaining in his Scope smelling mouth. For those of you that are a little slow, that number is zero.  

He's pretty much got everybody in the emergency department paying attention by now, as he's making such a scene. The other doctor is trying to reason with him, and having about as much success as you would expect seeing as how the guy's alcohol level is well over four times the legal limit. Then, his Oscar moment: ​

Doctor2: I understand that you are tired of waiting, sir, but the radiologist is still reading your scans, so it will be a short while longer before we can take off your collar and allow you to leave. 
​Patient: Get me the f**k out of here! If I wanted to be somewhere for eight hours, I'd get a job!

It is the first and only time that I have ever been a part of a standing ovation in the ER. Well done, sir. Well done. ​

50 SHADES OF OLD MAN.

50 SHADES OF OLD MAN​

Although I pretty much hate working shifts in urgent care, some days provide a little comic relief to get me through the torture.  

I picked up a chart of an elderly male who was coming to the emergency department for calf pain. These cases are usually very straightforward - does the patient have a deep vein thrombosis (DVT) in their leg or not?​ Open and shut. You don't anticipiate spending much time in the rooms of these patients because they, for the most part, have pretty simple complaints.  I spent quite a bit of time in this gentleman's room today. 

From the moment that I walked into the room, the man had me laughing. 84 years old, wrinkled as all hell, sweet moustache, dressed like he just came off of the set of Mad Men, and enough one-liners to fill a book. I imagine he was the 1940s version of Louis CK.  He tells me that he is a famous magician ("Google me!"), but his wife didn't bring his cards with her so he won't be able to do any tricks for me today. At this point he starts in on his wife... ​

Patient: ​She's still learning how I like her to do things.  From now on she'll always carry a deck of cards in her purse. 
at this point he turns to his left and looks her up and down like he's a starving dog and she's a fresh filet mignon
Patient: You like my wife? Pretty nice, right? She's twenty years younger than me! I met her on Match.com. She was looking for a younger man, but my profile caught her eye. It said, "I'm 84, single, rich, I don't need Viagra, and I can drive at night!" 

Hook. Like. Sinker.

If only I'm half as awesome as him in thirty years, I'll be a happy man. ​ Hell, in ten years.  He didn't have a DVT, and I went back to my terrible day in urgent care, a little more magical than it started. 

CONVENIENT RELIGION.

​CONVENIENT RELIGION

I came into the emergency department on a Friday night for an 11pm - 7am shift. It's one of those shifts that I really enjoy, for a number of reasons. I prefer to work nights and early mornings - the same amount of hours are spent at work, but I get the perception of all of those extra hours at home!  Not only that, but the type of people that come into the hospital at night are usually more entertaining than those who visit during the day. Not any less annoying, mind you, but more bizarre, more drugged out, and definitely with a better sense of humor. That being said, coming into work Friday night, I was in a great state of mind and looking forward to eight hours of craziness. 

The first patient I picked up off of the rack was not only my favorite patient of the night, but my favorite of the month. Captain of Team Awesome. 

Walking into the room, I was greeted by a pleasant Jewish man in his fifties with his legs crossed, hands behind his head, watching an episode of Seinfeld and chuckling away. Already I liked him.  Looking like Mahmoud Ahmadin​ejad, with a thick Middle Eastern accent, and smelling as if he bathed in the original Polo cologne, his 1970s John Travolta outfit completed his fantastic look.  He had an ellipitical laceration circling the outside of his right eye, his eyes were bloodshot, and he appeared as though he was well past his bedtime. ​ 

Dr. Z:  Welcome to 'Generic Crazy Busy Hospital' sir, my name is Dr. Z. What brings you to the hospital today?
Patient: Well, I am not exactly sure... 
Dr. Z: Okay, well why don't you just start from the beginning, like you're telling me a story? I'll pick out the important parts. 
Patient: Okay. I have been dating this girl. Beautiful girl. South African, tall, blond, blue eyes... she looks like she is one of those models from the lingerie store. Anyway, I am a simple man, a locksmith, but I am not very good at math. I needed some help managing my books, and she is studying for her Masters and needs some money. So... we came to an arrangement. She called me today because she needed some money, so I took her out for an early dinner. 
Dr.Z: But how did you get that wound on your face? 
Patient: So we are having dinner, and she asks me to go out to the bar with her afterwards. Because it is Shabbat today, I must be home by sundown. (If you are too lazy to click on the link and read through the article, I'll give you a quick rundown. Due to Orthodox Jewish Law, from sundown on Friday until sundown on Saturday, no 'work' or 'deliberate activity' can be performed during this time.) Instead, I asked her if she would like to come back to my apartment, and she said okay. She asks if she can invite her girlfriend over as well, and I told her that it was okay. Well, her friend comes over, we all started drinking, I took some of the Viagra, we all got in the hot tub together, we smoked something called crack? Crackers? I do not know. We had sex all of us, and the next thing I know I am waking up on the floor of bathroom and my wallet is empty. 
Dr.Z: I see. 
Patient: I am a divorced 50 year old man with three children. When a beautiful young girl offers you to have a threesome, you do not say no. Yes? 
Dr.Z: Uh huh. 

I proceed to complete the laceration repair, and after further examination/testing also diagnose him with a corneal abrasion.  I proceed to discuss with him his diagnoses and his aftercare (prescriptions including some anti-inflammatory medication and an antibiotic eye drop). He is very thankful, and shakes my hand before I leave the room. Like Jay-Z says, I'm on to the next one.  

Or so I thought. 

Fifteen minutes later, while I'm sitting at my desk charting on the next patient, I'm approached by my Friday night all star. 
Patient: Sir, do you think that you could give me the free samples for these medications? You see, it is Shabbat, and I cannot go to the pharmacy today to pick up these medications. I must observe the Holy Law. 
Dr.Z: So you can get drunk, get high, smash some Viagra, and take down two hookers, but going to the pharmacy is out of the question?? 

Okay, I didn't say that. Instead, I apologized for not having any free samples in the ED, and sent him on his way. Hopefully, he learned to hide his wallet the next time he enjoys a drug and alcohol fueled Holy experience. 

But probably not.