NOT A SHAKE WEIGHT.

NOT A SHAKE WEIGHT

Being in the ER gives me an opportunity to people watch quite a bit, and I'm never disappointed by what I see. Actually, scratch that - I'm very often disappointed, but never really surprised. I don't know what it is about emergency departments, but people get into the hospital and then act as if they are 5 year olds - crying, stomping their feet, losing anything resembling manners or respect. ​

When you're surrounded by weird adult patients all of the time, working a shift in the pediatric ER can be a little bit of a break. For the most part, all of the kids are healthy, and your job is to keep them there. You know what else exists in the pediatric ER, though? Parents. Parents are just the worst. ​

I was caring for a 6 year old boy with asthma in the early morning hours of a Saturday night - 2 or 3 am. The boy is cute as a button, wheezing a little bit - nothing that some albuterol and orapred can't cure. I interview his parents, note that his mother is absolutely hammered, but dad is in okay shape and seems to know what the deal is. I start him on his treatments, and then head to my desk to do some charting. 

A few minutes later, I go back to the room to check on the little guy, and this happens: ​

Dr. Z: So how is the little guy doi... ... ... ma'am, you're not allowed to do that in the emergency department.
BestMomEver: Oh. Okay. 

Dear moms - it's not okay to give your husbands handjobs while in the emergency department. Well, at least not in the pediatric emergency department. While your kid watches. 

THE CURE FOR DROWSINESS.

THE CURE FOR DROWSINESS 

As emergency physicians, we work pretty weird hours. It's basically shift work, without the benefit of a union to force our employers to schedule us on a pattern most in line with our natural circadian rhythm. You work at Meat Hooks Incorporated? Great - you get two weeks of morning, two weeks of afternoons, two weeks of nights, and wash/rinse/repeat.  Work in an ER? We'll just schedule you for whatever we need, k? Thanks. 

I was in my final year of residency; I had just come off of a night shift and was incredibly tired.  I saw a million patients, was like an Energizer bunny for over ten hours, and I just wanted to go home. ​BUT I COULDN'T. No no no, not yet. Today was Radiology Conference day! Yay! What that meant was that after rounds, I had to go and sit in a dark room and be quizzed on various x-rays/CT scans/ultrasounds - for an hour. Typically at this conference, the residents who show up in the morning will stay awake throughout the conference, and the ones who are coming off of their night shift end up passing out at some point. Come on, it's a dark room and we finally get to sit down, what else do you expect? 

This particular conference was a little... different. I got to conference about ten minutes late, as I had an unstable patient that needed some extra care before I could leave the department. It's not as if patients just stop being sick because I have conference, you know? By the time I got to the conference room, all of the chairs were taken, so I took a spot on the floor, surrounded by five others. As the radiology attending discussed a chest x ray on the screen, my eyelids started to feel heavy. The already dark room began to become darker... and... I was out. And then it happened. ​

I jolted myself awake with a violent fart. ​

It wasn't your run of the mill squeaker. My sphincter saw an opportunity, decided to swing for the fences, and took it deep to left field. Out of the park deep. ​

The radiology attending ​stopped talking. People started snickering all around me. The sound of whispering was all around me! As it was very dark, I could have gotten away with it - but I had just been asleep, wasn't thinking clearly, and quite frankly didn't really care. 

Dr. Z: Yup. That was me. 

Luckily for those around me, this one had a lot of bass, and not a lot of chase. Loud and not proud. Basically, it didn't smell. And hey - if I've learned anything from watching Major League Baseball's steroid era, it's this - they'll still love you if you come clean. Even if you leave an air bagel. 

IDIOTS IN THE SNOW.

IDIOTS IN THE SNOW​

I love winter, and everything that it entails. I love snow, I love shoveling, I love hurtling down a snow covered mountain on a thin piece of plastic. I love hockey, I love skating, and I love the twinkle of snowflakes as they fall past a sunburnt orange streetlight. ​

Snow also provides for really amazing stories. People go CRAZY with snow - and when you're dealing with people who are already working with half a deck of cards, things only get better. ​

A couple of years ago, the area that I was in was absolutely crushed by a blizzard. We had just experienced snow like the East Coast hadn't seen for decades. Overnight, the area that I was in received 32 inches of snow - THIRTY TWO. Overnight.  
A State of Emergency was declared.
Highways were closed for days, with people stranded in their cars for hours, requiring helicopters to fly them out. 
Public transit was shut down - all of it. No taxis, no buses, no train, no subways.
A man who had attempted suicide by jumping out of a ninth story window was saved when he landed on a huge pile of garbage that had accumulated during the blizzard. 
People died because emergency help was not readily available to everybody who needed it. 
The world came to a standstill. For most people. 

After spending two and half hours shoveling and praying, I made it into work.  I used the not as of yet plowed highways, I passed the stranded snow plows, and I actually made it into work on time. There weren't many others that could claim the same, and the hospital was a veritable ghost town. 

We had about 15% of the regular staff, and all of the immediate roadways surrounding the hospital were an absolute mess. Ambulances, not the  most nimble of vehicles to begin with, didn't have a chance in hell of making it to the ambulance bay. But those gung ho paramedics, God bless them, were doing everything they could to get the sick to the ER. Some were carrying patients in from over a mile away. And amidst the struggle, with everybody coming together in a time of hardship to provide the best emergency care possible - this happened: 

One of my senior physicians approached a young female of 18 years who had come into the emergency room with a special female problem that day. BY AMBULANCE. ​

DoctorPeds: Hi. I'm DoctorPeds. I understand you came into the hospital today because you're having an abnormal discharge. And it started three days ago. Is that right? ​
Patient: Yeah. 
DoctorPeds: And you called the ambulance? 
Patient: Yeah. So what? 
DoctorPeds: The state has declared an emergency. People have been stranded in their cars for hours and are being airlifted to safety. There are elderly people dying from heart attacks in their homes, and we can't get to them because of the snow. And you took one of the very few ambulances that we have on the road, and abused it for a vaginal discharge that you've been experiencing for three days? What were you thinking?
Patient: *sucks teeth* Well, my vagina be just as important to me as my heart is. 

You need a license to drive a car, but not to have a baby. This person is going to procreate.

POOPING IS AWESOME.

POOPING IS AWESOME

Tuesday morning. I come into the ER for a 7 am shift, and the first patient that I see is a middle aged lady that has been sitting in the waiting room for ten hours. TEN HOURS.  Being a Tuesday morning, this likely occurred for one reason alone - nobody comes to the hospital on the weekend, so they flock to the hospital on Mondays like it's Free Sandwich day. This overloads every aspect of the hospital, from the emergency department to the inpatient floors, and forces most people with very low acuity to wait for hours to be seen. It appears as though this is the case here. 

Dr. Z: Hi Patient Waitalot, I'm so sorry for the extended delay in your care. What brings you to the hospital today? ​
Patient: Well, I was at home yesterday and my legs got all numb and tingly. I couldn't feel them for about 5 minutes, and I was very concerned.
Dr. Z: Well, that does sound concerning, and I understand why you came to the ER. Can you tell me a little more about what you were doing when this happened? 
Patient: I'm a little embarassed... but, I was in the bathroom having a bowel movement. It took quite awhile. But when I got up I couldn't feel my legs. It was about five minutes long, and my legs were tingling and numb. I thought that I was having a stroke!
Dr. Z:  Hmm. 

It was at this point that my higher functioning kicked into high gear, and I relied on my vast medical knowledge to help me find a solution. I recalled something extraordinary that allowed me to crack this case:  ESPN - The Magazine. It's got a special spot next to my toilet. And I have experienced these symptoms.  Many, many times. 

Dr. Z: Ma'am. When you were on the toilet, were you reading?
Patient: Yes I was. I was reading a novel.
Dr. Z: And when you were reading, were you leaning forward and resting your elbows on your knees?
Patient: Yes I was.
Dr. Z: Let me tell you about what I think happened. 

This lady waited for ten hours, so that I could tell her that she experienced paresthesias secondary to the pressure that she was applying to her knees. Or, more simply, she shouldn't lean on her knees when she drops the kids off at the pool*.

MEOW.

MEOW​

Working shifts in the pediatric ED can be a nice change of pace. Cute kids, everyone (for the most part) is healthy. Parents, however, are the worst. I get a first-hand ​view into the premise of Idiocracy. 

"My kid bumped his head 4 years ago. Now he is acting up in school. Where do I go for a CAT scan?"

Home. And put a cat on his head. If it meows, you win! Everyone else has already lost.