TRANSPORTATION PROCLAMATION.

PAIN PAIN PAIN.  

Cardiac arrest. Sepsis. Intracranial hemorrhage. Flash pulmonary edema. Gunshot wounds. Open fractures. Violent psychiatric patients. Women. The emergency department is a high action, high octane place, with life changing decisions made on a minute-by-minute basis. That's why today's story hits so hard. 

I took care of a woman in her 50s today who came in with a complaint that rocked the very foundations that this profession was built on - knee pain. She described to me a bilateral knee pain that had been plaguing her for well over 6 months, but TODAY - today was the day that she made the difficult decision to come into the ER and annoy the shit out of me with her complaint.  

Dr. Z: Why don't you tell me what brings you in to the hospital today?
Annoying Woman (AW): My knees. Doctor, DOCTOR. My knees be hurting all the time. Why? Why are they always hurting? For months and months they always hurt. I keep calling my doctor all the time, and he sent me to a specialist but I never went. Today when I called him he said, "Go to the ER." 

Oh hey. Hey you. Primary care doctors. Go punch yourselves in the face, a lot. Like, more than 14 times. I know its the weekend, and its 6 am, and you're really tired of answering calls from the crazy woman with chronic issues... but STOP SENDING EVERYBODY THAT ANNOYS YOU TO THE ER. You know what you should do? Stop giving out your cell phone numbers. I know you want to be the trustworthy doctor that can text with your patients, but stop. Just stop. Would you give a hooker your bank card? You would? Nevermind. 

I saw the patient, spent some time with her explaining what her issues were and why she would need follow up with an orthopedist, treated her with pain medication, and had her smiling as she left the emergency department.

About a half hour after the patient was discharged and left the hospital, our secretary received a phone call... from the bus driver that had picked up my patient. Yelling into the phone, the bus driver told the secretary that the lady in question still had knee pain, and should have been admitted to the hospital overnight. He was now going to take a picture of the patient, with his cell phone, so that she could sue me and use it in court. 

This interests me for a few reasons. Firstly, what the hell kind of picture was he going to take? Was it just a picture of the lady writhing around in agony on the floor of the bus? Was she standing next to the seat at the front reserved for the disabled, pointing at it and looking sad? Would the picture be Instagrammed so as to highlight the pain in her knees, while blurring out the rest of her features? Would he be artsy, and focus in on a solitary tear that is slowly rolling down her left cheek? Would it be a Vine of the lady trying to get on the bus, unable to climb the bus steps, and subsequently being rescued by the bus driver as he carries her to her seat? Or would it be a photograph of the prescription that I gave her that wasn't Percocet?  In hindsight, I should have given the bus driver my cell phone number so that he could text me the picture that he took, and relieve me of the hours that I would spend laying awake at night wondering these things.  

In the end, I learned two things:  

1. I hate people. More and more every day. 
2. Bus drivers are the worst. Except for the one bus driver that absolutely destroyed that one ratchet chick with an uppercut...  MORTAALLL KOMMBBAAAATTT!

THE LOVE FACILITATOR​.

THE ART OF DEDUCTION.

Finishing work at odd hours allows me to enjoy experiences that I would have otherwise missed out on - please see below. 

A nice young couple watches my dog (AKA the love of my life) sometimes, usually when I'm working an overnight shift in the emergency department. The other night, they were kind enough to allow me to pick him up at 430am, on my way home from work. Why was that amazing? Because instead of going home and struggling to stay awake watching Sham-Wow infomercials until I could go back and pick him up at 7am, I was able to grab that warm little monster and head straight to bed.  

The following day, I sent them each a text to thank them for the good deed that they had done for me.
She responded with, "No need to thank me. Because he wasn't in bed with us, I got to cuddle Jeff* before work!"
He replied, "Please feel free to pick him up early ANY TIME on those overnight shifts."

So, yes, he definitely got it in. I take full credit. 

 *names changed to protect the sexually sated

DIFFERENCE IN OPINION.

JOB QUALITY.

I came home the other night and told my SO about my day, which included a brown recluse spider that was running loose throughout the emergency department, as well as an examination of an odd rash on an elderly man's scrotum. This, I discovered, my SO found hilarious.

As she lay on the sofa, cackling with her head thrown back, she was barely able to get the words out:

"Babe... your job is so bad... oh my God... please... don't ever let me complain about my job... oh man... a gross hairy spider and an old guy's balls... hahahaha... oh, what did you do today? Oh I just looked at a guy's balls and ran away from a spider... hahaha..."

I thought it was a fun day. Different strokes, for different folks.

A FEW OF MY FAVORITE THINGS.

A FEW OF MY FAVORITE THINGS. 

Every day in the emergency department is an adventure. It’s a constant battle, waged on many fronts. Through the subtle heart attacks, strokes, and surgical abdomens, we must weed out the drug seekers and histrionics. Some days, however, the weeding out is a little easier than others. 

One of the benefits of an electronic medical records (EMR) system is that we have access to a great deal of information before we even enter the room. In triage, the nurses obtain vital signs, a chief complaint, brief description of the problem, etc., and enter this information into the computer. We can even look at your previous visits, which is vital in assisting us with making our ultimate disposition. One of my favorite parts of the EMR, however, is the brief little blurb that tells us why you came into the hospital in the first place. Just a few words - but they can mean so much. 

Although I’m unable to provide actual screenshots of the complaints, for obvious reasons, I can list them. And list them I will. Take a look for yourself, as I’ve provided just a small sampling of complaints - we get some of these on a daily basis. A little spice, if you will.  Those of you that haven't worked in medicine will doubt that these are real - if you have any kind of experience within an ER, however, you know that these complaints are quite common. Here we go...

“Nasal congestion.” 

“Possible maggots in vagina.” 

“Fell backwards walking down steps.”  Who the hell walks down steps backwards?

“Feels like my spine is swollen.” 

“Exposure to rain.” 

“Motor vehicle accident and vaginal discharge.”  This lady was on a backboard with a rigid cervical collar in place after an accident on the highway, but still found the time to add vaginal discharge to her complaint list. 

“Hit with volleyball.”  

“Green string coming out of stomach.”

“Allergic to sweat.”

"My kitty stink."

“Attacked by a robot.”

“Drank pot tea.” This person drank some tea infused with marijuana, and felt intoxicated. Perfectly reasonable reason to come to the ER... one might think if they were high.  

“Wants pregnancy test.” This is pretty much an every day thing. I don’t know what type of propoganda these people are being exposed to, but they seem to think that the urine test at the hospital is far superior to the one at the drug or dollar store. Or they just don’t feel like paying for a test. At the least, I can appreciate the women who tell you that is what they are coming in for, rather than the others who pretend that they have lower abdominal pain so that they get a pregnancy test, and then elope after they’ve heard the result. Ugh. 

“Contractions. Not pregnant.” I mean... whatever. 

“Maybe pregnant in my thyroid.”

“Exhausted, poor.”

“Shortness of breath, broken tooth, ankle pain.” One stop shopping! If the person had tripped, sprained their ankle, subsequently breaking their tooth, causing them to aspirate their tooth and partially block an airway, leading to shortness of breath... fine. But do you think that was the case? No. No, it was not. 

“Ran out of percocet.” This one is my absolute favorite. These people are the worst. Don’t come in when I’m working, because I’m not your drug dealer. Call ahead, save yourself a trip. 

“Chest pain and vaginal discharge.”

“STD and chest pain.”

“Clitoris stuck in underwear.”

"I think I broke my c*nt bone."

In between all of these patients, the job of nurses and doctors within the ER is to find the truly sick people, and pay them the attention that they deserve while getting the rest in and out as quickly as possible. And the government chooses to pay us less based on negative ‘care scores’ from these people. I wonder how it would play out on The People’s Court. 

Dr. Z: Well, Your Honour, I was in the middle of stabilizing a hypotensive patient with a massive GI bleed. Unfortunately, I was delayed by about 30 minutes, and was unable to immediately attend to the woman who was exposed to rain. 
Exposed To Rain Woman: I ain’t less important. I was there first and they didn’t see me first. And then the bathroom was dirty, and they only had ham and cheese sandwiches left when I asked for turkey. And when I left I was exposed to rain again and had to re-register. I should only be charged for one visit. 

Sometimes I just want to be Wayne Brady. With my luck, she’d just re-register with neck pain. Blah. 

MOM VERSUS DAUGHTER. ROUND 1.

PUNCHES TO THE GUT

Violence exists in the world. Lying exists in the world. The emergency department exists in this world - often, all things exist together. 

When you grow up watching sitcoms like Full House and Growing Pains, you develop a sense of how family conflicts should be resolved. You learn that familes comes together, problems are discussed calmly and rationally, and a decision is made that solves the problem while providing an important learning opportunity. Then everybody goes to sleep with their sneakers on. Seriously, what is that? Have mercy. 

In inner city America, this is not what occurs on a daily basis. Not even close.

I came into the emergency department one afternoon, and encountered a young female with abdominal pain - not terribly complicated. 18 years old, with her mother sitting at the bedside - that's the complicated part.  Do you remember being 18? I certainly do, and I would say that approximately 50% of my life would have been met with disapproval by anybody outside of their 20s, let alone my mother. What that means is that everything that this girl says will count for nothing, because she'll be lying through her teeth. Dr. Sherlock Holmes, activated (kind of like Robert Downey Jr., but with less cocaine and more formal education).  

Before I even began speaking to the patient, I apologized to her and her mother, and excused myself for a moment. Different smells often permeate the emergency department, but today's was particularly different - and especially pungent. You know that scene in Anchorman where Brian Fantana busts out Sex Panther, by Odion?  It was kind of like that. A used diaper, filled with Indian food... and a can of tuna. I thought that perhaps one of the foreign medicine residents had dropped their half eaten lunch into the garbage while walking through the ER... and then a tuna fish magically escaped the ocean and died directly on top of it. A careful inspection of the garbage cans in the ER did not prove that theory to be correct. I tried to forget the smell, and forged ahead. 

Dr. Z: Hi there Ms. LiarLiarPantsOnFire (LLPOF). What brings you into the emergency department today?
LLPOF: My stomach hurts a lot. It started two days ago, and hasn't gotten any better.

A careful history taking revealed nothing of worth. Apparently, she had just moved back in with her mother after having been kicked out of her father's house for sneaking out at night. Other than that, she seemed like a pretty normal kid. Except for this.

Dr. Z: Are you sexually active?
LLPOF: Well, with girls. I only date girls now.

Why was this abnormal? Well, it seems as though the girl had a boyfriend last year, that mom hated. He was banned from her daughter, banned from her house, and banned from her life. So, naturally, my patient turned to the most reasonable method of throwing her mom off of the scent (see what I did there?) of her continued love affair - homosexuality. I could see where this case was going, and I'm sure that by now, you can too. Mom, however, was willfully ignorant.  But not for long. 

As I let the patient know that I needed to conduct a physical examination, she became a little nervous. The emergency department is set up like a casino - air conditioning always blasting, no windows, etc. So it didn't really seem out of the ordinary that my patient was wrapped in two blankets like she was in a cocoon. Until I began to unwrap the blankets...

It all happened very quickly. The first layer of blankets was unwrapped, and mom's brow furrowed. As I began to unwrap the second layer of blankets, and the full wave of nauseating aroma made its way into mom's nostrils, she flipped. Mom smelled the spoiled mayonnaise, and it wasn't something new to her. Fists started flying, daughter rolled off of the bed and attempted to escape, but it was too late. Mom had channeled her 12th grade track team quickness and cornered her, and was punching her daughter in the gut, all while screaming, "I TOLD YOU NOT TO LET THAT BOY INTO MY HOUSE ANYMORE! HOW MANY TIMES DOES HE HAVE TO GIVE YOU AN STD?? ASLKFSDKGFKGFDJHGUEGJF..." Mom went berserk. Daughter was crying. Security was called.

And I had my diagnosis. Just another day at the office. Elementary, my dear Watson. Elementary.