Deer are stupid bastards.

There, I said it.  

You want proof?  Go watch Bambi again.  Go watch that idiot fall all over himself on the ice for an hour and tell me you don’t just start craving venison.  Then watch Bambi a second time and answer this question… Does Bambi get shot?

Woohoo!  Correct.  Bambi takes a shot.  Unfortunately it was not my brother who was in the woods at the time, since the hunter that plugged Bambi had crappy aim.  

Perhaps you’ve picked up on my worsening angst towards deer, I realize I’ve been pretty subtle with it.  However, those four-legged jerks continue to poop all over my yard.  I can hardly play Frisbee with my daughter (read as “playing fetch with a Frisbee with my daughter”) without getting covered by the small piles they leave behind.

However, when other people slip and fall due to a pile of poop pellets… well that’s just hilarious.

I actually opened a window and yelled at them one night.  They looked up, and trotted to my neighbors yard.  This is fine, they can poop all over Steve’s yard, he’s a nice guy, I’m pretty sure he doesn’t mind poop.

Some interesting times.

I have seen so many people lately going through so much pain.  Often I am the one who acts as messenger for that news.  

In the last two weeks, I have told three people they have terminal cancer.  I have had a lengthy talk with a husband and wife about how incredibly sick he is, even though right now he feels well (and in four hours he died).  I helped to resuscitate a teenager who came into the ER with respiratory failure without a known reason who died.  I have had four patients with drastically life changing strokes.  I had to tell a good friends father that he needs to cancel his vacation plans due to invasive cancer.  I had to tell families that their son was burned and possibly fatally injured in a car accident.

So much pain.

Then, after each and every one of these occurrences I had to go back to work and smile and see more patients and pretend a part of me wasn’t crying on the inside.  I had to take care of other people  who were not dying, many who really were  not even that sick and pretend to truly care that their hip pain that they have had for over six months is today an emergency.

It helps me keep things in perspective.  

The time we spend.  The choices we make.  So many little decisions.  

Make more time for family.  

Make more time for friends. 

One of my partners went to a funeral for a friend who died after fighting cancer for two years.  He was 35 years old with a 3 year old kid.  Man does that hit close to home.  Life is too short to be full of yourself.  Keep smiling and laugh as much as possible.

A friend of mine (Family Practice Resident) was recently telling me about an experience he had.  I find this terrifying.  This apparently actually happened… and it’s not that infrequent.

Dr. Optimistic: “Hey there Mr. Loh-Ai-Cue I see you are here for your routine check up”

Mr. Low-Ai-Cue: “Yeah, I just wanna make sure I’m doin’ OK”

Dr. Optimistic: “Sure thing, let me just get up your labs and… HOLY CRAP!  Your Hb A1c  is 12.5!  That means you have the worst diabetes I have ever seen!  Oh, and don’t get me started on your blood pressure”

Mr. Low-IQ: “Yeah, well, I didn’t change my diet”

Dr. O:  ”But, your diabetes…”

Mr. Low-IQ:  ”Yeah, I’m not exercising either, and those insulin shots hurt, so I’m not taking those.

Dr. O:  ”But… but… you really need to.  I mean you are going to destroy your kidneys, and your blood pressure is through the roof.  You are horribly straining your heart-”

Mr. Low-IQ:  ”Listen.  I’m not going to change my diet or take those pills, K?  I’m just here to get my check up”

Dr. O:  ”But if you ignore everything we say, why even come here in the first place?”

So that’s medicine in a nutshell.  In fifteen years this person will have a heart attack, his toes will be falling off, he will need dialysis three times a week and his quality of life will be absolute crap compared to now.  We could prevent horrible things from happening, but the typical US citizen would rather face the horrible consequences later than have mild adjustments now.

I really feel for the Family Practice doctors.  It is impossible to help someone who will not help themselves.

Thoughts??

So I think enough time has passed that the guilty parties can no longer get in trouble.

In residency, people were all suffering together.  As residents you work crazy hours, get limited sleep, and your life is essentially non-stop studying, working, and gaining as much experience as humanly possible.

Occasionally you need some sort of break.  

Me, being a good nature soul, often became part of said fun.

Them: Hey, you have a kid in room 19 that made you a balloon animal from a glove, it’s really cute,

Me:  Oh, cool, I’ll check it out (huh, that’s weird I don’t even have room 19)

So I go into the room to see the cute little kid with his balloon for me.  When I pull back the curtain, what do I get to see but a nearly naked, extremely drunk man, legs sprawled out in the frog-leg stance because in his drunken stupor that seemed comfortable, with his tremendous shlong out for the world to see and a puddle of pee on the ground.

Ah residency, the memories.  

Our bodies are amazing at keeping a wide variety of electrolytes precisely monitored to maximize its efficiency.

Several elements and chemicals can drastically (and often horrifically) alter our ability to function if they become even a little deviated from the norm.

Our sodium, potassium, chloride, pH, carbon dioxide, oxygen and many more are continuously checked and rechecked to be sure we are functioning at our prime.

 So I had a fine young man coming in with “exhaustion.”  

He didn’t have diabetes, but his significant other did.  She also felt “exhausted” two days ago, and, when she checked her sugar at that time, it was critically low at 88 (which is actually in the normal range).  

She figured that since her severe fatigue had been from her low blood sugar (which is wasn’t), then his must also be from low blood sugar.  So, logically (illogically), they checked his sugar today and found that he was also was exhausted from a low blood sugar of 105 (which is also normal).  

So… now follow this closely here,… they came to me to help heal him from his disease process (that he didn’t have) so that they could go to their regular doctor (where they should have been in the first place) to tell him that he needed to be put on medications (that he didn’t need).

Oh, and they smelled like pee.

I digress.

I digest.

I ditch mess

I dig vest.

<ahem> 

I also had to educate a few people about the importance of a comma.  

I was told I had a priority one patient arriving in 2 minutes with stabbing chest pain.  Normally this makes me worried about someone with a possible heart attack or serious lung issues.  As it turned out, he had been stabbed in the chest.

Stabbing chest pain…

vs.

Stabbing, chest pain.

Then later in the shift I took care of a patient that had a listed chief complaint of vomiting diarrhea.  Man that must be the worst aftertaste after puking you could ever imagine.

Remember your commas people, they can be lifesaving

!

I have learned that Emergency medicine often has a hefty amount of psychiatry in every single shift.  True psychiatric illness is devastating.  Fake psychiatric illness pisses me off.

For example, of all of the patients I saw this evening, over 75% of my patients had psychiatric problems, even if they were not listed in the primary chief complaint.

One patient had a GI bleed, which partially stemmed from his many years of alcoholism and very poor life choices (crack, heroine, alcohol, and paint-thinner seems to add up after a while).

Another three had suicidal thoughts, though all these fine young citizens also enjoyed drinking 2 beers (all only had two, how weird, since my blood alcohol after two beers does not normally go to seven times the legal driving limit after two beers).

However, the difficult ones are those that have amazingly obvious, painfully obtrusive personality disorders that everyone can see but the patient.  I don’t like to generalize (this is of course a lie, but it’s a nice thing to say), but every single one of these patients is a 30 year old obese female who comes in holding some sort of lovie (teddy bear, blanket, soft rabbit), who has a family member who continuously reinforces their helplessness.  They all have about 200 different vague complaints that can never be confirmed and all their labs come back negative since they never have anything wrong with them.  Oh, and 98% have fibromyalgia, always fibromyalgia.  I’m starting to think that it might be contagious, and that possibly one side effect of fibromylagia is an immediate and precipitous decline in the patients IQ.

Me (looking like a stud):  What seems to be the problem?

Her (stroking a dilapidated one-eyed teddy bear): I’m having a panic attack and seizures.

Me (appearing concerned): Oh?  When did it start?

Her (seemingly calm):  It started about two years ago.  Oh, wait, here comes one now (she then blinks rapidly for two seconds) Whew!, OK, I made it.  I need help.

Me (flag down on the field): So you are here for the, uh, seizures or the panic attacks?

Her:  Both.  And my allergy to aspartame is acting up.  It’s so bad that I can’t even let my sister sleep, I have to keep waking her up.

Sister (seemingly also concerned): She sure is anxious, you need to fix it.

Me: So what is different today?

Her: What do you mean?

Sister: Uh oh!  There goes another seizure.

Her: Oh, you’re right, I’m having another seizure (she wiggles her fingers for ten seconds).  Whew, OK, I’m better now, aren’t I?

Sister: Yeah.

Me:  Um.  

Her: Can you fix me?

Me:  I’m pretty sure I can fix you.  But the therapy involves living in Antarctica for 40 years.  It has done wonders for my other patients.

I think I know what bothers me the most.  Patients that have true psychiatric disorders requiring help cause me little frustration.  I can empathize and always help them to the best of my abilities.  However, when a patient’s problem stems from their own attention seeking behavior, it irks me.

I can’t fix the choices you make.

I can’t fix whininess.

When people come into the ER, they always have a “chief complaint.”

This is the main reason that person is here.  Usually it is quite easily summed up.  

“Sore Throat”

“Leg pain”

“I have a cockroach in my ear (true story)”

Now while some of the complaints I see cause no immediate alarm, others cause even my callous blackened heart to beat a little faster.

“Status Asthmaticus” = terror

“Bleeding Fistula” = better check this out soon

“I’ve been shot” = ought to poke my head in the room in the near future.

So our hero came in with a chief complaint of “I’ve been shot”

As it turns out, he had been shot… about 20 years ago.  This made it slightly less concerning.  He was also concerned (4:30am) that said bullet now was deeply lodged in his spine.

Unfortunately, he truly had a bullet in him.  Fortunately the bullet was just under his skin where it had been for a long time, and nowhere near his spine.

Another life saved…

Here’s some more fun quotes from the ER:

10.  Patient:  ”I gotta see if there’s a baby up on in here so I can get it out”

9.  Patient (after snorting out a blood clot the size of a large garden slug from a nosebleed): “I got something for your toast!”

8.  Dr. R:  ”The patient needs something.  In fact, he needs a cold pill.  A very cold pill.  Perhaps even a chill pill?”

7.  Nurse “But what if there was a policy that you HAD to wear a white coat?”

          me: “Then I would ignore the policy”

      nurse: “What if they bought you a white coat?”

           me: “Then I would put it in the trash, next to my copy of the policy”

6.  Pharmacist:  ”Just in case, if anyone needs anything anywhere… I can help”

5. (waiting for  C. Diff room to be cleaned)  Dr. M: “Just tell the next patient not to rub her rectum on anything.”

4. Nurse:  ”I believe my patient may be a dementor, she is sucking the soul out of me”

3.   PA to me:  ”You are kinda like a kiwi, a bit fuzzy yet succulent”

2.  Nurse: “I don’t even want to look at the post delivery vagina.  That’s like a trampled wizards sleeve.”

1.  (And for the Starwars and Yoda fans out there)

      “It was just scary.  She was over 450 pounds and had an STD.  When she opened her legs it was like Degobah in there.”

The ultimate procedure in the ER is the open thorocotomy.  

This is a procedure where you take a scalpel, and make an incision just below the nipple and continue all the way down the side of the body till you can’t go any further.  After that you insert rib spreaders and spread open the chest to find a problem as fast as possible.

This procedure is quite rare since it is only done when a patient has a penetrating trauma (read as bullet to the chest) and loses vital signs in front of you.

This recently happened to me.

I actually won a writing contest a while ago writing about this.  Here is a link to that article if you want to read it.  But I have actually never seen it before.

It was as intense as I had thought it would be.

Granted the trauma surgeon really did everything while we resuscitated him (fluids, blood, epinephrine, compressions etc.)

Did I mention the patient came in through the front door?

Did I mention the patient was way too young for this to seem real?

Did I mention that I visualized a heart with two holes in it, then they got sewn shut, then the heart started beating again?

Did I mention how cool it seemed both at the time and after?

Did I mention we placed paddles directly on the heart to defibrillate? 

Did I mention that, unfortunately, the patient died…

For how amazing the medicine was and how heroic all our efforts were, the end result was the expected tragedy of a person with a bullet to the heart.

But, if it happens tomorrow, you better believe we’re going to try again, just in case that’s the one we can get back.

This is a google image I found, but this is pretty much what it looked like, that’s the heart and lung there (minus the bullet holes)

In Hall Patient (IHP): “eH! EEH!  EEEEEH!”

Me:  <sigh> “What do you need?”

IHP: “Eh!  In met beet.  Nah in mae beet.  In bagga Fiss!”

Me:  What?

IHP: “In bagga fiss!”

Me:  What?  You want fish?

IHP: “met in me beh!  begga fiss!”

Me:  I can’t understand you.

“Rah no!  RAH.  NO!  IG MANNA FISS!”

Me: Man, I’m sorry, I just don’t know what you’re saying. You’ll have to wait until your are more sober until…

IHP: <starts peeing onto the floor right next to me.  Continues to pee on the floor for the next 2.5 minutes.  Try to pee for 2.5 minutes.  That’s a long time>

Me:  Oh.  Ig manna fiss means you gotta piss.  Got it.

I have been working on my medical Spanish, which comes in handy from time to time.  However, my medical drunk talk is still needing some refinement.