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.”