The Emergency Room is often a unique place.  Where else do you strip naked in front of total strangers and let them assault you with an assortment of needles, probes and devices? 

During a typical shift I have to do rectal exams, pelvic exams, inject people with needles and sew wounds together.  I have seen more people naked (note: for those of you who have seen the Seinfeld episode, this is invariably the “bad” naked, not the good naked) than I care to count.

All of this is done with the single intention of figuring out what ailment a person may have and to try to make them better.  I don’t like to do rectal or pelvic exams, but it is a necessary part of the job in order to find out what is wrong, and the general public understands this.  It is a place that you do what you have to do to help people to the best of your abilities.  It is a place where critical decisions must be made quickly with incomplete information.

Similarly, I never order tests unless I think it will aid me in discovering what is wrong with a person.  However, I do order lots of test.

Sometimes though, I have patients that confuse me.  For example…

Some time ago I took care of  a person with an entire laundry list of problems.  Sore back, sore throat, toe pain, chest pain, short of breath, cough, on and on it went.  From the ER standpoint, not too much of this would be categorized as an “emergency.”  That being said I always get worried about shortness of breath + chest pain.  The patient stated they also worried about this.

Here’s the kicker… the patient didn’t want any tests performed.

The patient had done “research” on the internet and was scared of tests, since sometimes tests could be wrong, and other tests could actually cause problems.

This really confused me.  It was like taking your car to the mechanic but not letting them look at the engine.  Or like going to the dentist and not opening your mouth.  Or like going to the breakdance coordinator and not letting them see your headspin.  Wait, maybe not the last one.

After doing a thorough history and a physical, most doctors have a decent idea what is going on, but to know for sure we do tests.  There are hundreds of causes for chest pain.  Could it be a strained muscle?  Could it be a bronchitis?  Pneumonia?  Heart Attack?  Pneumothorax?  Esophageal tear?  Acid reflux?  Cancer?  Nothing?

Fortunately I had the secret weapon that this patient needed.  I don’t like to reveal my secrets to the general public (or do I?).  What this patient needed was the secret that I take out for many of my patients… buttering up.  I complement their research and their choices.  Ultimately he let me do a few test, all of which were negative.

You know a patient is tough when I find myself missing the drunk guy who was walking naked down the hall to try to find the beer that the cops took away from him.  Though, to his credit, he did offer me some of the beer (which was in police custody).  Quite nice of him.

Swine flu.  Who wants to hear me whine.  I don’t care.  I’m whining anyways.

Heard about it?

Ever been an ER doctor when these something like this comes out?

Emergency rooms all over the country are shutting down because people are coming in with sore throat and sniffles instead of doing what they would normally do which is stay home, drink fluids and sleep.  Not only that, but everyone is in such an uproar about it that personnel in the ER have to wear giant Hazmat suits just to see patients.

Fortunately for you, I found the ultimate source of the swine flu and I have begun the eradication process…

Don’t use any tissue-paper dispensed by pigs, just to be safe.

Please Stay Away From the Swine Flu! 

I used to read about people who had a kid and ALL of their entries became about their kids and the stupid little things that they did.  I did not want all my entries to become about things I thought were amusing about my child.  Now here’s an observation about my child that I find amusing.

What does the term “blow-out” mean for you.

Let me tell you what it used to mean to me.

It used to mean that when I was driving one of the tires just exploded.  A blowout would mean I would have to pull over, change the tire.  Also I would have to get the other tire fixed or replaced.  This would be a bit of a hassle, but nothing that would strike fear into my very soul.

Things have changed.

Now, the word “blow-out” means something completely different.

This means that the super absorbent diaper reached critical mass and was unable to hold the load that my daughter provided.  This happens only rarely (so far).  However, when it did happen, it blew my mind.  It was everyone.  Up her back, down the leg, and in her belly button.

Think about that.  Think just about the logistics.  Where does poop come out of and where is the belly button.  We are talking about opposite hemispheres here.  North vs South pole so to speak.  Yet, despite the incredible odds my beautiful daughter found a way to poo her way around to her belly button.

I was so proud.

If you are new to the show, I tend to talk about poo probably 3,493% more than the average human.  I think it stems from the fact that as the rest of the boys in the playground grew out of fart jokes, I continued to write them professionally.  I don’t know.  Either way, I am glad to see that my daughter is at least taking after her father in some small ways.

My beautiful 9 day old daughter will look up at me with what I can only hope is love and adoration while I feed her and she takes a dump right in my arms.

This is fatherdom.  You just don’t care about the little things, like getting any sleep anymore.  OK, that’s a lie.  I still want sleep.  Badly.  But priorities have been adjusted so rapidly and so drastically that I hardly remember how life was just a mere 11 days ago. 

All the other parents keep telling me that this is the most wonderful, magical, and greatest thing anyone can do with their lives.  I am sure with time I will agree, though now my wife and I are so sleep deprived it seems almost inhumane. 

One of our friends, Hoosh, stated that “it borders on torture.  Waking up every hour to either, feed, change, console, or just responding to a cry that quickly goes away.” 

Today, my wife let me sleep in… I got to sleep at 5am and slept till 10:30.  I woke up and felt great.  So weird, since I usually would try to get a solid eight hours.  She on the other hand is currently passed out on the couch.  Though she says she is better prepared for this, since she has had interrupted sleep for the last three months or so with pregnancy. 

She also has started pumping breast milk.  We received the lectures in the hospital by the nursing Nazis who informed us that if we did not breastfeed our child would most likely grow into a serial killer by the age of 9.  That is, of course, if our child did not spontaneously combust which also comes from not breastfeeding.  Now she has brestfed for several days, and Samantha has started drinking more, she has to pump all the time.

My wife summed it up best: “moo.”

Parents/family has come regularly dropping off food/support, which is awesome.

Currently on the TV?  Classical music lite.  Sweet.  Great.  I was hoping to bone up on Salieri’s Ericlito E Democrito/Overture.  Our house looks like a Babies R Us threw up all over the place.  But, life is sweet, since I have this to keep me going:

Meet Samantha!

Both mom and Sam are doing well (mom’s a bit whooped from being awake the last 30 hours)
Eight pounds, Eleven ounces.
21 inches long.
Born Today!
First poop was about 10 minutes after being born (takes after dad!)
Already suckling pretty well.

Still sleepy from the big move!

YAY!! YAY!!!  YAY!!!!

That’s my daughter!  Age… 11hours

The ping pong champion was not me, I’m sorry to say.  I’m pretty good, but just not good enough.

In other news.  My daughter is being VERY disobedient by not being born yet.  I figured by now I would already be a pro at changing diapers and feeding and all that.  Unfortunately, she has decided that her liquid goo phase of incubation must last the full 40 weeks.  What a lazy baby.  When she gets out of there, she is Soooo grounded!

To my wife’s credit, she has tried every possible way to induce labor… except for inducing labor.  Our sister in law is a OB nurse where she is planning to deliver.  She was on vacation and came back today.  She “gave” her permission for us to have it tonight.  So help me if we do have it tonight, they are both going to be grounded.

We also have received many helpful books and advice from our friends.  One of our friends gave us a book on what to do and what not to do…  here are a few examples

I am relatively positive I know this guy from work…
 
I’ve heard a dry baby is a happy baby…

Recently I have had a bunch of patients that have required intubation in the ER.

That is fine.  If you can’t breath, and the only option you have for survival is for me to put a piece of plastic through your vocal chords to breathe for you… well then fine.  I like the procedure.  It is something that makes life in the ER quite exciting since you are taking away the on thing that keeps everyone alive… breathing and replacing that with a machine.  We have to do it to all sorts of people from the typical difficulty breathing to the people who are so drunk that they forget how to breath in the first place…  Pretty crazy stuff.

However.

Current trends have changed from the past.  Now, if a patient is receiving CPR, doctors are supposed to ask if family wants to watch as their family receives chest compressions, intubation, and other treatments.  I know CPR on TV can be glamorous and amazing, but in the real world it is brutal.  Ribs break, patients vomit and soil themselves, and blood can be everywhere.  It can be a total mess.  what I am told is that people want to see that the doctors/nurses/techs are all doing everything they can to save their loved ones life.  However, it seems like it might be a pretty graphic last image of a loved one.

Recently a patients spouse asked to stay in the room while their significant other was intubated.  I did not have any problem with that, other than it was a bit awkward.  I don’t think I would want to watch my wife get intubated, and I have more experience with it than the vast majority. 

Out of curiosity, just wondering if anyone out there would want to watch CPR of a loved one?

Would you want to watch your loved one get intubated or other invasive procedures?

I try to keep most entries rated in the PG to PG-13 ballpark, but sometimes, after a shift like today, you have to crank it up a notch.

You see, I have never had, seen, or known anyone with priapism… till today.

Warning!!  Warning!!  Warning!!
If you really want to know what I’m talking about, go google priapism, don’t say I didn’t warn you.

For those of you who are wise and did not click on that link, let me enlighten you using made up words that may make you feel either more, or much less, comfortable.

<I mentally sit down here like a grandfather around a Campfire.  I’ll explain it in terms we can all identify.  More specifically, terms I stole from Harry Potter>

You see children, priapism is when a mans special part, lets call it the Voldemort, gets really firm.  When a man and woman love eachother very much, they can make sweet sweet Dumbledore to each other.  After making Dumbledore, the Voldemort normally becomes quite Hermione after you Quidditch in a woman’s Hagrid.  However, sometimes men have difficulty getting the Voldemort firm, or, in medical terms, Neville. 

If a man uses a potion or elixir to make the Voldemort artificially Neville, it can become Neville for a prolonged period of time and become quite painful.  This is called priapism, and it is no laughing matter (tee hee).  Several options exist to try solve the riddle of priapism.  You can try a drug called Terbutaline (real name), which works in upwards of 30% of the time (fact).  Other, more horrendous options exist, which actually do work.  One can perform a ring block around the Voldemort and ram a 19 gauge needle into the Voldemort and drain off 30 mL of Weasley.  Another option is to inject Phenylephrine directly into the Voldemort. 

This is what the Urologist suggested to me.  So I looked right into Voldemort’s one good eye and plunged in for the kill.  “Avada Kedavra“ I would have yelled, if not for my awkwardness at grabbing another guys fully Neville Voldemort.  5 minutes later, his Voldemort was not longer Neville.  In fact it was completely Hermione, so everyone was happy.

Sometimes, my job is just weird.  Weird weird weird. 

I have to preface this entry with the following.

My wife is a beautiful, absolutely brilliant human that I love very much.

However, currently she has an ocean of hormonal insanity circulating through her system that I am pretty sure impedes her judgment.  She is still brilliant, but sometimes the hormones make actual decision making a little cloudy.

We recently discovered that Meijer (grocery store) has an online deal where you can click on all of your food purchases and then just go and pick up your groceries.  That’s pretty cool.  It saves time and effort and is quite convenient.  Gwen did this and we both smiled.

However.

She also saw on that site that you can buy stuff in bulk as well.  I think that her normal mind and pregnant mind had a conversation and it went something like this:

Gwen’s Normal Mind:  “Hmm, bulk items not a bad idea, at least for the food we eat a LOT of”

Gwen’s Preggo Mind:  “Me HOUNGRY NOW, FEED BABY, FOOD GOOD, EAT, OOH, CHEAPER THAN NORMAL, GET FOOD!”

Gwen’s Normal Mind:  “Indeed, I think getting some of this might be a good idea to save money, but certainly you don’t think we should get all of these items, do you?”

Gwen’s Preggo Mind:  “ME LIKE CHERIO!  HUBBY LIKE LUCKY CHARM GOOD!”

Gwen’s Normal Mind:  “Now you’re being rediculous.  Maybe some juice but you can’t possibly—”

At this time Gwen’s Preggo mind attacked her normal mind with an assault of Estrogen, Progesterone, and Images of cute pink stuff with ‘princess’ on it that the Normal mind was rendered helpless.  Thus, we ended up with 14 boxes of Cherios, 10 large boxes of Lucky Charms, 16 large containers of juice, and one confused husband.  When it all came, we pretty much both started laughing.  It was substantially more than she had it planned in her brain.  But, on the bright side, I’m going to be magically delicious for a LONG time.

Got milk?

For those of you who are new to the program, I work in an ER.

If you have not gone to an ER recently, it is a highly entertaining place to go, especially on Friday and Saturday nights.  Several layers of crazy come out to play and I get to be the lifeguard at the giant community pool of insanity and incontinence.  Most of these people are drunk.  Some of them are pretty depressed.  Only very rarely do I really get to see 100% pure, wholesome, unadulterated crazy.  Today, I saw crazy.

What is nice about the ER is that it really takes quite a bit in my daily interactions to cause any concern.  Most people rarely behave in a manner that cause me to become even slightly worried.  In fact, I cannot really recall the last time I was really confounded by human behavior… till today.

It all started (insert Waynes World fadeout…) when my wife and I went to Red Robin (yum!) for burgers.  They were delicious, and yes, you suck for not going.  After that we went to Babies R Expensive to pick up some random crap for our soon to be born parasite.  It was on the trip that things started getting weird.

We have all seen bad drivers.  We have all seen (or had) road rage.  This seemed different.  I was peacefully driving down the road, with only one car in front of me.  This car was roughly 200 yards in front of me.  I’m talking NO WHERE CLOSE to my car.  The road was pretty empty, and it was a side road without too much traffic.  There was a very minimal amount of light rain.  Not enough to obscure vision, just enough that you had to manually turn your windshield wipers on about every 40 seconds or so.

I’m trying to make it perfectly clear that this was a pretty boring drive home… UNTIL.

The car in front of me swerves to the left, still in its lane, then swerves to the right, then quickly comes to a stop on the shoulder.  It stops there. 

At this time I assumed no big deal.  Possibly car troubles, I dunno.  Being a caring person, and also a curious person, when I caught up to the car I peered inside to make sure the person inside was ok.  You know, the driver could be in trouble and that is why she stopped.  This is where the fun starts.

As I slowly drove by, the very large woman in the car glared at both my wife and myself.  She was obviously livid and was screaming at what I could only assume was the top of her lungs.  I’m not positive, but I think a little rabies-like drool was foaming from the corner of her mouth.  While she did this, she held in her right hand what appeared to be a small recipt from a recent purchase.  She pumped her arm repeatedly while she screamed at us with her now red face as we passed her.

I looked at my wife.  She looked at me.  Neither of us was sure what had just happened, but shortly thereafter the not so sane lady began driving again.  Fortunately for us another car was right behind us.  I looked in my review mirror and the person in the car behind us looked right at me and shugged their shoulders as if to say “huh, that was kinda weird, eh?”

I was scared.  She had the burning white hot rage of insanity.

Thankfully she turned when we went straight.  I’ll assume I will hear about a string of murders soon, but we made it home without any other event.

Out of curiosity, any of you ever had a brush with pure crazy before?  I think I might be a magnet for such activity.

This is what I saw in the car as I passed.  No joke.  Maybe worse… maybe.