True story.  Left without interpretation for you to discuss among yourselves.

Her:  ”Doc, I need you to test me for drugs,” she said, straight-faced and serious.

Me:  ”OK,” I answered, “why is that?”

Her:  ”Well, I think they put something in my crack.  After I smoked it, I got all paranoid and felt all dizzy.  It’s been 2 hours, I’m fine now, but I think they put something in it.”

Me:  ”Wait, what?  You smoked crack and then you felt dizzy and paranoid.  But you want me to test you for drugs?”

Her:  ”Test me to find out  what they put in it.  They can’t do that.  I’m gonna sue them!”

Me:  ”You want me to test you to see what your dealers may have put in your crack so that you can sue them?”

Her:  ”Yeah, I got an attorney and all that, just test my blood,”

Me:  ”You know crack is illegal right?”

Her:  ”But they can’t do that,”

Me:  ”<speechless>” 

Patient:  It’s not my fault, the problem is that obesity runs in my family.

Doctor: No, the problem is that nobody runs in your family.

I consider myself quite tolerant, though I have been a documented fattist.  Losing weight is the fourth most important thing my patients can do for their health.  You want the first three?  OK, fine, since you’re looking especially handsome today, I’ll give it to you.

The top 5 best things my patients can do for their health.

#5:  Stop existing in a vegetative state.  If you need a small cart to haul yourself around while you shop, you should not be in a small cart to haul yourself around when you shop.

#4:  Lose roughly 2/3 off your weight (get that BMI below 30 (25 for the dreamers))

#3:  Stop smoking crack, doing heroine, and other drugs (yes stop smoking pot, it doesn’t kill you but it makes you useless to society.  Also, don’t let your 7 year old child do it either).  Pot does not cure cancer, sorry.

#2:  Stop drinking.  One glass of red wine is good.  Two fifths of vodka, not so much.  It just makes gravity stronger for your face.

#1:  Stop smoking.  No.  Shut up.  Please just shut your mouth and stop smoking.

There you go.

I’ve ranted about all of the above.  But #4 was reminded to me by a nurse who was trying to insert a foley catheter into a man, but he was so fat that she could not find his penis.  Yep.  COULD NOT FIND IT.  You know how you can have an inny or outie belly button?  Usually that’s not so true for your penis.  Oh well.  In fact, she actually thought his penis initially was his belly button… but he said “yes” when she asked if that felt like the area where urine usually came out of.  And Lo and behold, under the folds was a ding-dong and a ding-a-ling.

Secondary gain: And external usually incidental advantage resulting from a disease process. 

Usually people get secondary gain in the form of attention from other individuals, days off work, rest, gifts, etc.  If you have the flu, people often try to make you feel better and thus provide secondary gain.

Sometimes people actually pretend to be ill in order to get attention, or days off work, or disability or whatever.  This is where our story begins.

If you have ever seen a seizure it is a terrifying experience.  Though there are a wide variety of seizures, grand mal are both the most common and visually the most terrifying.  A person collapses to the ground, their entire body stiffens, then this is followed by rhythmic jerking while the body is unconscious.  This is often accompanied by tongue biting, incontinence, and periods of apnea (breath holding).  Also (and this is important), after grand mal seizures there is a period of confusion, disorientation, and exhaustion immediately after seizures called the “post ictal” phase.  After a seizure, you don’t just wake up and feel completely better, your brain just pressed the reset button, it takes a while to reboot.

However, there is an entity known as Pseudo seizures.  These are when a person demonstrates seizure-like activity without the actual neurological brain firings seen in epileptic seizures.  There are a wide variety of causes for these, the most frustrating (and seemingly the most commonly seen in the ER) are pseudoseizures for secondary gain.

Yep, some patients actually just pretend to have seizures so they can come into the ER and have people feel sorry for them.  Now, don’t get me wrong, all pseudo-seizures are not willfully caused by patients, but let me give you an example from one of my nurses.

My nurse: Yeah, she’s having another whatever you want to call that.

Friend in room: “Can you get the seizure pads?   She’s having a seizure”

Patient:  <Moves arms back and fourth randomly in a poor representation of a pretend seizure>

My nurse: <Walks into the room> “Yeaaaaah.  We don’t need to do that right now, she’s fine.

Friend in room: “Why not?!”

My nurse: “She’s fine.  She’s not having a seizure.”

Patient:  ”Yes I am, this is a real seizure.”

My nurse: <sighs and walks out>

So we did a thing called “Trunk or Treat” this year where a group of people pull all their cars in a line and kids can go from car to car in the lot and do rapid pre-Halloween Trick or Treating.

My daughter went as a black “Kitty-girl,” my niece went as Princess Aurora (Sleeping Beauty), and my nephew went as Spiderman.

Got to the endearing 77 year old who likes to compliment all the kids on their costumes…

Her:  Oh what an adorable little puppy

Me: Actually she’s a-

Her: And look, here’s Cinderella

Me: Well, she’s really

Her: Oh, and look out, it’s Batman.

Me: Yes, they really do look nice.

0 for 3, but at least she’s handing out candy.

We also went to our yearly party.  I dressed up as Zippers the Zombie Machine.  Kind of a Terminatoresque zombie who has his outer flesh later peeled off.  These are 3 (different, believe it or not) pics of the costume (note the glowing gears for heart on the first  )

This costume took me several hours to make (spirit gum, liquid latex, painting/make up and detail work), yet, like an idiot, I didn’t get any pictures till much later in the night, ah well.  Still was an awesome party and great fun for all!

So this happened.

Me: So whats going on

Her:  (points at mom) That Chupacabra is trying to suck it out of me

Mom: No I ain’t

Her: Really, that Chupacabra tried to get my blood

Mom: I don’t know, this is why we’re here.

Her:  And then it doesn’t even go there!

Me: What doesn’t go where?

Mom: You said it goes where, hun?

Her: And I can’t sleep.

Mom: She can’t sleep.

Her: But I can sleep sometimes.

Me:  What?  So which is it?

Her: Well, I learned to shrink my soul into a watermelon seed and then I put it in my pocket and then I can sleep.

Me: OK, well, that’s enough for me (out the door I go to try to figure out what just happened)

I meet such interesting people at work, I really do.

Also, if you type Chupacabra, it auto-corrects to Abracadabra, which is also kinda cool.  I’m going with puppy and kitty themes for the pics today.

OK, I must admit it, I sometimes try to gross people out.

Now, similar to that scene from White Men Can’t Jump where Woody Harrelson argues with Wesley Snipes that part of the reason he likes demeaning other players is that when it is done to him, he only plays basketball better, I find that whenever someone tries to gross me out I just bring it up and gross them out right back followed by writing ridiculously long run-on sentences that most likely some people never finish due to the fact that funny pictures are just a mouse scroll away.

Let me refocus.

Certain words make people feel awkward for whatever reason.  I know people that hate the word moist.  It just irks them for some reason.  Others despise bulgy, or tromboner, whatever.  I’m fine with just about anything.

So during my last night shift I saw many many people.  It was just a crazy busy night.  That was not the weird part.  The weird part was that all of my patients had 1 of 2 complaints.  

Complaint #1:  I am drunk and depressed.

Complaint #2: My vagina has something coming out of it that I don’t think should (so I’m in the ER at 3am even though it’s been going on 3 weeks)

(Complaint #3: Both 1 and 2)

One of my lovely nurses introduced me to a new term she learned while interviewing a patient and her mother.

Nurse:  So ma’am, it says here that you are having malodorous vaginal discharge.

Patient: <blank, confused stare>

Nurse:  Is this true?  Are you?

Patient: <deer in headlights, looks over to mom for help>

Nurse (looks at mom)

Mom: She’s askin’ you if you’re CREAMIN’

Patient: Oh.  Yes.

Yeah.  That’s right.  You’re creamin’.  

I’m just waiting to use this casually with my friends.

Oh, I found this. Yes, I truly would hate it if my patients stopped showing up when they are creamin’… wait, no, no I wouldn’t.

Yes, this is exactly what we see when we do a pelvic exam.

I thought that by now, I would be immune to the ridiculousness of complaints in the ER.

Not yet.

In retrospect, I’m thinking drugs were on board.

The following occurred around 3:30am

Her: My pinky toe hurts!

Me: Uh-huh, for how long?

Her: Like a year.  And my feet have been sweating.  Like a lot!

Me: Uh-huh.  Well, let me check it out. (I put on gloves and try to examine her foot)

Her: Whoa!  You can’t just go grabbin’ someones foot.

Me:  I’m sorry, did that hurt?

Her:  No.  But, you know, my toe.

Me:  Um.  So, it’s not hurting?

Her:  No, but you’re grabbing it.

Me:  Right, well I have to check it out.  That’s what you’re here for.

Her:  Yeah.  

Me:  <So I check out her foot and her toes, and everything is completely normal>

Her:  Oh, and I’m pooping a lot.

Me:  Oh.  OK.  Any pain or discomfort with that?  Diarrhea? Constipation?

Her (angrily):  No man!  It’s all normal.  Does your boyfriend ask you how much you shit?

Me:  No.  So you have no pain, you feel fine, but your here for toe pain that you have had

on and off for a while in your pinky toe.  

Her (very angry):  Your acting like you don’t even care that my feet sweat.

Me:  No, I don’t care that your feet sweat.  This is an Emergency Department, if you are concerned about your feet sweat, you can follow up with your primary care doctor.

So I released the patient back into the wild.  I was unable to cure the frequent normal bowel movements.  I couldn’t stop the foot sweat.  She left angrily.  Oh, but let me get on my soapbox for a second, my job performance is directly related to how satisfied and happy my “customers” are in the ER.  Thus, she can fill out an unsatisfied survey and I get in trouble.  Sweet.  

I try to be very nice, kind, patient, and compassionate towards my patients.  However, in the ER, you often have to give terrible news.  ”Aunt Mertyl has cancer, or you have pneumonia, or your mom just died…”  This is not your normal customer provider interaction.  I know vast majority of the time I have a great rapport with my patients, but inevitably people still hate hearing terrible news.

Also, I often have to tell people things they don’t want to here.  You really should stop smoking.  Drinking that 1/5th of vodka a day is going to kill you.  You are way too fat and that is what is making your back hurt.  As it turns out, unprotected sex can cause pregnancy, and no, drinking mountain dew will not prevent it (i wish that was made up).  Also, if you come to the ER with a sore back that has been bothering you for 2 months, the guy with the heart attack is going to go in front of you, even if he came in after you.

Do you think patients in an ER should be treated like customers in a restaurant? 

Recently one of the fine nurses I work with had a patient come in who was stoned off his rocker on crack.  

This is not unusual.  On any given day it is quite likely that the majority of my patients are either drunk, high, or psychotic.  Many are all three.  However, what made this unique was that she stated that she didn’t use any drugs at all.  Some people are pretty good at pretending they are not drunk or high.  However, this fine man was not of that caliber.  Also, she had more crack on her in the ER.  We’re not cops, so we don’t care all that much about what you do at home unless it starts making our lives difficult, then we care a whole lot. 

As it turned out, she also had a crack pipe on her, along with the extra crack.

How could this be possible.

Fortunately, she explained.

“Yeah, some guy made me do the crack and then put all that stuff in my pockets,” she said, as if this were the most logical explanation in the world.

“Riiiiiiiiiiiiiiiiiight…” said the nurse, while using her saint-like patience not to throttle the patient.

So it turned out that our hero actually was on probation and didn’t want to be caught using illicit substances.  However, I’m sure any judge would wave such grievances since all of these drugs were forced on her by some random stranger.  I don’t know how many druggies you know, but most that I know love to give away their drugs to people for no reason.

Don’t you hate it when that happens?  Just walking down the street and some random guy forces you to do crack.  

Man I hate that.  I was going to go to Costco today, but now I have to get high and scream obscenities at squirrels for three hours.

Oh well “GET OFF MY LAWN YOU PUFFY TAILED RAT!”

Also, if you were wondering, these are the highlights if you goto google images with “Crack squirrel”

Woodland rodents need their fix too, don’t be so judgmental.

So I took care of this nice young woman the other day. She was pregnant and having pain, like many women have when they are pregnant.  I did some tests and she and her baby were fine.  Everything was going perfectly till her friend (I’m guessing 18 years old) started helping.

I fully encourage the asking of questions.  I think problems often arise, especially in medicine, when even the simple questions go unanswered.  Her friend mostly had comments.  I’ll name her Brittanee Barbie Bubblesworth, cause that seems about right.  Now remember, Brittanee was not even the patient, just a friend in the room.

Me (to the patient): “So take Tylenol for pain, since that’s pretty much the medicine of pregnancy”

BBB: “Um, you know, Tylenol really doesn’t do much for pain”

Me: “Yeah, she has no pain now, she’s doing fine, if she is hurting, she can take Tylenol.”

BBB: “Can she have Vicodin for pain? Cause my OB gave me Vicodin”

Me: “I’m not giving her Vicodin.  She has no pain.  She is feeling fine without complaint, I’m telling her that if she has pain, she can use Tylenol.”

BBB: “Well, Vicodin doesn’t even do anything for me anyways.

Me: “That’s great.  But she’s the patient, and she is fine.”

BBB: “I usually get something stronger.”

Me: (and this is society at its best)

I walk out of the room.  I find getting scolded by an entitled 18 year old somewhat irritating, especially over not prescribing Vicodin to her friend who has no pain.  I return a little later.

BBB (dramatic sigh): “Well, can I have something to drink?”

Me: “Sure, come with me.”

I took BBB out of her room, just across the hall is a water dispenser that  can be used by all.  I showed her how to use it and I handed her two cups.

BBB: “Wait, so you want ME to get the water?”

Me:  ”Yeah,” I said, and then walked away.

Now don’t get me wrong.  I’m not above getting water for my patients, especially if they are sick.  But, when you are a fully capable 18 year old, who isn’t a patient, somewhat arrogantly demanding Vicodin for your friend who has no pain, this gets a little irritating.  Needless to say, it was just another day in paradise.

Oh, that reminds me, she of course had a YOLO sticker or tattoo or wristband on.  ”YOLO” stands for “You Only Live Once.”  The thought behind this is that you should embrace life and live it to the fullest.  It essentially breaks down to carpe diem for really stupid people (thank you Jack Black).  Something like that.  

What YOLO actually turns out to mean is “Your Odorous Liquid Ooze.”  Which is their discharge after too many YOLO experiences.  You may only live once, but you can get Chlamydia lots and lots of times!

When first you taste the sweet fruit of insanity, you may never want an apple again.

I have taken care of quite a few people lately that have received penetrating trauma.  No, I am not referring to people who are experimenting after reading 50 shades of Gray.

It seems that with the heatwave in the midwest, the only activity that can really get people cooled off is shooting and stabbing one another.  They have been of various races, ages, and backgrounds (though all have been male).

Now, if you have ever worked in an ER, you know a few irrevocable facts.  By using these facts, you can prevent yourself from being shot or stabbed, or at least decrease the chance.  

1.  Never, EVER, mind your own business.

Now I know this sounds counter intuitive, but just ask any single person who just got shot or stabbed what happened.  They ALL answer the same thing.  Every single time they respond “I was minding my own business when I got shot!”  This is not a new story.  This is the same story.  Every single person who gets shot is minding their own business.

My suggestion is to really get into everyone else’s business.  Not a single person has said to me “I was up in someones face doing something I shouldn’t have been doing.”  So, get in people’s business.  What are those people over there doing?  GO FIND OUT, get in there.  As soon as you start minding your own business, you better look out.

2.  Look out for two dudes.  

These two dudes get around.  I am relatively sure they are shapeshifters of some kind, since not a single person is able to describe what they look like.  They have no color, they are guys though.  They have no ethnicity, they are just two dudes.  If you see two dudes, especially if you are minding your own business, get the hell out of there!

3.  Don’t do nuthin’.

This is a dangerous activity.  I’m sorry, but if you don’t do anything, somehow this attracts people with guns.  For some reason, as soon as you do nothing, people want to shoot you.  If you find yourself in a situation where you would describe it as “I wasn’t doing nuthin’” you are likely already in the cross hairs. 

4.  Never use your porch for anything ever.

This is simple but powerful advice.  Some people think dangerous things happen in the kitchen.  These people, of course, are idiots.  Most of my gunshot victims come in saying “I was on my porch minding my own business and two dudes shot me!”  Thus, just stay off the porch.  I’m pretty sure the two dudes patrol neighborhoods just looking for people on their porches.

5.  If you see any of the following, it’s time to move quickly