Weird night.

On call last night I got not one, but four, unrelated calls from four different wards on four different patients with four entirely unique medical problems. Every single one of these gentlemen was experiencing. . .

A bleeding penis.

And of course each of the four different nurses prefaced their call with "Hey, doctor, you probably want to come take a look at this."

(For the records, whenever a call starts that way, it will almost indefinitely lead to something I really really don't, thanks for asking, want to take a look at).

Now they each turned out to have four different and perfectly valid excuses for having blood in their urine.

But still. Really weird.

And awkward for me when I received repeat calls that evening:

"Hey doc, it's me the nurse with the patient with the bleeding penis. . ."

Me: "I'm sorry. . . can you describe which bleeding penis you're with?"

Guess the medical condition

Middle age lay-d presents to the ED with the chief complaint: "I couldn't find the tv remote."

See if you can guess what actual medical-condition-mixed-with-a-dash-of-human-folly precipitated this emergency-department-at-one-am worthy disaster.

. . . .

. . . .

. . . .

I'll tell ya.

So lay-d has multiple medical problems including diabetes, heart failure, high blood pressure, previous heart attack etc. She was sitting on the couch a few weeks ago watching her stories when a television ad came on: "You may be able to control your diabetes with diet alone," proclaimed the ad.

Excited, the woman heaved herself off the couch, gleefully discarded her 12 daily medications and made herself lunch. "I eat a diet!" She thought. "That should control my diabetes." (And heart failure and blood pressure and coronary artery disease too? Well, why not).

As the weeks progressed, she started to notice her legs swelling. Then she became short of breath, developed a cough, her arms swelled up, her chest started hurting. . .

None of this concerned her too much, life went on. Until. . . the evening of admission. Lay-d woke up from her afternoon nap and her eyes were swollen shut.

She groped around for the tv remote. Unable to find it, in a (hehe) blind panic, she yelled for her neighbor to call an ambulance. Not to transport to the hospital, oh no, to "fix my eyes so I can find the g-d tv remote".

Wisely, EMS realized that her "diet" of whatever foods she feels like eating is not exactly the kind of diet that will cure diabetes, coronary artery disease, and congestive heart failure, and they brought her in to our ED. . . in florid heart failure with a blood glucose >400.

Once in a while, I'm proud I don't own a tv.

Phone call of the day

We're an underfunded, understaffed community hospital, so I've gotten quite used to labs not being drawn, medications being given hours to days after they were initially ordered, charts getting lost. (It's a running "joke" here that orders should really be called gentle suggestions).

Anyway . . . mix ups, omissions, oversights, I pretty much count on them.

But this morning's error of commission caught even me off guard (and this is word for word):

"Good morning Dr. S, it's Nurse Jack on 4E. Your patient in room 63 was having some pain this morning and I know she's written for tylenol but I accidentally put in an IV and gave her 2mg of IV morphine."

::confused silence::

"Can you write an order for IV placement and the morphine for me?"

I actually did write the order after checking on the patient, though I had to file an incident report as well. At least I can relax a little, now that IV morphine has been written for, I can be relatively assured that my patient will never get it again. :-)

Welcome to the Community Hospital

New intern, day 1, patient 1:

Hey S, can you help me out with one of my patients? He's already been cleared by psych twice and they're refusing to come see him again, but every time I go near him he hides under the bed and starts screaming that I'm killing him with my word bullets to his brain.

Yes please

Do wake me up at 2am 5 minutes into the only 17 minutes of sleep I'll get with the following phone call:

"Hi Dr.! It's that nursing student! Remember? You ordered some labs for me to draw a few hours ago? Well, I just drew the tube for her CBC (blood count, looking for anemia) and her blood looks so dark and thick, I don't think she could have anemia! Her blood just looks so good. Do you still want me to send it to the lab?"

Now as much as I want to believe that my nursing students are magical and can actually perform a complete blood count just by looking, I decided to yes, still send it to the lab just in case. The patient's hemoglobin level turned out to be just above the level you'd expect from an average cucumber, or starving vampire. She's receiving her second blood transfusion now.

I love the nursing staff her, and the students, and it was actually really cute. Just would have been cuter at 2 pm.

What goes around

Comes back around.

One of my patients got pissy a few days ago and decided to walk out of the hospital before discharge was complete barefoot, in his hospital gown, with his central line in place (like a giant IV that goes into a vein below his collarbone and is sewn into his skin).

Security couldn't find him and he was technically no longer a patient, his paperwork had gone through, so we just let it go and figured he'd come back for his clothes at some point.

He wandered back in around 9pm last night with the chief complaint "take this IV out of my nipple."

Turns out his plan had been to cover the line with tin foil and just leave it in forever. But he got really drunk on Sunday and his buddies were making fun of the line and pulling on it and he lost the piece of tinfoil and it was starting to hurt a little so he decided it was time to drop by and visit us.

Oh, and by the way, can he have his clothes back and a free ten day supply of his pain meds?

:-) Gotta love a community hospital.

Most PG-13 justification for prophylactic antibiotics . . .ever

We consulted on a 20something patient with multiple psychiatric problems (admitted for inserting multiple household implements into her intestines through every imaginable route. Yes, including her belly button. I know, gross.)

Anyway, we went to see her, she was doing fine. We went over her home medications: 5 psychiatric drugs and . . .an antibiotic.

How long had she been on the antibiotic?

About a year.

Why?

Why indeed.

So it turns out that about a year and a half ago one of her doctors came up with a novel suggestion for stress relief involving a certain plastic vibrating male body part (actually a sage and semi-safe alternative for someone with an uncontrollable proclivity for inserting objects into assorted orifices). Well, her hygiene, shockingly, was not setting any world records, her mechanical "assistant" was likely not being wiped down on a regular basis, and she quickly developed recurrent infections.

Instead of, I don't know, patient education on proper vibrator hygiene, the doctor opted to put her on lifelong prophylactic antibiotics.

:-) Whatever works.