Ah, irrational hatred in the morning

Me (having a relatively skinny day, I think): Good morning!

Patient who instantly hates me for no clear reason: ::suspicious glare:: You pregnant?

Me: No, awkward ha ha, I just had a baby 7 weeks ago.

Full-of-hate: But you still got a bump like you pregnant.

Me: Okay. ::pointedly polite smile:: How can I help you today?

::Patient's friend enters the room:

FOH to friend: "This doctor isn't pregnant even though she got a tummy like she is."

Awesome.

It's all a matter of perspective

7:15am, first visit of the day at the peds urgent visit center. 17 year old male with no known medical problems.

Me: Hi! I'm Dr. Scopes. What brings you in today?

Him: So. . . ::dramatic sigh:: I'm trying to get it on with my lady last night and, I couldn't get it up for long enough.

Me: . . . . . Um. ::blink blink:: . . . . .

Him: Like she's hot and everything and it's all cool, but then when we go to do it, it just doesn't work any more.

Me: Well, we'll definitely try to help you out, but you know, this is the urgent visit center, it's really for people who are sick. You should probably talk to your regular doctor about this.

Him: Ma'am. It's an emergency to me.

Spelling 101

True baby name:

Lyllylla (I attempted to pronounce this as written and mom stared at me like I was a
block of cement. "It's Li-la." ::what's-wrong-with-you-glare::)

Bruklon (Mom: we just love New York.)

Teon and Tion (Twins! Pronunciation? Exactly the same.)

Sir Prince William (What do I even say when I enter the room? I said "William?" ::withering death stare from dad:: "It's Sir Prince. William's his middle name." My bad.)

Babyboy (A 32 year old. Legal name.)

Shocking

Scopes MD: So ma'am (stretching the term a bit), what makes your rectal pain worse?

Patient: When I wear a thong.

Neat-o

We are using maggot therapy on one of our patients with a terrible pressure ulcer.

It's endlessly delightful to pretend to be ultra-scientific about dumping a bunch of creepy-crawlies into sores. We use 4-5 maggots per square inch of wound. The dead tissue can usually be removed by 1-3 "applications."

The good news is it works, fantastically. Our patient loves it, says it's not uncomfortable at all.

It's working so well for him, in fact, that I got to spend a good part of my day was filling out forms to try to get Medicare to cover home maggot therapy.

We'll see if it goes through.

overseen in a chart

"Psychiatry was consulted, state that patient is not acutely suicidal or a threat to himself or others. Patient continues to state that he will jump off a bridge if discharged from the hospital."

Hmm

Unclear on the concept part 10,000

I see a patient at 3:17 am. She's been sitting in the waiting room less than 23 minutes, which is the equivalent of a minor miracle in an urban emergency department on a Saturday night.

"Wow. Took you long enough. I got a situation here."

I ignore this.

"An urgent situation. My boyfriend's wife (managing to make this word sound like a weird necrotizing fungal infection) is claiming that I gave him trichomonomas (I'm guessing she means trichomonas?). I need you to test me for it. But I can't wait for the results, I got to get to work, so when you get them just call her and him and tell them that I'm clean. And hurry up please."

Sometimes the trouble with the emergency department is that the patients are allowed to come up with their own definition of emergency.

(She was clean, surprisingly. No I did not call the boyfriend. Or his wife. Patient confidentiality, I respect it.)

Another one . . .

. . for the list of things I didn't realize I needed to be worried about.

Called to one of our shock rooms for a woman in profound shock due to vaginal bleeding.

We started fluids, ordered blood, called Ob-gyn and then asked her how long the bleeding had been going on.

-1 hour.

Have you ever had bleeding before?

-Never.

What were you doing when it started?

-Sex.

Any foreign objects. Toys?

-Just normal sex.

So we stuck in a speculum to take a look.

She had a 3 cm laceration through the wall of her vagina.

Yes. Her boyfriend . . . popped her vagina.

She ended up going straight to the OR.

The even scarier part?

When I went to find the staff physician to let him know about the patient, he wasn't at all shocked. "Oh yeah," he said, "we saw the same thing two weeks ago."

This happens???

Oh no!

You know it's a Saturday night when not one, but three, of your patients are arrested while under your care in the emergency department.

For the record: screaming "fuck the cops!" while displaying your kill the police tattoo as you walk by the, well, cops, sitting at the security desk, intentionally peeing on your nurse (twice), and trying to hump an ultrasound machine, all poor ways to pass the time while you're waiting for your doctor.

Well there goes that

I spent a good hour and a half throwing two layers of stitches into the head of a borderline white supremacist ("I don't think I hate black people or Jews, I just don't really know any or want to"). I passed the time by trying my best to make neutral conversation with his "third and final baby-mama," as he introduced her to me.

This snipped of conversation pretty much changed the destiny of my unborn child.

Baby-mama 3: What are you thinking of naming your baby?

Me, reluctantly: common boy name

BM3: No!! No way!!! That's what my first baby-daddy is named and he always locked up. He been locked up like 3 times in the past year. Don't choose that name.

Yup, back to babynames.com I go.

Emergency! of the day

"I had a blood test a few months ago that was abnormal and they told me I need to get it checked again. I called my doctor and he can't get me in until April so I came to the Emergency! department to get it checked today. Oh, and I'm in a hurry today, I can't wait for the results. Can you just call me when they come back?"

Someone was born under a lucky star

We had a young electrical worker in the department a few days ago who was shocked across the chest with over 7,000 volts of electricity while working up in a bucket on some power lines.

He came in sitting up in the stretcher, talking, making jokes. His chief complaint was "it feels like my insides are being microwaved." Being very detail-oriented, he later adjusted this to "it feels like I ate a huge bowl of spicy chilli" (admitting that he'd never had his insides microwaved so couldn't be entirely sure that was accurate).

He ended up having no complications other than some skin burns, but we all kept nervously walking by his room waiting for his heart to stop or his spleen to explode or something.

Lucky, lucky, lucky man.

The cell phone in his breast pocket was still working too.

His shirt was singed to pieces.

Amazing

49 year old gentlewoman presented around 3am this morning with the following symptoms:

-runny nose

-scratchy throat

-dry cough

Duration? 3-4 days

Sick contacts? Husband and kids with similar symptoms

Fever? Nausea? Stomach pain? Headaches? Any other complaints? Negative times five.

"Doctor, I've been to Other-Emergency-Department three times in the past three days and they told me there's nothing wrong and nothing I can do. I've just got to know what's wrong with me! What could this possibly be? I won't leave until I have an answer and something to make it go away!"

49 years of life and three kids and apparently she has never experienced the common cold before.

This may just be a true medical miracle.

Outcome? Luckily she was duly impressed by the diagnosis "viral upper respiratory tract infection" and some saline nose drops.

I'm not sure if I find this more incredible or the 29 year old who came in a few weeks ago with a chief complaint of "vaginal bleeding" one day before her period was due (it can't be my period, something else must be bleeding in me, my period isn't due until tomorrow).

Be afraid

More things that happened to innocent people who were "just minding their own business" last night:

1. Sucker punched in the face with brass knuckles

2. Knocked down and kicked repeatedly by four men

3. "Arm started swelling up out of nowhere" (yes ma'am, that may due to the heroin needle that has somehow broken off and embedded itself in the soft tissue of your forearm while you were distracted by minding your own business)

I'm sorry sir. . .

I seem to have forgotten my x-ray vision at home.

Me: Good morning Mr. Belligerent-Intoxicated-Patient, how can I help you today?

BIP (accompanied by a glare that nearly melted the lenses off my glasses): Are you even a real doctor?!? Or are you one of those student doctors?

Me (ta-da!): I am your real doctor.

BIP: Then you should be able to tell what's wrong with me!

End of interview.

It's better than TLC in here

Today we had surprise babies x 2!

Mom number one discovered she was pregnant, with a full-term baby, when her water broke during 5th period math. I give this one leeway because it was her first pregnancy and she was essentially going through puberty and could have mistaken the signs. And mad props to her for realizing that this wasn't a normal occurance and making it to the school nurse before the baby actually came out (which happened in the hallway on the way into the ER).

Mom number two (a mother of 4) discovered she was pregnant. . . again. . . when she felt the urge to go to the bathroom, did so, stood up, and there was a baby in the toilet.

As a 6 month pregnant woman myself, who feels as though her uterus is literally going to explode at any moment, that is if the child doesn't kick through my rib cage first, I find this phenomenon remarkably difficult to comprehend.

Comforting though that apparently delivering a baby is indistinguishable from mild constipation. :-)

The dark lining to the white cloud

There's a phenomenon among residents in which some have the most extreme bad luck every time they're on call (3 codes, a fire drill, the two other on-call residents come down with appendicitis, an actual fire, and 17 new admissions between 3 and 6am) while others blissfully watch The Bachelor in the lounge, check on a patient or two, grab some midnight McDonald's soft serve, and then retire to their cozy call room for up to 4 hours of sleep in a row.

The former residents are known as black clouds; The latter, white clouds.

This effect is so pronounced that there have been multiple studies attempting to document it. So far none of these studies have been able to conclusively prove that this occurs.

Oh, but it does. It really does.

I have the great fortune of being a tremendous white cloud. The force of my luck is strong enough to counter even some of our more infamous thunderheads, and it's not unusual for me to spend up to 3 hours at a time lying down while on call.

I almost never get paged or called for anything important. In fact, my past three calls, I was only woken only 4 times/night for normal deliveries and was back in bed within half an hour. Last night, I was miraculously uninterrupted from 10pm to 4am, practically a full night's sleep. Despite this being normal for me, I still have a constant bat-sense alarm going off in my head every 40 minutes or so telling me that clearly something is tragically wrong with my pager, my cellphone, the overhead paging system, and the call-room phone, that all my patients are crashing right now and everyone is trying to reach me, and here I am, asleep, and tragically unaware.

So, every hour, on the hour, I find myself waking up, checking the phone, checking my pager, removing and replacing the battery in my pager, paging myself just to make sure, and more often than not, wandering over to the nursery just to make sure I didn't miss anything.

This has now spilled over to my home life as I still find myself waking up every hour or so convinced that I've slept through some catastrophe of epic importance.

[This is extra funny since, as the intern, I'm about the last person you actually want to show up at the bedside if your patient is having an actual medical event. My typical response to being paged : "Sure I'll come look at the baby, but you should probably call a real doctor too."]

I suppose I'll choose to view this sleep disorder as good practice for the rapidly impending motherhood sneaking up on me early June.

And I will enjoy enjoy enjoy my white cloud as long as it lasts. We'll see if it can handle adult cardiology next month.

my hero

OB report of the day:

"Mother, feeling the urge to go to the bathroom, accidentally delivered twin A at home. Upon arriving to the hospital, twin B was found to be in breech position. As mother was being prepped for c-section she sneezed, delivering the second baby."

These were full-sized babies too.

Awesome.

The babies are coming . . .

Yup, I'm on newborn wards now.

Our staff physician, Dr. Z, is notorious for her anti-bra, anti-hospital-childbirth, anti-baby-shampoo ways. She preaches skin-to-skin contact between mother and baby 20+ hours a day for the first 6 months and rumors abound that she breast-fed her own children until the age of either 4 or 9, depending on who's recounting the legend.

If she asks a question about what's wrong with a baby, 9 times out of 10 the answer she's looking for is that we broke it. All you have to say is "well, the mom opted for an epidural and is bottle feeding, that could explain the baby's [birthmark/heart murmur/poor feeding/rash/dysmorphic features/lack of limbs/etc.]" and she may jump up and hug you.

She's fond of picking up a newborn, holding it at arms length, sniffing, and with a just-stepped-in-dog-poo expression declaring: "this one is obviously bottle fed."

As my senior resident was leaving for the day prior to my first overnight call, I stopped him in the hallway. "Should I call Dr. Z overnight if there's a problem with any of the newborns?"

He considered for a moment. "No, about the only reason you'd call her is if you're thirsty for some breast milk."

overheard in peds clinic

And oh I wish I was making this up.

Resident: Has your [9 month old] baby started eating solid foods yet?

Dad: Well, yes. Mostly we feed him skittles.

::long pause::

Resident: I'm not sure that we would recommend skittles for a nine month old. They're a choking hazard.

Dad: No, it's okay. I chew them up for him first.

Obviously

Dood presents with a minor skin infection.

Me: Doo doo doo doo. Okay, any other medical problems?

Him: Nope.

Me: You're a generally healthy guy aside from this infection.

Him: Yup.

::Hours and hours later::

Him: Is my blood count normal?

Me: Yes, totally normal.

Him: Oh good, cause I have HIV so I was curious.

Me: ::pause:: You're HIV positive? Any other medical problems I should know about?

Him: Oh, you didn't know? I thought you all could tell that stuff.

(Oops, I appear to have forgotten my physician-x-ray-vision glasses at home).

WHYYY?

Pleasant 3o-something dude in room 12, chief complaint of rectal bleeding and pain since 2am.

Me: Did you insert anything in your bottom?

Him: Ew, no.

Me: Have you had anal intercourse recently.

Him: Not recently

Me: Did you do anything unusual last night that might have irritated the skin down there?

Him: Not really no.

Me: Well, what were you doing when the pain started?

Him: I was doing a douche.

Me: Like an enema?

Him: Yeah, with peroxide.

Mmhm. Child gave himself an enema with hydrogen peroxide (note in above dialogue that he does not consider this unusual behavior).

He never really gave me any reasoning behind this decision.

The irritation was so extensive that we ended up admitting him for observation.

Moral of the story, don't do that.

Priorities

A young woman came in on New Year's Eve with medium-sized pieces of a beer bottle embedded in her neck and back.

I quickly assessed that she was relatively stable, though bleeding, ordered a few images, and asked her what was bothering her.

"My neck hurts a little cause there's glass in it or something. And I have these bumps in my butt crack. They're itchy. It's probably herpes from my a**hole husband. Can you look at those?"

----------------------------------------------

Hours later, after consulting ENT, trauma surgery, and the CT scanner to very thoroughly confirm that the glass hadn't nicked any minor structures like the carotid artery or the spinal cord, I sewed her up (23 stitches), bandaged her, provided a life-saving tetanus shot, then helped her find a battered women's shelter to stay in, set her up with social work to work on getting a restraining order against her husband, and finally got her discharge stuff ready.

I turned to leave.

"Doctor. What about them bumps I got?"

(I'm so sorry, ma'am, I was every so slightly distracted by your gaping neck wound and trying to safely sneak you out of the hospital with your abusive husband literally in the room across the hall).

Well, I did take a look.

Discharge diagnoses?

1. 4 cm zone II neck laceration

2. 7 cm back laceration

3. Anal Herpes

Overheard in the peds ER

Doc: We can give you one shot now, or we can give you pills to take for a week. Which would you like?

9 year old: Pills!

Grandpa of the 9 year old: What are you, a marshmallow? Take the shot and take it like a man.

9 year old: I'll take the shot.