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.

birth control in the water anyone?

I discharged a patient this afternoon with a newly diagnosed feeding disorder. He has poor oral motor skills, gets most of his nutrition through his abdominal feeding tube, and can only eat pureed and soft foods like oatmeal and baby food by mouth.

I was warned ahead of time by social work that the mother is slightly "limited" so I sat down with her and spent a good 15-20 minutes explaining why her child had trouble chewing and going through lists of foods that would be good or bad for him. "His mouth works like a baby's mouth so he can only have very mushy foods like a baby would eat."

Mom seemed to get it. I sent our dietician and nurse practicioner to spend some more time, help her come up with a meal plan, and make sure she understood. I went to see another patient for a few minutes and then returned with the staff physician to complete the discharge.

"I hear you've been learning about the right kinds of foods for Chase to eat. What do you think you'll feed him when you get home?" Asked my staff.

Mom thought about it for a second. "Pizza."

::headdesk::

Sensing our mild disapproval she tried again, "Peanut butter and jelly sandwich?" . . . "Chicken?"

His discharge form now reads, in capital letters: CHASE MAY ONLY EAT PUDDING OR YOGURT. CHASE MAY NOT EAT ANY FOOD THAT IS NOT PUDDING OR YOGURT. NO PIZZA. NO CHICKEN. NO SANDWICHES. ONLY PUDDING OR YOGURT.

::Sigh:: Sometimes. . .

sounds valid to me

I got called down to a patient's room around 3pm. The nurse cornered me in the hallway. Mom was discharged hours ago but she's refusing to leave now.

I enter the room and am greeted by the healthiest looking three year old in the entire hospital. . . and mom.

"Hi mom. I've read through the chart and it looks like little Manhattan has been eating and drinking well for two days, hasn't had a fever in three days, has no new symptoms, and was cleared for discharge this morning. What's concerning you?"

"Well "doctor" (spoken in that way that makes it sound like there are quotes around it), I told the nurse and the doctors this morning that her poop smells different today than it ever has before. They seem to think it's okay to just send her home when something is clearly wrong with her poop. I mean, the doctors didn't even look at it!"

After an agonizing 35 minutes during which I, yes, examined the poop in question (it was poop)and offered mom multitudes of perfectly reasonable and not at all alarming explanations for poop changes (getting older, changes in diet, recent illness, new medications. . .) , well, little Manhattan ended up being readmitted for the night.

For smelly poop.

(Bonus points for taxpayers when the child picks up H1N1 during her extra overnight stay and ends up staying another week).

We all win.

Not quite clear on the whole "baby" concept yet?

Chief complaint of the day

"Good morning! Why did you bring your 4 day old in to be seen today?"

"Well, he sleeps all the time. Like even in the day. But then he wakes up in the night.
Oh. And he cries a lot."