I'm on a child abuse elective and have been spending a few days a week observing trials in court.  I spend a majority of the time trying to contain my "squeeee!"s when they say "objection" or "order."  (That really happens!)

I also never realized how challenging it must be to be a state-appointed defense attorney when your client is clearly guilty.

And guilty of, like, sexually assaulting babies.  Oh yes, really. 

The DA yesterday looked visibly pained whenever the prosecutor didn't land a point or stumbled on her words and actually winked at her as she declined to cross-examine yet another prosecution witness. 

It's definitely better than an attorney being happy to defend a child molester, but a strange dynamic I hadn't thought about deeply before. 

I suppose it must feel a little bit like writing an order for morphine when you really don't think your patient is in pain.  

Almost there

I'm in the delivery suite getting ready for a premie who we're expecting to have some breathing difficulties.  The baby is crowning and the respiratory therapist still isn't in the room so I send her a page.

A few minutes later, she bursts into the room, out of breath, and. . . without any of the needed respiratory supplies.

Me:  Hi, respiratory therapist, I'm glad you're here.  You wouldn't, by chance, have any . . . respiratory equipment?

Respiratory therapist:  ::still panting::  You paged me STAT so I figured I shouldn't stop for the airway cart.


Oh boy.

Nonchalance of the year award

Note a 2 year old's mom received from daycare today:

Morning activity:  Today we learned proper handwashing.  Practiced using soap from a pump!
12:00 - 1:00: lunchtime, ate well.
1:00 - 2:10: naptime
2:10 - 2:40:  Shaking all over.  Seizure?
2:40 - 3:00:  Great participation in circle time!

Anyone looking for a new daycare?

Overheard in the ED

MD (to custodian carrying heavy-duty pliers): What do you think those are used for more often, cutting locks off lockers, or removing objects from genitalia?

Custodian: Eh, about 50/50

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. :-)