Happy Halloween from karaoke zombies and teh Josh

So last night was my first trauma call.

Again, call began at 5pm where after finishing up notes and paperwork on all my patients, the resident and I attempted to get some "prophylactic sleep". Twas not to be, however.

The biggest concern of the night was a gentleman who had come in with a minor pneumothorax after being hit by a car. While intially we were not concerned, he continued to desaturate to the point where we wanted to put in a chest tube, to drain the blood in his chest and allow the collapsed lung to expand a bit, letting him breath easier. Now this man, who the rest of his stay with us and consistently been thanking us for all our help and being overall pleasant, was resisting the chest tube like nobody's business when we said it had to be done to save his life. LITERALLY. No metaphors, if this man did not have a chest tube in, he was going to code and probably die later in the evening.

Of course as soon as we started pushing him to sign the consent for the chest tube, the once friendly man busts out of nowhere with "i want to call my brother-he's a lawyer"

how quick people are to turn. So the first thing we did is gave him some pain medication and asked if he still wanted to call...he opted to not, and let us perform the procedure...which if you dont recall from my ER stories, is basically cutting a hole in the chest wall, prying it open (not with a finger this time-in surgery, it is a sterile procedure) and inserting a tube hooked up to a suctioning system. Blood got all over our shoes. Nerts. good thing i just wear sneakers to the hospital right now. Not counting the blood that drained out on the bed and our clothing, approximately half a liter (think half of one of those plastic coke bottles) of blood drained out of him. He began breathing easier initially

initially. Then he resumed desatting for some reason, and was eventually moved to the ICU and intubated. He is now in stable condition and off my service. Still..exciting stuff. Here was a man who absolutely would have died if not for our intervention. And for the record when we called his brother to notifiy him of the pts status, he emphatically supported and thanked us

As a brief aside, one of the anesthetics given to numb the patient for chest tube insertion was a benzodiazepine, which has the side effect of amnesia...meaning that you wont remember things that happened shortly before you were given the anesthetic, like threatening to sue, or being scared...convenient how that works out, isnt it? Dont worry he thanked us for saving his life when he woke up

Then I practiced my suturing technique on another gentleman in the SICU, who needed eyebrow lacerations closed. It was my first time ever suturing on the face, which was a little intimidating with the resident standing over my shoulder. I couldnt get my knots to tie correctly and had to redo them a couple times...which would have been a bigger concern if the patient was not in an induced coma Hey, we all gotta learn somewhere, right?

All in all a rather uneventful night-but with the need to constantly get up, its hardly restful.

1 week left of family then its on to surgery

Thoughts on family medicine coming soon

In less than 2 months, I will probably know what kind of doctor I want to be.

It's like they are reading my mind

And the award for best psych patient response ever...

Pt: I just do what the big man tells me to do
Dr. J: and who is that?
Pt: God
Dr J: so god talks to you?
Pt: I plead the fifth

Dr J: Do you ever see or hear things other people cant see or hear
Pt: Yeah-music, BACH MOTHERFUCKER

Dr J: And do you ever hear voices or see things?
Pt: I don't see ghosts, I aint no crazy
Dr J: and do you hear voices
Pt: yeah...yours you dumb motherfucker

All from the same psych patient

In other fun procedural news, I got to Put in an NG (naso-gastric) tube into an unconscious intubated patient. And shortly after got to take an ABG on him...and although it took me a couple tries to find blood, when i finally got it in the syringe it was arterial saturation 100% I am 3/3 on abg's yo!

Also had a patient who was not all there. I asked her how many times she had been pregnant. She begins silently counting on her fingers until all ten have been ticked off-At which point she responds-six times. I follow up with and how many children do you have? Seven.

Took me a moment as well...one pregnancy was twins

Finally, I had to reference future dr julie's progress notes, one of the med blogs i follow, for this excellent summary of the third year experience

"being a third year med student is kind of like having erectile
dysfunction: you're perfectly aware of your surroundings, and you
really want to do something... but you just... can't. Everything that
happens around you is because the MD's
with their mighty pens can sign order forms, and even if you do all the
work ahead of time (writing orders, verifying doses), when the moment
matters, your pen is just not pen they want"

I have focused quite a lot on the psych and poop stories lately, or as I like to call them, "Odds and Ends". Lets digress for a moment, shall we?

Saw a case of priapism today. For those of you unfamiliar with the term, it is basically a persistent erection due to blood engorgement, often caused by a sickle cell crisis. Now for those of you guys who are thinking it would be great to have a persistent erection, ponder the fact that persistent can mean anywhere from 4-5 hours to a couple days, and the entire time you are in pain and an awkward position. The treatment? Terbutaline first, a vasoconstrictor to help get the blood out of the penis. Failing that, puncture and drainage of the blood. Yes, a needle is put into the penis and the blood is forcibly leaked out, just like draining an abscess. Doesnt sound so great anymore does it?

Also had a fun "scrubs moment" today during suturing on the trauma side. Due to the angle of the cut, I was suturing the patient with my left hand, as opposed to my right, which is what I normally use (despite the fact that I am indeed a southpaw).

Pt: Why you got such a big grin on your face doc?
Dr. J: Because I know something you do not know
Pt: Oh yeah? and what's that?
Dr. J: I am not right handed

Haha, no actually all i said was, because I enjoy doing this-but 2 points to all of you who caught the movie reference and how i mentally dressed myself

Psych patients are probably the source of most of the interesting stories in the ER. The other day i was talking to a gentleman who seemed perfectly normal in every way. I asked him why he was there, he said he didnt know, there was nothing wrong with him medically, we had a very nice conversation. So finally,

Dr. J: Well who brought you in?
Pt: Oh, the police
Dr. J: and why was that? were you and the police having an argument?
Pt: Oh goodness no
Dr J: So how did they come to bring you to the hospital?
Pt: Well I just walked in and told them I was a time traveler and for some reason they brought me here...weird huh?

At this point the little lightbulb began to dawn...ohhh, THERE'S the crazy. mmkay. Turned out the patient had just gotten back from a trip to saturn and was checking to make sure none of his belongings had been stolen while he was gone. He then went on to tell me he had been killed 9 times. I confirmed-he had been shot nine times? No, KILLED. luckily his friend had a re-animator and was able to bring him back. Later on my attending went in and the patient asked what the plan was in a perfectly normal tone of voice. When the doctor told him he needed to just hang out for a little bit while they ran some tests, the pt bum-rushed the doctor becoming suddenly aggressive and tried to make a break for the door, shouting about how he had to keep an appt on Mars and no one was going to stop him. Scary stuff, and I am glad i did not go back in.

The other psych patient was much more mellow. She was convinced she was hearing voices from god, and that she was mary and had to kill herself to bring back moses.

What I am wondering is why are all the crazies convinced they have a direct line to God? It's ALWAYS the judeo-christian pantheon. No one ever seems to want to talk to Allah, or Buddha, or Zeus, or Odin. I mean, cmon guys, the major deities have backlogs out to the end of time...pray to or converse with your favorite minor heavenly figure...you more likely to get a response.

But I digress. The two observation psych rooms both have microphones installed in them, so when patients get too agitated, they can be told from outside the room to calm down. That began to happen in this case, so one of the nurses simply told the woman when she started getting worked up, to relax and wait for the doctor. Of course since no one was in the room, she asked who the voice was, and when the nurse responded, God, the woman settled right down.

Pt: Oh, okay then. you just tell them to hurry up, i be having things to do.

classic.

One other fun fact I learned is that a lot of ED's are all macgyver when it comes to medical treatment based on what is available. One of the doctors pimped me with a hypothetical patient who was having a severe asthma attack, out of meds, and unable to make it to the hospital in a timely fashion due to inclement weather, or transportation issues, or simply can not afford it due to no insurance or some other such reason. WHAT DO YOU DO HOTSHOT?

A: You tell them to drink as much coffee as possible. One uncommonly used treatment for asthma exacerbations is theophylline, a chemical found in caffeine that can help to relieve asthma at least a little, though it is present in only trace amounts in coffee, so the more that can be consumed, the better. And that concludes today's lesson in jungle medicine, because sometimes, not everything can be solved with pills

And on a follow up from yesterday's post, my buddy nakochan found this lovely rant that explains how the two of us both feel about the phrase "babydaddy" as well as other urban lingo. Please watch for edification and entertainment