I’m Feeling a Little Anxious

A rare thing happened in my ER last week when two major traumas were brought in after what appears to have been a drug deal gone bad. I was not working when they came in, but got involved two days later when the prime attacker came into the ER for “anxiety and trouble sleeping“.

J tells me when I walk into the room, “You probably heard about what happened earlier this week right?” I had certainly heard bits and pieces from some of the nurses but never got the whole story so I told him I wasn’t sure what he meant. So he gave me his version.

“Well, I was gettin together with some of my friends who were buyin some cocaine and other stuff from me when they started arguin with me and for no reason at all grabbed me and started poundin my head against the pavement. [perps always seem to be violent for no apparent reason at all don't they?] And then they pulled a shotgun and a knife on me. I tried to calm ‘em down but they were real angry [coke heads angry? nah, I don't believe you!] so I pulled out my knife and we scuffled and they ended up comin here to the ER and were flown out …”

What I knew had happened was that two people had come code three by two EMS units with “their intestines hanging out” from knife stab and cut wounds. They were stabilized rapidly and moved on via helicopter to the nearest trauma centers. The attacker, the one who was my patient presently, was unhurt and arrested. He had gone directly to jail but apparently was released on bail somehow so he could come and visit me. Police had searched his house and taken all of his drugs – an assortment of meth, cocaine, benzodiazepines, narcs and other drugs as well as weapons.  That left him in the precarious position of being unable to get high.

So I told him, “Sounds like you’re pretty skilled with a knife from what you’re saying.” He replied, Not really, it was all in self defense” [its always self defense isn't it?]. So he continues, “I just need something to help me sleep and to calm me down.”

I could understand. The guy was facing some serious jail time for attempted murder x 2, drug dealing, weapons charges and probably some other bad stuff – he couldn’t get high off of his supply and neither could his wife, who was apparently outside raising hell in the waiting room because she too was “anxious”.

And then his mom, who looked like she belonged in WWF, shows up. I guess you could say that he had some reasons to be anxious.

I didn’t buy into writing him any more drugs though and gave him a shot of Geodon to get him the hell away from our hospital. He may be anxious, but as they say, “you make the bed, you sleep in it.” I doubt he’ll be getting anything in jail to calm his nerves so might as well start getting use to it now right?

The Radiologist Examined a Patient!

Those of us in the medical field know the radiologists – the doctors who read xrays, CT’s, etc. – usually sit in their dark room all day and read films, often times with CYA statements at the end of their official report that say something like, “_____ cannot be excluded, and so a [another imaging study inserted here] would be recommended …”.  The type of person who typically goes into radiology is a person who doesn’t much like dealing with other people, and so they only “see” patients when, and if, they have to do a procedure, or if they pass them in the hall. It is rare that I even have the chance to discuss my clinical exam with a radiologist since they don’t usually seem to care about our seemingly worthless thoughts.

But in my hospital, I have the great honor (doesn’t always feel that way) of working with some of the smartest doctors in the world when they moonlight here away from their Ivory Tower. Their hospital is internationally recognized as one of the best medical centers in the world. Among this distinguished group are the radiologists that will moonlight here on weekends. I have to say that some of them have their nose so stuck up in the sky that we only look like ants to them, and that is how they speak to us. But something cool about medicine is that experience almost always trumps medical training. There are many nurses I would rather have treat me that some of doctors I have had the horror to meet.

So, last week I came into work and my first patient was a poor old woman who was run over accidentally by her husband with a farm tractor. I called to request a CT of the chest, concerned about flail chest and significant thoracic injury. The Ivory Tower radiologist balked at my request and stated with great annoyance (how dare I interrupt his computer game) that he would read it, but that he thought it was totally unnecessary. He felt a simple x-ray should provide adequate information. I responded by saying innocently that I was unaware that x-rays would show vessel damage since after all there are some big pipes running through the chest (aorta, IVC, subclavians and oh, that darned thing that keeps beating).

He made getting the CT a chore as well (some sort of punishment I suppose) by having the techs refuse to do it until I checked her kidney function. It was a trauma! Why should I wait for kidney function? But they insisted.

He humbly called me back an hour into this poor woman’s ER course to tell me, “Man, this lady’s really messed up!” I asked if that was his medical diagnosis.  The “official” report was that she had broken 10 ribs on one side, had a collapsed right lung, and bilateral lung bruising. Nah, we didn’t need that CT now did we? I resisted the urge to rub it in and focused on taking care of the patient instead.

But every now and again, we do get an exceptional resident from the Ivory Tower. This weekend, I have the true honor to work with one such radiologist. Professional and personable, so much so that I am almost convinced that he is not a radiologist by training. Maybe he’s like that guy from Catch Me If You Can? He doesn’t call us to give us reports, but comes in to see us in person on almost every case in order to discuss the case and provide his report. This not only makes him courteous, but way smarter than the other radiologists because getting the clinical backdrop is a very good way to not miss something important. When you understand in detail why the test was ordered , it helps you zoom in on the area of concern with a different perspective.

But then he did the unthinkable. Our stellar resident actually went and examined the patient! I don’t think that in all my years of medicine I have ever witnessed such an event. I thought radiologists had lost the art of examining patients by the time they finished their internship, but this guy proved us wrong. Kudos to you my friend and maybe you will be an inspiration for the others in your field to come back down to earth.

When Funerals Go Bad

While at work yesterday, I overheard the ambulance going out to a call at a graveyard. Now, I personally like to give everyone at least one round of ACLS no matter how long they were down prior to arrival, but I think you have to draw the line somewhere right? In the end though, it turned out to be nothing. It did remind me though of one bizarre funeral that I received some clients from once while working in the South.

Family members had gathered for the funeral of someone who had died young. While the eulogy was being given, one of the deceased man’s brothers couldn’t contain his grief any longer and tore open the casket, dragging his dead brother out in front of the whole family so he could hold him. Needless to say, people started fainting, screaming, crying and the rest were just frozen in horror at the macabre proceedings.

I received two people via ambulance from this funeral with complaints of anxiety and fainting. Nothing a little bit of Ativan and a lot of counseling couldn’t handle though. I never did get to meet the hulk who ripped open the casket though. And that is a very good thing.