Some People Have Nine Lives Too

July 12, 2009
Medical Cynicism 101

Medical Cynicism 101

I remember someone giving me a book to read called The House of God when I was in medical school. I imagine that a lot of you have read this book as well. I thought that it would have been a better book had it not digressed so much into sex and I never really finished it for that reason. Looking back now at the some of the book’s ideas, especially that of the GOMER, a lot of it really rings true.

There are certain people that come to the ER that seem to command little to no empathy from all ER staff. They go by different names but they seem to make their way to all ER’s irregardless. They just don’t die, no matter what they – or someone else – does to them. They survive such extreme conditions that would kill even the most hardened average person a long time ago. And they just keep on ticking away.

I saw one such person in the ER this weekend. A staffer at the ED told me that he knew him well as he used to see him regularly when he owned a liquor store. The guy apparently had 6 kids with 6 different women (another f#^&er setting up franchises I noted), and was clearly proud of it when I asked him. This time, he was driving his motorcycle at about 100 MPH down the highway, weaving in and out of traffic, until he lost control. His bike slammed into the median strip ditch at this insane speed and he went flying into a field where he landed on his back. Of course, he wasn’t wearing a helmet. Would you or I have survived an accident like this? No. We would have died when the bike hit the ditch or even before that maybe. Did it kill him though? Not even close. He ended up with a broken collar-bone and first rib. He went home after a short observation period in the hospital.

Or not so long ago, when I saw a raging @$$hole in the ER demanding that I give him a prescription for ritalin. I had already looked into this guy’s long list of abuse (cocaine, meth, alcohol, narcotics, benzos, etc.) as well as the previous notes describing his charmingly prickish personality and habit of physically attacking those who disagree with him.  So, I explained to him as politely as I could (while maintaining a safe distance) that this was not something that we ever did and that he needed to speak to his doctor if he felt he should be on it. He threatened me and used enough profanity to make someone from the Sopranos blush, and then left the ER.

He was so angry at so many people that he decided that enough was enough and he was going to die. He took an overdose of someone else’s Vicodin and Xanax and locked himself in his room at the house he was staying at.

An hour later, one of his house mates came to check on him because he was “unusually quiet”.  No answer and so he broke down the door only to find his “friend” lying facedown on the floor with two empty pill bottles near-by. He tried to wake him up and then called EMS. They arrived within 5 minutes – 5 minutes where no one was doing any CPR on this 37 year old man. He had to have been dead for at least 30 minutes before EMS even layed hands on him. They worked him for 15 minutes with nothing and brought him back to me.

In the ER, we worked him for another 20 minutes and just before I called time of death, wouldn’t you know it – his heart started beating again. I really don’t know what happened to him eventually, but how could a man who has been totally dead for at least 30 solid minutes to one hour get anything back is beyond me.

If it was some kid who had drowned in a pool and was given CPR by mom and then brought to us he would have been dead of course. Its the people that seem to be the most vile that survive. The ones that you hope make it are never the ones that do make it. Their stories are tragic. As for these people, I honestly believe that they are anaerobes like bacteria.

They seem to actually thrive when they don’t have oxygen or other elements essential to life for the rest of us. They fall off a building and the next day they are walking out of the hospital after they have drained the life out of everyone they have come into contact with – which may in fact be their secret. Maybe there is some truth to Vampires after all?

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Hookin’ Up at Work (How to Get Fired)

June 20, 2009

office romance

I know I haven’t been updating the site recently, and I’m very sorry for that. I have a growing list of posts in my head, but I have been working too hard to get them down. Usually I don’t like to work this much, but I have had to pull several extra shifts because one of our docs got fired. Docs don’t get fired too much these days due to the whole supply-demand thing, but every now and again, some idiot takes it too far and becomes a statistic. This is his story.

Dr. Dumass, as I would like to call him, had a good thing going. Cush hospital, good position, great co-workers, and even a nice office. But apparently for Dr. Dumass, the nursing staff was a little too nice for him. Dr. Dumass was actually working on marriage #4 (I am not making this up) when he met Nurse S. Not only was this his fourth wife, but he had a litter of kids spread out all over the country from the last three. To quote Brad Pitt from Fight Club, “F$%#@* was setting up franchises“.

Nurse S was cute, pretty and they hit it off as friends from the start. She was having problems in her marriage and enjoyed talking to Dumass about her marital conflicts. He in turn would share with her his own marital problems with wives 1-4. They got closer and closer. 

Finally Dumass made a great suggestion, “Why not get divorced from our current spouses and get married to each other!”  I can only imagine that Nurse S was married to a drug addicted, alcoholic bridge troll with anger management issues, because I am not sure what exactly would be the attraction to a guy who has already blown through 4 wives and 10+ kids? Maybe she thought that she would be “the one“. Silly wabbit.

Things were moving along smoothly for our confused couple and they could hardly stay away from each other while at work. Either our darling little nurse would be in the docs documentation area or Dumass would be out at her nursing station whispering sweet nothings into her stethoscope. Just some advice for any of you readers involved in a similar relationship – you may think that no one notices, but in reality, everybody notices. Even the blind frequent flier behind curtain #2 knows about it because he overhears the gossip.

Before long, Dumass had already filed divorce papers and was waiting for wife #5 to-be to do the same, but that’s when trouble in ER paradise started. Nurse S comes in to work one morning and tells Dumass the hard news – she was having second thoughts. Suddenly, Dumass starts to have chest pain – you know the kind you get when you really want someone to feel sorry for you and give you that big hug you want so much and tell you everything’s going to be alright. But instead of calling in a replacement, Dumass decides to work himself up.

He goes and gets an EKG and Troponin heart enzyme done on himself. “Hmmm, looks like there might be some changes on this here EKG“, he says to himself. So he calls up the trusty cardiologist who tells him that he should get a stat echo. The echo ends up showing some wall abnormalities and is not conclusive (imagine that?). So the cardiologist tells him to high-tail it over to the cath lab. That’s when the proverbial crapola hits the fan.

Dumass tells Nurse S that he needs to get cathed … that indeed this might be their last moments together. The sappy soap opera romance is too much for her and she tells the charge nurse that she needs to clock out and take her dying beloved Dumass to the cath lab. There is no ER doc now and the chief of staff – a pathologist (autopsy doctor) – is called in to cover the ER. Must have been interesting for him to have his patients actually talk back to him.

At the end of it all, Dumass’s heart was perfectly fine – no blockages of any concern whatsoever. But folks over at admin weren’t exactly ready to throw the welcome back party for him. Instead they fired him for his Dumass behavior. He had taken this too far, and he put patient lives at risk. I actually thought he deserved an award for entertaining the hell out of the rest of us in the ER though, but decided I would keep that idea out of the suggestion box for now.

What lesson can we take from this story? I will quote a wonderful colleague of mine who once told me, “A doctor can be totally incompetent, but as long as patients like him, he will remain employed. But the moment he has sex with the wrong person or comes to work drunk or stoned, he’ll be fired in a heart-beat.” I guess Dr. Dumass can testify to this one.

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I’m Feeling a Little Anxious

May 31, 2009

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?

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Death and ATV’s

May 24, 2009

Sorry for the recent absence, but I’m back now. And what better way to get back into gear after being on vacation than to work Memorial Day Weekend! I should have my head examined.

ATV – All Terrain Vehicles, or as I like to call them, four-wheeled death machines. I hate ATV’s and wish they would be banned. I have seen too many tragic consequences from them and think the risk-fun ratio is just way too high. I like to have fun as much as the next person, but when people start dying, we need to take a time out and reassess. My first bad patient experience was my first year out of residency when the respiratory therapist that i work with brought her son in DOA (Dead on Arrival) after he was riding behind his brother who hit a tree. Unfortunately no helmets were worn. This weekend though brought on more sadness.

23 year old woman, drunk, riding an ATV at night runs into a barbed wire line at speed. The wire cut into her belly, removed the right kidney from its blood supply (a big hose), lacerated her liver and spleen and cut some intestine. She went immediately to surgery and bled to death on the table.

30 year old woman, majorly drunk, riding an ATV in daylight and rolls it in a field. She suffers multiple spine fractures, lacerated spleen and liver as well and dislocates her hip. Ouch! She survives surgery, but quality of life after this accident will be questionable. She will have pain everyday for the rest of her life I imagine.

Please, if you read this post and either ride an ATV or know someone that does, make sure they always wear a helmet and that they don’t drive after even one drink. If you can send the whole thing to a junk heap to be crushed that would be even better. You can have fun in far safer ways. Have a safe weekend please.

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Daddy It Hurts: A Poem About Child Abuse

May 14, 2009

One of the most difficult aspects of working the Emergency Room is seeing abuse. We see domestic violence (spouse beating), rape and the most difficult of all, child abuse. Someone sent me this poem that I wanted to share with you – and even though you have may have seen it before, I encourage you to read it again. Child abuse is one of those things which is 100% preventable. Maybe you might know someone that you could help and maybe this might encourage you to do something about it.

———————————————————————

My name is Chris

I am three,

My eyes are swollen

I cannot see,

I must be stupid

I must be bad,

What else could have made

My daddy so mad?

I wish I were better

I wish I weren’t ugly,

Then maybe my mommy

Would still want to hug me.

I can’t do a wrong

I can’t speak at all

Or else I’m locked up

All day long.

When I’m awake I’m all alone

The house is dark

My folks aren’t home

When my mommy does come home

I’ll try and be nice,

So maybe I’ll just get

One whipping tonight.

I just heard a car

My daddy is back

From Charlies bar

I hear him curse

My name is called

I press myself

Against the wall

I try to hide

From his evil eyes

I’m so afraid now

I’m starting to cry

He finds me weeping

Calls me ugly words,

He says its my fault

He suffers at work

He slaps and hits me

And yells at me more,

I finally get free

And run to the door

He’s already locked it

And I start to bawl,

He takes me and throws me

Against the hard wall

I fall to the floor

With my bones nearly broken,

And my daddy continues

With more bad words spoken,

‘I’m sorry!’, I scream

But its now much to late

His face has been twisted

Into a unimaginable shape

The hurt and the pain

Again and again

O please God, have mercy!

O please let it end!

And he finally stops

And heads for the door

While I lay there motionless

Sprawled on the floor

My name is Chris

I am three,

Tonight my daddy

Murdered me

And you can help

Sickens me to the soul,

And if you read this

and don’t pass it on

I pray for your forgiveness

Because you would have to be

One heartless person

To not be affected

By this Poem

And because you are affected,

Do something about it!

  • Children ages 0-3 are the most likely to experience abuse. About 1 in 50 U.S. infants are victims of nonfatal child abuse or neglect in a year, according to the first national study of the problem in that age group done by the CDC  along with The Federal Administration for Children and Families.
  • 1,500 children die every year from child abuse and neglect. That is just over 4 fatalities every day.
  • 79% of the children killed are younger than 4.

To learn more about Child Abuse click here.

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House MD: Good Ratings, Bad for Medicine

May 12, 2009

house_md_pillsAs TV season starts to wind down to the season finales, I can’t help but express my frustration at some of these medical dramas on television. I remember how fun it was as a medical student to watch the show “ER”, but how the relationship factor eventually made me lose interest. Unfortunately for some, in the real ER’s of the world, partner swapping is not a reality (at least not publicly).

Sure some relationships may develop between some of the staff from time to time, but I hesitate to say that it is no more often that what happens in any other workplace. And when it does happen, those involved usually like to keep it very private. Discussing what you and Nurse Janie did last night over CPR just hasn’t ever happened in my experience. But this issue is far from being the most publicly dangerous idea promoted by these shows. That goes hands down to the idea that ER doctors can do anything.

Watching ER, there were episodes when the ER doctors did c-sections in the back of a grimy ambulance after a gruesome car accident – and amazingly everyone survived! Happy endings all around. Unfortunately, the only C-sections we might ever get involved in are the emergency ones where mom is pretty much a goner and you’re worried about saving baby. There are no fine bikini cut incisions. Its blood and guts, and the baby’s chances are not very good either. Unfortunately, we also don’t take out your appendix or cure cancer.

Watching House MD though, things have been taken to an even higher level of unrealism. The docs on that show are not only walking encyclopedias of rare diseases, but they are also genetic specialists, nurses (all specialties), pharmacists, x-ray techs (who do CT and MRI), respiratory therapists, phlebotomists, social workers, abuse counselors, chaplains and private detectives. I personally have never gone through a patient’s trash or through their drawers to look for “clues”.

And House himself, as funny as he can sometimes be, would have been hauled off to jail a long time ago and lost his license for his interest in pornography and narcotic pain medication addiction. Just try imagining the guy from the Percocet video posted a few days ago being your doctor – not the kind of person we would generally associate with mega-book smarts if you know what I mean.

Yes, I know you are probably thinking, “dude chill out! It’s just a TV show”. So why does this matter? It matters because there are a lot of people out there who have a big problem between fiction and reality. They actually believe that we can do all these things and are very disappointed when we tell them we cannot.

I cannot even begin to count the number of times a patient has shown up in the Emergency Room saying, “I have been to my doctor and so many specialists and they can’t figure it out, so I decided to come here.” Then I have to explain to them how, unlike “House MD” or “ER”, I am more akin to “Scrubs”. I am pretty good with the common stuff especially if it has recently started (acute conditions). Once you get into chronic diseases (ones that have been there for a long time) or rarer conditions, then as much as I would like to stroke my ego, I am pretty lost.

I wish I could possess vast amounts of knowledge in several specialties. But I figure that since the people that go into those specialties have to spend several years honing their knowledge in that corner of medicine, it would be quite arrogant of me to assume that I can do their job so easily. I certainly get annoyed enough when someone training in dermatology or rehab medicine thinks they can step in and do my job, so I don’t want to be hypocritcal and do the same. These people have the training and specialized knowledge that don’t and they should be consulted. At least in “Scrubs” they usually use consultants and there are no “jack of all trades” doctors.

And in case you’re wondering, we also don’t have “quickies” in the medication or supply room.

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Drug Seeking Personalities: Don’t Be Like These People

May 10, 2009

I recently did a quick search on the narcotic pain medicine Percocet to see what people are saying on the internet. I was hoping that I might be able to give those inexperienced with ER drug seeking personalities a glimpse into precisely the type of people we despise. While we train for years to prepare ourselves to handle emergencies in the most expedient and proficient way, and while we stay up for long hours tending to the medical problems of many – there is another element in society that saps our trust and faith in humanity; the drug seeker. If I had wanted to be a drug dealer, I wouldn’t have spent so much time studying and so much money in training. I am not here to get you high.

Yet, for those who have not spent time dealing with this element of society, our comments and attitude may seem harsh and even inhumane at times. We reserve humanity for the first ten times we deal with these people, and then it pretty much drops off a cliff afterwords. So what exactly are these people like you may wonder? I will allow them to tell you in their own words as recorded by their own hands in comments all over the glorious world wide web. And please try to remember one thing as your read these comments – while you and your sick child wait patiently in the waiting room, or while you try to take your mind off the horrific pain in your broken wrist, or to control the bleeding from your cut – we sometimes are spending way too much time trying to get one of the losers out of our ER.

Just a few Percocet comments:

“on average i take about 20 to 25 and on a bad day 30… i know its gonna catch up to me i dont give a f@#$ though…….im gonna go overdose.. peace!”

[Comment: Just for perspective, the prescription dose is 1-2 tablets every 6-8 hours or maximum 8 per day]

“Percs are like a hug from Baby Jesus….<3”

“i stole my moms perks i was on them for a month straight. snort snort snort..”

“percs/vics/oxy/ is my drug of choice as well…..i know what ya mean by getting you through the work day….”

“Does it really make a differnce to crush percocet and snort it?”

[Comment only if you want to die faster. Stupid idea that puts a lot of people in the hospital and several others in the morgue.]

“im havin fun with my percs :D”

“I gotta say, percocet does rock. Nothing better to take the edge off a hard day of construction work.”

[Comment: And we wonder why it takes roads so long to get finished. Hmmm, let me get stoned and go drive a bulldozer.]

And lastly, I would like those who may be interested to check out this video for even more perspective. I personally am not one to listen to foul language or use it myself, but I guess on this subject it’s all part of the package. The first 60 seconds is what deals with the drug usage and I didn’t care to listen to the rest and don’t recommend you to either. If someone knows how I can cut out the portion I want, please let me know.

Watch with caution:


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