I picked up a young man in turnover. That means his care had been started buy my partner on the evening shift but he was still in need of care when I arrived so he became my patient.

He was in his thirties and came in saying he had been hit by a car. There was no witness and the police who took the report called his story into question.

When I arrived, he was getting his CAT scans and x-rays. After reviewing them, I determined they were all normal. I then went to check on him and get him discharged where I found him to be most disagreeable. I don’t think he was drunk but he was the kind of antisocial person that was just horribly obnoxious even when sober.

One example of this obnoxiousness was that he swore constantly. When I asked him why, he said he was a skateboarder so when he gets upset, he just has to swear.

After many efforts, I was unable to get him up and walking, though he didn’t seem to be injured. Since I can’t really discharge someone who can’t walk, I called the trauma surgeon with the bad news that they were going to have to admit him to the hospital.

When I went in to tell the patient we were gong to keep him, he said he was not going to stay. I asked him how he was going to leave if he couldn’t walk. He demanded a wheelchair and got mad and called me nasty things when I told him we didn’t have wheelchairs. “What the fuck kinda hospital is this if you don’t have wheelchairs?”

I told him we had wheelchairs but they were for hospital use and not for people to take home. “I’ll bring it back” was his promise.

When he finally understood there was no wheelchair for him to take home, he went down onto the floor in his underwear and said, “Then I’ll crawl out!”

I pointed out he was free to crawl out if he wanted to but he couldn’t leave with the IV catheter the trauma surgeons had placed under his collar bone. Hearing this, he reached up and tried to yank it out. I politely pointed out it was sewn in and I would be happy to take it out before he left. I then promised to take him in a wheelchair out to the waiting room and he could crawl from there.

At first he refused to let me take the catheter out because I was “a quack” and he didn’t trust me. I pointed out I had been nothing but nice to him and was trying to get him to stay so we could keep him comfortable and make sure he was OK. “I can’t fuckin’ stay in the hospital!” he bawled at me.

Eventually, he let me take his IV out. He took some clothes the staff found for him, then let himself be wheeled to the waiting room with no clear plan of where is was going or how he was going to get there. I have no idea what happened to him though I imagine he probably walked away.

A 30-year-old woman had a seizure. She had never had a seizure before. Understandably upset, her husband called 911 and the patient was brought to our emergency department.

By the time she arrived, she was still a little confused as is common after a seizure. I examined her and ordered tests to see if there was an identifiable cause of the seizure. When all of the tests came back normal, I went back to tell the patient and her husband the results.

I had noticed that, while we were talking, the patient kept her eyes closed and was tearful. I assumed this was from being emotional about this potentially life-changing event.

When I asked them if they had any questions, they wanted to know why her eyes hurt so badly. This explained why she had her tearful eyes closed but really puzzled me. I knew nothing about having a seizure that would cause one to have painful eyes.

When I looked at them more closely, they were very red and swollen. Staining with fluorescein dye showed both of her corneas (the clear front part of the eye) were damaged but just on the bottom halves.

I had no idea how to explain this so I asked more questions. As it turned out, when the patient had started to seize, the husband tried to “bring her out of it.” To do so, he threw rubbing alcohol in her face. She was unconscious and her eyes were half open so the irritating alcohol went right into her eyes causing damage to the corneas. When she recovered from the seizure, she was aware that her eyes were burned and painful. She went home with treatment for “chemical keratitis” with anticipation that it would be all healed up in a couple of days.

I took care of these people when they came to the emergency department for care of their burns. I never saw anything like that before.

http://www.thedailybeast.com/cheats/2012/07/23/several-burn-feet-at-seminar.html?utm_medium=email&utm_source=newsletter&utm_campaign=cheatsheet_morning&cid=newsletter%3Bemail%3Bcheatsheet_morning&utm_term=Cheat%20Sheet

Last week, my friend, Dennis, came over to fix the ice maker in our refrigerator. He commented on this blog and said I certainly must be making up my stories as they were just too weird to believe. I assured him they are all true. Every story I have told is true and from my own personal experience. And there are a lot more yet to come.

In the middle of the night, the medics brought in a middle-aged lady who was severely burned. They said she was a street person who had been drinking and lit her blanket on fire in trying to light her cigarette. They said her husband had left for some reason and returned only to see her engulfed in flames.

My first thoughts when she rolled in the door were, “She is going to die” and “It will be a merciful death.”

She had full thickness burns over her body from the waist up and other burns scattered over her lower body as well. Her hands were crisped so they looked like the feet of the Peking duck hanging in the window of King Egg Rolls. Having her whole face burned made her look like she had on a gruesome mask. It was grayish-yellow in color and tight so the eyelids were pressed closed, the nose was just a couple of tight holes and her mouth was a narrow slit.

She was moaning and thrashing around, resisting our efforts to try to help her. I reassured her we were going to give her medicine to put her to sleep, which we promptly did.

Next, we needed to get a tube into her windpipe before everything swelled up and we were unable to do so. Because her nose, mouth and face had been turned into a cruel, stiff leather mask, there was no way to pass the tube the way we normally do through the nose or mouth. The only option was to cut a hole in the front of her neck and pass the tube directly into her windpipe.

Once that was done, we had a lot of other things to do to stabilize her and get her up to the burn unit, which we did in short order. We were not surprised when her alcohol level came back at 465 (80 being legally intoxicated in this state.)

After returning to the care of my other patients, I was informed that my next patient was the husband of the burned lady. That caused me to take a gulp and prepare myself emotionally before I approached him to evaluate the minor burns he had suffered in the event. I found him to be rather uninvolved emotionally and not interested in my expressions of sympathy. He also had no questions and showed no interest in how she was doing. I attributed this to his level of intoxication. In fact, after being treated for his burns, he just rolled over and fell asleep.

When he later woke, somewhat more sober, he again showed no interest in his wife. All he could do was complain because none of the donated shoes we had was size eight-and-a-half. He took his prescription for pain medication and his discharge papers and walked out.

Later, I was walking down the hall of the hospital on my way home when I ran into him again. He had made his way to the Customer Service Department. Though it was still not office hours, a very nice lady had opened the door and tried to give him some advice about how he might find some shoes. He didn’t seem to recognize me and still showed no signs of any concern about the wife.

The next day, there was an article in the newspaper saying the police had arrested the husband and charged him with her murder! No wonder he seemed more interested in size eight-and-a-half shoes than in his wife.

I went into the room of a man about sixty-five years old. He was naked except for a disposable diaper. He was strapped down by leather restraints on all four of his extremities because he had been disruptive at the psychiatric home where he stays.

He had been sent in to the emergency department because he was on Coumadin, a medicine that decreases the blood’s ability to clot. He had been having some bleeding from his mouth that concerned his caretakers.

He was smiling a big, wide, toothy smile. There was fresh, red blood all over the visible parts of his mouth, teeth and lips. It was running down his chin, neck and into his right armpit. Along with the wild-eyed look on his face, it would have made a great scene for a horror show.

I opened with my usual: “Hello, I’m Dr. Tad. Welcome to The Medical Center.”

His eyes seemed to open even wider and he spit a little bit of blood with each consonant as he said, “Well, hello, Dr. Tad. Do you want to suck my dick?” I wish I could fully convey how bizarre, funny and sad it was at the same time. The nurse and I just lost it and I had to walk out of the room to get our composure.

A 21-year-old woman was drinking with her girl friends the night before she was to be wed. They decided to crash the bachelor party that was going on at that same time. I don’t know exactly what the ladies did once they arrived at the party but they left quickly. When they jumped in the car and drove away, the bachelors chased after them.

As they raced each other in their respective cars, the bachelors pulled up next to the ladies. The groom then threw a full can of beer at the other car. It went in an open window and struck the bride on the side of the face and knocked her unconscious.

By the time she arrived in the emergency department, she was alert but had a badly bruised face and hysterical blindness in one eye. The bride’s CAT scan showed no broken bones or brain injury. Her vision returned and she was discharged home to get married the next day – or not.

The medics brought in a 41-year-old man whose wife found him unresponsive in bed next to her in the middle of the night. She didn’t know what to do so she called her sister-in-law who was halfway across the country in Dallas, Texas. The wife didn’t speak English so the sister-in-law called our 911 system for help. It’s unclear if the man was actually dead when his wife discovered him. But any chance of reviving him was gone by the time the paramedics actually got to his home.

By doing CPR and injecting him with adrenalin, the medics were able to get some electrical activity to show up in his heart. They transported him to us, continuing CPR. I used an ultrasound machine to look at the man’s heart. There was no pumping activity, which means there was nothing anyone could do. He was dead.

I then had to go tell the man’s pregnant wife and three and five year-old daughters they no longer had a husband and father. That is the worst part of my job.

When I got to the private family room used for difficult conversations like this, I followed my usual pattern of introducing myself and sitting down. The chair I took happened to be next to the older of the two daughters. With the help of a Vietnamese translator, I told the wife her husband was dead. As I did s, I tried to show sensitivity to her and also to the girls. I was surprised to note they showed no emotion at all. When I looked at the older girl, touched her on the shoulder and told her I was sorry, she smiled at me. I wonder, as the years go by, what kind of memory she will have of that event and of me.

A 27-year-old man was dropped off by his friends after having been assaulted. He said he had been kicked and punched by several men earlier in the evening.

On exam, he was found to have hospital scrubs on under his clothes and was wearing hospital booties for socks. He had minor trauma on his face. When he was rolled over to check his back, a partially-used bottle of tetanus vaccine was found tucked in his gluteal fold (butt crack.)

When I asked about it, he said he had been naked when he was in the ambulance and had rolled over and it accidentally stuck there. I pointed out to him that he didn’t come in by ambulance and that ambulances don’t carry tetanus shots.

He thought for a second then said, “I don’t want to lie.” He then told a story about how his friend had given him the bottle as he headed to the emergency department, telling him it was pain medicine. He could use it if he needed it once he got here and no one would give him anything for pain. Once he took the medicine from his friend, he got worried he would get busted for having it so he hid it in his butt crack.

The third story that eventually came out was probably closest to the truth. He finally admitted he had been at another hospital earlier in the evening and left against medical advice before his evaluation had been concluded. While there, he saw the bottle of tetanus vaccine and, thinking it was pain medicine, stole it. On arrival at hour hospital, he became worried he would get caught with it so he tucked it in there for safekeeping.

My evaluation found nothing more than alcohol intoxication and some minor facial trauma. He was discharged home, without the tetanus vaccine.

I spend most of my time at work taking care of sick people, which is a serious and rewarding exercise. I also have an interesting and fascinating job. Sometimes my job is fun and makes me laugh. A conflict arises, however, when a sick person is funny. It makes me feel bad to laugh at someone who is sick.

The most obvious example of this conflict is dealing with bipolar patients in their manic phase. Manic people can really be funny. They go on and on, talking rapidly about truly crazy things. Sometime, it is really impossible not to laugh at what they say though their “humor” is a manifestation of their illness.

One of the places I sit to put my notes in the computer is right in the middle of the main emergency department, an area we call “The West Station.” Since our ED is too small to care for the number of patients we need to see, we often put patients on gurneys in the hall. One of the hall beds is right across from where I sit at the computer.

One night, a very manic lady was assigned to bed 5X, right across where I was busily entering notes in the computer. She talked constantly and it was very entertaining to listen to her as she waited to be taken to the emergency psychiatric department. Sometimes, her statements were directed at a member of the staff, sometimes at other patients or family members, sometimes at no one in particular.

In order to avoid her attention and get my charting done, I had to keep out of her sight by keeping my head down behind the computer monitor. This also hid from her the unavoidably amused look on my face.

At one point, I had to go do something and when I came back to my workstation, she started calling to me. Since I had already talked to her several times and attempted to answer all of her many bizarre questions, I felt it better to just avoid talking to her and get my other tasks done.

As I sat behind my computer screen, she started to call me. At first it was not too loud but, as I failed to answer, she started calling louder and louder. Then she started calling me names. The name she settled on was “Dr. Yeast Infection.”

So, there I sat, trying to remain inconspicuous behind my computer monitor, with a woman in the hallway across from me screaming, “Dr. Yeast Infection” at the top her lungs, over and over again, faster and faster, until the whole department was consumed by the show. It painted such a hilarious situation, that I was doing everything I could to not laugh.

Since my efforts to stay out of her sight and attention were obviously failing miserably, I got up, went over and tried to talk to her. My efforts to calm here were unsuccessful and she wouldn’t even listen to me. She just screamed, “Dr. Yeast Infection” over and over again until they took her off to get the help she needed from the psychiatrist.