A helicopter ambulance service called saying they were bringing in an eighteen-year-old man who had been stabbed in the chest. The radio report from the frantic flight nurse painted a picture of a very seriously injured person. He was confused and had a weak pulse and a low blood pressure. We quickly prepared for his arrival: trauma team called, equipment readied, blood ordered up from the blood bank.

By the time they got him down from the rooftop helicopter pad and into the trauma bay, he was in his last gasps. All hands went to work at once. I sedated and paralyzed him so I could put a breathing tube in his windpipe. We could then get air into his lungs and  provide him with oxygen. When it was clear that he had no pulse, a tech did chest compressions. The trauma surgeons put in large IV’s, through which he was given fluids and blood.

It soon was apparent that all of this was not enough so a thoracotomy was preformed. This is similar to what is done when someone has open-heart surgery but is, obviously, simplified and done as rapidly as possible. A cut is made between two ribs on the left side, all the way through the chest wall, into the chest cavity. A spreader is inserted into the cut and positioned between the ribs. The ribs are then spread open so the surgeon can get to the heart. If the source of the bleeding is identified, it can be sewn closed. The heart can actually be squeezed by hand, which is more effective in moving blood forward than the chest compressions done during CPR.

All of this was done quickly and successfully but was to no avail. His heart never started beating again and he was pronounced dead. When the decision was made to stop the resuscitation, a dramatic change took place in the feeling in the room. Immediately, all feverishly applied efforts to save a life just stopped. Rather than hollered commands and replies, voices were quiet and subdued. Rather than aggressive, heroic actions, activities moved to the mundane like cleaning up and preparing the body for the morgue.

Telling someone his or her loved-one is dead is the worst part of my job. It is bad enough if the person was old and had lived a full life. It is really hard to tell parents their son was murdered with a stab to the chest and at such a young age. Thank goodness I didn’t know at the time that his brother was the person who stabbed him, during an argument over a video game.

Some time ago, I posted a story called Dancing with the Stars. http://badtadmd.com/dancing-with-the-stars/

In that story, a young man hung himself upside down, on purpose, to “dance.” The stress on his leg caused widespread breakdown of the leg muscles. This is a concern to us in the ED because damaged muscle cells cause proteins to leak into the blood stream. A high concentration of these proteins is toxic to the kidneys and can cause kidney failure. This condition is called rhabdomyolysis.

Here is another story that is bizarrely similar:

Hanging from the Bathroom Window

An 88-year-old woman was found hanging by her legs out of the bathroom window. She was unable to say what happened to her, but those who found her believed she may have been there all night.

When she arrived, she was very confused, dehydrated and both of her legs were swollen, discolored, and tender. A bone in one leg was broken, but that was the least of her problems. She had two very serious complications of having prolonged stress on her leg muscles. Like the “upside down dancer,” this woman had rhabdomyolysis and the risk of kidney failure. She also had a compartment syndrome in both of her lower legs.

A compartment syndrome of the leg develops when there is damage to leg muscles, which are bundled in compartments made of strong fibrous bands. The damaged muscles tend to swell but the fibrous bands prevent the compartments for enlarging.  This leads to increased pressure in the compartment. If this is not identified and treated, blood is unable enter the compartment and the muscles can actually die from lack of blood supply.

The treatment for a compartment syndrome is called a fasciotomy. Long cuts are made through the skin and the fibrous bands so the muscles have room to swell. These cuts are left open until the muscles heal. The defects can later be closed with skin grafts. This lady required fasciotomies in both of her lower legs before she was admitted to intensive care.

Here is a picture I snagged from the Internet that shows what a fasciotomy of the leg looks like:

And here is one from our son-in-law’s brother’s fasciotomy:

And Wikipedia links for the same:

https://en.wikipedia.org/wiki/Compartment_syndrome

https://en.wikipedia.org/wiki/Fasciotomy

A young man was seen at another hospital in our fair city for a nasty jaw fracture. His jaw was broken in multiple pieces and needed to be surgically put back together. Without surgery, his jaw almost certainly would not heal correctly. One possible outcome was that he might heal with an abnormal alignment, preventing his teeth form coming together correctly. Another possible complication of such a fracture is that it might never heal at all. We call that a non-union. In such a case, he would be left with a loose jaw that would cause him pain every time it wiggled. Because this patient had no insurance, the other hospital arranged for him to be seen in the Plastic Surgery clinic at our county hospital to arrange for his needed surgery.

When he arrived for the appointment, the clinic discovered a big problem – he was not a resident of our county. He was here for work but his residence was still in another county. Not only had he no insurance, he was not eligible for any county-sponsored charity program. Before the man could get a much-needed surgery, he would have to come up with $10,000 cash.

Understandably discouraged, he went back to where he was staying and, I think, accidentally, took too many pain pills along with some Valium a friend gave him. When he went unconscious, his friends freaked and called the ambulance. He ended up in our emergency department.

I kept an eye on him all night as he gradually woke up. When I finished my shift in the morning, I asked a Customer Service representative, to come see him. This patient and his situation took up a good part of her day. She tried every possible way to arrange for him to get surgery, either at our hospital or back in his county of residence. She tried to get him qualified for Medicaid. She tried to see if he could somehow qualify as a resident in our county. She explored with him ways he might be able to come up with the $10,000. He finally left with information on how to try to get the care he needed when he got back home.

This is a great example of just why we should quit pretending the government is not already running healthcare and get rid of this ridiculous double standard in our medical care payment system. The man had to have surgery on his jaw. We, as a society, are not comfortable relegating people who can’t pay for needed surgery to a lifetime of permanent disability. If he had been a resident of our county, they would have operated on him and the taxpayers of the county would have paid for it. Out of our county? No way! Go to your own county and have your county’s tax payers pay for it! What kind of a crazy system is that? One way or the other, he will eventually get the care he needs and the taxpayers will pay for it. Why not come up with some system that is fairer in regards to who pays and who gets treated? That is what we need but would Obamacare fix this problem?

Emergency departments often attract people who have nowhere else to go. If you think about it, homeless people retain a certain amount of anonymity in large, busy places like hospitals. There, they can be in out of the weather. They have access to restrooms. They can easily charge their cell phones and electric wheelchairs. If they don’t cause trouble, they are often allowed to sit and rest in waiting rooms. This is a regular thing, but huge problems come up when certain homeless people refuse to leave and can’t be thrown out.

Mr. L— was a homeless man who weighed in at over four hundred pounds. He had serious medical problems and had been admitted to the hospital many times for treatment. When it came time to discharge him, social workers usually tried to transfer him to a long-term care facility. In trying to do this, they faced two challenges. First, Mr. L— refused to cooperate because he didn’t want to spend his disability income on nursing home care. He chose to keep his money for other purposes. Once, when he was admitted to the hospital, he had over $10,000 in cash stuffed in various places on his person and in his belongings. Secondly, even if
Mr. L— agreed, many local nursing homes wouldn’t take him based on their past experience with his nasty, unpleasant behavior. So, when it came time for him to be discharged from the hospital, he would usually motor his over-sized electric wheelchair across the street to the bus stop in front of McDonalds and set up housekeeping.

Early one rainy day, we found Mr. L— in the main hallway of the hospital, right behind the emergency department. He had been there all night. The top part of his body was precariously perched on the edge of his huge wheelchair but the lower part of his body was actually on the floor. To keep himself from sliding all the way to the ground, he had hooked his arm around the armrest of the chair. The reason he had trouble staying in the chair was that it was slippery from his urine and feces.

Most of Mr. L—‘s abdomen and groin were exposed as his pants were sagging down and his shirt was pulled up. He had placed one of his dirty shoes on the window ledge next to the wheelchair. It was being used to hold a plastic bottle that was half-full of urine. Urine and feces dripped down the wall from the shoe to the floor and pooled under the wheelchair. It was quite a sight for the day shift staff that passed by him on their way to work… and the smell was horrendous. Patients, visitors and staff complained he made the air smell so bad they felt like they were going to vomit.

Asking Mr. L— to leave was not really an option because he was not capable of doing so. Yet, he was not cooperative with any efforts to help him. He wouldn’t let himself down onto the floor, but couldn’t get back up into the chair. He constantly complained about being in pain. Yet, he threatened anyone who approached, trying to help him. So, there he was.

Someone from hospital administration finally made the decision to force him to move out of the public area. A team of twenty staff members was assembled. It included 5 medical assistants, 6 nurses, 2 doctors, the shift supervisor, 2 emergency department technicians, 2 security officers and 2 physical therapy staff members. Three administrators stood by directing the effort.

A plan was laid out to get Mr. L— down onto the floor, wash him up and get him back into his wheelchair.

A crane was borrowed from an inpatient unit. Partitions were set up around him to provide some privacy. When he was forced to let go of the wheelchair, he slipped entirely onto the floor. The team of staff rolled him from side to side to cut off his clothes. It then took 30 sheets, 20 blankets, 30 towels and 30 disposable pads to clean and dry him. Twenty packets of antibiotic ointment were used to cover his skin, which was raw and irritated from being in constant contact with his excrement. Over-sized hospital clothes were pulled onto him. His wheelchair was also cleaned. Then, the sling from the crane was laboriously worked under him so he could be safely lifted back into his chair. Once back in his chair, it was impossible to remove the sling from under him. So there it stayed– at a cost of $300 to replace.

It took all morning to get Mr. L— cleaned up. Once he was reseated, he was wheeled to a hallway out of the main thoroughfare. He refused recommendations to sign in as patient and receive medical care. The Sherriff’s deputy, who was called in, said it was not an option to arrest him for trespassing, saying that the jail staff would refuse to accept him into jail because of his many problems. No one had any idea what to do with him, so there he sat. I don’t know what happened after that.

On my way to work the next day, I saw him back at the bus stop across the street from the hospital. From time to time over the next few weeks, a Good Samaritan would call 911 to get him help. Paramedics who responded to the situation told me he always refused care. He lived at the bus stop for several weeks, and then he was never seen again.

I checked vital statistics online and found he died soon after that event, though the details of his demise are unknown to me.

I Needed to Eat

A thirty-year-old man came into our emergency department saying he had been treated for a broken jaw at an out-of-state hospital. This was done by placing two “arch bars” along his upper and lower teeth then wiring them to each other so his jaw could not move. In the three months since then, he had not had any follow-up care. When he got tired of not being able to eat because his jaws were wired shut, he cut out the wires but the arch bars were still in place. He was now in our emergency department for some unrelated reason and had no plans to have the wires removed. We also discovered a 1 by 2 inch piece of glass that was under the skin of his buttocks and had been there for the same time.

Very Nice Cops

My patient was a twenty-seven-year-old lady who had been stabbed by her pimp in Oakland a few days before. After being treated at a hospital up there and released, she made her way to our fair city where she was staying with her auntie. Three days later, the pimp found her and stabbed her again. She came to our hospital by ambulance.

Fortunately, her injuries were not serious. We sewed her back together but the most interesting thing to me was how the police dealt with her. My impression is that police are usually not all that nice to drunken black hookers who have been stabbed. In this case, however, the guy who stabbed her is a well-known crook in Oakland and the police were extra-nice to her with the hopes she would testify against him so he would go to jail. Their whole demeanor in dealing with her was unusually calm, patient and understanding. They even came back after her treatment was over and took her back to her auntie’s. I have never had police come back to give anyone a ride home so this was clearly out of the ordinary.

I recently came across a letter I wrote to my parents at the start of my first clinical rotation in medical school. It was one of the first times I actually had the chance to provide medical care to a patient. Here’s my unedited account of a patient I helped care for in the emergency department the first night I was on call:

“Last night, a real victim of self-abuse came in. He was a horrible drunk with feces dried down his legs, in between his toes and under his toenails. He had scrapes and cuts all over from falling down his stairs. I cleaned him up with the help of a nurse and stitched his head closed. That was a new one for me. It was a perfect one to start on, too. He was pretty much out of it so I didn’t have to put on any appearance of looking like I know what I am doing. Also, only one cut needed to be stitched and it was on the scalp, was straight, and only needed four stitches. I also had to pass a naso-gastric tube down him to see if he was bleeding into his guts and that was a new one for me. I kept choking him and the tube kept coming out his mouth. Again, a perfect one to learn on because he wasn’t really with it.”

Finding this gave me pause to consider how I have changed…

I cringe now at my use of the words “victim of self-abuse” and “horrible drunk.” Though these words were probably accurate, they reflect a judgmental tone I am not proud of. It is very hard to stay up all night taking care of people like this and keep a good attitude about it, but I hope my writings now might display more patience and understanding than were demonstrated after my first encounter with such a patient.

Doing procedures for the first time on a real human being was exciting for me as a third year medical student. But, I frequently felt like I needed to act like I knew what I was doing, even when I did not. Putting in sutures and passing a tube into someone who was unaware relieved me of that stress. I didn’t have to pretend I knew what I was doing. Now, thirty-two years later, I don’t have to pretend. I know what I am doing and it is nice to have that confidence.

Four stitches in a scalp was a big deal to me back then. Today, it is about as straightforward a patient as I could imagine seeing. I was really buzzed to actually be able to stitch someone up. Now, it would be a simple, hardly noteworthy event.

Passing a tube through someone’s nose into the stomach can actually be kind of tricky. Way back then, both the novelty and the technical challenge of doing this procedure were exciting. Since I had never done it before, the nurse showed me how to do it. Now, our nurses pass naso-gastric tubes most of the time, so I rarely do it anymore. I only get involved if the nurse has trouble and they need my expertise to get the tube down.

Finally, I have taken care of so many drunks that, if a drunk came in tonight with poop down to his toes, I wouldn’t even be fazed.

It’s no wonder I took time to write my parents and tell them about this first patient – and no wonder it wouldn’t even impress me if I were to see that same patient tonight.

Last week, I told you a story about an intern draining pus.  ( http://badtadmd.com/grand-geyser/ ) It makes sense to follow that with another story of an intern draining pus.

First, some medical background… The Bartholin’s gland sits at the opening to the vagina and secretes fluid for lubrication. Like other glands, it has the potential to get plugged so the fluid can’t get out. The gland, which is normally not even identifiable under the skin, keeps making fluid and starts to swell. To make matters worse, the fluid in the gland is great for bacteria to grow in, so a plugged Bartholin’s gland often becomes infected. This causes redness, pain and more swelling.

The treatment for a Bartholin’s gland abscess is to cut it open and drain the pus. To keep the abscess from reforming, the abscess cavity needs to stay open so it can drain until it is fully healed. A guy named Word invented the absolutely coolest thing to help do that.

The Word catheter is a silicon tube about two inches long and about as big around as a pencil. One end can be blown up with water to form a balloon about an inch in diameter. The other end of the tube has a place to insert a needle to fill the balloon with water. This is what it looks like when the balloon is filled:

After numbing the area, a small hole is cut into the Bartholin’s gland to drain the pus. Then, the rounded end of the Word catheter is placed into the abscess space and the balloon is inflated with water. The balloon allows the catheter to stay in place for about a month while the infection drains and the body’s natural defenses allow complete healing.

So, that’s the background. Now the story:

One night, an intern told me she had a young patient with pain and swelling at the opening to her vagina. That was about enough information to make the diagnosis of Bartholin’s gland abscess. One peek down there was enough to confirm it. Hers was a very large one.

The intern had drained abscesses in other parts of the body but never a Bartholin’s gland abscess. She was excited to drain this one. I verbally took her through the procedure, including some caveats to make things go more smoothly. First, I warned her to not make the hole too large. (I did that once and the balloon wouldn’t stay inside the cavity.)  I also told her it can be hard to pass the catheter through the incision if you wait until the abscess is empty. So, she should make the cut and then quickly insert the catheter before the pus stops flowing out.

After giving the patient morphine for pain, we put her legs up in stirrups and coaxed her to relax as much as possible. The intern numbed the area. I warned her that the pus would be under a lot of pressure and might squirt out once the cut was made. I positioned a suction device to capture any pus that came out.

When the intern poked the scalpel into the abscess, the pus immediately started squirting out. The sudden gush of pus caused the intern to freak out. She hollered and jumped back. Pus squirted all over. The intern pulled herself together and tried to push the catheter into the hole. Unfortunately, she had not made the hole large enough, so the catheter wouldn’t pass into the cavity.

With pus continuing to squirt out, she tried to make the hole bigger but was still unsuccessful. I quickly took the scalpel and made an appropriately larger hole. Pus continued to spurt out as the intern tried to pass the catheter into the cavity. At that point, she made a bad move. Somehow, she pulled the needle out of the catheter and she poked herself with it. Again, she jumped and hollered. I told her to hurry and put the catheter in. Finally, just as the pus stopped flowing out, we got the catheter in place and blew up the balloon.

The intern pulled off her glove and saw blood on her hand from where she got poked with the needle. That caused her a lot of alarm until she realized she had been poked with a clean needle.

Everything ended just as it should have.

Well, almost everything. I had been prepared to suction the pus as it exited the abscess. But, when the intern freaked and needed my help, I was less than diligent in my suctioning than I could have been. We ended up with pus on the patient, the bed, the floor and the intern.

In the end, the procedure was perfect but it really felt like “The Three Stooges” or “I Love Lucy” while we were doing it.

Doctors often place catheters in patients who have problems emptying their bladders. The catheters are frequently placed directly through the urethra but, if they are going to be in place for a long time, a suprapubic catheter is often placed. It is called this because it is placed through the skin, just above (supra-) the pubic bone, directly into the bladder. The urine leaves the bladder through the catheter and is stored in a bag, which is emptied as needed.

Patients with suprapubic catheters are at increased risk of urinary tract infections since we were not designed to have a rubber tube going through our skin into our bladders. When such patients come into the emergency department with fever, we send urine to the laboratory to test for infection. We don’t just send urine out of the bag, however, because it has usually been sitting there for a long time and is over-grown with all kinds of bacteria. In order for the test to be accurate, we remove the catheter, replace it with a fresh one and test the urine that collects in the new catheter and bag.

The other night, I had a patient from a nursing home with fever, low blood pressure, a high pulse – and a suprapubic catheter. A urinary tract infection was high on my list of suspected diagnoses.

Helping me care for this patient was an intern, a doctor working in the hospital during the first year after medical school. I asked her if she had ever changed a suprapubic urinary catheter. When she said she had not, I offered to help her do so.

I told her it was a simple thing to do and verbally took her through the ways in which this is different from placing other catheters, which she had done in the past. One thing I warned her about was that, if the catheter had become plugged, the urine in the bladder could be under pressure and squirt out of the hole in the abdominal wall when the old catheter was removed. I told her I always like to have a towel ready in case that happened.

After explaining to the patient what we were going to do, we positioned her flat in bed and gathered our supplies. We put on sterile gloves and the intern carefully swabbed the area around the old catheter with antiseptic. She slowly removed the old catheter from the hole in the patient’s lower abdominal wall and, as soon as the catheter came out of the hole, a torrent of foul-smelling urine gushed out in a geyser over a foot high. The intern jumped back and I jumped forward. I grabbed my well-placed towel, quickly covering the hole and trying to control the flow of urine. In spite of the towel, the urine flowed out all over the sides of the patient’s abdomen and down between her legs, soaking the sheets and pooling underneath her.

Soon, enough urine had escaped to allow me to move the towel out of the way without risk of being squirted. Now, oozing out of the hole was a thick, yellow-green liquid that looked much more like pus than urine. By then, the intern had gathered her wits and was able to push the new catheter into the hole. Once the balloon on the catheter was blown up, the infected urine started flowing into the catheter rather than out of the hole. We collected a sample to be sent to the lab. The nurse cleaned the patient up and changed her bedding while I went to order antibiotics and arrange for hospital admission.

This was the very worst I have seen urine squirt out when a suprapubic catheter was removed and, for the intern,  was a memorable learning experience to have a handy towel ready.

Note: Grand Geyser, in Yellowstone National Park, is the tallest and most spectacular of the predicted geysers. It erupts from a pool of water making it a fountain-type geyser as opposed to Old Faithful which is a cone-type geyser. Grand’s eruption is about 150-180 feet high and lasts about 10-12 minutes.

I recently posted blogs about the “Chief Complaint,” which is the patient’s most important symptom. Another type of complaint is what the patients send in when they are unhappy with some element of their emergency department experience. The complaints that relate to the doctor are sent to the Medical Director of the emergency department. Since I was the Medical Director of our department for several years, I got to review quite a few of this type of complaint. Here is the longest one I ever received. I have reproduced it at closely as I could, changing things to protect the patient’s identity, of course. Please don’t feel like you need to read it all but it is a fascinating insight into one unfortunately patient’s situation.

10 June 2004

Re: Billing Account #XXXXXXX, SS# XXX_XX_XXXX Medicare

From: JLB

My aim was to never pay this account balance due and furthermore, the Federal Government Medicare system should be refunded for your charges.

Admitting Diagnosis – Principal Diagnosis 298.9 – psychosis NOS and Secondary Diagnosis 303.91 – alcohol dependence NOS

My aim was to retain an attorney and sue for elder abuse and misdiagnosed services I was given on 20 July 2001 and for the next 72 hours.

I contacted the State Bar of California to use their referral service – all law offices contacted stated the same message – that they do not file lawsuits against the County and State and this must leave you all free and clear to keep on abusing the elderly!

I am going to tell you the Hospital, the County, and the State right up front that one of the psychiatrists in the acute psychiatric ward, stated to me, my husband, and my daughter– “You should not be in here!” He was absolutely correct – his name, Dr N.

I primarily chose to go to the emergency care at the medical center for the following reasons: I was having a very bad allergic reaction to “something” for the past 20 days. I was having muscle contractions with stiffness and soreness. Pain in the stomach. I had an extreme metal taste in my mouth. I had been vomiting. I had diarrhea. I was dehydrated. I had an itchy red rash and hive bumps. My equilibrium was off balance. I was swollen all over my body. I was constantly belching a “mold like” smell and taste. My gums were bleeding and I could not eat properly. I had gone to another hospital for emergency care on 13 July 2001 (7 days prior.) I was given a referral to see an internist/allergist. I made an appointment, showed up – only to be told by the doctor, that she was not an allergist. This upset me. I just don’t understand why I wasn’t informed when I made the appointment! I left this office with the intentions of making an appointment with an allergy doctor I had seen in the past.

I began to feel much worse and I had to make another decision. I chose to go to the medical center to try and find the cause of the allergic reaction. Mold, mildew, gas smells, environmental pollution can and does cause a great deal of problems for me. Yeast infections are also a problem for me.

My son drove me to the medical center. He was not my choice to drive me there or represent me. He was my only ride! He did not know my health problems and why he was asked about my health problems by the doctor on duty, he accumulated some wrong information right up front!

I was never asked who my choice of a family representative was/is! It is/was my daughter. Reason – she never forgets what I tell her about my health! My husband is not my choice for a representative because he will listen to other people before he listens to what I have to say!

When I checked in at the emergency care desk, the desk clerk asked me what my problem was. I stated why I was there – I was having an allergic reaction to “something.” I “feel like” I had been poisoned. This woman asks who “I think poisoned me.” I told her, “Nobody, but that’s the way I feel!” I had been sipping on wine mixed with water earlier, as it relieved the belches and the itching and the bloody taste along with the metal taste in my mouth.  I was not asked for any other symptoms – just go prepare to see the doctor on duty. I was actually prepared for a trip through hell! This female Asian doctor comes in to see me. She starts on me – – –

“You’ve been drinking? You’re drunk!” It made me very angry to be accused of being drunk. When I wasn’t. I told her to “get out of here” – that I didn’t want her taking care of me! They sent in another doctor. He did not apologize for the terrible bedside manner. I heard them asking every patient in the area to be examined – “Have you been drinking?” Why didn’t these doctors check my alcohol level before accusing me of being drunk? They would have found I wasn’t drunk!!

If that is your hospital policy about greeting people with  – “Have you been drinking?” May I remind you that dinking alcohol is not against the law! You should post a sign that is noticeable in your waiting room that we ask “how much alcohol you have been drinking” even if drinking is not against the law. I won’t buy any explanation as to it helps you diagnose a person’s problems!

I was diagnosed with the two mentioned on page 1. I was put under arrest.  I was thrown into your “Looney Bin” and it is a “Looney Bin.” I didn’t know why I had been thrown in? My gun rights were taken away and this police lady that came by and stated I was a danger to myself??? I don’t know who ordered the “drying out” pills that I was made to take. Strange, for someone who has never been drunk a day in my life – yes, I have drinks, but not to get drunk.

Next comes the pills to treat my “mental illness.” I tried to refuse these pills. No, there was no refusals available. I was threatened with a stay of an extra 9 months in some “holding place” and the head psychiatrist has one of his nurses shove a paper at me and ask me to sign it! I asked them (the head psychiatrist and at least four nurses) what the paper was about? It was a paper to give them (same people) the right to take away further rights and declare me unable, unstable, (whatever you want to call it!) of taking care of myself and they would have some county worker check in on me twice a week. I polled all the healthcare people present and they had to admit I didn’t have to sign the paper. I didn’t. But, I still had to deal with the threat of that 9-month “bonus.” I chose that “mental illness pill.”

It turned me into a near zombie. It made me sicker than ever. My pulse rate was extremely high. I couldn’t walk without running into the walls. “It was the wrong medicine” and this statement came from the psychiatrist. I went to see why these doctors at your hospital thought I had a “Mental Illness.” The pills they give me could not be tolerated. No further visits were needed.

It is scaring the living daylights out of me to get old and be treated in this way! That you can allow your doctors that represent your hospital, your county, your state, to use the judgment they declare to be correct – gained many many times by someone from a person’s family that is not the chosen representative. I learned later that your doctor that declared me to be arrested had caused a vengeance between my husband and me by telling my husband that I stated he had poisoned me. There was also written in my medical report that I was hooked on epinephrine, I had been stealing it to inject myself and I had something like 10 shots within the last 3 days. If these people – your doctors and nurses – make such claims, (I have no idea where they got such claims) they should have checked my body for justifiable proof. There was NO needle marks on me!

How in God’s World can anyone be sent to your “Looney Bin” and be cured of anything? When you are called, “You are coo coo head!” In my report: She has a persistent paranoia that she is infested with molds. She is delusional and preoccupied with mold. Her general appearance is loud and snapping. She drinks to get rid of mold. She is pre-occupied with her mother dying young from a “bee sting.” No, it was a flu injection! Where did they get all this crap? Is this the States, Counties and the State/County run hospital’s way of getting more money from the Federal Medicare system? I am reporting this mistreatment and abuse to the Federal Medicare System. We as human beings should be allowed a second opinion before we are abused and mistreated and thrown (arrested) into your Acute Psychiatric Ward. We should be asked who our choice of family representative is! We should be allowed legal advice before we have to sign any & there are many papers – often. We have had our rights taken away and without informing us older people that all the laws are on your side! You don’t need to ask or tell me when your doctors make a poor judgment! This stinks!

The temp help that came to our office to take my work area also came down with an allergic reaction. She was unable to drive herself to the hospital. I drove her. She was treated correctly! She was 22 years old. I am 68 years old! I now know the source for the allergic reactions was coming from the work place. I found it. Our office unit’s furnace room had uncovered water pipes that were leaking a steady drip into two large size plastic containers which was overflowing into wood. The wood was decaying and the plastic containers were full of green mold (I took pictures.) I had a building contractor and air conditioning –furnace contractor give me an opinion – – extensive changes had to be made and were made.

My workspace was first in line to get this poisonous rotten wood (also odor) and green mold spores (moldy odor.)

I called the State of California Environmental Department asking for information about the environmental condition. It is a poisonous situation and advise workers to use masks when cleaning and replacing the area, and the only real way to be rid of it is to remove and replace!

How could your hospital doctors and your staff declare the mold and poisonous situation was a figment of my imagination and diagnose me with the “Mental illness and a danger to myself” and Medicare (Federal system) is billed for this charge? This is wrong and should not happen to senior citizens! I can get a letter from the building contractor stating the situation he observed in the furnace room to our work place. I also learned that he has had to go for emergency treatment to the hospital for becoming overwhelmed by the poisonous spores wet/dry rot conditions.

I am not retired as my report states. I am not full supported by my husband as the report states. I am 50% owner of my husband’s business and I still do 50% of the work. I am of sound mind and body (still have allergies.) I had myself checked out for proof.

I am not an AARP member. I just don’t feel old enough and I do not have enough time to be a “good” member! But, I am for these members and their rights. We deserve to be treated better. The Federal Medicare system has got to quit wasting money for false diagnoses I call fraud! Medicare has got to start calling for second opinions if you people from the County and State of California can’t clean up your act of allowing older people to be abused by your system and doctors.

Every person arrested or declared mentally ill or both should be allowed a second opinion and legal advise for our own protection before being take by force to your “Looney Bin” and then asking our Medicare Federal System to pay this charge!

I want these people dismissed for abusing me – by false statements – getting wrong information through family members by causing vengeance and asking my driver for my health information then putting him (my son) down as a family member to contact. My adopted son had never been given that privilege. It’s apparent my privileges no longer mattered. I want my chosen family representative – everyone should be asked for their chosen family representative.

These persons should be dismissed from the medical center. Some names are not legible in the written report:

1. The desk clerk (female) on duty for writing down the wrong information about the poison remark. Why would she misunderstand a statement?
2. The first doctor (female) Asian that accused me of being drunk. Without proper testing.
3. The other Asian doctor that took over after I didn’t want to be treated by the rude female doctor. I should have the right to refuse accusations when they are not true. This is the one that started the whole arrest process. He talked to my driver about my health (my adopted son.) He did not ask me if my driver had privilege to speak on my health issues. He didn’t and had never been given privileges! This doctor did not check me for injection marks. Yet accused me of having injections given to myself. I had no such marks! These doctors should not be working anywhere. No. I am not prejudiced toward Asians. I work with them and I like them as friends.
4. AJ, MD. He had false information written in my medical report. He was using passed-on false information and misdiagnosing with this false information.
5. The psychiatrist in charge of acute psychiatric ward. He has to go for sure. I was forced to take his prescribed pills for “drying” me out and “mental illness.” These pills made me very sick. I was forced with an extra long stay as already mentioned. I was detained for 72 hours against my will.
   This doctor, his assistants (females) and your hospital handed me preprinted “rights” information and at the same time telling me what he had the power to do to me! Later, this doctor asked me to sign a paper stating I had “Anxiety.” I signed. His pills gave me anxiety. (It was really a very fast pulse rate.) I signed because I did not want that 9-month “bonus” of a hold on me. He wrote information in my health record that did not come from me the way I discussed/answered his questions. Example: What did your mother die from? I stated: flu injection. Which is correct. His report stated, – bee sting. Now, who in this world would want a doctor – especially a psychiatrist – to treat your brain for a “mental illness” that didn’t know a bee sting from a flu injection!
6. I want my gun rights restored. I was surprised when a female police person came into my room and stated I had lost my gun rights – because – I was considered a danger to myself! I was so sick from the “pills,” I couldn’t even get my head off the pillow (I think, I had a pillow?) to give my protest! I needed legal advice. I don’t want my mind, body and soul taken over by the State of California!

JLB

Where Did that Tampon Go?

A 34-year-old lady came in after attending her hypnosis session earlier in the day. She said she was on her period so, before going to hypnotherapy, she remembered changing her tampon, placing a fresh one.

When she got home, however, she was surprised to discover there was no tampon. She was unable to remember everything that happened while she was under hypnosis so she was worried. Where might her tampon might have gone? Was she molested while under hypnosis?

Using a vaginal speculum, I looked and could clearly tell there was no tampon. Every thing was normal. I was unable to tell her where the tampon may have gone or under what circumstances.

This put me in a position of having to make a decision. If there is reason to think someone may have been sexually assaulted, we call the police. They come, take a report from the patient and decide whether to call in the Sexual Assault Response Team to do a forensics examination. Since the only reason to think this patient may have been assaulted was that there was no tampon in her vagina when she thought there should have been, I chose not to call the police. In this sort of situation, I often wonder if I made the correct decision or not.

Another Fall?

A 43-year-old man was seen for shakiness, which was determined to be a side effect of his psychiatric medicines. He was discharged and, while walking out of the emergency department, tripped and fell. He was reexamined and found to have no injury. As he was trying to leave the second time, he was walking backwards, smiling, waving good-bye and thanking our staff when he tripped, fell backwards and hit his head. This required a third evaluation before he was finally discharged without problems. It was tempting to write on his discharge instructions: “Don’t walk backwards while smiling, and waving good-bye.”

I Just Want to Kill Someone

A young man tried to stab someone and was apprehended by the police. Rather than arrest him, they put him on a psychiatric hold, called an ambulance and sent him to the emergency department. He told me, “I just have to kill someone.” He needed no medical care so he was sent to the emergency psychiatry.

The police later called the emergency department. Apparently, after sending him to us, they came up with more information about him. They asked that we keep him until they could come and take him into custody. We immediately called emergency psychiatry to let them know the police wanted him. We were told he had been discharged less than an hour after arriving there.