From the monthly archives:

January 2009

One unfortunate occupational hazard of being an ER doctor is learning way more than you want to about the sexual practicesbaby-snakes of your fellow citizens. This may give us a skewed perspective on what most people enjoy doing in their spare time, but it also keeps the job fascinating. A young man presented to the ER one day with lower abdominal pain and cloudy urine. Urine testing confirmed an infection in the bladder, but he was quite uncomfortable, so an Xray was done as well. This showed very strange, wispy coils of material in the location of the bladder that baffled the radiologist. “Clinical correlation is needed.” said the radiologist, which is what they say when they have no idea what they are looking at, so you better go talk to the patient again.

The ER doctor went right back to the patient and asked him why he might have strange material floating around in his bladder.

“Well, I suppose it could be the snakes I’ve been putting in my penis.” said the patient.

Apparently, there are tiny baby snakes that fit right inside the urethra, and can make it all the way into the bladder. It’s hard to imagine this being a pleasurable sensation, but evidently this patient thought so.


Welcome to another installment of the Top 10 Ways to Avoid the ER.

Number 5 – Drive slow


Whenever I go to the airport to fly somewhere, my wife worries about me. She is terrified about plane crashes. When I point out to her that I am far more likely to die on the way to the airport in my car, this makes her feel no better. But it’s true. I think we need to really think about what is most likely to kill us. And motor vehicle crashes are a significant cause of death for otherwise healthy people. You have a risk of death from car crash of slightly more than 1 in a thousand, per year! If you are a male, you are more likely to die than females. And if you are between 16 and 24 years old, you are in the highest risk group of all. Why? Because young people drive too fast!
We all need to drive slower and decrease the risk of getting killed or injured out there. We would not tolerate any safety measures being skipped as we get on board a jetliner, just to save a few minutes, and it should be the same on our roads.



What is the difference between using staples to close a cut rather than stitches. Do they have pros and cons?
Greg T. – Atlanta GA
The biggest advantage to staples is that they are very fast. Once a wound has been cleaned and anesthetized, I can staple a typical laceration closed in less than one minute. However, there are several situations where I prefer sutures. If you have a complex, jagged laceration, sutures can help bring that wound together in a more anatomic way. Sutures tend to leave a smaller scar, with tiny little holes on the sides of a laceration, where staples leave the more typical “railroad tracks.” With sutures, you can get wound edges very close and provide an excellent result. I never use staples on the face.
Every doc I know uses staples on scalp cuts, which are very common. You can put in staples with minimal hair removal which patients appreciate. Sutures are a pain to put in without shaving the area around the cut.


When the ER gets busy, we need to rush things a bit to keep the patients moving. Ordinarily, this is not a big deal, but occasionally things can be overlooked. Years ago, a patient came in with a narcotic overdose on just such a busy day. His wife suspected that he was addicted to pain medications and had been trying to keep it a secret. She also thought that he had gotten hold of some fentanyl-patch from a relative. These patches release potent narcotics gradually into the bloodstream. Hmm. He was pretty sleepy when he came in, and his pupils were small, consistent with a narcotic overdose, but he didn’t have any patches on his body. He needed to be admitted because of his poor mental status, so those arrangements were made. Later on, the admitting nurse called down to the ER to report that she had found a fentanyl patch. It had been placed carefully underneath his scrotum, where his wife was unlikely to spot it. Fooled us too.



Welcome to another installment of the Top 10 Ways to Avoid the ER.

 Number 6 – Opt for comfort care

Okay, now I’m not saying if you’re a 38 year old with foot fungus that you should call hospice. But anyone that works in the ER can tell you that there are many debilitated, elderly people who are way past the point where an ER can help them. Nursing home patients who are demented, chronically ill, and have no quality of life often times are brought repeatedly to the ER for a variety of medical problems, or just a change in their mental status. Usually, their families say that they wan’t “everything done,” but I bet these patients (if they were capable of it) would disagree.