Your ER Doc » Emergency Room Stories

Naked Side Effects of Ambien

Your ER Doc — Thu, 12 Nov 2009 00:49:34 +0000

I believe this could be a new protocol for cardiac stress testing.
Recently on the late shift, the nurses on the telemetry unit were alerted to an elderly female patient who was having tachycardia. Her heart rate had been steady at around 80, but for no clear reason it accelerated to about 150 beats per minute. The charge nurse walked quickly over to investigate.
The patient noted that she had been having some insomnia, so she decided to read her romance novel. Suddenly, she had a very realistic hallucination.
“What did you see dear?” asked the nurse.
“Well, it was a very good looking man, who just walked into my room and asked where the grocery store was. And, he was . . . completely naked.” She admitted.
The nurse reassured the patient that it was nothing, and tucked her back into bed, and then chuckled her way back to the nurses station. A few minutes later while doing some charting, she was surprised to see another patient standing in front of the counter. It was a 40 year old man admitted for gallstones. He had been given a dose of Ambien for sleep about an hour before.
“Excuse me, can you show me where the grocery store is?” asked the man.
“I certainly can,” said the nurse, who then gently walked the sleepwalking (and completely naked) patient back to his room.

Diagnosis? You’re drunk.

Your ER Doc — Wed, 17 Jun 2009 02:29:57 +0000

A middle aged man recently drove to the ER looking to get some medical attention for a rash that he had for over a year. It was a bit unusual to come to the ER for a chronic rash, but I’ve seen stranger things for sure. The timing was stranger still, since it was about 2am. But let’s give him the benefit of the doubt, and assume he was just trying to come in when the ER wasn’t too crowded.

It wasn’t though–pretty much packed and full of cops who were there for a car crash and an assault. This turned out to be bad news for the man with the rash since he was completely drunk. He knew it was bad mojo when he pulled into the parking lot and saw all the squad cars. If his plan was to be inconspicuous, that didn’t work too well, because he drove in the wrong way on a one-way driveway. As calmly as possible, he tried to perform a casual 3-point U-turn. Unfortunately, he ended up on the curb, and nearly hit the ambulance entrance doors. This did not go unnoticed by our boys in blue, and the man was quickly arrested for DUI, his car was impounded, and he was given a notice to appear before the court. At that point, he should have just been glad he wasn’t going to spend the night at county jail, but he was pretty mad. He stomped over to register in the ER and demanded a blood alcohol level, since he “wasn’t even drunk!”

1 hour later and a measured blood alcohol level of 0.25, the man was ready for discharge.

“Well what’s my diagnosis?!” he demanded.

“Looks like you’re drunk, sir.”

Gratitude

Your ER Doc — Fri, 15 May 2009 03:21:28 +0000

I think one of the fundamental desires of humans is to be appreciated. They want to do things that are important, they want to make an impact on other people, and they want acknowledgement for their efforts. I suspect ER doctors are no different, and many of them (including me) probably went into medicine to satisfy this desire.
Sometimes however, you don’t want to be thanked.
One such time was a few years ago, when I had a man in his early 60’s present to the ER with fevers, rash, and feeling crummy for a couple weeks. His symptoms were not adding up to a typical infection, so I ran some tests. Turns out he had acute leukemia. This was obviously terrible news, and I had to deliver it. The man was typically upset, but took the news with great composure. He then asked if he could go home.
I said, “No, you’ve got to be admitted for treatment, and you’ll probably be in the hospital for quite a while.” He needed induction chemotherapy, and he was going to have a tough time. He really didn’t want to be admitted to the hospital, because it turns out, he had cancelled his health insurance last year. He couldn’t afford the premiums anymore. He was hoping to make it to age 65, and get Medicare benefits, before he had any serious health problems. As the wheels were turning in his head, I came to realize that I had given him several pieces of bad news all at once. He was very ill, he could die, he was going to have a long and difficult hospital course, and he was going to lose all his money.
I checked on him several more times before he was admitted, and each time, he expressed his sincere appreciation and gratitude to me.
I wanted to say “For what? So I could give you the worst news of your life?”
Sometimes feeling appreciated is a shallow goal.

Stop punching me in the butt!

Your ER Doc — Fri, 24 Apr 2009 23:59:37 +0000

One of our more commonly seen fractures is the appropriately named “Boxer’s fracture.” This results from punching objects, usually a wall, sometimes another person’s face. The hand is broken at the neck of the pinky metacarpal bone, just before the big knuckle. One recent sufferer from this injury is a young man who I know well. However, he did not punch a wall, or a person’s face. No, he punched his friend’s butt. Yes, that’s right. I thought I’d seen it all. All I know is, I wish my butt was firm enough to cause hand fractures, but sadly, punching it would barely result in a sprain.

Night shifts

Your ER Doc — Tue, 14 Apr 2009 03:30:42 +0000

Perhaps my least favorite thing about my job is night shifts. As I get older, they get more and more painful. If I don’t get a nap before going in at 11pm, my brain gradually turns to oatmeal. Come 4am, and I’m hoping I don’t have to think very much. A sore throat or ear infection is about all I want to tackle.

One surprising side effect of night shifts is that the nurses start getting chatty, and all kinds of intense conversations spring up. Last night, I was working with some of my favorite nurses and we somehow started talking about religion. My usual rule is not to get into any debates about religion, because it never ends well. Unfortunately at 4 in the morning, it seems like you can really get to the bottom of these issues and solve them. You can’t. We spent a good hour sifting through all kinds of intense religious theory, wasting valuable charting (or napping) time. Huge waste. Luckily, I don’t think anyone was mad or offended by the end of shift.

Liability reform

Your ER Doc — Tue, 31 Mar 2009 00:43:45 +0000

I just returned from an emergency medicine conference in San Diego. Outstanding place for a conference, depressing to leave actually. The prevailing theme at the conference was avoidance of law suits, and how to defend against them. I strongly feel that any efforts by our government to reform our health care system has to include liability reform. Every ER doc worries about this problem on a daily basis. Every patient is a potential plaintiff, every complaint a potential disaster. All of us are aware of cases where the ER doctor simply did their best job possible, and got sued anyway. There are many cases where juries award huge sums of money to plaintiffs simply because they felt sorry for the defendant, even if there was nothing wrong with the medical care. Plaintiff’s attorneys often file cases on contingency, so that the plaintiff doesn’t have to spend any money on the lawsuit, and the attorney is heavily motivated to acquire a large judgement.

As a result, physicians often practice defensive medicine–ordering lots of tests, CT scans, and admitting lots of patients who could probably be discharged home, for fear of liability. They also have to pay huge liability insurance premiums. On top of this, ER doctors are required by law to examine and stabilize any patient who arrives at their ER, regardless of the patient’s ability to pay. All of these factors result in increased costs to patients, and unhappy physicians. I know that unhappy ER docs are not a primary concern of the general public, or the government, but they should be. I for one, would like to have the best people available in the ER when I arrive with my heart attack, broken leg, stroke, or meningitis. I have personally seen many ER docs hang up their stethoscope for jobs with lower liability, where they can make more money. If the trend continues, quality will go down.

Brave new world

Your ER Doc — Wed, 18 Mar 2009 04:08:16 +0000

When I was told recently that our emergency department would be getting a robot to help us, I must admit I was a little nervous. What exactly would this robot be doing, I wondered. Perhaps it has every medical fact from every specialty downloaded onto its hard drive, and a better bedside manner than me. Perhaps in a few weeks, my services will no longer be required. The day arrived, and the robot was delivered to the ER. It stands about 5 feet tall, and its head is a flat screen monitor. Two video camera lenses gape at you like oversized fish eyes. There is a speaker in the center of its chest and it moves around on wheels.

Now here’s the good part. It can’t do anything without a doctor. Pheww! What happens is I call up another doctor who is not anywhere near the hospital, and he can talk to me (and presumably a patient) through the robot. That’s it. That means my job is safe. However, I don’t want to understate how valuable this tool could prove to be. If I need a specialist that we don’t have, I could get a consultation from a doctor anywhere in the world as long as they have an internet connection. Totally cool. Now if I could just figure out a way to see patients myself while I hang out in the hot tub I’ll be set.

Dairy allergy

Your ER Doc — Wed, 11 Mar 2009 01:52:46 +0000

Don’t parents know that rashes can be caused by food? I had a young girl, about 4, brought in by her parents for a rash a while back. She had eczema, and had been suffering from it pretty much her entire young life. I launched into my quick question mode and found out that no one had even considered various allergic causes of the rash. I asked if she seemed particularly sensitive to any foods, and the mom said, “Oh well when she drinks a glass of milk, she has terrible diarrhea and bloating, and maybe her rash gets worse.” Trying to lead them a bit, I asked if they thought she might be sensitive to milk or dairy. They weren’t sure. I asked if they had ever tried a dairy free diet. No.

It’s hard to imagine having a child with these symptoms, and not trying a couple diet changes to see if that would help. Unfortunately for this child she has suffered now from fairly severe allergic symptoms for several years that were most likely preventable.

What a pain.

Your ER Doc — Thu, 05 Mar 2009 15:51:28 +0000

Narcotic medications are a big problem in every ER I’ve worked in. They are powerful medications, and can cause tolerance when used chronically. We get a lot of patients in the ER who want refills of their pills, and I have heard some far-fetched reasons why. Lost or stolen pills is pretty common, and one that I hear occasionally is, “I accidentally spilled my pills down the toilet.” Come on. Does that really sound believable to anybody?

One thing that continues to surprise me is patients who come in to the ER with a narcotic overdose, but are just awake enough to ask for for more pain medications, usually by name. One moment completely asleep, then, eyes barely open, asking for a dose of dilaudid. Umm, no.

Like most ER’s, we use a pain scale from 0-10, to gauge how much pain patients are having. Seems like 10/10 is the most common response, but sometimes it’s even higher. One of my former colleagues (not known for subtlety) would become irritated when he got a 10/10 pain level from a patient. He would roll his eyes and say “Oh really? So I could take a chain-saw and chop your legs off, and you wouldn’t even notice because you’re having so much pain?” Really sensitive. He had various other horribly painful examples to use depending on his mood. “So if I dropped you into a bathtub full of scorpions, you wouldn’t even notice because of your ankle sprain?”

This same doctor liked to sneak up on patients to see if they appeared to be in pain when they did not think they were being watched. He would literally creep around the corner, on his tip-toes and then pull back the curtain just a smidge. If he thought they were faking their pain just to get narcotics, he would be livid. Come on man, what are we? Twelve?

The grass was greener

Your ER Doc — Tue, 17 Feb 2009 08:34:14 +0000

Now that the economy has totally fallen apart, I finally have some career validation. I must say, I had been feeling somewhat regretful about my job choice, especially at 3am when there was an intoxicated teenager vomiting on my shoes. I would think, “Gosh, I could have a med spa someplace, and be a dermatologist or plastic surgeon catering to rich healthy people during regular hours.” Now that everyone is scrambling just to pay their mortgage, I’m pretty happy I didn’t throw down on a medspa.

Hmmmmm

We’ll see how long I remain happy about my career choice, after the state starts paying my bills with I.O.U.’s.