From the category archives:

Strangest cases

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

Number 4 – Drugs

Drugs like methamphetamines, heroine, and cocaine are the scourge of every emergency department I have worked in. Meth is the biggest problem now. If these drugs did not exist, I have no doubt that health care costs would be much lower, people would be much happier, and my job would be way easier.
Here are the problems you can anticipate if you are using these drugs:
Heart attacks
Infections in the skin, heart and blood
Psychotic behavior (sometimes shrieking profanities at your ER doctor)
Rotting teeth
Heart failure
Liver damage
Kidney disease
Brain damage
It’s always amazing when I see patients who have been using meth for days, and they come into the ER complaining of “Not feeling good.” Shocker! I usually ask why they expect to feel good after using these destructive chemicals for days on end. Then I explain that we are going to get to know each other very well, because they are going to come back repeatedly into the ER until their body is a complete toxic waste dump–unless of course, they quit. Sometimes this works.


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.


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.


Usually when I pick up a patient’s chart, it’s pretty clear what the problem is going to be before I even walk in the exam room. But once in a while, I get something vague, like “I need to talk to the doctor.”



Sometimes this means they are too embarassed to talk to anyone else about what the problem is. Such was the case when I saw a middle aged man who presented with his wife after some trouble with a flashlight.



I introduced myself to the nervous fellow and asked what the problem was.

“I was fooling around with a flashlight,” he sheepishly reported. “Now I can’t get it out.”



“You mean you put it in your bottom?” I asked. He nodded.

His wife was looking at him with such contempt, I really felt sorry for him.

I tried to make him feel better about the situation, and let him know that he was certainly not the first person with a rectal foreign body, but it didn’t seem to help. “When did you put it in there?” I asked.

“A week ago.”

At this point, his wife’s jaw dropped open, evidently this was news to her as well.

An xray confirmed the location of the flashlight, which fortunately had a plastic edge just perfect for grabbing with a clamp. A little sedation, and a couple pulls later, and problem solved. We discussed some strategies for avoiding this in the future, and the dangers of puncturing the colon. He assured me that I wouldn’t see him again in the ER. So far, he has been right.


Its very difficult to rank the most bizarre, fascinating or stressful case out there, but a few come to mind.
I shall never forget a young woman who presented to the ER with what she reported to be a “cut” on her abdomen. I walked up to her bed in a relaxed way, introduced myself, and said “how did you get a cut on your belly?”

She replied with a smile, “I cut myself!”


Something about the way she said that started a couple alarm bells ringing in my head. I asked her if it was an accident, and she said “No, I took a knife and cut myself.” At that point, all bets were off. I worried we were dealing with a major penetrating abdominal injury, and perhaps we were about to start a trauma code.


I pulled back the hospital gown, and found she had about a 10 inch laceration to her abdomen. But that wasn’t all. There was a large amount of gelatinous, yellow-gray goo oozing out of the wound. Now I’ve seen plenty of wound infections, but this was something entirely different. I was afraid to ask, but I had to know. “Um, what is all this stuff in here?” I asked in my most professional, not at all shocked at what I am seeing voice.


“Oh, its noodles, and rice, and some yogurt that I put in there yesterday.” She was clearly happy to be giving me this information and even happier to know that I was completely taken off guard by the whole situation. The poor woman had to be taken to the operating room for a thorough wash out, and later, a psychiatric consult.


Sadly, “cutting” or “self mutiliation” is something we see frequently in the ER. Usually it is less severe than this case, often times patients cut their forearms superficially. It is rarely intended to be a suicide attempt, but it is always something that I take seriously.