Make up post [12 Aug 2007|10:28am] [ mood | mellow ] Since I missed several days of posting I wanted to cover some 'basics' I've been meaning to cover.  Myths about Healthcare: ( Read more... ) Typical ER Cases: Undefined abdominal pain Half the time, you leave the ER with nothing but pain management. This is usually the tool of drug seekers or some other patient with a problem that is not life-threatening. Asthma Attack I doubt this needs explanation, though it would be nice if you took your nebulizer with you. Infant fevers Unless it's over 102, give it a large dose of Motrin and let it sleep. If it is over 102 and it's a girl, it might be a urinary tract infection. If it's a boy it is probably an ear infection. Adult Migraine Take ibeprofin and tylenol together. That's what the ER will do for you and then let you sleep.  Go home, we can't do anything. Children who swallowed(or put in their nose) a coin/marble This is a legit concern, especially if it might be in their wind pipe. Old Ladies who want pity They usually come on sunday evenings. They realize they haven't gotten out of the house all week so they come in for whatever complaints they can think of. Pseudo Seizures This means fake seizures. People will fake them for some unknown reason or drug seeking. We can tell. So just quit already. If you can talk during your seizure, you're not having a real one. Laceration Some cut that needs stitches, this is legit as well. But this gets pretty mundane after awhile. Vaginal Pain/Bleeding Very Legit, especially if you are pregnant. This usually means STD or miscarriage, very sad. give a thought

You are NOT a ninja [11 Aug 2007|09:25pm] [ mood | impressed ] I apologize to all you who check this thing. I haven't been posting recently because we're so busy at the ER that I'm exhausted when i come home personal life gets in the way cases in the ER lately have been "usual sorts of things" Patients of Interest: Sturgis rally is also going on and can be blamed for 1/2 the trauma's we've been getting in. For those that don't know, Sturgis is a huge motorcycle rally with drinking, music, and partying. It's insane. None of them wear a helmet and many many crash because they're not used to wind, dark, or riding in general. We've had at least 3 crash victims a day. I usually have to skip dinner because of how busy we are. However, today we got a 30 yr. old guy who came in bleeding profusely. Apparently, his 'friend' stabbed him with a Samurai sword.  Yes, a really Samurai sword. It wasn't just a joking thing or a pretend fight. It was a "I-wish-you-would-die" fight. His friend was drunk and jealous and stabbed him through the foot between his third and fourth toes. The exit wound was almost at the heel at the bottom of his foot.  The 'friend' also ended up stabbing him (not deeply) in the kidneys, punching him in the stomach, and trying (he missed) to stab the guy's eye out. He was a bloody mess. He had 3 bones in his foot that were broken and had to be taken to surgery to be cleaned out and have a screw put in. I was allowed to come along and observe the surgery. It was interested but hardly worth mentioning if pictures aren't involved.  I told the guy that he needed to get new 'friends'. give a thought

Trauma, Trauma, Trauma [01 Aug 2007|10:46am] [ mood | exhausted ] We had a lot of little crap that was all trauma. Lots of neat stuff, I just covered the biggest. Doctor's Notes: I went to coffee with the new doc and the other interns. It was fun. We met his pharmacist wife and had a lot of laughs. Basically, he said most people just need some encouragement that if you got to med school, it will be okay, you will live, and you can do it.  He explained that getting in is the hardest part and med school is a lot like college once you get in. He answered a bunch of questions for us and we made fun of the students who go all out to get into medical school -- the people who have been to cambodia three times and have tattoos of orphans on their backs.  We talked about interviews, how much it cost to apply and attend a school, what to look for in a med school, etc. I really can't repeat most of this information, because much of it are things I already know from having reseached and read and asked a million and a half questions. The good thing is I got his email address, just in case I have more questions. Patients of Interest: Last night a boy on a regular bicycle got into an accident. I guess he was tyring to come off a curve and as he landed the front tire popped off and he landed with his face. He had several huge lacerations and a spot under his eye where you could stick a pencil in the inside of his face. He had crushed his frontal and maxillary sinus cavities. He had scrapes everywhere and blood just covered him. His neck and his cervical vertebrae are still in question and he was going on suture # 29 when I left.  It was a long night... I also saw a man who worked at a landfill. He was hit in the head with a pipe, that knocked off his hard hat and casued him to loose his footing and fall into a large metal machine behind him. He was out for a witnessed 2 minutes if not more. Lucky for him the machine was off! He had 3 different brain bleeds: subdural, subarachnoid, and subparankamal. He was an angry old codger and he wanted nothing to do with us. He kept insisting he was fine that he couldn't even remember what happened (and therefore it must not have).  Since we don't have a neurologist here, he had to be transported to a bigger hospital. He refused the transport because we wouldn't let him smoke. He was a very abrasive person. The doctor finally talked him into it by bringing his employer into the discussion. Next was a weird one. A girl named Mega came via ambulance. She was found passed out and unresponsive. Most times these cases are fakes from people who want drugs. But she didn't respond to ammonia salts or a foley cathader. The test to see if they're faking is to raise their "limp" arm above their head and let it fall to see if it hits thier face. People who fake their arm will conviently fall above or below or to the side. However, her's was hard to tell. It hit her forehead. And we couldn't tell what was going on. Finally, she woke. She only muttered  "Mama". Later she did ask me to call a friend of hers, but when I asked her how she felt or how this happened, she wouldn't say anything. It's this last part that made me suspicious. But we admitted her, and let the hospitalists decide if this is a real, fake, or some of  both kind of situation. In the ER, you see quite a few disturbing things that no one really talks about. This is one of them: the number of grown men who come to the ER in need of "foreign body" retrieval. If you ever say this to any ER/OR worker they will give you this look and you will know. It is someone who shoved something that's not supposed to be up their butt. So far we have seen: light bulbs, oranges, a dozen cherries, dildos, a shower rod, a glass cup, action figures, pencils, markers, hair brushes, and the most disgusting live gerbils/hamsters. What possesses you to think that shoving a living animal up your rectum is a good idea IS WRONG!!! DON'T DO IT!  The animal dies, and your rectum sucks it in, not to mention it bites and claws inside. It can cause considerable damages. Most people like this have to go to surgery to get it removed.  Beyond why these people do this, my question is can't they tie a string on it so I don't have to fish it out of their bum? 2 Bandaids| give a thought

missed opportunities [26 Jul 2007|08:09pm] [ mood | jealous ] Today wasn't very interesting minus the biggest, most dramatic patient of the summer!! At 9 a.m. this morning a 59 year old woman walked into our outpatient services to get a medport placed. For those who don't know what it is it is basically a perpetual IV port so all injections and blood can be taken out of the port rather than being poked a million times. The woman had terminal lung cancer.  Before she was allowed in surgery the triage nurse yelled and everyone came running. The woman was puking huge amounts of blood. The walls, nurses, doctors, and beds were covered. they tried to intibate, but she wouldn't stop puking blood. Within 5 minutes, the woman was unconscious. CPR was started, however, she was a DNR so we had to let her go. Her husband was there through the whole thing, grabbing random nurses to cry on.  Apparently, what had happened was the lung cancer had eaten through her pulmonary vein, thus everytime her heart beat, it would pump the blood up the tube, into the lungs, trachea, and out the mouth. She literally pumped/puked all the blood out of her body.  She died within 10 minutes of this fateful event happening.  The nurses kept saying that all the years they've been in the ER it was the most amount of blood they've ever seen. It was the most amount of blood all the doctors said they've seen.  And i missed it!!!  lucky larry -------- On top of all this, I have been trying to see a delivery all summer (you know the part where the baby comes out) and thus far I haven't had the opportunity. I did though last night as I  finally caught one of the OB/Gyn's running through the ER entrance. The first time she said it would be another couple hours, and I decided to stick around to wait for this baby. But when I caught her the last time,  we got to the nursery and the baby was already born. Like just born.  I got to see the delievery of the placenta. Its cool and super gross, the most interesting part was just the fact that the dad, regardless of the 5 am time, called everyone he knew to tell them. He was so excited he was literally jumping up and down. He kept saying, "She's so beautiful" and "Good job hun". I had to work hard to contain my laughter when his wife looked like she was going to knock him out with a crow bar. She had ripped both sides of her vagina and the doc told me that its uncommon for a woman NOT to rip. (oh the joys i have to look forward to). Her muscles were shaking and she was so exausted I was surprised she didn't pass out. I did get to ask the doc a few questions and one included post-partum depression, which everyone gets since the estrogen levels used to make the baby and keep you feeding the baby suddenly plummet. Everyone supposedly gets weepy and sentimental, even if they aren't that kind of person. Childbirth is still pretty dangerous she said, though she hasn't had a person die on her yet.  She hasn't been sued either AND she even had 3 kids of her own. Crazy woman! :) Hopefully next time! give a thought

dates & rapes [22 Jul 2007|08:11pm] [ mood | amused ] Doctor's notes: Really you have to learn how each doctor likes it, some want it one way and some won't take it any way but their way. Its crazy.  Patients of Interest: We've been having a slew of sexual assalts lately. We have special nurses that have to deal with the collection of evidence, called S.A.N.E. Nurses.  I followed one into the room of a 15 year old girl and watched as they collected hair, mouth and vaginal swabs. They did a lot! Collected all the clothes and it was pretty gruesome. I was afterward reemed by the doctor for 'inappropriately' watching a rape collection. She said I knew how she felt about it and went behind her back. (talk about ridiculous).   As much as it sucked, the doc got over it by the end of the night. We also saw the suspect in that rape and took samples on him. I didn't watch, he disgusted me.  We also had several drunks come in with lacerations. Several which decided I was hot and started chugging saline water (which is gross) and trying to put in his own stitches. It was ridiculous. One absolutely refused to let me out of the room until I have him my number. I gave him a fake one.  Another was older and grabbed my arm saying "I haven't had sex in a long time," I couldn't help but laugh and mentioned it would be a while longer.  How awful who dates patients? Especially dumbasses? Notes to Self: -be lax on the judges -don't have to have it your way.  -come up with a good come back for drunks and dates. give a thought

Night Shift [17 Jul 2007|03:16am] [ mood | restless ] doctor's notes: The coolest part of today wasn't the patients. Instead it was our newest doctor. Today was his first day and I only got to see him for an hour, before he went home. He has just and I mean two weeks ago, finished his residency. It is his first time being on his own. I need to formulate some questions, when I finally work with him again. I didn't get much of a chance tonight. But i'm really excited. Patients of Interest: none. That's right, we really didn't have anything I haven't talked about.  A little boy who couldn't swallow pills and a little girl who tried and did. Yet again the boys are wimpy thing. Lots of chest pain, but nothing conclusive.  Larry the intern showed me a CT of someone who had excess CSF in their brain. Looks the same as a subarachnoid bleed, but it appears darker on the CT. I didn't get much to do... give a thought

code blue [12 Jul 2007|07:51pm] [ mood | contemplative ] I watched a man die today. We had two code blue's. Code blue means that someone's heart has gone into ventricle fibrillation or (v. fib.). It means we have to shock someone with the paddles everyone sees on all those medical tv shows. The first one happened when I first arrived on shift. The man was having a heart attack in front of us. He went into v. fib and it was very startling. I wasn't expecting the large jump from the guy. That must hurt! The man was driven to a cardiologist.  He lived and is doing quite well. The second one was the hard one. All we knew was he collapsed and was unresponsive. Our John Doe got to us, he was mid-forties. He already had a breathing tube down his throat. He coded on us about 5 times, several times we had to do CPR Chest Compressions. I did them. He started to breathe on his own and his heart beat became regular. Until his brother got there. Then he coded 8 times and the brother started crying. The shocks had less and less affects and he started coding faster and faster. I really started wearing down. Chest compressions really take it out of you, especially when his organ function depends on you getting him 80 heartbeats a minute. It was adrenaline rushing and very stressful. Finally the brother said to stop, officially making him a DNR (do not resuscitate).  Finally he went down. We took everything off and let him die. I learned the brain stem is the very last thing to go. So even after you're technically "dead" you continue to gasp. It's called agonal respirations. When he died it was weird, he turned purple & grey. There was no defining moment. I felt a little guilty, because I knew he died right in front of me and I didn't feel anything. Not numb, not sad, not anything. I just went to the next patient. I helped the coroner put him in the shiny red bag. It made me wonder a lot though, how many people die each day? How many people don't get to sleep tonight because they died? How many people spend the night lying awake, staring at the ceiling wondering if their was a heaven for that person? After being in the ER only a few months, I have to say, I can't believe everything happens for a reason. Many things happen because of stupidity, but some things just happen.  give a thought

the real ER life [09 Jul 2007|02:11am] [ mood | bone tired ] Doctor's Notes: I learned more about one of our newer docs. he's really neat with many interesting stories about big trauma's in Cleveland, Oh. He also made somewhat of a discouraging comment for me. He said docs need to be anal and detail oriented, because if you miss the detail that's when disasters happen. That's a problem for because i am the least organized, least detail person that ever exsisted. I wonder if there is hope or not...... Patients of Note: Today nobody wanted what we gave them. We had several patients we actually had to hold down and restrain. One was a little boy who needed stitches in his butt. He wasn't too happy and all he wanted was to leave. It was kinda sad, but easy to hold him down. Right after that we had a 16 year old girl whose boyfriend broke up with her, so she drank as much vodka she could find in her house, did some pot, and took tons of pills. When she came in she was glazed over, stone, drunk, and really out of her gourd.  Because we didn't know what pills she had taken we had to pump her stomach, something we do so uncommonly the nurses had trouble remembering how the device worked. The girl obviously didn't realize what was going on and she fought. HARD.  She bit, she hit, she screamed, she spit, it was awful. Finally the doc threw her in the bed, tied on restraints and literally shoved the tube down her throat. I was so surprised by his aggression. He had apparently lost patience with the girl . Then he got mad at the nurses for not remembering the device to pump her stomach. It was a rather tense situation. She gagged and fought with us the whole time and it took the entire ER staff to hold her. She got vomit everywhere and we finally got some charcoal down and she vomited it up so we had to do it all over again. Talk about an ordeal. She got put in ICU, she won't remember it tomorrow. Her alcohol level was sky high and the pills we had taken out of her stomach were enough to kill her, she's lucky we forced that tube when we did. We also had one paitent who broke his arm by the wrist, and we had to call three docs in to try to 'reduce' or put the bones back in place. I have never heard a guy scream louder. It was awful. He didn't take to anestheia well. Notes to Self: -if you're going to have this job, work out more. So you can be of much more help. give a thought

Life Flight Anyone? And Finally a Surgery [06 Jul 2007|09:30pm] [ mood | excited ] We had several people who were life flighted out to bigger hospitals. It is not unheard of but not exactly common. I also got ahold of a cool surgeon and she let me watch one of her better surgeries today! How cool!! Patients of Interest: We had a guy who broke his neck, quite literally. He completely snapped C2 (the second spinal bone) and broke C3 in the body, pedicle, and lambda. he got bucked off a horse. Apparently he walked home and drank a few shots of whiskey. He got flighted out. We also had a guy who worked at the coal mine. I guess he stood on a grate and the coal dust spontaneously combusted and he was engulfed in a ball of flame. He had second and third degree burns on his arms, face and belly. He was sent to a burn center. Poor guy. I also got to see a subacious cyst. I guess he gets them every couple of years. He was seen by another doc and she didn't really help him or listen. I know because I was there that first time. Today, he actually had a good doc. And i think he's going to be fixed. Finally, The SURGERY!!! It was a thoracoscopy. It was really cool. Basically, this woman had something grown into her shoulder and chest cavity and we needed to find out what it was. It was really interesting we deflated the lung, it turned purple which means no air. (pink means yes air) But there was some stuck to the top of the ribs with a pearly goop. We sampled the pearly goop and I got to hold the aorta away while the docs did the rest of the surgery. It was fun, they are really funny. Its like kids playing in a mud puddle. Both surgeons really like their jobs, but they're really rude to their nurses. They treat them like crap, I felt sad for them.  Turns out it was malignant cancer (the bad kind). Notes to Self: -If i ever become a surgeon I swear to be nicer. give a thought

today's special: posterior splints [06 Jul 2007|06:32am] [ mood | apathetic ] Doctor's Notes: I had some time to talk with the hospitalist. He said his daughter was just accepted to med school. I was able to ask him a few things about med school and some advice.  He said, "If you want to go to med school make sure it fills your soul to work with patients and sick people otherwise its not worth it,"  Oh by the way, this guy, loves his job. We got a new nurse today from Oklahoma. She worked in a teaching hospital with real medical residents and med students. I've been trying to pump her for informations, but she doesn't really know what I'm looking for, and I don't really know either. Patients of Interest: We had a guy come in showing symptoms of a Kidney Stone,  so we gave him an MRI and instead of a kidney stone he has a mass on kidney which is bleeding and causing clots to travel down his ureter, which is causing the pain. So we did a biopsy on his mass and he has cancer. Can you imagine thinking everything is fine to find out you have cancer! We had several posterior splints today. Other than that, pretty boring day. give a thought

Happy 4th! [05 Jul 2007|08:45am] [ mood | drained ] Yes, I have missed a few entries because I was so tired. But everything I was going to say is now lost forever. I do not remember. However, the fourth really wasn't as big as I had hoped, but i guess that's good. Doctor's Notes: I learned "Orthostatics" today. It's the test for dehydration. First you have the patient lay down and take thier heart rate. Then after 5 minutes have them sit up and take it again. Then repeat while standing. If the difference between the laying down HR and the standing up HR is greater than 15 the test is positive. Patients of Interest: There was a little boy who was 2 who had been seen yesterday. Apparently his older brother of 4 had squirted something into his eyes, some kind of chemical. The ER washed out his eyes and gave him numbing eye drops but the mother brought him back because the little guy refused to open his eyes. He would scream bloody murder if we tried to even touch them. We flushed them again and the doc  put in some kind of dye. Turns out the chemical had heaten away at his cornea and it hurt the kid to have air on it. Poor little guy. We had an African American guy who had had bypass surgery recently who was feeling 'strange'. Next thing we know he looks like he's sleeping and we are unable to get a response. It was kinda scary. I watched the doc put in a central line. Talk about fascinating! So we saw a case that so far has topped all my others. A 17 year old girl walked into the ER crying and complaining of vaginal pain. Many of the nurse's were skeptical of her story because of how many drug seekers we get. However, the doc did a pelvic exam and the smell that eminated made everyone in the room want to pass out. She was oozing this yellow puss-like substance. She had little sores down there and lots of pain. The doc came out saying "She has the worst case of whatever it is i've ever seen!"  Turns out she had the most severe case of Herpes. The sad thing is that she is going to have it for the rest of her life, at 17.  We saw a family who had opted to get the series of rabies vaccinations because a lamb of theirs died from rabies. The doc was telling me that its always best to do it because if you contract it, it's 100% fatal and it's an ugly death. Kinda interesting to see. They don't give shots in the stomach anymore, it's all in the bottom. There was also a guy who had "accidentally fallen" on a bottle of asprin who had the bottle lodged in his rectum with some suspiciously clear liquid that resembled petrolum but he swore he "fell" on the bottle. He had to be taken to surgery to get it out. talk about gross. No firework injuries. Kinda sad. Notes to Self: -The doc says 30% of the population has Herpes. Ewww. -Force self to write these before going to bed, instead of days afterward. -Sleep more than 5 hours a night dummy!! give a thought

Goodbye Dr. Ally you will be sorely missed! [25 Jun 2007|12:45am] [ mood | tired ] Dr. Ally is leaving on tuesday for her traveling doc job to vermont. Today is the last day I get to see her. I will miss her jokes, her way of explaining things, and her frustrations. Doc's Notes: Today I got my first writeup. A drunk patient complained about me to the administration! How exciting. His complaint was I gave hima  call light. Oh darn it. ^_^  but no regrets here. It was kinda fun. I saw a family who had hereditary angioadema (swelling) and learned they have a shot for that kind of thing. Its $2,000 a dose and it goes bad so the US doesn't carry it. You can only find it in Europe and China. How weird is that? Patients of Interest: Today was very busy. I saw a guy with scabies today. Dr. Ally told me that she had scabies twice in residency because of patients she saw with it. Kinda a funny story. We also saw a guy who put a gun to his head. A little over dramatic, but i guess he has a history of this kinda stuff. Post tramatic stress syndrome. Guess he went over to iraq and couldn't handle the reality of it.  Dr. Burnout told me that there is about 30% or more of the population who just can't mentally handle seeing anyone be killed. I spent three hours with a guy who wrecked his company vehicle. He was a disaster. He was alive, but had broken his humerus into three fragments, broke 8 ribs, fractured 2more, had a deep 5.5 in. scalp laceration from his forehead to the back of his head, and two black eyes. It was crazy. I had to help hold his arm for hours while they tried to get xrays, but he was on a backboard and those always cause more problems than they're worth. He had blood everywhere and it was really interesting. The guy was a little older, but he was very nice. Needless to say, he was admitted. I also saw the pits of the Er today. A mom brought in her 9 year old girl, because she had a sunburn. The mom called the cops, because she claimed the dad abused the kid. FROM A SUNBURN. It wasn't even that bad. Nurses said this kind of thing happens all the time. The parents split and use the kids against one another. Its awful. The mom just wanted documentation that the kids were seen in the ER and the police came. I guess many judges don't really read the doctor's reports. What a shame. give a thought

heat = patients [23 Jun 2007|07:36pm] [ mood | sad ] Today was 99 degrees and we had PLENTY of patients.  I had to run about today that I really didn't get to watch the complete care of any one patient. Sometimes i'd just see procedures, or hear half a story before I was pulled away to do something else. But this is as good as I can get it. doctor notes: I talked to a D.O about being a D.O. He said he never had a problem finding a job, and many people (including me) never knew he was different than an MD. He did however, admit he hadn't done manipulation in many years. He said many things, but the most interesting was that he said the main difference in schools was that he loved his classmates a lot more than many of his MD co-workers. Most people go to DO school to learn how to help people, the status and the money doesn't really factor in, he said. That's a good point. Something to consider I suppose. Dr. Ally's last day is Tuesday, and I don't work anymore days with her except tomorrow. I am heartbroken. but she told us a story of what happened this week. I guess she was off for a few days and a very unpopular doctor called her in because he needed help. She came in and there was two patients in the whole ER, she saw them expecting them to be really hard or something. But they were very easy. In the meantime, the unpopular doctor (let's call him Dr. Burnout)  snuck out. That's right he just left.  Well of course they got slammed later and only had Dr. Ally. That sucked for her, and she got a call later that night. It was Dr. Burnout who asked if she was getting out there soon, because he was having beer and nachos and a party at his house. Needless to say Dr. Ally was so angry she started laughing hysterically. She's just one of those people. I understand why she's not staying. I finally feel apart of the hospital staff. My services were required today. And I finally felt at ease. Everything will be okay. I even like my job, STILL! Patients of Interest: I saw a popular girl I went to high school with. She gained about 70 lbs and was pregnant with her first kid, by a guy she didn't even like. That was kinda sad. The baby is a boy, she is about 23 weeks along. We had several life or death 'couldn't breathe' cases, they all lived and got admitted to ICU. If we can't figure out the cause we send them up to let the hospitalists figure it out. We also had a woman who had breast cancer in her brain. She was really funny and interesting. But she showed me how hard it would be to be an oncologist. To watch cool people like herself, who didn't deserve to die.... die.  I couldn't take it.  I'd rather work on the psych floor! (which I wouldn't) We also found a woman who has pnemonia AND a tumor in her lungs. That sucks, alot. I witnessed a blood headache and a blood patch to fix the headache. Basically there was CSF leaking out of her spinal column because of an epidural. So we put blood from her arm in the hole and it clots and Viola! A blood patch. It was like magic. Notes To Self: Don't leave us Dr. Ally! I will miss you!!! give a thought

night shift [20 Jun 2007|10:14pm] [ mood | bored ] Second night shift I brought my computer, so of course it was busier. But nothing too cool. Doctor's Notes: Today I learned to hate medical articles in newspapers. In our paper, there was a large article about a girl who had a rash and got super sick. Doctors didn't catch that it was some kind of tick bite, and she got super sick. So we had oh, about 20 patients come in today with their kids claiming they had tick bites, or rashes, or something ridiculous. Patients of Interest: I saw my first case of West Nile. He had a fever, chills and a headache. We see it fairly frequently apparently and there is nothing we can do. If you have 'brain fog' that's when you're in trouble.... I also saw a pair of twisted testicles. It wasn't that cool. I also saw some shingles. Its chicken pox on only one part of your body. I found out that chicken pox and shingles is from the herpes virus. Who knew? Also many rashes,etc people mistake for insect bites. Its rarely an actual bite. Note to Self: Night shift sucks. give a thought

paid programming [19 Jun 2007|07:29am] [ mood | tired ] so this is going to be out of the ordinary. I just pulled a 7 to 7 shift. And i should have slept longer, we're all lucky i don't pass out now. basically we got no interesting patients. from about 3-7 there were literally no patients. The doc slept, the nurses gossiped, and I got paid to watch early morning star trek and paid programming. It was the most boring thing I have ever done. And i have to do it again tonight. SO i'm going to sleep, but next time I'm bringing a book. literally nothing interesting. the random narcotic seeker and a girl who had mono who slept in an exam room until 3. it was pathetic. Is it wrong to hope for a car accident? give a thought

lac day [17 Jun 2007|12:32am] [ mood | busy ] GAH! I just typed this stupid thing and the computer deleted it. I could... toss it out the window right now dang IT!!!! Basically, lots of patients today, but they were all just whiney. We had lots of lacerations, lots of little old ladies who fell and broke something or got a cut, lots of stitches, lots of narcotic seekers, and a few crazies. Doctor's Notes: There was a hot topic in today's news that was on everyone's lips today. A woman in a JFK Hospital died in the waiting room of GI bleed. The journalists tried to make it seem like it was the nurse's fault and that made lots of our nurses angry. I don't know the whole story but i guess the woman would vomit and the janitor would mop it up and nobody noticed or something. Not a good deal at all. But as the doctor pointed out, closing that hospital is not the answer. Its already in a place where no one wants to work and closing it makes the surrounding hospitals under pressure... not going to be a good situation. Interesting discussion. Patients of interest: One was a boy who jumped on a trampoline and had an 11 cm laceration on his leg from falling. He was 19 and he fainted at the sight of his own wound. It was pretty impressive though, you could see fat, tissue, blood vessels, muslces, fascia, and bone. I had to keep telling myself i wasn't in anatomy class. It is a sad thing that no cameras are allowed in the ER, because i would have taken a picture for you. he got 24 stitches. We also had a vehicle rollover from a group of teenagers (who weren't wearing seatbelts) who all worked at Applebees. One particular girl had hundreds of deep, tiny, dirty lacerations that went 360 degrees around her upper arm, including armpit. It was hard because of how dirty they were we needed to clean them, but because of how many there were we couldn't numb them all. I'm sure it was quite painful, but she handled it well. Notes to Self: Defeat Kung Fu a little better, because the problem has not been remedied. The good thing, I start my night rotations Monday, so that should be interesting. give a thought

my kung fu [16 Jun 2007|01:07am] [ mood | bored ] so a particular doc is known for having bad kung fu, as in all the trauma's and cases come in when he's working. Think attracted like a bug zapper. My kung fu is well known because when I work I miss all the interesting cases and traumas. When i work nobody comes into the ER. Today we discovered my Kung fu is stronger than the other doctor's. He worked today as did I, and we had a grand total of 15 patients. TOTAL. In a County Hospital on a friday night. Yeah, it was pathetic. Doctor's Notes: I talked to several docs today about DO vs. MD. And as far as i can tell they think that DO is almost the same thing, but DOs are the people who couldn't get into MD school.  KInda lower on the totem pole. Patients of Interest: this gets pathetic. We had a girl with a fishhook through her finger. We cut it with wire cutters and popped that sucker out. Not as cool as I had hoped. We had a woman who had 3 tattoos and 2 children come in for a hangnail. Then when we went to numb the area she freaked out, as in had to restrain her physcially because "she didn't like needles". Talk about ridiculous! Finally we had a drunk, who came in almost non-responsive but woke to ammonia salt and started threatening nurses and punching doctors. Needless to say, we had him arrested. He was 25. A cab noticed his body in a ditch outside a bar. Notes to Self: Defeat my own kung fu. give a thought

Medicine & Crashes [12 Jun 2007|01:33am] [ mood | lethargic ] Today I had an "off" day. I seemed to be very tired, I was making stupid mistakes, and didn't seem to get anybody of interest in the ER. I felt lazy even though I tried not to be. doctor's notes:  Perscription Pad a GI cocktail, used for heartburn, epigastric pain, and GERD: mylanta lydocane tylenol shake well. take like a shot, works in 5-7 minutes. the most prescribed medications in the ER: 1- morphine for the pain. if you don't have pain why are you in the ER? 2- Benadryl - that's right, just the over the counter kind. the nurse's favorite by an overwhelming majority: phenergan- it is given to calm the stomach, reduce nausea, non-narcotic, relaxes you, makes you drowsy, and is an antihistamine. it is given to stop vomiting, help with dizziness, anxiety attacks, over zealous patients, and patients with angioadema and swelling (with benadryl) Patients of Interest:\ Today we had many many car accidents. We had a three car crash and a fracture vertebrae. We also had a rollover due to alcohol use. He had glass everywhere and  two small head lacerations, which covered his body in blood. How head wounds bleed! It was kinda interesting. I also saw a really cool birth defect today in a 21 year old man. He had regular kidney stones, but his kidney was the interesting part, a horseshoe kidney. Instead of two kidneys he has one giant kidney shaped like an upside down horseshoe. It is a manageble as long as he doesn't hurt or lose any part of his kidney. It was interesting. We also had several railroad employees who are milking their company for as much money as possible. The companies seem to be settling for ridiculously high amounts. So they claim to have driven through a mine blast and had a "bad taste" in their mouth and DEMANDED to have blood cultures taken. Problem being a) they were just fine and b) blood wouldn't tell us if they were poisoned anyway. They called a lawyer who demanded we do the cultures. Some people and their thinking they know better than the doctors! How annoying! I also got to see a guy who touched the radiator in his car when he thought it had cooled down. His entire thumb was a giant blister. One of the older docs let me lance it, drain the puss, and bandage the thing. How cool is it that I GOT to LANCE it. That rocked. It was a second degree burn. Notes to Self: Get a life. I find myself depressed on days I don't work. I don't know what to do with myself and find I would much rather be at the ER. I usually think of all the cases I am missing and sometimes wish I was the only intern. 1 Bandaids| give a thought

Severe Vaginal Bleeding Day [08 Jun 2007|01:00am] [ mood | determined ] lots of menial stuff today, we were quite busy. The intern who had worked here last year finally showed up. Intern Larry. Intern Larry is one year my elder and quite the charismatic hottie. He's smart and all the nurses just love him. I feel a bit left out, even though I know I lack his confidence and charisma. I now feel like I have to work extra hard to stay in the nurses radar.  Even after he left, he was all the nurses could talk about. Looks like I've got my work cut out for me. Doctor's Notes: Dr. Ally also wanted to know the status of our patient Justin and so we called many docs and finally got one who would tell us he was alive and breathing on his own, though not conscious. So that is good. I also discovered there are two docs in the ER who are resented. They're brothers and they never want to work. They are what we call, "burned out" to the most severest degree. One more than the other, but they're still both gone. I also found out a regular work week for an ER doc is about 120 hours, the two burn outs only work 80 if that and are considered full time.  There is another doc who is female and apparently is really well known for doing urine tests and rectal exams when they are unnecessary. I've heard a lot about her, but I didn't know how overboard she went until today. Sprained ankle and some back pain, let's stick a finger in his butt!. Awkward! Patients of Interest: So one of the doctor's today made me accompany him on all pelvic exams. He also made me look inside, which I'm almost glad about. One woman I knew, yeah, now I might know a little too much. How you shave your pubic hair, something i don't really want to know. However, one woman came in with severe vaginal bleeding and her case was interesting, but sad. She came in 5-7 weeks pregnant, so we blood tested her to find out how long. We also did a pelvic exam, but this time she had a very large about the size of your palm chunk of blood clot and TISSUE coming out of her cervix. When I saw this I exchanged looks with the doctor and he nodded. She was having a miscarriage right there in front of us. Talk about gross, yet fascinating. Don't worry though, the lady already had 3 live kids. Wow, I have really spent way too much time in the ER. We also had our pysche case for the day, a 21 year old male stabbed himself in the throat then called 911. That was superfun. He came in covered from head to toe in blood, screaming, cussing, and in handcuffs. When he finally got in the trauma room, and I started frantically cleaning his neck to find the cut for the doctor, he begged the handcuffs be released and promised to be a "good boy" which was rather amusing. He wouldn't answer any questions about why he did what he did. I got him all cleaned up and the cut turned out to be two centimeters wide and about 1 deep, just barely missing his jugular and carodid vein and artery. Lucky kid. His parents came in and they released him from the handcuffs. "all he wanted to do was give them a REAL hug" whatever that was.  Then he cried and told his parents he did it cuz "of the pain in my heart" was all we got out of him. We didn't get to sew up the cut because it was on the neck, and he couldn't go to psych until it was healed. It was a mess. We later found out it had something to do with his girlfriend, but he wouldn't speak with anyone including her about it. What a weird kid. I also discovered today that many moms cry when their kids are crying. That is kinda a weird concept for me since I'm not a mom. Oh and we had two 13-year-olds, unrelated come in at the same time. One I went with Dr. Ally to see. Apparently this boy had threatened to commit suicide. He didn't have a plan and he told the doctor he didn't mean it. The mom had been in rehab the month before for drugs and though the kids still live with her, she doesn't have legal custody. She believes that he does what he says, and I got the impression she just didn't know how to handle her own issues, let alone his. She absolutely begged Dr. Ally to keep him overnight, at which point the boy cried hysterically promising he didn't mean it and would never do it again. I think taking him to the ER is a weird way to show your kid there are consequences for your actions, also very random and mean. But there were obvious issues with this family and so we did keep him. The other 13 yr old turned out to be girl who was abused by her father, also had a druggy mother, and threatened to commit suicide. But the doctor beileved her whole heartedly. She tested positive for PCP, asked for a pregnancy test, and openly scorned her mother. We kept her too. The final interesting patient was a lady who just seemed off. She acted the way I expected a homeless, drunk person to act. She was hazy, lost her train of thought easily, couldn't get up, said things that didn't make sense, and her legs kept moving. The doc does a neuro exam on every patient who walks through the door but this patient is the only one I've ever seen to fail it. One of the very few relevant things she kept saying was "Make my legs stop! I can't make them stop!" She was visibly and not faking trying to make them stop. Her husband was crying. He told the doc that not an hour ago she was completely sane "like the rest of us" and she wasn't like this ever. Apparently it had just started an hour ago.  She was given benedryll and that immediately improved her mental status but here legs were flying everywhere. Turns out she had toxic shock. Weird case of it, but that's what it turned about to be. One of the medications she had been given for her post-surgerical neck. Notes to Self: figure out why I'm so competitive with Larry, and fix it! Also work harder. Make friends faster. Go above and beyond, even if that means giving up the cool cases. give a thought

do no harm [07 Jun 2007|12:59am] [ mood | indescribable ] Today quickly started getting interesting starting first before I arrived at the building. We had a crazy large storm that hailed and we had several tornados touch down. This made it hard for me to get out of my car regardless of the fact that I was in the parking lot. I got a large welt on my arm and head from the hail, but I dealt with it. Patients of Interest: We only had two patients of interest but both were worth it. The first is an elderly woman who looked like she had 2 buckets of blood spilled on her. It was another nose bleed, but this time it was fairly intense. Everything had quit bleeding by the time she had gotten to us, but she looked as if she couldn't have had any blood left in her veins. Apparently she was on blood thiners which didn't help the process. She was an overweight woman and it took two of us to get her out of the wheelchair even though she could walk. We tried to help put her in a bed, when she fainted on us. And we couldn't hold her up. Luckily her son was there and helped us. Though I must say that she smelled rank. Blood + pee + old people = nasty.  We finally got her in and cut off all her clothes and put her in a gown. We gave her an IV and some extra blood. She looked much better afterward. The doc came in and he gave her some actual COCAINE. That's right COCAINE. He mixed a white powder with some liquid and put it up her nose. He said it would dull the pain, constrict the vessels, and overall make her feel much better. And what do you know it did! The second was a kid I saw on my way in. He was about 14 and brought in by ambulance. I didn't think much of it other than he moaning and seemed to be not all there. Later, I gave him a blanket and he smiled at me. He waved shyly and as he tried to speak I realized he was autistic. I was told he had the brain capacity of a 5-year-old. His real name was Justin. I didn't get to see Justin much, because I didn't know he was special. I was running about doing things interns do, when I went to check on Justin. The amount of oxygen in his blood was very low and they were trying to give him pure oxygen, but he kept puking into the mask. Finally, Dr. Ally makes several calls to specialists but hung up because, Justin had crashed. I find out as Dr. Ally is screaming at the nurses that Justin was found at the bottom of a swimming pool and pulled out after 1-3 minutes. He was then given CPR which allowed him to breathe on his own until now. They had done an x-ray when the boy was fine and it didn't show anything worse than pneumonia. But it turns out that once you're underwater it makes your lungs a little marshy, and your aveoli don't like it, so they go on strike. We had to intibate him, it took three tries between him moving around and his anterior trachea, but we did get it. We then put every tube in him we could. A Catheter, a tube to suck the contents out of his stomach, a suction tube to suck what bloody water we could out of his lungs, and three IVs. Our first venture is to make sure we got the breathing tube where it should be, so we xray and run more tests. The xray shows us his lungs are WHITE, which is very very bad. What of the nurses pulls me aside to explain to me what ARDS is, Acute Respiratory Distress Syndrome. It means the oxygen is in his lungs, but it's not getting into his blood. It also means that he is probably not going to make it. At this point things have calmed down and since he's one of two patients in the ER, I get to find out more and ask more questions. Justin was taken away from his family when he was 8, and he belonged to the school for mentally challenged kids. He came in with a single teacher, who was trying his hardest to care. At this point we normally would have hiim life flighted to the nearest children's hospital, but because of the bad weather the helicopter can't come. We can't keep him in our ICU because the beds are all taken and no doctor feels comfortable with a pediatric case like near-drowning (especially since he probably won't make it).   In the meantime, Justin's oxygen rates continue to plummet and his blood pressure is sky high. Dr. Ally is pacing the room now, biting her lip, chewing her fingers, very distraught. She brings in several medical textbooks and looks through them and keeps murmurring "I don't know what else we can do! Why is he getting worse? Why?" and other things of the like. Many bad words were said until she got a bright idea. Maybe the tubes and not breathing well is causing him pain. Give him some morphine. And like magic his blood pressure slowed. HIs oxygen rates did not get much better, but they become stable since his blood wasn't flowing as fast. After this the helicopter crew calls us and says they won't be able to come up until 3a.m. if we can keep him alive that long. I think Dr. Ally was the most frustrated I've ever seen her. Instead she hung up and started calling other hospitals nearby but none of them could get here or they didn't want him. So we run about and call many people until we finally assemble a ground crew of 3 (EMS driver, Respiratory therapist, and ICU nurse) to drive him 7 hours to the nearest children's hospital. He wasn't doing better when they left, but he was somewhat stable. After they left, the doctor felt more comfortable talking to me about what had happened. First she told me that she didn't think he was going to make it. As in a 98% chance of death. She said he had about a 75% chance that he would die before they could get him there. And that was really depressing. Then she said dictated a 3 page transcript of what had happened and explained that this was a prime case where the parents are going to sue. She said she would bet her medical liscense that they will try to sue: her, the hospital, the nurses, the government, the pool, the ambulance crew, the mentally challenged school, and anybody else they could get the names of. It was a very interesting case to be apart of. It wasn't a death, but it was definately life or death. It was weird because every small thing counted. When he moved his hand or foot or mumbled something everyone wondered, will that be the last time he ever moves? Will that be the last thing he ever tries to say? It was hard, some parts of me were ready to deal with his death.In some ways I was unaffected and looked at him as just a patient who needed to be saved, almost like a project. And other parts of me wanted to go to the bathroom to cry because he was just a boy, because he had never really lived. And even if he does, he will have further brain damage. But one part in particular made me excuse myself for a little break. The fact that I will never know if Justin made it. Once he gets on that ambulance he is out of my care and I'll never know if or when he died. I'll never know how or who came to his funeral. I'll never know if he made it to go back and play with all his friends at the school. And in some ways, I almost don't want to know. Because the last time I saw Justin there was still hope, even if it was only 5%. give a thought

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