Holiday Hijinx

My white cloud brought me no traumas Christmas Day (yay!), so I kept myself busy helping in the other sections for the day. First theme of Christmas: there were many, many people who didn't chew their food well enough, coming in with foreign bodies in their throats.  I have to say, pulling steak out of someone's throat wasn't what I was expecting to be doing!

Another theme of the Christmas season has been the dropping off the elderly at the ER because nonnie or poppy "wasn't acting right." Unfortunately, because the holidays are the only time the family visits, the mental changes in their beloved, albeit neglected parents/grandparents/great aunts/great uncles were not necessarily acute.  "Yes, Mr. Dementia is confused sir, yes, he probably wasn't like this the last time you visited, no, actually, this isn't new- we've seen your loved one several times already this year and this has been his/her baseline. Also unfortunately, it is the holidays and their immediate placement in nursing homes is very unlikely until at least the next business day, please don't yell or call your lawyer?"

There were also many, many overdose patients.  One family found their son unconscious in the bathroom because he had taken whatever pills he had found in the medicine drawer in a suicide attempt.  The parents removed and brought the whole drawer to the ER. It was full of empty pill bottles. The only one still half full was the bottle of Vitamin D pills.  Waiting in the family room, the parents kept harassing our resident.  However, the clean-up process was long. The young man was covered in paint-chip-like flakes, which turned out to be half-digested pills. Yours truly also figured out how to work the new "stomach-pumper", but it yielded little, as mostly everything was already expelled or digested. When we finally invited the parents in, I could understand why the resident got so frazzled. If you could picture older hippie Trekkies, they were the disheveled stereotype.  When we transported the young man to the ICU, the father was at the bedside telling his son that they were going on a spaceship and warping to another universe.  Privately, though, he choked to me, "thank you for the best Christmas present ever, for bringing him back." The father then asked me if we shaved him.  "No, we haven't done anything, why?" "Well, you see, he was about five days unshaven the last time I saw him... So I was just wondering." It was probably how his son meant to look at the "end."  Poor family- I hope the best for them.

Another young man had overdosed on narcotics and was intubated when he came in. A nurse and I felt the long track marks on his right arm and looked at each other- "this guy must be left-handed!" Later, a respiratory therapist had undone the restraint on a wrist in order to draw a blood gas.  Alas it was his left hand! He was apparently awake, pushed her hand aside and ripped the endotracheal tube right out of his throat, balloon still intact and puffed up. Ouch!! He then looked at me and asked me for juice!! The doctor said no and he was admitted to the ICU for observation anyway.

Our Christmas Trannie came in to visit wearing a Christmas speedo. We know because she/he/it was smoking funny things and flashed us while in four-point restraints, shaking her booty and grinding toward the sky for all to see while viciously lambasting us at the same time. Talk about mixed  messages.  She/he/it was visually very feminine and attractive, so hearing his voice screaming in the ambulance bay was rather incongruous.  His bright lipstick made her fast-moving lips a hypnotic and mesmerizing point of focus.

In the midst of the hustle, one of our drunk/psych patients came in and latched onto me in triage while I was taking vital signs. She wouldn't let me go and bawled her sorry eyes out while pretending to be someone else. We knew her from her many visits by name, though, and called her out on it, making her sob even harder.  Meanwhile, our Christmas Trannie was tranquilized, and in the moment she/he/it rolled by, Ms. Hot Mess was distracted and I extricated my hands. The evening thus became considerably calmer.

This weekend has been at moments uplifting, hilarious, and poignantly sad.  All in all, though, I am just very tired... Managers had scheduled me on Christmas Eve Eve (1530-midnight), Christmas Eve (1100-2330), Christmas Day (0730-2000)... I am feeling the most burnt out I have felt since June, the month I was stuck in the drunk tank almost every day.

However, I am thankful to have today off. Post-holiday Manic Monday doubly busy- the day when everyone who said "I'll wait till after the holiday" or "We'll see if it gets better by Monday" decide to come in.  Looking forward to an early bedtime tonight. : )


S

Curiosity Satisfied

I had a patient last night- a youngish man, very thin, with the most beautiful eyes I had ever seen. They were blue, cat-like, full of things unsaid, and fringed with jet black lashes that were long and straight. He came in for his swollen foot and was polite when I asked him if I could take his blood pressure and then take a blood sample.

When I looked at his veins, I found a long, wide streak of brown over one. It was the width of a quarter and a few quarters long on his skeletal arm near the crease of his elbow.

"What's that?" I asked with wide eyes.

"I used to use heroin."

"Oh..." I looked at it again. I couldn't help myself. "Can I touch it??"

"Sure." He was bemused by my request. I am not sure if anybody had asked him that before.

It felt like a large bubble, later I learned about how shooting-up can cause pseudoaneurysms beneath the skin, covered by a thin sheath of brown, leathery callous. http://en.wikipedia.org/wiki/Drug_injection

Some people who lose their peripheral veins from shooting up too much will go and use major vessels. The doctor on duty told me a story about seeing someone who had destroyed the skin and flesh in the upper thigh, creating a perfect funnel exposing the femoral vein.

My patient with the beautiful eyes had stopped using 3 months ago, but he already contracted hepatitis. I hope he stays off.

S

Jailbreak Week: The Smiling Hipster

According to UrbanDictionary.com:

Hipster \hip-stur\n.

Definition 1: Hipsters are a subculture of men and women typically in their 20's and 30's that value independent thinking, counter-culture, progressive politics, an appreciation of art and indie-rock, creativity, intelligence, and witty banter.

Definition 2: Usually has some degree of monetary conformability, although sometimes only because of their parents, due to cost of living...

Definition 3: The Hipster walks among the masses in daily life but is not a part of them and shuns or reduces to kitsch anything held dear by the mainstream.

Definition 4: Aged indie kids, Hipsters still maintain the air of snobbery, still shop atsalvation army, and still have a completely astonishing array of knowledge when it comes to obscure music, pop-culture non-sequiturs, and political sneers.

Definition 5: Referring to young people of around 18-30 years of age, who drink cheap beer (most often Pabst Blue Ribbon, on occasion Budwiser), smoke Parliaments, Lucky Strikes or hard to obtain foreign cigarettes (such as Gauloises) and take recreational drugs, coke being the most popular. Use a great deal of sarcasm, claim to be ironic. Are usually less than 5% body fat, drink copious amounts of coffee and eat children's cereal.

Check check check x5.

He was smart, he was well-spoken, and he was also a heroin addict. He informed us of this in a nonchalant, sing-song-y tone. He was in custody when he tried to hang himself and ended up as a trauma patient on my shift. Because he had "suicidal intent", I was stuck sitting with him, even though I was supposed to be working in the trauma bay.

Alex was very thin, younger than me, with translucent skin. His long eyelashes made his face look innocent, but looks can be deceiving.

He listed all the things he had done as if none of it mattered- in addition to heroin, he took cocaine, but he wasn't worried about the cocaine, just the heroin. So how did he pay for it all? (He looked around with wide eyes- this is all off the record, right? The cop chuckled.) He sold drugs in order to buy drugs. He also lives in an extremely affluent neighborhood with a good friend whose father was a millionaire who owns a successful local business. He had been through college, partially, till he discovered his predilection for narcotics.

He also added serious points to my street cred: So, a bundle of heroin is 20 bags. He takes a bundle and a half to two bundles each day. In each bag, there is about 50mg of powder. In the northeast, the purity rate, according to various online sources, is about 75%. Therefore, if he is taking 1.5 bundles, he is using 30 bags, which is 1500mg of powder, of which 1125mg is pure heroin. >1 g of heroin a day. Mein gott!

Alex had never thought about detox or trying to get better. He described drug-euphoria for us and charmingly made everyone laugh. He keenly grilled the cop about various checkpoints and code names in the city, even offering to help him bust drug dealers.

"Oh Alex, we got to get you out of this life." Nurse 1

"Oh Alex, you don't belong to that world." Nurse 2

"Oh Alex, you gotta find new friends, we can help you get to a program. You're too smart for this." Nurse 3

Everyone was so charmed, but I had a few pointed questions for this young gentleman who answered everything with a smile. I sensed a hint of triumph in his face- one that said, that was too easy.

"So, just between us, did you really want to kill yourself?"

"No, actually," answered the honest lad, "I made sure my feet were partially on the ground when they found me."

I heard a mental gasp from everyone around me as the facade of honesty and pure youth lifted from their faces.

"What? I just didn't want to detox in jail. I figured the hospital was the best place to be."

The injuries he sustained on his neck were from the warden, who really held him up the wall and punched him for faking it until the ambulance arrived.

"So," Alex tried his luck, "Officer, you're a good guy. Can you turn around, I'll take this neck brace off and take off, and you can tell them that you never saw me."

Ah, the hopeless romance of youth. He simpered, smirked, and made love to us all (who knows the reference?), but to no avail; he stayed in custody and stayed in our facilities for the night.

Nice try, hipster kid.

The happy hipster is an oxymoron. The smiling one is just a snake in the grass.

Bye Alex, best of luck, because you really are a smart kid. Here are some discharge instructions from another facility that says it perfectly:

Till tomorrow!

S