Bloody Assumptions

A woman dressed in all white rushed in and slapped her hand on the triage counter to get our attention.

"My husband! I need to see my husband!"

S: "Ok, let me look him up in our computer to see where he is."

"Hurry, this is an emergency!" And she burst into worried tears.

S: "It looks like he is not in our system yet. Did he come in by ambulance?"

"Yes. I can't believe you won't let me see him."

S: "Please try to be calm ma'am, you actually arrived before the ambulance did. What is he coming in with?"
She tearfully listed an extensive list of cardiac surgeries and history, his passing out at dinner, and that he had "stopped breathing twice." The triage nurses and I looked at each other- this sounded bad. We looked up to see him coming into our ambulance bay, and Ms. Hypochondriac ran to his gurney.

I followed her, and saw, with horror, a vomit basin filled with bright red foamy stuff. I've seen bloody CHF spit-up before, and this looked just like it. He groaned and seemed weak so the triage team expedited him to critical care before even getting his history.

I brought him into the room and helped the critical care team immediately undress him, take an ekg, and put him on our monitor system, gingerly removing the large red-filled basin to a biohazard bin. Upon looking closer at the bin, I froze. What were those little granules?

I asked Ms. Hypochondriac if it was blood. "Oh, goodness no, he raspberries right before we arrived."

I stared at her blankly as it began to register. "He ate such a big bowl," she added with big eyes, as if eating more would have made a big clinical difference.

Raspberries! Such a big fuss over vomited raspberries!

It was not blood in the basin, which I verified with a gastroccult. I could barely leave the room without letting Ms. Hypochondriac see the grin on my face. I don't think she could have appreciated it.

Working in the ER, we are so hyper-focused on the worst-case scenario that it is sometimes hard to see the most obvious (and comical) possibilities.

S

"So I Was Having Sex Today..."

(in an increasingly serious order from funny to NSFL)

Patient 1: "... when my boyfriend grabbed my boob and now it feels kinda lumpy and sore."

S: "Is that why you came to the ER today?"

Patient 1: "Yes, it's sore and I wanted to get it checked out."

S: *keeps straight face* "Ok, well the doctor will come in to see you in a moment."

Patient 2: "... and my girlfriend was on top ya know, and she was goin' up and down when I look down and it's like a ****in' bloodbath. I was so pissed she didn't tell me she was on her period, and then I started to feel pain, man."

PA: "Well, yes, it sounds and looks like you tore your frenulum." !! ouch!!

Patient 3: "... and I just felt a lot of pain."

PA: "Um, ok, well let's take a look at it. We might have to do a swab for chlamydia..."

...

PA: "... oh my... I think you fractured it."

What the PA won't tell him is that after surgery, it's common to lose an inch or two.

Patient 4 didn't say much, but it was obvious what happened. He had been using a cockring which he did not try to remove until 4 hours later. By then, his scrotum had swollen to about 3 times its normal size and was quite stuck. Our first attempt at using lubrication to slide the ring off was laughable. Even more funny was how our ring-cutter broke with no noticeable dent to the ring. At this, patient 4 finally admitted that the ring was made of titanium! Now, the fire department had to be called and much to the chagrin of a very private patient 4, he was surrounded by a room full of very fascinated male residents, nurses, firemen, and one female tech who was pouring ice water onto the electric saw to keep the ring from over-heating and burning him. After the ring was cut off, patient 4 left us wordlessly, probably too embarrassed to even say thank you to the team that saved his genitals from falling off. (In animal husbandry practices, this is actually how they castrate sheep and calves)

So next time you feel like gettin' busy, be safe! Otherwise, you should know that there is a small but distinct possibility you could end up awkwardly meeting yours truly,

S

Proctologian Mimicry

Mr. Jumpy eyed me suspiciously. "Don't let her near me! I say, don't let her come anywhere near me!" He shuffled to another side of the bed.

"Why, what's wrong?" A nurse asked.

"I can't believe she did that to me, that doctor there," he pointed at me. I had been nowhere near the new elderly patient, so the nurse smiled and humored him, "what did that bad, bad doctor do to you, Mr. Jumpy?"

"I'd know her from anywhere. I will never allow anybody to put a finger there again, you hear? Now if you'll excuse me, I'm going to hide my anus."

I have logged another "first" to my list of experiences. This was definitely the first time I was mistaken for anyone's proctologist.

For the rest of the morning, everytime I walked by, he would mutter and shift, presumably hiding his anus. He watched me as I went about my duties and eventually allowed me to give him a pillow/blankets.

"You know what," he mused a few hours later, "you' all right. Just never do that to me again."

"Ok, Mr. Jumpy, I promise that you have nothing to worry about from me."

Mr. Jumpy didn't turn out to be mentally ill, surprisingly... he was just a man terrified of rectal exams.

S

Why We Keep Our Legs Crossed

In an epic battle between pit-bull and testicle the other day, the pit-bull most decidedly had the upper hand.

Frolicking in the snow, it waited until the human in question looked away into the distance, smoking a cigarette outside in his underwear.  Sensing preoccupation, the stray little dog grabbed the opportunity, so to speak, and the hapless gentleman made a visit to my trauma room.

Usually, rabies shots are administered 0, 3, 7, and 14 days after the bite. The first is an immunoglobulin shot, then a series of shots in the arm.  Usually, the first shot is given to the bite-area, but as this case was in a sensitive spot, the shot was administered to the patient's backside.  Interestingly enough, this was the most frightening part for the patient, who is lucky to still be, for all intents and purposes, an intact human male.

His animated re-telling and subsequent musing that at the sight of any dog, he will run inside or jump headlong into a motor vehicle was amusing, to say the least.

Moral: Keeping one's legs crossed isn't just polite, it's potentially life(/genital)-saving.

S

What is That?!

We had a very pleasant trauma patient who needed to go to the CT scanner for a fall. I had adjusted the blanket on him and exposed him during the trauma exam to uncover a large metal ring around his genitals. Like this:

Between the nurses, techs, and doctors, none of us had ever seen a penile ring before, but we all kept extraordinarily professional faces and demeanors despite this fact.  As soon as people walked around the curtain, however, their faces changed into varying expressions of "What IS that?"

Finally, a male nurse mustered up the courage to ask, "so why do you wear it? What is the purpose of wearing one?"

"Purely decorative purposes." Mr. Cockring smiled. "I can remove it if you like."

He took our intrusion into his personal life with such a great sense of humor and grace.
It made for a good experience in the trauma room in face of the several homicides (shootings and stabbings) that also came in during the course of the night.

Also, because we had three extraordinarily good-looking male trauma nurses that day who did not want to be hit on, I helped Mr. Cockring with various tasks throughout the evening. We had a few inspirational conversations with his partner about their travels together around the world.  They were just really lovely, open-minded and intellectually curious people.

Then, I tried to troll the security officers by hiding the ring in the bag of valuables to be locked up, but they chased me out of their office.

S
http://en.wikipedia.org/wiki/Cock_ring
I looked it up later- apparently, they are also used as a sort of tourniquet to engorge the area even more
 so.  Interesting.

Once a Scientist...

Mr. Curious is a little old man with knobbly knees.  When I first saw him, he was under assault by two nurses pulling his clothes off.  As his little knees knocked against each other in cold, he politely answered the questions shot in rapid sequence.  I grabbed him a blanket and he exclaimed, "what is this blanket made of?"

S: I'm not sure, Mr. C.
Mr. Curious: Speak up, I can't hear you!
S: I am not sure what they're made of.
Mr. Curious: They feel so warm- why is that?
S: Well, Mr. C, I got them for you out of the warmer.
Mr. Curious: No! I mean, what is this material? It's remarkably warm.
S: I think all the little pill-like fibers keep heat in. More surface area, crevices, and insulation.
Mr. Curious: I'm a scientist, see, and I don't know if it would be too much trouble, but can I have a small piece of this blanket?

I told him he could keep it and he was enthralled.
He explained to me that he used to design polymers for industry and had amassed many patents in his 90+ years of life. It was wonderful to see that at such an age, in such a situation, his sense of wonder and intellectual curiosity was intact. Once a scientist, ever a scientist.

Happy New Year!
S

Mrs. Sharp is Sharp

Mrs. Sharp came in exclaiming, it was so bright, I just couldn't see! It was so bright! A tiny little woman at the age of about 90, she could probably barely see over the steering wheel into the setting sun when she crashed into a telephone pole. She had no major injuries except a blood-soaked bandage over her lip. She was so slight, she reminded me of hare-lipped children I worked with in Asia.

Her eyes were unnaturally bright, like cat-eyes, with facets gleaming with different angles of light.  She had the most delightful mannerisms, however, and was very fussy.  She took care to remember all our names, the name of the ambulance driver, and various pieces of information about us.

First, before everything else, she wanted to use the bathroom, so I fetched a commode and bedpan, but then she wanted to talk to the doctor. She refused to get undressed because she insisted her sweater would not fit over the collar. No amount of convincing, cajoling, insisting, commanding would do.  However, she did try to bargain with us. "If you take this Thing off, I can get my sweater off."  "Just for a moment, no one else will know." (Because it's cute, here's a picture of an elephant shrew...)

When she couldn't get her way, she pouted and refused to get undressed. It took several doctors to convince her to do so. She insisted it was impossible! I walked her through how we would do it, arm by arm, then slide the sweater neck opening over the collar.  Knowing she was defeated by yours truly, a certified professional clothes remover, she sighed and began to undress.  She refused all help with the removal of her clothing ("I am a very independent woman, you know!"), however, and threatened us, "this sweater is cashmere! If it is ruined, you will be buying me a new one."  Then, as a declaration as she demurely slid her little pencil skirt down, "I will keep my slip on, thank you."

The feeling of the room was a little tense, so I smiled warmly and said, "you have always been a bit of a spit-fire, haven't you?" She looked at me with a poignant lift of her chin, "always was. Still am, always will be!"

If I were to guess her profession, by her organization of mind and manner of dress, I would have said lawyer. However, she was actually a schoolteacher, newly retired, so she says.

I took her on my arm to go to the bathroom a few times. She draped her purse over my shoulders and insisted I take the wet bath towels and tissue box in case she had to dab at her bleeding lip.  Very thankful for the attentive care, she became quite sweet and held tightly onto my arm as we walked.

At one point, while I was taking her vital signs, she looked very pale to me. Worried, I asked her if she felt all right- she was a mentally sharp little thing and looked me in the eye, "why wouldn't I be, dear?" I took her blood pressure, and it was a little low. "Here, try my other arm," she offered. The pressure was higher. "Let's try this arm once more, just to see," she said, and memorized the numbers for later. I was bemused. She was a curious little soul and likely because of her profession, quite young at heart.

Mrs. Sharp is as sharp and interesting as I should ever hope to be at her age. : )

S

Where Artists Go in Old Age

Mr. Fuzzy Beard was picked up by the police for public masturbation.  Given the choice between jail and the hospital for psychiatric evaluation, Mr. FB chose the latter and sat comfortably, staring at everyone and everything with large, disconcerting eyes.  During the course of his stay, he received a sandwich and was very much pleased with it, temporarily distracted... until he saw me walk by.

"Hey, hey, are you *ethnicity 1 or *ethnicity2?"
"*Ethnicity 1, how did you know?"
"My wife, she's a painter, you know. She teaches painting to two little girls who look just like you."
Because all of us look the same, I know. "Oh, acrylic or oil?"
"Oil. You know, I'm an artist too.  Give me paper and a pencil. I'll draw a portrait of you."
"Really?
"Yeah, you'll have to give me $10 for it, though." I humored him and brought him a clipboard, a few sheets of paper and a pencil.
"Mr. FB, it looks like you're still eating."
"Yeah, I guess I am. You can draw a picture of me until I'm done. I bet you're better at it than I am."
"Why do you say that?"
"I can just tell that about you."

I smiled and asked his sitter if she minded me sticking around. "Nah, anything to keep him happy and quiet."
So I made a rough sketch of him.  It was a good likeness- if you can imagine a Harry Potter-world "mad wizard", Mr. FB would be it.  He had long hair around his balding pate and a full beard. His fingernails were dirty and he had a necklace of beads made from rolling up pieces of magazine.  His features were fine, however, and in some alternate universe would have looked scholarly provided his twitch tic and crazy eyes didn't betray him.

"Well, well, let me see it! You're taking an awfully long time, aren't you?"
"Good art takes time."
"What, you think Picasso more than a few minutes?"
"Absolutely sir, here, what do you think?"
"Ahh, that's wonderful.  See, I would give you $10 for this. Don't I look like a professor?" He smiled beatifically.

I should have included the dab of mayonnaise left on his beard, but otherwise, the likeness was real. I would take a picture of my drawing and show you, but wouldn't that be a HIPAA violation?

Later, he drew a picture of his sitter. From his picture, one can clearly see that he has been majorly influenced by Picasso. His sitter was less than pleased.

S

Patients Say the Darndest Things

I set up a pelvic exam tray for bed 13. She eyed the pelvic light with a wide eye, "what is that black thing?"

"Oh, it's just a light", I switched it on and off for her to see. 

"I just had twins, so I mean, it will fit, but y'all aren't gonna stick that thing up there, are you?"  

"Ms. Colorful Language, have you had a pelvic before?"  

"Yeah."

"Then you know, it will be really quick. This light won't stay up there."

"Ok." She kept eyeing the light.

"Don't worry, honey, either me or the other tech over there will be here with you through the whole thing, ok?"

She nodded, but didn't say anything. I left the room and the very straight-laced, so-academic-as-to-be-a-bit-socially-inexperienced resident soon entered with the other tech.  He came out ashen-faced a few minutes later. "Well, I have never heard that expression before!" He sputtered.  "What did she say?" He wouldn't repeat it to me.  Later, I entered the room with him for something else. 

"Doctor, are you going to **** me with that black thing again?"

"No, we're all done," he said, blushing. I could barely hold my face straight.  "That's what I was referring to," he whispered to me as we left the room and a grin crossed my face as I bolted to find somewhere to laugh.  

S

Schizophrenic Encouragement

I was in a somber, pensive mood walking to the gym early in the morning when I saw Mr. Orange Juice riding toward me on his bike.

The first time I met Mr. OJ a few months ago, he came up to the triage desk and asked me for orange juice.  I asked him if he was a patient.  Then, the other nurses pulled me aside in hushed voices and told me, it's just Mr. OJ the happy schizophrenic. Just give it to him and he'll leave because he is harmless.  I was curious- ok, but why the hushed voices? He was good friends with K, they explained. K was a middle-aged night-shift Charge Nurse who had suddenly died a few weeks before of a brain aneurysm. It shook the whole department to the core because she was a constant presence up until that fateful day.

I took out two little cartons of orange juice.  Mr. OJ graciously thanked me and called out, WANT TO SEE MY NEW BIKE????? The staff followed him out to see his new bike. I didn't go, but was highly amused..

Mr. OJ probably didn't remember this instance when he saw me on the old flagstone entrance of the gym. I lowered my eyes as he got closer, but then I heard an indulgent "you'll be all right." The huge black schizophrenic man on the bicycle grinned ebulliently at me as I looked up in surprise, "you are just like me when I was younger. You'll turn out ok." He zoomed by me without stopping, a flash of fluorescent orange, and called cheerfully once more over his shoulder, "you'll turn out ok!"

I couldn't help but grin stupidly to myself.  He is the happiest schizophrenic I ever saw. And totally made my day.

S

Musical Misinterpretation

I got to work today in Valhalla, the Emergency Room section above the rest, upstairs in an area resembling an actual hospital wing, It always smells like fried food, is bright, cheery, and actually has windows.  Up here, there is signal for the cell phones, patients have their own rooms, bathrooms, and a television to remedy the long hours of sitting there waiting for test results. Patients are happier up here, and so are we.

A few weeks ago up in Valhalla, I had a tough-guy patient. Wiry, with a sleeveless black shirt, a mustache-beard, and bald, he was the epitome of "biker".  He talked in a folksy but brusque way and was an all-in-all stereotypical middle-aged biker dude.  Imagine my surprise when I walked by his room to hear, blasting, the most beautiful Beethoven quartet. I smiled to myself and listened outside the door for a few minutes- I miss hearing this kind of music. I remember chastising myself mentally for stereotyping.  Maybe even biker dudes had that sort of introspective, sentimental side to them.  

Today, when I was taking vital signs on a patient, I heard elevator-grade flute music playing loudly from the room next door. Curious, I walked in and asked the patient if she was playing the music to calm herself.  "Are you kidding?" she stuttered in an agitated way, "it's a pain in the *** and I can't even turn it off."

I checked the controller- the tv wouldn't turn on or off. The volume controls for the music would only get louder. And the music was awful.  The off-button was not working.  The only way I could get the music to turn off was by unplugging the whole TV set-up.  

I couldn't help but laugh, remembering my tough biker guy sitting in the room, captive audience to very loud Classical string quartets for 8 hours.  I don't know if he was enjoying it or gritting his teeth trying to jam all the buttons on the controller, to no avail.  Poor man, I hope it was the former. 

S

Humor in the Time of Overcrowding

"Do you have time for a short story?" Mr. Professor asked as I was pulling my nurse-on-a-stick vital signs machine out the door. I stopped, "sure."

"So on Good Morning America this morning, this is a true story, mind you, there was a guy who got his foot stuck in some machinery and had the strength of will to cut off all five of his toes. When he called the ambulance, his friend said to him, why did you call the ambulance? Why didn't you call the tow-truck?"

I laughed at him for being silly, but he insisted, it was a true story- how great it is to have a sense of humor like that in such a time. It's true- it's a sign of the just how deep the friendship was and how smart the guy had been to do what he could to make his friend feel slightly better about the situation. Mr. Professor quickly became my favorite patient of the day. A local college lecturer, he had been in the middle of a class when the room suddenly felt very warm. After a dizzy spell, he came in to visit us and we observed him for changes in troponin-levels- something that signifies damage to heart-muscle.

Every time I came in, he would greet me warmly and I would open up and talk to him, tell him stories of what I had seen, including when I had a full half-hour's worth of one-sided conversation with a man who was completely deaf. He was surrounded by loving family who carefully and tenderly cared for him. A man with a great sense of humor and presence, who really made my night.

S

Punintended Joy

Call me S-ilvertongue. I finagled my way out of being in the drunk tank for 8 hours out of the 12 I was working tonight. Thank goodness, because we had the rowdiest, most foul-mouthed, foul-spirited, putrid drunk patients ever, evidenced by the fact that all 4 of them were put indefinitely into 4-point restraints and some had spit-masks. On top of that, we were completely inundated with patients. So in the spirit of recuperating from the night's trials and tribulations, I will tell you a story with a happy ending.

I had a half-hour conversation with a nice old man. It was only when he told me that I realized he was totally and completely deaf. One could never tell because his elocution was perfect and he told a lot of punny jokes.

How do you transport blood to Europe? Through blood vessels. Where is it taken? To the Red Sea.

I got hit with a fish as a child. That's why I have a herring problem.

He was hilarious. His stories looped round and around- and I must admit, I dearly love a silly pun. I got a notepad and a pen for him. This was my lame joke that I told him:
What's the most dangerous vegetable to have on a boat?

A leek.

He loved it. "You really love doing what you do, don't you? I can tell." Yes, sir, I do.

"Through all my years of (extensive and very serious) health problems, I have come to find that humor really is the best medicine."

Oh, delightful LOM, I totally agree.

He was discharged with no complications. :-) It's nice to see that humor really does keep him going.

S

Fencing, ER-Style

Mr. Mumble-de-Gook is incomprehensible. He is one of my regular drunks that I ignore completely because the last time he begged me for a sandwich, he thanked me by eating it, then peeing in the box for me.

Ms. Prissy Regular comes in like clockwork- every week. There is usually nothing wrong with her, but she likes to come in for a nap and a sandwich under the guise of some problem related to her morbid obesity.

Our ER was full to capacity again last night and both of them were put in the same back hallway to await sobriety. The stage was set for disaster because Ms. Regular is spoiled and Mr. Mumble-de-Gook does not ever shut up. I have never understood a word he said except that time I figured out, he was saying "hungry" and gave him the sandwich.

Ms. Regular: Can you please be quiet?

Mr. Mumble-de-Gook: Hrrrrngh! muauambuleaa-aggh.

Mr. Mumble-de-Gook: Arrrm aerrddd nyumm uh huhh errdaastt meehh

Mr. Mumble-de-Good: auyumm aereeedsss miisssto miiiikkk meraamernumer astimurkat

Ms. Regular: What is wrong with you? I'm trying to sleep here.

Mr. Mumble-de-Gook: aghg-mummbrrr orrr ehhhh

Ms. Regular: I don't need to sit here and listen to you all night. You sound retarded.

Mr. Mumble-de-Gook: ARRR-EEMBB EEREM NYAN NYAN NYAN

He stands up and makes a menacing motion.

Ms. Regular: You get any closer I'm gonna clock you with my cane. (She swings it for effect)

Mr. Mumble-de-Gook swings out *his* cane and says the first comprehensible sentence I have ever heard from him: MMRM I'mmmm gonnarr knock mrrr your wigg offf.

There was to be a cane fight as both of them started brandishing the canes in menacingly, but I called security and Mr. MdG was released back onto the street because he was walking as steadily as he ever did. Oh, the joys of sitting...

S

Problem Solving

Here's a real life riddle for you:

If you were a homeless drunk and it was unbearably hot/cold outside, what can you do to stay in the comfortable Emergency Room drunk tank indefinitely without getting kicked out/sober?

Answer:

In the shuffle at the ambulance bay when you're being registered, discreetly stow a handle of vodka under your stretcher. Sleep through the tests and scans and become medically cleared for everything but drunkenness. This is how you get to the drunk tank.

Warning: don't get caught trying to access your liquor in order to spike your apple/cranberry juice that comes with your free turkey sandwich lunchbox. The technician will call security, have your alcohol removed, and have a good laugh with everybody at your expense.

True story.

S