Holy Cow

Yesterday was my penultimate shift in the ER...and medical school. I walk into the unit and the first thing I hear was "She's trying to start a fire with her cigarette!" Welcome to work!!! This was a very challenging patient! She had been brought in the ambulance, for a reason we weren't sure because the report had the wrong name, ethnicity, and date of birth on it, so we couldn't trust it. As soon as she got put in the room she decided she wanted to leave,  so she lit a cigarette and tried to set her bed on fire. Her mood depended on the moment. She could be very nice and cooperative or completely belligerent. She hated blacks and Filipinos, but being gay was ok as long as it was your business. Her family had all been murdered by doctors. Her mother had been beaten to death at a nursing home. She was an atheist. Then she wanted her Bible and was going to forgive everyone because she was a Christian and would forgive. She was verbally abusive the entire.night.

We had another patient who came in because she was experiencing seizures. She was telling us that "I'm having one right now." While she's wide awake and walking. A quick check to her record reveals a diagnosis of paranoid schizophrenia. She was also a real pain in the ass. She was belligerent until the nurses made it clear that she was not going to be allowed to be disruptive. Sometimes dealing with these patients is like dealing with a six year-old.

Most of our patients that night were serious. Which is a bit out of the ordinary. In the ER a lot of the patients really don't have emergencies. Mexican moms in particular bring their kid to the ER every time they throw up. This is not an emergency. Kids get sick, and they throw up every once in a while. If it does not stop or is accompanied by a very high fever, and cough, or the vomit looks weird, that's different. But one episode of vomiting does not an emergency make.

Aren't They a Gem...I'll drink to them!

Ok, so I took the title of this post from a line in the song "The Ladies Who Lunch," of the musical Company. I'm not a theater geek, but I do enjoy it from time to time, and particularly the snarky variety. Anyway, the song itself is a snarky swipe at judgment and cynicism. For me that was a bit of the last couple shifts. I've found myself using the word "gem" over and over again. Perhaps just a little too much.

I've had some terrible patients in the ER, and a further taste of what's to come. I've certainly seen psychotic patients, so their behavior wasn't new, but it has actually been a while, so it was a refresher.

One patient had left his nursing home over ten miles away and had bounced from hospital to hospital, subsequently signing himself out. By the time he got to Chicago Hope's ER it was later in the day, and after a short while he it became apparent he had missed his afternoon medications because he became what is referred to medically as acutely psychotic. In layman's terms he flipped his lid. He started calling everybody a "fucking nigger." Security had been called and one of the security officers simply looked at him, smiled, and said "thank you!" Brilliant, I thought. I'm going to have to remember that.

The next day another patient came in, and we had just gotten him discharged when he decided that he could not find his wallet. Not only could he not ifnd it, but he insisted that somebody had reached into the back pocket of his pants, while he was seated in a wheelchair the entire time, and taken his wallet. And he was not leaving until he got his wallet back. That certainly was interesting.

That same day we had a patient who was brought in by his mother. He did not want to be there. He kept telling his mother how he was going to get his wallet, go down to the club (I didn't find out which one...) have him some BEER, and hang out with some GURLS. This was a 30-something year-old man. I felt sorry for his mother.

It's just been interesting. We also had a patient with a rotten foot. Over half of it was black. Oh my god did it smell. The smell stayed in my nostrils most of the night. I felt like dipping my head in a vat of rubbing alcohol to see if that would kill the smell.

What a gem of a day!!

Today was my last early (6a-2p) shift in the ER...thank God. I'm sure there will be periods of time when I'll need to be awake that early for residency, but I guess I'll have to cross that bridge when I get to it. A friend of mine is doing a surgery rotation in California and he has to get up every day at 4:30. Excuse me?? Je ne comprends pas!  That hour does not compute. And you want to go into this field why?? But I'm getting off track. Today was an interesting day.

For starters, I had a new attending today. Always awkward. He spent twenty-five minutes lecturing my fellow students about brevity...

I walked into a room to find that both people in the room were expecting to be treated. This isn't exactly typical, so I just hopped back to the desk to make sure that both patients indeed were registered before I went through the rigamarole of examining both of them. I don't typically read too much about a patient before I see them because I want to see them from scratch. Good thing I did that, too. Both patients, indeed, were registered. For genital discharge. Oh goody. I must've made some sort of face, or audible expression because half the staff at the desk and the attending started to laugh. It became clear at that point that the attending was purposefully not seeing that patient before whichever schmuck of a student got lucky and took that patient. Thankfully a thorough examination was not necessary. What I did observe however, was that the female (aged 21) had this ever so sexy habit of sucking on her thumb while she was talking. Yes ma'am. Nothin' says sexy more than a 21 year-old who can't speak English properly AND sucks her thumb. Mmmmm baby. Oh, and by the way, soap is cheap. Please use it more than twice a month. You reek. The 20 year-old guy in the pair was clueless. Or stone. Or perhaps both. I don't know. He just kept walking around like he didn't realize he was in a room...with walls. I kept waiting for him to hit a wall and then bounce off of it in a daze. Really, a real pair these two were. What a special time I'm sure this was in their relationship. Getting treated...together...for the clap. They got sent home with a shot of ceftriaxone, and scrips for azithromycin and doxycycline. Please don't ever come to the ER for STIs again. I will hurt you. And I have the right to do so, since I'm paying for your ER visit. Also, wear a damn condom because I really don't want to have to pay for the baby you two chuckleheads will invariably make...and not know how.

I also correctly diagnosed a migraine from presentation! Thank you neurology and awesome neurology attending. I'm not sure I would have recognized it as a migraine off the bat without that experience. Go me?

I diagnosed several URIs in kids under two. It's that time of year folks. I understand love for one's children, but I also think that when 16 year-olds start bringing their 19 month-old children into the ER because they are PANICKED because they have been coughing for six hours...that it's time to stop letting uneducated 16 year-olds have children. This brilliant girl didn't grasp, despite several declarations, that a bottle, is indeed feeding a child. Oy, some people. 

I had more than one patient whose parents didn't speak English. And I found myself rattling off Spanish like I actually knew what I was saying. Weird. I have days like that every once in a while, but few and far between.

Emergency!!

I'm about a week into my last (!!!!) rotation: Emergency Medicine. I figured that this would be a good one to end with because my interest in doing another rotation is pretty much nil, and this would at least keep me moving and doing something. And so far that has indeed, happened which has been great. The schedule? Not so much. Because of interviews (mine and everyone else's) what is normally four or five overnights in a row, followed by the name number of morning shifts, and the same number of day shifts, and totally been thrown askew. Everybody is gone at random times, and as such the schedule is totally random. It messes with my sleep schedule (I know, I just have it so rough). 

Got to incise and rain and abscess. Had done it before in surgery, but they patient was unconscious. This guy was awake.

Had a rather strange occurrence, a patient came in for whatever reason with her mother. Mother had been there for about four hours (and I saw her sitting more or less content and comfortable) when she decided to inform the staff that she had been suffering from gastritis for about a week and needed to be seen. I'm not sure what to make of that.

So a full-blown tonic-clonic seizure, which was kind of cool.

Had more than one schizophrenic patient (one with pronounced tardive dyskinesia) who proceeded to make their presence very well known, which for me as a future (hopefully) psychiatrist was good experience and a bit interesting.

I've been on the interview trail for the past month as well...and goodness between the travel and the interviews themselves and working that around my rotation schedule it has definitely been interesting. They have for the most part been fun and enjoyable. But there's always this feeling of inadequacy within me, and I have no idea how it's going to turn out. Stay tuned for updates.