Welcome to another installment of the Top 10 Ways to Avoid the ER.
Number 9 – Weekend warriors retire.
Okay, you know the type. You’re mid forties, maybe you used to play a few sports, and you still think you’ve got some moves. Or maybe your buddy’s got an extra dirt bike he’s going to let you try out. Slow down my friend, you’re about to make a visit to the ER. I know it sounds perfectly reasonable, a quick basketball game, a mountain bike ride, an indoor soccer league, but watch out. If you don’t carefully ease back into rigorous sports you are going to sprain, break, contuse, or rupture something. As we age, our ability to repair damaged body parts becomes much worse. Injuries tend to accumulate, and it’s much easier to get hurt in the first place. If you really want to participate in a contact sport, or something really crazy like dirt bike riding, you must gradually ease into it, to let your body acclimate. My wife would argue that I should heed my own advice here.
I admit I’m not a huge fan of elective cosmetic surgery when patients say “I’m just having a little work done.” I know we’re in a youth obsessed culture and normal aging is considered the enemy, but I think the cost and risk of surgery is too much for many situations.
Quite a few years back, a male patient presented to an ER in very serious condition after an elective face lift. He had developed post-operative swelling and it became so severe, that it occluded his airway. He ended up starved of oxygen and suffered permanent, disabling brain damage as a result. I know that cosmetic surgical procedures are improved, and safer now, but you really need to be sure that even a small risk is justified.
I have recently learned of a new facelift procedure known as “Energy facelift” which is apparently less invasive. It can be performed under local anesthesia, and the surgeon uses a laser to “shrink tissue.” This does sound better than the complete facelift, but I’ve got a better idea–Let’s all reset our beauty standards. Here’s what we do: First, throw out all your fashion magazines and clothing catalogues. Next, get a coffee table book of famous circus freaks. You might also consider an atlas of bad skin diseases. Finally, don’t watch any TV shows that feature attractive people. Andy Rooney is fine, and you may safely watch Larry King. Just make sure he’s not interviewing Cameron Diaz or Brad Pitt.
After a few weeks of this, I guarantee we will all feel very attractive, and isn’t that the whole point after all?
Recently I performed my least favorite procedure, a manual disimpaction. This is when I use a finger to mechanically remove extremely hard, impacted stool from a patient who is constipated. No one enjoys this, including the patient, but they always feel better afterwards when they can have normal bowel movements again. I washed my hands, and left the room feeling a a somewhat morbid sense of self-satisfaction and went back to my desk to do some charting. However, the distinct smell of stool followed me. At first, I assumed there was another patient who had a bowel movement and had crop-dusted the ER with what I call “the smell of victory.” Gradually however, the horrifying truth dawned upon me. I looked down and saw a sizable chunk of poop on my wristwatch and forearm. It sat there, looking at me as if happy to have made it out of the exam room and into the world. I was frozen with disgust for a moment, and then sprinted to the nearest sink to remove the offensive turd. I do believe it’s time for a new watch. . .
From time to time, I like to reflect on how unnecessary my professional skills would be if everyone made perfect decisions 100% of the time. This sounds like a wonderful utopia at first, but then the little problem of how I would pay the mortage comes up. Nevertheless, I am going to charge forward, at great risk to my bill-paying ability, by giving the first ever “Top 10 Ways to Avoid the ER!” in 10 installments over the next few weeks. So -let’s start off with Number 10:
# 10 – Minimize your alcohol intake.
Ah, yes, alcohol, also known as ethanol, the most commonly used depressant in the world. You may know that the Puritans brought a large quantity of alcohol with them on the Mayflower, en route to America, but this does not mean that you should bring a case of chardonnay with you to the laundromat. This libation can be enjoyed to excess. And that’s when I typically get involved. My patients have been drunk while driving their car, riding their bike, arguing with their spouse, walking their dog, and even just sitting in their chair minding their own business. Once, I had a drunk fraternity pledge whose brothers stripped him naked and let him loose in the woods. He ended up with hypothermia. The point is, bad things happen to
very drunk people. So by all means, have that glass of red wine with dinner–AND THEN STOP THERE!
One of the benefits of working in the ER i
s an opportunity to survey what is new in tattoos and piercings.
Most patients are only too happy to show off their body art  and provide a background story to go along with it.
By far the most impressive tattoo witnessed in the ER belonged to a middle aged man who was covered with a wide variety of very detailed pictures, some with color, some without. The patient said, “Oh, these are nothing, you have to see my elephant.”Â
He pulled down his shorts and he had a large elephant head done with striking detail just above his phallus. Naturally, the trunk of the elephant morphed directly into his manhood.
Somewhat at a loss for words, the nurse told him the tattoo was impressive. He said, “Oh, you should see him when he raises his trunk!”
