When the ER gets busy, we need to rush things a bit to keep the patients moving. Ordinarily, this is not a big deal, but occasionally things can be overlooked. Years ago, a patient came in with a narcotic overdose on just such a busy day. His wife suspected that he was addicted to pain medications and had been trying to keep it a secret. She also thought that he had gotten hold of some 
from a relative. These patches release potent narcotics gradually into the bloodstream. Hmm. He was pretty sleepy when he came in, and his pupils were small, consistent with a narcotic overdose, but he didn’t have any patches on his body. He needed to be admitted because of his poor mental status, so those arrangements were made. Later on, the admitting nurse called down to the ER to report that she had found a fentanyl patch. It had been placed carefully underneath his scrotum, where his wife was unlikely to spot it. Fooled us too.
Toxicology tip of the day.
Don’t smoke rat poison. Perhaps this warning is not necessary for the vast majority of patients, but for one unfortunate young man who presented to the ER with severe hemorrhage, it would have helped a lot. Evidently, he was combining marijuana with rat poison pellets, tossing it into a bong, and toking away.
Finally, someone comes along to make Cheech and Chong look like geniuses.
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. . .
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!”
