Years ago, a young male was brought in to the ER unconscious. Or rather, he was dropped off by some other men in a car at the back door. They quickly left the premises, burning rubber the whole way. The patient was completely unresponsive, but he didn’t have any sign of trauma on him, except for some bleeding from his ear canal. Bleeding from the ear can happen for a variety of reasons, including head injuries. The remainder of his physical exam turned up nothing, and a battery of tests were ordered, including a brain scan.
All the tests came back normal, except for the brain scan. It showed a small caliber bullet lodged in the brain tissue, with a large amount of damage to the surrounding brain.
The entrance wound was the ear canal. It was determined later that he was the victim of a drive-by shooting. Just another random act of violence with a very low probability trajectory.
Hilarious interaction with a young male patient last summer.
Me:Â What seems to be the problem sir?
Patient (grimacing):Â I twisted my knee water skiing!
Me: It looks like a sprain, we’re going to put you in a knee immobilizer, and you need to ice and elevate it. Do you need a note for work?
Patient:Â Oh no, I don’t work, I’m disabled.
Me (noticing he is on Medicare): Disabled? From what?
Patient:Â I hurt my back in a car crash.
Me:Â So you can water ski, but you can’t work?
Patient:Â Something like that.
Me: Wow, that’s that’s a bad deal, how are you holding up?
I picked up a chart recently and it was a middle aged man with a laceration on his hand. I noticed that under allergies, he had written “cocaine.”
I asked him what happens with it, and he said, “It’s the strangest thing doc. Every time I use cocaine, I break out in handcuffs.”
I’m not one to rant excessively, I’ll leave that to the professionals like
White Coat, but after a particularly painful night shift, I have something to get off my chest. When I walk into a patient’s room, there are a couple of phrases I don’t really want to hear anymore:
#1. In answer to the question–What seems to be the problem? Some seem to think the funniest thing in the world is to say is “I don’t know, you’re the doctor.” Perhaps I’m just getting cantankerous, or maybe it’s because I’ve heard this joke about 8 million times already, but come on. The evil doctor in me wants to just look right in their eyes and say, “I’ve got it, you’ve got skin failure!” and walk right out again. I’ll let you know if I try this one.
#2. Another opening line I sometimes use is “Hello, I’m the ER doctor, how are you?” Naturally, this question brings out the Don Rickles in many patients, and they of course answer with, “Not very good, why do you think I came here?” Oy.
#3. My least favorite response by far, is when I go in to see a patient with a non-emergency problem and the patient says, “It’s about time.” Wow. It takes a lot of willpower not to get snippy at these times, especially since I practically run from room to room. I have considered a few sarcastic comebacks to this, but I bet my satisfaction scores would suffer. One option, “Gosh, I’m so sorry, what time was your appointment again?”
Occasionally, I will encounter a medical condition that I haven’t seen before, and when I picked up the chart of an older man several years back, such was the case. His medical history indicated he suffered from “anal stenosis.” Stenosis means tightening or narrowing, so in this case he had abnormal tightening of his anal canal, making bowel movements difficult. He had been unable to pass anything for several days, and was quite uncomfortable.
The solution to this problem was to simply insert a plastic tube known appropriately as an “anoscope” and relieve the obstruction. In retrospect, I wasn’t totally prepared for the result. There was quite a bit more pressure than I anticipated, and I was really quite fortunate to be standing off to the side in order to avoid the blast that sprayed all over the gurney, floor and wall. The patient’s relief was dramatic. With a sense of accomplishment, I left the room and let the ER tech know that a room clean up would be necessary. He had no idea.
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Years ago, a young male was brought in to the ER unconscious. Or rather, he was dropped off by some other men in a car at the back door. They quickly left the premises, burning rubber the whole way. The patient was completely unresponsive, but he didn’t have any sign of trauma on him, except for some bleeding from his ear canal. Bleeding from the ear can happen for a variety of reasons, including head injuries. The remainder of his physical exam turned up nothing, and a battery of tests were ordered, including a brain scan.
