“There’s a crackling in my ear! ”
“Something’s making popping sounds in my ears!”
He was a 20 year old man, and looked quite anxious. He couldn’t sit still, and the expression on his face just said “Help me!” He was grabbing and poking at his left ear. “Get it out!”
I’ve had other patients with
ear symptoms with crackling noises, but this was different. I took a look inside and sure enough, there was a pincher bug inside the ear canal. With the magnification from the ear scope, the thing looked huge. I must say, I hate even the thought of having a bug in my ear, but this thing would be a nightmare. I seriously doubt whether I would be able to sit still enough for someone to get it out.
I told him he had a pincher bug in his ear, and he was revolted. “What is it even doing in there?!”
I thought about my answer carefully, and considered a joke to lighten his mood a bit. But somehow, I didn’t think it would help if I told him it was in there building a nest, and laying eggs. I ignored his question, and got a pair of forceps and grabbed the insect by the pointy part on his rear end.
It tried to scramble away from me, digging his wiggly little legs into the poor man’s ear canal as I dragged him from his hiding place. This was probably the worst part of all.
When it was over, the patient looked like he had just run a marathon. His face was red and sweaty and he stared at the pincher bug with horror. I put the bug in a plastic cup, and handed it to the patient. He looked at him for a moment, and then smashed it into dust with his thumb, while calling the bug some names I won’t repeat. He apologized for the profanity, but I completely understood.
People often ask if I frequently take care of sick or injured people when I am not at work. In fact, it happens all the time and it’s no big deal. However, one time in particular I shall never forget. My wife and I were attending a musical in San Francisco (“Les Miserables”) and the show was about to begin. We noticed a commotion suddenly over to the right of the theater and up in front. There were people standing up around a man who appeared to be down on the ground. I made my way over and found that the patient was a 350 pound man, unconscious, laying flat on the ground in full cardiac arrest. I must say that being in this situation, with absolutely no equipment on hand was very frightening indeed. I began to attend to him, and fortunately, paramedics arrived immediately. The patient needed to be intubated (have a tube put into his airway), but he had just finished a large dinner, and most of that was bubbling up into his mouth, making intubation quite difficult. I was able to just get a glimpse of his vocal cords, and passed the tube. We gave him epinephrine, atropine, and his heart starting beating again, and he started moving around. We loaded him onto the gurney and moved him out to the ambulance. At that point, the entire audience broke out into applause and cheers, either because we had saved the man, or because they were just happy the show was going to start. I looked up and realized we had been in full view of the audience the entire time. It was the only time I have ever been applauded for my work–and I must say, it felt great.
At intermission the theater manager found me. He said he wanted to thank me for helping the man, and he gave me an envelope. Inside were coupons for two free drinks. I had a glass of wine and thought about what a strange world we live in.
A word to the wise on your 21st birthday.
It is a time honored tradition for young people to celebrate their newly acquired drinking status by going out with their friends and drinking far more than they or their livers can handle. I have lost count of how many unfortunate 21 year olds I have seen in the sorry aftermath of their revelry. But I do know that young people who are extremely drunk are not funny or cute, despite what the movies would have us believe. ER nurses are never pleased when they have to take care of the ridiculously drunk young adult, because invariably they also must deal with vomit, urine, and attitude problems. Usually the patient has some relatively boisterous “friends” in tow, probably the characters that a few hours prior to arrival were shouting, “Drink, Drink, Drink!” But by far the biggest problem with the 21st birthday tradition is that people can get very sick or hurt from heavy drinking, especially if they are not used to it, and their friends are egging them on. I have treated patients with broken limbs, head injuries, dehydration, and even a fraternity member with hypothermia from being stranded outside by his brothers.
I recently treated a 21 year old who was already completely intoxicated when his friends encouraged him to gulp down a drink known as “Adios, Motherf—er.” The drink was so successful that he went into an unconscious state, and his friends ended up calling 911 when they could not revive him. He required IV fluids, and observation for several hours. His friends may have paid for the drinks, but I doubt seriously they picked up the ER tab. If you are about to turn 21 and are looking forward to a wild night with your friends, here’s my recommendation–pick your most responsible friend, ask him/her to watch out for you, and slide you into bed when you’ve had enough. Your brain and liver will thank you, and so will I.
Methamphetamines (aka Meth)
Drugs can make people do some amazing, incomprehensible things, and sometimes you don’t know whether to laugh or cry.
One night, a phone call was directed to the ER by the hospital operator, who said, “I don’t know who else can help these people.”
Not good.
The call was from two men sitting in the hospital parking lot in a car, and they were clearly distraught. They spoke very quickly and and hysterically. They stated that they were infected by some kind of bugs, and didn’t want to infect anyone else by coming inside.
I certainly appreciated their desire to not make anyone else ill, but explained there was very little we could do over the phone. They both agreed to come in eventually, but made us agree to wear protective gowns and masks. We were only too happy to comply.
When they stepped in through the ambulance doors, I could not believe my eyes. They were both wrapped head to toe in aluminum foil. Apparently they had decided that the foil would protect themselves and us from the “bugs.”
As it turned out, these men had been smoking methamphetamines for days on end. They had become very paranoid, and began picking at their skin, as methamphetamine users tend to do. Each person made the other more paranoid until they both were convinced that they were seeing bugs underneath their skin crawling around, which only made them pick and scratch more. They both were covered with many sores all over their skin from all the scratching. I sincerely wish that anyone considering meth use could have seen the sorry state of these unfortunate men. If that didn’t stop them from using meth, I’m not sure what would.
Case of the day:
An ER patient recently set a record for shortest period of time to elapse between drunk driving arrests. He clocked in at just over 12 hours. In addition, he was arrested after crashing his car both times.
When you think about that, it’s actually kind of incredible. He had to crash his first car, come into the ER, get checked out, be arrested, go to jail, make bail, then go get drunk again, drive another car, and crash again.
Now I firmly believe that alcoholism is a disease, and I truly sympathize with patients who are struggling with addiction. But when I think about how incredibly dangerous this man is, and how little he regards the safety of other people, it makes me angry.
The nurses often make jokes when we have patients who behave this poorly, and I think it helps them deal with the stress of the ER. This patient certainly increased their stress substantially, especially when he started to sober up, and made a point to give each of them the middle finger and some accompanying profanity. He then tried to make a break for it, running down the hallway when the police turned away briefly. His hopes for freedom were quickly dashed when the police wrestled him to the ground, and cuffed him. The patient was quick to complain of police brutality, and threatened them with “I’ll have all your badges.â€Â  Somehow, I think their badges will be just fine.
