Friday, March 27, 2009

Most Hardass Patient EVER

So, we got this guy in a trauma room today who had come from his job as an auto mechanic because he had gotten his thumb stuck in some machine and pretty much taken off the entire part above the fingernail. It was enough that he had actually brought the part of the thumb with him so the doctor could sew it back on. So everyone runs in there freaking out and irrigating the wound and trying to medicate him and such- we ask him to rate his pain-oh, yeah- 1/10. Like, I would put my achy throat at 1/10 now, and this guy is bleeding and part of his bone may actually be sticking out. All he really said was, "Oh, I'm fine right now. Yeah, I hope they can put it back on. This is my texting thumb." All the while, just kind of grinning at the EMT students in the room. Anyone else I would have run a tox screen on immediately, but he was totally calm and coherent- I think he was just the ultimate badass.

Sunday, March 22, 2009


A big apology to the 4-5 people that read this- I suck at updating lately. This week has kicked my ass. But! I'm learning lots! Lots and lots.
Highlights of the last few weeks:

A patient who came in for a shoulder he had pulled out of socket who I can almost guarantee was remarkably ghetto, even for where I work. He had all these awful tattoos of guns everywhere that no joke, looked like they were drawn by a 10 year old. They sent him straight back without triaging him, so I had to collect his medical history. Wowzer. Our conversation, as follows:
Me: Do you smoke?
Hilariously ghetto patient:Yuh.
Me: Okay! How many packs a day?
Patient: Uh, I don't smoke cigarettes.
Me (clueless retard): Wait, you don't smoke?
Patient: Naw, I smoke weed. A lot.
Me (worst poker face ever): Oh, Okay. That's cool.
I HOPE someone audits that chart, because it will totally make their day. Under Past medical history, the word "smoker" is circled, and written next to it is "Marjuana- "a lot"."
While realizing the hilarity of this, it was also a giant pain in my ass, because I later found out this guy had apparently burned one on the way to the hospital, which sucks, because I had to put him under sedation to get his shoulder back in place, and the rule is that you can stop taking vital signs when the patient returns to their original level of conciousness. Well, I really had no clue what the hell that was, so needless to say, I was in his room for-e-ver. I finally decided it was probably cool to stop taking vitals when he woke up and started trying to talk me into letting him out of the hospital 25 minutes after his shoulder reduction (in his words, his boo was waiting outside), regardless of how many times I told him only the doctor could do that. The best part of this whole situation was that before he left with his super pissed off girlfriend, he managed to kick an full urinal over onto the floor. Awesome.

Hrm. Other winners- jail patient who "tried to kill himself" by hitting his forehead really hard against a bedrail. Needless to say, it pretty much only resulted in a nasty lac to the forehead. FAIL. Although, I think he may have just been bored and looking for a free day, in which case, the joke was on us.

Patient who, when I asked her to pee in a cup for me, peed in the cup, dumped the pee out, rinsed the cup out, and handed me the cup. I'm pretty sure she wasn't all there, but it was still damn funny, especially since I didn't end up needing it.

Patient with abdominal pain in with her three year old who continously asked her- "Mama, you better yet? You need to poop mama? Go poop!" Cutest. kid. ever. Mom was super sweet, too, and her pain turned out to be gallstones- i.e., totally treatable. My favorite types of patients.

The most notable, this week anyway, was a lady who came in with altered mental status and progressively got more crazy and paranoid as the visit progressed. At some point she decided we were hiding her family somewhere in the hospital, and so she went out looking for them in other patients rooms. When the police tried to bring her back to her room, she kicked one of the cops in his junk and had to be cuffed to a wheelchair. I would feel bad about laughing, but the lady ended up being fine and coming to, and the cop who got kicked seemed more amused than anyone. He hung out at the nurses station and told us about it, saying "That old lady kicked me right in the groin! I ain't never been beat up by a senior citizen like that before, damn!" Indeed, sir, indeed.

Friday, March 13, 2009

I learned a very important lesson this week

Don't take the rooms right next to the nurses' station if you can help it. It's where they put all the crazy people.
I'm only taking two rooms at the moment (we eventually progress up to four), but somehow I ended up with not only a patient in methamphetamine withdrawals who I later found out had attacked some of the staff at another hospital, but a girl who post-ictally ( and possibly all the time) was so agressive that the last time she was in our ER, they had to put her under concious sedation to keep her from going bezerk, Wolverine-style, all over the unit. Awesome.
The meth detox guy was actually pretty nice at first- he was just super spaced out to a kind of scary degree. He had trouble completing sentences and was shaking like crazy, and eventually his very sweet, but rough looking girlfriend came and took care of him.
I wish I could say the same for my seizure patient. Apparently, she was a pretty regular customer because she isn't too complaint with her meds. She came in moaning and flailing and vomiting everywhere, and by everywhere, I mean all over the bed and herself. She kept getting out of bed and walking around complete with trail of vomit behind her- at one point sitting down in the nurses' station.
As all this is going on, my other patient starts coming out of his stupor and talking more clearly and angrily about how he wants to go outside and smoke a cigarette. I got an order for Ativan to help him with the tremors and agitation and then I went next door to help with the IV start on my seizure patient, who was already being held down by 5 people and had been stuck three times already, unsucessfully. Even our totally badass medic who has been doing this most of his life couldn't get an IV on her- the other nurses in the room finally started looking for a site in her foot. The whole time she was jerking around and screaming "Baby! Daddy! Oh fuck! That shit hurts! Baby that hurts! Aw shit! Aw fuck!" The first time they stuck her foot she yells "Hell no! Fuck that, give me back my arms!", then she gets one arm loose enough to fly forward and headbutt me in the shoulder while I'm holding her leg. Finally, badass medic tries on her arm one more and gets blood return, and by the grace of God, we get her Ativan before she pulls out the IV.
Just as she starts to take a nice nap, the guy next door is getting more pissed that he can't go outside with his IV and smoke- I calmly explain I wish I could let him but I can't, and that I have his chart up for the doctor to try and discharge him. He does that gabby hand motion at me and his girlfriend yells at him and asks me for more Ativan. I decide this is a good time to go to lunch.
When I come back 20 minutes later, he is livid and yelling obscenties and the police are there, because apparently he tried being rude to the doctor and didn't quite get the same response as he did from me. According to him, when he asked the doctor to go smoke, most assuredly with lots of colorful language, the doctor told him he didn't owe him anything and walked out of the room to discharge him. So he's sitting there screaming "Fuck that! Don't talk to me like I'm dumb! I'm only gonna have white doctors from now on!" (His doctor was white- he was just eastern European). Meanwhile, he has a 9th grade education and no insurance. I don't think you're gonna get that, man. The police officer calmed him down enough to let me take his vital signs and his girlfriend drove him back to the treatment center he came from. As he left, his started bitching to all the patients and family members in the hall who would listen to him, the whole time his girlfriend yelling at him to shut up.
After all this, I have to start a Fosphenytoin drip on my seizure patient because her level was 1.1(!) but- she was taking her medicine! She was just tired! Okay! She finally sort of came to at this point and I let her know that after the drip was done we would finally send her home. She gets on the phone trying to arrange her ride, screaming at the person on the other end for a few hours. She still hadn't gotten a ride by the time shift changed, but I did get her discharge instructions, which simply said- "You have to take your seizure medicine for it to work." Seriously. Nice.