Friday, August 31, 2012


Right, so I'm triaging this lady the other day for some vague pregnancy-related complaint and I'm asking her the standard OB type prenatal care GPblahblahblah type of questions.  I mean, I know these are easy things for me to answer, because the answer is currently and may always just be "naw dude, never", but I'm a little taken aback when the answer to "how many times have you been pregnant?" is answered with an indifferent shrug.
Huh? You don't know how many times you've been pregnant? I mean... can you give me, like, a general number?
Uh, maybe like 15 or 16?
Mmmkay then.  How many children?
So the other pregnancies were stillbirths, miscarriages, terminations?
Some miscarriages and some terminations.
How many of each?
Yeah, I don't remember.

Okay, look. I'm overall pretty pro-choice and women's health and freedom and Planned Parenthood and make it rain birth control at a reasonable cost for everyone everywhere BUT COME ON. SERIOUSLY DUDE. Hi, if you can't remember how many times you've been pregnant and your answer for how many abortions you've had is pretty much how I would answer if someone asked me how many sandwiches I ate last week, maybe it's time to look into condoms or maybe just not having sex for a while.  You're probably having the problems you're having right now because your uterus is tired and cranky and it just wants a vacation.  STOP IT.  Give it a break for like, a year. PLEASE.

P.S. Everyone.  Please don't make me regret sharing this anecdote by turning the comments section into a shit-throwing contest about Roe V. Wade.  You're never going to change each other's minds about anything ever. K thanks.

Wednesday, August 29, 2012

Depressing Developments and Therapeutic Crack Rocks

Nursing home sends the standard "altered but more altered than usual" via EMS at 3 AM.  Yeah, okay.  I do a quick head to toe and find that yes, the patient is still altered.  I'm trying to decipher the paperwork these fools sent over when I realize the name is someone I recognize- she was a former street person who would occasionally find her way to our ER, usually agitated due to some combination of crack and mental illness.  Both had clearly taken their toll-she looked about 20 years older than her actual age and was basically obtunded. Pretty depressing stuff, really.  
I'm going about my business when the patient's sister calls to check up on her. I talk to her for a while about what she was normally like and she gave me a brief history of what had happened over the last few years and how she had declined after an inpatient psych stay.  At some point it came up that I remembered her from her previous visits, which somehow seemed to comfort her.  She was obviously a pretty nice lady.  "I'm glad you remember her.  Yeah, she was on drugs there for a while."  "I remember", I tell her. "She was doing crack then, wasn't she?"  "Uh huh.  That was her." She paused for a while after that and then chuckled a little bit.  "You know, the funny thing is, she was good and strong when she was smoking that crack rock! She just started going bad when she quit!" I laughed a little bit without thinking, but by this point she was laughing hysterically.  "I'm sorry", I told her, after I'd regained my composure.  "No, that's okay", she said, still stifling laughter or tears, I couldn't tell over the phone.  "That's just how things worked out.  Will you call me when you guys know something though?  I know I'll be up all night worried about her."
Sure enough, she was wide awake when I called her back a few hours later to tell her all the tests we'd run were negative.  It makes me feel a little bit better that we aren't the only ones who do this kind of thing.

Monday, August 20, 2012

Basic Problem Solving Skills

Sometimes I feel like they're doing this to me on purpose now to listen to my rants and tirades, but anyway, charge brings a lady with cc: rectal pain to my room.  Of course. How long? Over a year.  Of course.
I'm sure I've mentioned it before, but I rarely ask why anymore.  I certainly never attempt to explore any situations like this myself, but I walked the young lady through what she could expect as far as the rectal exam and then threw the deuces up.  I had a couple of other patients with a more acute complaints.
I'm going about my business when sassy lady ER doc grabs me to chaperone the rectal exam.  Fun times.  Yup, little lady, there sure are some fissures there, she tells her.  Okay, so I'll go head and prescribe you some cream and  OH ALSO YOU SHOULD PROBABLY STOP HAVING TEH BUTTSECKS  FOR A WHILE NOW K?

Yup.  I don't know what the first thought that crossed YOUR mind was, but I was immediately shocked that after a year or more of relentless butthole pain that this chick was never like "hm, maybe a should lay off the anal intercourse for a little while." You'd think before coming to the ER and waiting to be seen for 8 hours you might try this, but yeeaah.  Her reaction to these discharge instructions was one of complete shock, like she had never made the connection before.  I tried to tell her about sitz baths, but I don't know if it really helped. .

Wednesday, August 15, 2012

Compassion Tap Out

Well, I sort of alluded to this a few posts back but some fuckery Nurse K has been showered in lately got me thinking about it a little more in depth.  You can get the full recap here, but the highlights would be 1)Nurse K posts about an shutting down some verbally abusive chick who is obviously drug seeking in a hilarious manner 2)Hijinks ensue when some spiritual healing jackwagon tries to lecture her for not having compassion for the poor drug seekers omegerd.
Fill a number of things into the drug seeking blank and you have the life of anyone who has blog about being involved in any type of medicine ever. One lovely reader a couple of months ago felt the need to go back into my archives and comment on any posts where I talked about making mistakes to call me a "dumb whore", including one in which I was  distraught about an abused child who I had cared for later dying, because I dared admit that I did not always think about the implications of laughing at the poor spelling and grammar on our check in forms. MMkay. Declined to publish all those, but you stay classy now anyway anonymous lady/dude/troll.
Anyway, as I've also talked about before, we may seem to the outside world like we don't care about a lot of shit.  I just want to clarify that it's not so much that as it is that it is absolutely imperative to our sanity and survival in this field that we are selective about what we care about.  I can't for sure speak for anyone else, but I can at least say for myself that I started blogging to work out a lot of tough feelings I was having about what I do.  But no one wants to read all that shit, because it's depressing, so occasionally I throw in things that happened that I found funny at the time. Sometimes the funny and the frustrating and the sad shit overlap, because you know what? When I really think about what I actually do every day, I see a ton of really, really sad shit.
I think the perception of the sad nature of the ER for a lot of people is basically "people die and that's a bummer".  Dude.  That's just the tip of the iceberg.  We see much, much worse.  We see victims of rape and violence, sometimes children, who are completely vulnerable and suffering for absolutely no tangible reason.  We see broken, frail, neglected elderly people covered in sores and wasting away forced to live in pain every day because their families who have forgotten them for years won't let them escape it until their heart fails after weeks on a ventilator. We see people unable to clean themselves or talk after a stroke who are perfectly aware of the world around them, trapped inside their own bodies, watching their families  carry on without them. People wasting away from cancer in horrific pain. Formerly happy, healthy individuals who now live in a completely different world than the rest of us because of mental illness.
Beyond the surface, there are so many more sad stories.  I talked to the sweetest elderly man recently who was telling me about how he lost his house after a prolonged illness- his only option was living in a nursing home which didn't allow pets, so he lost his dog, which was the only thing he cared about.  Seriously.  ALL he wanted was just to see his dog, and he was incredibly depressed because of how much he missed her. We bonded as I was talking to him about my dogs, and I was full on snotty-nosed bawling by the end of the conversation.  So many things will break your heart if you let them.
Nursing is awesome but at the same time, it's also one giant parade of getting bitch slapped with sadness. Depending on your personality, I think we live in a world where it's pretty easy to completely drown in the sorrows of others if you let yourself. There are nights where I sit up alone and think about how much suffering there is and how little I can actually do about it and weep at the pointlessness of what I'm doing in the world.
Point is, if we looked deeper at a lot of the situations we poke fun at, we would find, yes, even more sadness.  Is drug addiction awful and tragic? Absolutely.  Is the general level of education among the people I see in fact a huge downer and a symptom of a bigger problem that is overwhelming to even think about? Hell yes. Are the zany things our homeless patients do probably a sign of a much greater problem which without a doubt, is worthy of tears on it's own? Certainly.  It's not that we don't know these terrible things lie under the surface.  It's that we aren't digging under the surface because one person can only feel so much sadness in one day without going absolutely bat shit crazy.
Some people say that people like us, who laugh at some of the things we laugh at, are a disgrace to the field and we should do something else.  People that think compassion is not a limited commodity and that you don't have to save it up.  I'm telling you that's bullshit.  If you only want people with bottomless compassion to take care of you, stay at home and pray for healing instead of going to the hospital, because I'm pretty sure the only person with limitless compassion who walked the earth was Jesus. Right or wrong, I'm saving mine up for the people who seem to need it the most. I'm perfectly willing to admit I'm not always right on who fits that criteria.  But I'm also pretty confident it's not the girl calling me a bitch while asking for Percocet either.

Sunday, August 12, 2012

Chief Complaint of the Century

It's always a special night when a patient like this is the first one you triage.

Hi, first patient I've seen today at Hood Hospital, what's up?
Oh, you know, low back pain.
For how long?
Some time.
Well, how long is some time for you, ma'am?
Well... let's see.  It's been on an off.  It always kind of hurts. I think it first started in 1993, though.

It's never a good start when your reason for visit is older than some of our volunteers, but it gets even better.

Yeah. Alright then.  Any allergies?
Yes! I'm allergic to ALL medicines. All of them. Prescription and over the counter.  All medicine.

Wow. That's too bad, seeing as how that also means we can basically do nothing to help you here. But if you'll excuse me, I need to take my daily dose of face palm now.