Chief Complaint of the Night, EMS Edition

2300 33 y/o male with altered LOC at home. Per EMS, wife states pt drank 3/4 liter of tequila as well as several beers PTA. Pt awake and responsive here, displaying agitation and repeatedly yelling about ants crawling on his face.

Well, we were out of beds in main so he sure did have to go to a hall bed where he proceeded to yell at anyone who would listen about the ants of his face whilst rolling over on his stomach and sticking his ass in the air and moaning. All anyone heard for about an hour was the moans followed by someone yelling "NO ANTS! TOO MAS TEQUILA! GET BACK IN THE STRETCHER!"

A Sampling from a Good Night at Hood Hospital

90 plus adorable old lady, as I assisted her to the bedpan: Well, you see, I've got this diaper here now but I have a lot of trouble going in here. You know, they teach you your whole life not to pee your pants and then all a sudden you're supposed to do it again. Same with this thing. I learned not to pee in the bed but here I am.

This lady fucking ruled. Probably in my top ten most awesome people I've ever taken care of. I love funny, sassy little old ladies.

Free Medical Advice and Panda Taints

Middle aged man runs up to the triage desk in a panic talking about something bursting on his ass. I talk him down and think we're probably dealing with a standard buttock abscess that has caused a lot of discomfort and ruined a pair of underwear but not much else. I take him back to the triage booth and as I'm talking to him I discover that we are not, in fact, dealing with an abscess to the buttock, but in a less desirable spot:

Yuuupp. Perirectal abscess. Tender, puss filled wound right in or around the taint area.

And yes, this is the least disgusting google image search result. Don't do it, I warned you.

Now, this is unfortunate and could happen to anyone, but this is where the medical advising part comes in. Listen. If you ever wake up one morning and you find a painful spot on your taint that shouldn't be there, don't pussyfoot around about going to the doctor. And when you do go to the doctor and the doctor tells you that you need to make an appointment and get this shit taken care of, you should actually call the surgeon he refers you to, and in a timely manner, say less than 6 years. And if in that 6 years, you, for whatever reason, haven't called the surgeon, do not, I repeat, DO NOT, attempt to lance the abscess at home yourself in the mirror using a kitchen knife because that's how they did it back in the old days. Didn't work out so well.

I'm sorry. I know that was a gross story. Perhaps you might like to clear your head with some adorable, fluffy panda taint:

Chief Complaint of the Night

To increase customer satisfaction around here, my end goal in all cases in every area of my life, and to inject a little joy into the frequency in which I keep getting stuck in triage, I'm gonna start a little feature here called chief complaint of the night whenever I work out there. Today's first ever chief complaint of the night (as I charted it for maximum impact):

0230: Hernia x 2 years

Pt denies pain, but states "I might as well have you guys fix this

now. I want it out. I'll also take one of them AIDs tests."

+ETOH

He was obviously a winner. He threw a fit about thirty minutes after I had put him out in the waiting room insisting that he had been in excruciating pain the whole time, and scolded me for talking too fast. When he did go back to a room, he immediately fell asleep, and when the doctor went in to ask what she could do to help him, he responded with, "ask your mama."

He was of course, promptly discharged to the waiting room, where he tried to talk to the police officer at triage about his Snoop Dogg CD and demanded a cab voucher.

Yup. Saving lives as usual.

PCP

Listen kids. I'm not one of those people that's super uptight about alcohol or cigarettes or illegal substances. In fact, I am of the opinion that we should legalize just about everything and vice laws are a giant waste of our time, but I personally do not partake in anything but alcohol.

For me it's a pro and con issue-the benefits of sweet, delicious Guinness far outweigh any health risks for me. I understand some people feel that way about cigarettes, and others feel that way about their drug of choice. It causes some suffering, but at the time at least, it's worth it. I can understand in just about every case except for when it comes to PCP. I mean, really. When has PCP ever worked out for anyone?

Obviously I am only exposed to bad trips on PCP working in the ER, but I know that bad trips cause you to scratch yourself, injure your loved ones, pee yourself, punch city busses in busy intersections in the mid-afternoon, get tazed multiple times without feeling it, believe all ER staff are undercover FBI agents, hump the foley catheter as it is being inserted into your pee hole, bite everyone in your general vicinity, lick sidewalks in the hood furiously, and stand on the side of the road naked whilst throwing tires at passing cars.

What is a good trip on PCP like? Does anyone know?

Get him to the nearest McDonalds, STAT!

Some lady runs up to the triage desk last night all huffing and puffing and freaking out asking for a wheelchair- I don't know whether it's a statement about me or the patients that this automatically makes me suspicious- somehow the family of the actual sick people seem to make much less of a scene. Anyway, she starts telling me in a very frantic manner about how her husband has been having chest pain and drifting in and out of consciousness all day long, and now he's unresponsive. So I bring a wheelchair out to find a very obese man sitting straight up in the front seat with his eyes closed in a manner similar to a child pretending to a be asleep. I give him a good sternal rub and tell him to stand up and get into the wheelchair. Once he does the math on our respective weights and realizes I am obviously not going to pick him up, he hops up and gets in the chair. It's the most intense workout of my week but I push him up to the desk, where he starts to tell me about how it feels like an elephant is sitting on his chest. Let me also just add that approximately 90 percent of the people who say this where I am say it because they have watched Dr Oz or something and they think it's going to get them somewhere.

At this point he's been waiting approximately 45 seconds from the time I've pushed him in from the car, and I tell him to fill out the check in form. Not that I've automatically blown him off because of his complaint and presentation, but A, it's been going on for three days, and B, until people microchip themselves like my dog and I have the technology to scan them into the computer system instantly, I still need you to fill out the damn form telling me who the hell you are! It takes one minute if you are a literate adult, just sayin'. So, this was unsatisfactory to him, so he decides to add that yesterday his child hit him in the back of the head with a plastic toy "in the exact same spot where I had a concussion a few months ago" and that his doctor told him that if he ever got hit there again he could die instantly. Yikes.

So we get him into the computer system and I tell him he'll be triaged shortly. He then stands up out of the wheelchair, walks to the vending machine, buys a soda and some cookies and he and his wife walk to the other side of the waiting room and sit down, where she then pulls a McDonalds bag out of her purse and they proceed to eat them some tasty cheeseburgers.

Unresponsive? Was that prior to ordering the double quarter pounder with cheese? I can see the med alert bracelet now- If found unresponsive, please bring to the closest fast food drive thru. Surprisingly, his EKG was normal.

There But For The Grace of God Go I

Ugh. It's been a rough week and I'm feeling kind of meh. Took care of a 14 year old who attempted suicide last night. I see stuff like this pretty regularly, but occasionally the gravity of all of it hits me. She had old cuts on her arms. It gnawed at me for a good part of the night and I didn't really understand why. Then I realized, it could have been me. I knew that sad, lost vacant look because I felt that way when I was her age, too. I can't really tell you what kept me from being there but I can tell you I'm lucky not to be.

My psych instructor used to tell us we were one bad day from being on the other side of the doors. She, like many psych nurses, was nuts too, so I didn't pay her much mind but it's true. So much of where we are is blind luck. I'm one of the lucky ones. I should be as thankful as I am today everyday, but I'm not.

Choose Your Own Adventure

So, say you decide one evening to smoke some crack cocaine and then break into a house and steal some stuff. The home owners return to find you digging through their belongings and just generally doing other crackhead type stuff. At this point, you're faced with a decision. Do you:

A. Surrender and wait for the police to arrive.

B. Try to make a run for it; or

C. Throw yourself on the ground, pretend to writhe in pain, curl into fetal position and scream about stomach ulcers.

A and B would almost certainly result in criminal charges. But, if you chose C, like the man I took care of last night, you might be a secret crackhead genius. See, if you act a big enough fool you will avoid being taken to jail and will instead be taken to hood hospital by fire rescue unescorted because frankly, the police don't have time to deal with your ass. You might as well dive off the stretcher multiple times and demand pain medicine, and kick the trashcan in your room at the staff when they don't respond to your screaming as quickly as you may like. We will take it, because that's what we're forced to do here. You may get an unnecessary IV start, but overall, it's better than the pokey.