a harmless trip to the chiropracter…

as i spend my enlightened days doing retrospective chart reviews for research, i see cases of stroke after stroke.  most of them are 70 year old men, but then i came across a 34 year old woman.  and, i stop and think to myself, wtf?

so i start reading about this woman.  and you know what happened?  she went to the chiropracter who was doing some “safe” manipulations on her neck - and she suddenly developed stroke like symptoms.  She chalked it up to a side affect of her migraines (not totally unreasonable).  She eventually got worried and came into the e.d..  after much imaging, you know what they found?

a vertebral dissection.  what’s that you ask?  it’s when you get tears within the vertebral artery - which coincidentally runs in the vertebrae in your neck.  she had a stroke at 34…thirty-four.  so, great - this 34 year old woman who just had a baby (yeah, didn’t mention that in the beginning, but yea - new mom) now has permanent disability because of high velocity neck-cracking.

boo alternative medicine.

hodgepodge

really the only reason i am writing is to procrastinate studying the physical exam of the hip and pelvis.  the doctor i work for insisted that i read this book, and while informative, it is most certainly dry.  i have since tried every form of procrastination, yet i am too efficient with procrastinating, so i am down to my final method, which is clearly writing in this blog.  i don’t have much of the book left, but it’s enough.

today, i didn’t go to church.  which to many, you might be like, so?  but i have gone pretty religiously (ha) since i started dating my boyfriend.  the last couple months i have been more deliquent, but i just haven’t wanted to go, and i am of the attitude that if you don’t want to do something, generally you shouldn’t.  (as proven by the fact that i don’t want to read this book).  mostly i didn’t go today because the church i like is a half hour away.  there is a closer one about 3 minutes away but i hate that hippie church with their guitars and tambourines.  nonsense.  how can you possible focus when someone is going to town on a tambourine?

yesterday i had the distinct honor of draining the biggest abscess i have seen yet.  there is nothing more gratifying than draining an abscess filled with pus.  numb up the area with some lidocaine, go at them with an 11 blade (aka an exact-o knife) and have fun squeezing that baby open.  pack it with some gauze and send the poor soul out.  i love it.

bitch please

how ironic that this would follow an article on drug seekers.  this afternoon i saw a patient who came in for gross hemoptysis (coughing up blood in chunks).  I read over his records and he had been there two days prior for the same complaint (usually doesn’t bode well in terms of what the patient wants.)

however, i look at some of his stuff (and his complaint is legitimate) and find he has possible bone cancer, and the man is missing an arm.  bearing all of this in mind, i tell the doc about him, and the patient at multiple points had asked for pain medication (bone cancer or any cancer = pain, lots and lots of pain).  so, a new nurse comes on the shift, and because of his long wait, the patient is cranky.  he sort of takes it out on the nurse.  she comes up telling the doc that the patient wants pain medication.

“is he a drug seeker?”

“yes.”

my jaw just about dropped.  i wanted to slap this woman.  i’m sorry, but were you hit by a train, only to lose your arm?  do you have some GI cancer that has spread to your bones?  are you coughing up blood?!  then shut the hell up.. you don’t know why he’s here, you didn’t ask, don’t answer that question you cynical bitch.

this isn’t a common occurrence, but boy when it happens…if i were the attending in that case, i would have probably gone back and said something to the wench.  like, before you tell me a patient is a drug seeker based solely off your pride and cynicism, maybe talk to the damn patient.

pain

drug seekers… most of the time, these people are very difficult to tell from people with real pain.  today, i had a blatant example of one.  and it’s not what you would expect - i usually picture a young guy.  not this one, it was a little old lady.  so how do i know?  well, here are the basics.

she comes in telling me that she fell, tripping over some carpet while trying to get a lamp.  she fell on her knee.  her knee hurts.  i physically examine the knee and i am pressing hard.  she doesn’t even flinch.  ooooh but it’s an 8/10 for pain.  well, because this woman is over 55 (thus, at risk for fractures), i need to xray her knee, knowing full well she doesn’t have a fracture, and she probably didn’t fall.

xray is normal.

i go in the room -

“well you xray appears to be normal, but i can’t be sure.  i am going to wait until the doctor i work with takes a look because i may be wrong.”

“oh, my ankle hurts too.”  as she points at her ankle.

“oh, really.”  i start pressing her ankle with no flinching.  “does it hurt more than the knee?”

“oh yes, definitely.”

i tell the doc i work for about this.  the pt is now clearly seeking drugs in my mind.  he goes in the room now.

“the xray is normal.  you just have some arthritis.”

“oh and my hip hurts.”

“what helps take care of the pain for you?  tylenol? motrin? vicodin?”

“hm…vicodin.”

peace out lady.  we give her the infernal vicodin and boot her.

there’s your tax dollars at work people…and to think - you want to make healthcare free for everyone.  because clearly it’s being effectively used now.

 

er barbie

oh you bet - that’s the nickname i got last night, nicely given to me by a patient.   i won’t write about all the patients i have, but i will definitely always share the highlights.  the fascinating part about working the night shift is what comes out of the cracks.  there is the woman who comes in faking being sick - as in, she put on makeup to white for her skin, pretended to have terrible abdominal pain, and somehow managed to get her hands on some blood. 

you might ask why i think she’s faking…well i didn’t at first.  she was just that good.   she jumped from hospital to hospital that night just hoping for some kind of attention.  then a nurse noticed her putting on makeup to light for her skin - now girls, you all know that you buy makeup too dark.  it is the rare girl that severely underestimates the darkness of her skin.  this woman knew it would make her look sicker.  then she claimed she had been bleeding profusely from her vajay…but when we did the exam…nothing.  her urine? absolutely negative.

she wasn’t my favorite patient of the night though.  that award goes to the woman who walked miles  after being bit by a pitbull (her boyfriend’s i might add).  how do i find her? with her pants off (fair enough - told to take them off), but her gown free flowing.  she doesn’t seem to have a care in the world despite the fact i can see her gastrocnemius (that big calf muscle).  once we finally get her laying down so i can suture her up, she at some point tells me i am adorable and that i am an er barbie…awesome.  the doc i work with obviously thought this was hilarious, so i can only pray it doesn’t stick.  nevertheless, she was amusing. the whole time we’re jabbing her with the syringe to numb her up with some lidocaine, she’s just jabbering away about lord knows what.  she kept refering to the other medical student as the brawny man (partly my fault as i did ask her if she thought he looked like the brawny man).  it took about a half hour to get this thing all stitched up, and the whole time she didn’t complain a bit - although that could have been the drugs she was likely doped up on… whatever, still a good patient.

like i said, never a dull day in portion of the hospital - something that makes me a little happier every day with my likely profession.  unless there is some major turn in opinion, i have a feeling this badboy will stick.

more stories to come

holey jaboley

well first and foremost, my bad.  i have been very delinquent, but very busy.  being on vacation.  fortunately, while on vacation, i had niether tv nor internet, and wouldn’t you believe it, i got even less work done.  nevertheless, i came back refreshed and ready to begin my time in the ed aka emergency department.

this post will still be brief, but i’ll get back to it soon as far as regular postings.

i just wanted to let all know that thus far (day 2), i love working in the ed.  the fast pace, the variety, the amount of work, the way time passes…it’s perfect for me.  in the meantime, i’m busting my butt with research, trying to get it done.

submitted my irb protocol, so once that’s done, get the data ready and submit an abstract, which, hopefully will be accepted.  i then have the pleasure of presenting it at a national conference - wahoo!

that’s all i got for now - adios.