Buy the right sized condoms, please...

Dear sir:

Please buy the appropriate sized condom for your penis. And please, also, if it isn't too much to ask, "pull out" as soon as possible after you are finished. One of the nastiest things I have to do at work is pull your wadded-up used condom out from your wife/girlfriend's vagina.

Thank you, in advance, for your cooperation.

Sincerely,

Your Emergency Room Doctor

Why are you so fat?

I'm sorry, but sometimes I have a problem with fat people. And their families.

I'm not talking about people that are just "overweight." I'm talking about 400-500 pounds or more. I do take issue when patients are so large that we have to haul them and an empty bed out to the hospital loading dock to put them on a freight scale---> haul the patient in bed on to the scale (685 lbs)... roll them off the scale... roll the empty bed (+ sheets!) on to the scale (175 lbs.)... substract the two, and gigantor weighs 510 lbs.

That's a bit too much. Show me a person that large and I'll show you a patient that's in the Emergency Room for either "shortness of breath" or (my favorite) "abdominal pain."

Trouble is, there's not much we can do for these people. Medical equipment is NOT designed to treat human beings this large. CT scanner weight limits top out around 400-450 lbs. Plus, the diameter of that 'donut hole' is finite.

I had a patient once that weighed 760 lbs... at least that's what the freight scale had him at the last time he was admitted about a month before I saw him. Chief complaint? Yup, "shortness of breath," what else? He was 29 years old, and his father could NOT understand why he was so short of breath?!?!? I finally explained to him that if he laid down on the ground and had 2 people stand on his chest, he might have a better understanding. He never got it. He also didn't make the connection (and the patient didn't either) that part (all) of the reason that he was so short of breath was due to the fact that he sold his home oxygen equipment the week before for some quick cash...

...but he's not dead yet!!!

This is the story of Mr. K, or just K as I'll call him...  K showed up in the ED back in the fall of 2004.  He came to the ED complaining of this uncontrollable vomiting that happened to start while he was working on a construction site.  Well, since he was causing such a disturbance with all the vomiting, he was placed on a hall bed to wait for his EKG.  Between fits of vomiting K said something about chest pain, which prompted the nurses to get an EKG.  Unfortunately, K's heart couldn't wait for the EKG and decided to stop beating before we could do anything about it...  The nurses noticed it mostly because K suddenly stopped vomiting and became uncharacteristically quiet.

I was sitting in a separate area of the ED and wasn't anywhere near K when his heart stopped...  I just saw the nurses---  one of them pumping his chest--- pushing his bed, running, into the resuscitation room in my area.  

I jumped up and ran into the room with the nurses to 'run the code' and find out what happened.  I got the brief story while I was getting ready to intubate K and in ran the Trauma team who happened to be in the ED as K was rushed into the resuscitation room.  I alerted them that this was NOT a trauma CPR but a medical CPR as they pitched in to help save K's life...

After one round of drugs and 3 rapid defibrillations (shocks), the trauma surgeons put an ultrasound probe on K's chest to see if there was any cardiac activity; which is something they do quite often in a trauma arrest.  Seeing no cardiac motion, the decided that K was dead and the code should be "called."

I, again, reiterated that K was a "medical" code and not a "trauma" code, and that we were NOT going to call it...  So, we kept going... and they were irritated (and not too subtle expressing their disapproval)...  This story is getting longer than I anticipated, so I'll bring it to a close.

After around 45 minutes of resuscitation efforts... multiple drug combinations and drips... multiple attempts at defibrillation (I lost count after 15 or so)... K's heart decided to beat on it's own.  Within 15 minutes of "stabilizing" him, K was in the cardiac cath lab.  A >95% occlusion of his LAD was opened nicely with a stent and K was off to the ICU to recuperate.  

...It's now 3 years later, and K still comes to the hospital for his clinic appointments...  I check his appointment list in the computer every so often just to see that he's still alive.  He is, by far, my best "save" ever.  I often wonder if he realizes how close he came to dying that day...

What a night!

GI bleeders are an interesting bunch... Its amazing what hard living and lots of booze can do to you. Some guy puked so much blood out in triage that the place looked like a scene from Carrie... People in the waiting room were pretty horrified, but at least now they understand why they have to wait so long if they're just here for a sore throat that they've had for a week!

Poor guy. I hope he lives. He went up to the ICU, but I heard he started puking blood again.

Surgery's taking him to the OR...

Just getting started...

I've been at this emergency medicine thing for a while... I've been told I need to write my stories down, but I've never been one to write a journal. I hope to start doing that now with this blog. I'll write about my favorite patients.... patients that I hate (yes, all doctors hate some of their patients. If they tell you otherwise, they're lying)... funny ER stories... my pet peeves (I have A LOT)... and some commentary on what I think is wrong with the health care system in this country (and why Hilary is the one that can fix it!)... Anyway, I don't know if anyone will read this, or where this is going, but for now, here it is. Please post comments if you feel like it... it'll let me know someone is actually seeing this! Cheers.