I took care of an unfortunate young man recently who had, to say the least, a sucky year.
Saturday, November 21, 2009
When Life Throws You Lemons....
Another misguided attempt by
Tex
at
2:31 AM
0
Thoughts about this post
Friday, November 20, 2009
Coumadinization
A physician used that word in his progress notes regarding a patient on Coumadin for PE (pulmonary embolus).
Another misguided attempt by
Tex
at
1:30 AM
3
Thoughts about this post
Thursday, November 19, 2009
A Medical Excuse For Murder?
A recent murder in my area has a lot of medical professionals, well, kinda pissed.
Herbert Lawrence Peck was arrested for shooting and killing his wife after an argument. When police arrived, they found Peck hiding in a closet. The next day, he copped the "my sugar musta dropped" excuse.
I believe the defense will counter with the "liar, liar, pants on fire" gambit.
I wrote defense, meant prosecution.
Lack of caffeine will do that to you.
Another misguided attempt by
Tex
at
8:20 AM
3
Thoughts about this post
Tuesday, November 17, 2009
What Do You See?
Another misguided attempt by
Tex
at
6:47 AM
6
Thoughts about this post
Sunday, November 15, 2009
Saturday, November 14, 2009
So, Who's The Boss?
This is what can happen when the medical community bends to family pressure:
An elderly lady has been hospitalized for nearly a month due to complications from a severe bout with pneumonia. During her stay, she developed renal failure and proteinuria.
Another misguided attempt by
Tex
at
6:27 AM
8
Thoughts about this post
Thursday, November 12, 2009
Wednesday, November 11, 2009
Logical Thinking
These are the thought processes of a male EMT who recognizes the heart attack he is having:
*Don't drive yourself to the Cardiac Center (my facility). It's 15 miles away, and I don't want people to read about the traffic accident caused by the driver with a 'medical condition'.
*Drive yourself to the nearest ER, it's only 5 miles away.
*Don't call 911 from your vehicle, even though the pain, nausea, diaphoresis and dizziness is close to overwhelming you. You don't want to leave your truck on the side of the road.
Lucky for him, and the early morning traffic, he did make it to the ER, was quickly transfered to my facility and got his 99% occluded LAD stented.
The only thing worse than 'man-thinking processes' is 'man-thinking processes' with rationalization.
Another misguided attempt by
Tex
at
7:23 AM
0
Thoughts about this post
Monday, November 9, 2009
Reprise: Nailed It!
As can unfortunately occur, "I's has writer's block!"
Not so much writer's block, as lack of blog-worthy material.
But fear not, stupid is as stupid does.
Until then, a blast from the past.
One of my more unusual patients was a 19 year old gentleman who came to the ED with a complaint of 'Injury at Work'.
The young man was helping his father at a construction site with nailing sheetrock. Back in the old days, when I used to help my dad, we used nails and a hammer. Nowadays, nailguns are the norm.
Apparently, this kid had finished putting up a sheet, sat down, and placed the nailgun on his lap....oops!
You guessed it, the gun went off.
The nail went through the shaft of his penis.
Being the only male nurse in the ED that day, I was asked to take his room to save him any further embarrassment. I introduced myself, asked for his back story and then examined his injury. Nothing bad, just a puncture wound through the shaft, no bleeding, and a puncture wound at the left pubis, also no bleeding.
I asked him where the nail was.
Pt: My dad took it out.
Me: Did he just pull it out?
Dad: "snickering"
Pt: No, he had to use pliers.
Dad: "laughing"
Pt: You think I'm gonna be able to use it again, you know....fuck? I'm supposed to go to California in 3 months.
Dad: 'bent over laughing'
Me: Umm. Lets just wait for the Doctor to examine you and we'll go from there.
Damage: Hairline fracture of the pubis, puncture wound of the shaft of the penis
Treatment: Antibiotics and follow up with Ortho as outpatient
Afterwards one of the younger NAs asked me what the odds were of a nail going through his penis. My reply:
His odds were substantially better than most.
Another misguided attempt by
Tex
at
7:06 AM
2
Thoughts about this post
Saturday, November 7, 2009
It's A Family Affair
I got a transfer from a neighboring hospital to the Telemetry Unit I was working the other day.
Another misguided attempt by
Tex
at
3:32 AM
3
Thoughts about this post
Friday, November 6, 2009
Get Off Your Ass...
I was working on one of our step-down Units recently, a Unit I don't like working because I feel that some of the staff are lazy.
Another misguided attempt by
Tex
at
6:25 AM
10
Thoughts about this post
Tuesday, November 3, 2009
Waste Not, Want Not
Sometimes what appears as a sad case is, well, funny.
I recently cared for what seemed to be a very sad case. A homeless man, who worked a menial position at a large department store, was admitted for possible stroke.
The man, in is early 50's lived in a tent in the wooded area behind the department store. He bathed in the restrooms at his work place, cleaning his clothed in the sink.
Should he need to heed the call of nature while 'home', the nearest tree or bush sufficed.
He spoke intelligently and stated he had attended college 'up north'.
Alcohol had been his downfall, he drank a fifth of vodka every night, not because he was an alcoholic, but to help him sleep. (His 'stroke' was Wernicke-Korsakoff syndrome, secondary to his alcohol consumption.)
And he wasted nothing.
Every little scrap of paper was utilized. He described his abode as a collection of discarded items.
He said he wasted nothing in his tent.
I can think of only one thing that was wasted in his tent.
Another misguided attempt by
Tex
at
6:55 AM
0
Thoughts about this post
Sunday, November 1, 2009
ED Sing-a-Long: Ballad of the Frequent Flier
Another misguided attempt by
Tex
at
1:24 AM
3
Thoughts about this post
Saturday, October 31, 2009
Thursday, October 29, 2009
Reprise: The Family Doctor
I've had this blog for 2 years now, so I thought I'd put up an early post, just for the hell of it:
When we think of the family doctor, we have images of the mildly-portly, elderly, wise-looking Marcus Welbish MD. Or at least the quack in the Forrest Gump movie, "His legs is strong, but his back is crooked as a politician." Of course in the ED, we recognize the family doctor just as easily.
No, no, not the MD from the family practice across the street, I'm talking about the family member that not only knows more than the ED doctor, but knows about every illness, surgical intervention and medication of every single family member going back 3 generations.
Yes, I am talking about the dreaded Family Doctor, whom henceforth shall be called Dr.Kia (Know-It-All).
Had a lady show up at the registration desk yesterday requesting her spouse be registered immediately:
"He's having a heart attack!"
"Where's your husband?"
"He's on his way, hurry up. We can't waste time with this registration crap!"
"Is he coming in an ambulance?"
"No, he's driving."
That's right, drove himself while having a 'heart attack.'
So he ambles in, we get him registered, much to the ire of Dr. Kia. She plops him in a wheelchair, (Paralysis Point strikes again!) and into a treatment room we go.
I walk into the treatment room as the patient is wheeled in and with the help of the CNA and charge nurse, we quickly place him in a gown, hook up the monitor and get an EKG. Hell, for all we know he might be having an MI (not even close). Meanwhile, Dr. Kia starts writing everything down, VS, names, times. Dr. Kia's PA, the patient's sister, is on her cell phone calling the patient's cardiologist in Durham. That's right, some 250 miles away. The ED doc hasn't even walked in the room and Dr. Kia is already arranging a transfer.
ED doc walks in,
"Hello, I'm Dr. ED. What seems to be the problem?"
"He's having a heart attack. He had the same look when he had his heart attack 3 years ago."
"He 'looks' like he's having a heart attack?"
"Yes, I already consulted his cardiologist in Durham and told him he's having a heart attack. He needs to be transferred ASAP."
Off in a corner of the room, Kia PA is frantically dialing on her cell phone, notifying all near and far of the life and death struggle of their beloved family member.
After initial assessment and the determination that no REAL emergency exist, the doc orders some meds and labs. Dr. Kia is not impressed.
"He's had a nitroglycerin already today. Why are you giving him more? And more aspirin? He takes a baby aspirin every day!"
"I don't know," I said, "I've never done this before."
If that wasn't enough, Dr. Kia questioned us as to why we would give a patient with angina, morphine.
"Doesn't it concern you that you may be masking the pain of his heart attack?"
"No," I said, "That's why we have that TV screen with the squiggly lines connected to him. If he starts having a heart attack, the TV says, 'heart attack in progress'."
It also concerned Dr. Kia why we didn't just go ahead and transfer him NOW.
"We haven't gotten all the lab results back yet," I said, "and besides, Durham hasn't called us with a bed assignment."
"It's a 3 hour drive. They should have a room by the time he gets there."
Incidentally, the patient had been 'looking like he's having a heart attack' for 3 days.
Another misguided attempt by
Tex
at
1:22 AM
3
Thoughts about this post
Wednesday, October 28, 2009
Monday, October 26, 2009
ED Sing-a-Long: Paralysis Point
Paralysis Point:
Every ED has one.
Another misguided attempt by
Tex
at
1:34 AM
0
Thoughts about this post
Sunday, October 25, 2009
Anal-ogy, Part Deux
Some people's religious beliefs can interfere with even the most basic care. I had that problem last week.
Another misguided attempt by
Tex
at
1:15 AM
0
Thoughts about this post
Saturday, October 24, 2009
A Little Goes A Long Way

Another misguided attempt by
Tex
at
7:53 AM
2
Thoughts about this post
Thursday, October 22, 2009
Update: I'm Pissed
I recently had a post regarding a nurse who allegedly diverted narcotics. I worked the same unit not too long ago and the nurse was marked off the schedule for it's remaining 5 week course.
Another misguided attempt by
Tex
at
1:49 AM
2
Thoughts about this post
Tuesday, October 20, 2009
ED Sing-a-Long: Burn Out Blues
Another misguided attempt by
Tex
at
8:19 AM
0
Thoughts about this post
Saturday, October 17, 2009
Medical Acronyms
Folks in the medical field love acronyms.
We got 'em for just about anything ranging from diseases (CAD, PE, COPD) to surgical procedures (CABG, TURP, TVH) to lab and x-rays tests (BUN, MRI, US) to patient descriptions (GOMER, PIA, CTD).
Last week I had a patient, whom through a series of unfortunate events, had gone for 7 days without a bowel movement. Why it had not been addressed is another story, but I notified the Medical Doctor regarding this when he came to examine her.
His main concern was ileus, so he ordered an abdominal series.
In his progress notes he wrote:
'No BM for several days, will get abdominal series to rule out ileus vs (+)FOS'
Another misguided attempt by
Tex
at
1:05 AM
4
Thoughts about this post
Thursday, October 15, 2009
That's Dedication, Part Deux
I posted about a patient's need for a cigarette, but he was confused.
Another misguided attempt by
Tex
at
1:10 AM
3
Thoughts about this post
Wednesday, October 14, 2009
Anal-ogy
My facility, as well as many other, employs staff from varying backgrounds. We have several physicians from India, the Philippines, Africa, etc. Although they speak English, at least well enough to be understood, they have some difficulty with our colloquialisms.
Another misguided attempt by
Tex
at
1:54 AM
4
Thoughts about this post
Tuesday, October 13, 2009
PSA: Hygiene
To the twenty year old chickie who has made her fourth visit to the ER in 3 months with a complaint of abdominal pain:
Another misguided attempt by
Tex
at
2:05 AM
3
Thoughts about this post
Sunday, October 11, 2009
'Nothing Runs Like A Deere'
To the drunk idiot the police brought to our ED the other night:
Another misguided attempt by
Tex
at
4:46 AM
0
Thoughts about this post
Saturday, October 10, 2009
ED Sing-a-Long: Narcan
Special thanks to EMTB2RN for the suggestion.
Another misguided attempt by
Tex
at
1:41 AM
0
Thoughts about this post
Thursday, October 8, 2009
Jury Awards Man $9 Million After ED Treatment Leave 'Permanent' Scars
I saw this headline and thought about Whitecoat's insistance that the ER should be called the ED.
Another misguided attempt by
Tex
at
5:59 AM
2
Thoughts about this post
Wednesday, October 7, 2009
I'm Pissed
I know that drug abuse runs rampant in the Medical Field: nurses, doctors, hell even the housekeepers for all I know, and I have known.
Just keep me out of it.
So I go to get some pain medication out of the Pyxis for my patient... specifically IV Dilaudid.
Now for those that don't know, or haven't noticed, when you log into Pyxis, chose a patient and see their list of medications, you can also see the last time that medication was accessed for that patient.
Low and behold, the patient had been accessed not 10 minutes before by another nurse and Dilaudid was removed.
The nurse that the Pyxis says accessed that patient and medication had just going off shift.
I asked her if she gave anything to the patient, she denied it, as did the other nurse on duty. The off-shift nurse then went home.
The patient denied being given anything.
FUCK!
I showed the entry to the Charge Nurse, then to the Administrative Director.
I was told not to worry about it, and that I shouldn't fill out an incident/occurrence report (WTF). She would take care of it.
I know I did as I should: I went up the chain of command, but no paper trail? I don't have definitive proof, I mean, I didn't actually see her take the vial, but should I report it to the Board of Nursing?
Will the hospital find reason to reprimand me if I do report it to the Board?
DOUBLE FUCK!
Something tells me that either way, I'm a gonna need some Vaseline.
Another misguided attempt by
Tex
at
4:39 AM
12
Thoughts about this post
Tuesday, October 6, 2009
Zombieland
Must see.
Another misguided attempt by
Tex
at
8:37 AM
2
Thoughts about this post




