Wednesday, April 7, 2010

What's the Craziest Thing?

My last post was getting a little long so I thought I'd break it up into two, on a similar theme. 

Often when I am out with non-medical people, after a few glasses of wine someone will ask,  "What is the craziest thing you've ever seen in the emergency department?"

This is a tough question to answer because there are many different kinds of crazy.

There is crazy-sad, crazy-funny, crazy-weird, crazy-annoying, crazy-smelly, crazy-gross, crazy-bloody, crazy-interesting, get the point.

Of course I love telling stories and talking about my work but the point is to entertain, not to bog a captive audience down in all the depressing things that haunt you.

For now, these are two of my crazy-wow stories from the ED. 

When you are a health care worker you have to really work at an impassive expression when you see things that disturb you. Mostly because patients are acutely aware of even the slightest muscle tic on your face when you greet them and their problem. The last thing you want to do is make them feel more embarrassed, upset, exposed, or vulnerable. You really want them to feel like you've seen, smelled, heard, felt, their problem 1000 times before and they can just relax and not worry about it.

There are very few sights that freak me out. But two patients in the past 6 years have actually caused me to take a quick polka step backwards before collecting myself (and my professional behavior) again.

The chief complaint on the emergency form said "bit tongue".  It was busy in the department and I was annoyed that someone would actually come in for such a trivial complaint. (This is where I think--do people in this world have absolutely *no* coping skills for minor injury??)

The couple was a calm middle-aged duo, a little wobbly from the drink, in matching leather jackets and riding boots. The patients husband smiled when I approached, almost giggling as he told me the story---she'd slipped in the bathroom and bit her tongue when her head hit the sink on the way down.

I was now doubly annoyed because it is a major pet peeve of mine when husbands speak for their wives (or parents for their children and vice versa with the elderly). I asked her to open her mouth and out dropped 95% of her tongue, sagging down to her jaw line, hanging by a thin ragged edge.

Yep. I actually jumped back in surprise. She then jerked her head to throw the thing back in her mouth. They both found my reaction hysterical. Ok world, I get it...preconceived judgments are a bad idea.

I kindly warned the plastic surgeon before he examined her that this was no small injury. Even he came out of the room with his eyes widened.

The other time I did a dance step away was when one of our more colorful frequent flyers developed a severe cellulitis, with a twist.  He was coming in four times a day-ish for IV antibiotics and every three or four days for a massive dressing change. The weeping, festering wound stretched from just below the knee to the ankle. He told me one day that there were maggots in his wound and he wanted them cleaned out and the dressing changed. He wasn't due for a dressing change for another couple of days and the department was swamped so I tried to talk him out of it. When I worked in adult psyche probably every third person complained of 'bugs crawling out of their skin' when they were going through withdrawal so I was nonplussed by his description. But, truth be told, I felt bad for the guy and life afforded him no luxuries, so if a dressing change was going to make him happy, I'd do it.

I peeled off the dressing and much to my shock and "egad!" I jerked back at the sight of dozens of tiny white wiggling maggots diving back into the flesh from the bright disruption to their darkened world.

"Seeeeee! I TOLD you there were maggots* in there but no one believed me!!!"

The timing for these types of encounters seem to always coincide with getting too cocky developing a false sense of confidence in your powers of prediction and assessment. 

*And yes I know that maggots are grand for wound healing and debriding necrotic tissue...but it was shocking nonetheless to see it unexpectedly.


Nature Nerd said...

Please let us non-medical types know when you have gone back to non-vomit-inducing blog posts.
Thank you.
NatureNerd (the non-vomit-inducing kind of nature).

Albinoblackbear said...

Heheh..Sorry NN!

I know...last time I talked about nails et al I gave a warning. My bad!!

(I *did* a post on pizza just a few short days ago!)


RH said...

When I read tongue bite, I knew what was coming. Notice how it usually is the little things that turn into big things!

Thanks for sharing and the morbid chuckle.

Albinoblackbear said...

RH--Yes exactly! Murphy's law dictates life at all times in the ED.

Whenever you say "this will be a quick in and out" to convince a doc to see a patient before going on his lunch break in turns into a multiple consult and ambulance transfer to another hospital.

If you see the most banal chief complaint and mentally roll your eyes, it turns into a code (true story).

If you get excited about a seemingly salad patient assignment one of them will definitely end up tubed, on insulin, heparin, dopamine, and potassium drips with q 2 hourly blood transfusions.

It's no wonder that most emergency workers are totally superstitious~no uttering of the word 'quiet', etc.

GENOVEZ said...

hey...ABB!!!well I really prefer the pizza post.... :D:D

Albinoblackbear said...

Gen--Glad you liked it.

I put a lot more about food on my other blog but have toned it down a bit on my slightly more medically oriented blog.

Then some days I feel like, what the hell. It's *my* blog. If I want to talk about pizza, I will. :)

Fordo said...

Wait a sec, now. What happened to Maggot Man? Did you clean the maggots out of the wound, leave them, or get him a bed? Rest of the story, please.

Albinoblackbear said...

Fordo--My apologies! I soaked his entire leg in saline, I then carefully removed all the maggots I could find with tweezers, then irrigated the whole leg again with saline and bandaged it up again.

He was very happy.

Funny, I still think about him from time to time, wonder if he ever cleared up that infection or if he lost the leg or not. I really liked the guy. He was a total character. One of the downsides to emerg in the city, you never know what happens to most people.

Albinoblackbear said...

Oh, and he was never admitted. He was coming in for IV therapy of antibiotics so was never an inpatient.

Anonymous said...

I live for the crazy stuff. Even if it's stressful or gross or shocking or whatever at the time - it's the stuff you get the best stories out of that I love.

(Okay, maybe I love all of it but it's the crazy you-know-what that really keeps it interesting...)