Fooled Me Once

The emergency room is a popular destination for both people seeking help- and people seeking drugs. Usually it’s pretty easy to tell the difference. When someone is 11 out of 10 on the pain scale- and allergic to everything besides dilaudid…that’s a good clue. “I lost my medications,” or “someone stole all my vicodin,” are common excuses that patients give for needing more pills. Sometimes it’s easy to spot the drug-seekers…other times, it can be very challenging.

A week ago a patient comes in for suicide watch. I spent the last part of my day with them, drawing blood, taking vitals, and getting them settled in. I got the feeling that they were a good person, in a tough spot- and really wanted to get help. In the emergency room, we get everything from people seeking attention- to people who have made serious attempts on their lives. It’s up to the social workers, psychiatrists, nurses and doctors to make a determination on the seriousness of each case.

The patient stated that they had thrown out their medications because they were worried they were going to overdose on impulse and I genuinely believed them. Tears and stories of troubled times convinced me that this wasn’t another attention-seeking -resource waster. I left at the end of the day before the fate of our patient was determined as far as long term care went- and thought nothing more of it.

Days later, I’m surprised to see the same patient- back again. I start through the same process but this time- something is different. I sit by as the social worker does the interview and I can sense deception from the end of the patient. The social worker is straight-forward and says that she thinks the patient might be drug seeking. The patient quickly denies and changes the subject.

I’m not sheltered, and have about as much street smarts as anyone. As I teenager, I ran with a bad crowd, and at times- the bad crowd ran with me. I know the tricks of the trade and the “tells” of a good liar. I’m picking up the vibe that this is a desperate-drug seeking visit.

The thing that really blew my mind about the whole experience was how much I had been utterly fooled on the previous visit. I felt compassion and empathy- a desire for the patient to experience joy and a change in life- the first visit. The second visit- my compassion never surfaced- I couldn’t believe it. Is my lie detector getting rusty? Are my streets smarts fading from lack of use? Am I losing my touch?

I don’t think any of those things are happening- we all get fooled sometimes- and addicts are some of the best deceivers- they have much to gain from the deception. We all get beaten sometimes- there’s always someone better out there.  I realized that we were playing a game- I lost the first time (badly,) but I won’t get fooled again…

Full of It

Ever been constipated? I’m happy to say- I don’t have this problem. Not being able to go for days at a time…must be miserable. Narcotic pain medications can cause constipation. A patient who hadn’t had a bowl movement for seven days- reminded me of a case that had slipped away into the memory banks.

Once, on a slow day- a patient checked in for constipation. No big deal right…a few days without a bowl movement…no biggie. Try a few months. The patient had not had a bowl movement in over sixty days! No once could believe it- the x-ray looked like a volleyball of fecal matter trapped inside this poor person.

I’m walking down the hallway and one of the nurses asks another ER-Tech, if one of us can help the specialist with disimpaction. A momentary lapse in judgement saw me voluteering for the task. For some reason or another- when she said “disimpaction,” I pictured “I and D” (incision and drainage.) While cutting open an infected abscess and suctioning up the resulting puss is certainly disgusting- it doesn’t hold a candle to fecal disimpaction.

The procedure is rather simple- the specialist puts on some gloves (and gown and mask) and shoves a few finger up the bum of the affected patient and tries to loosen and remove the blocking feces. Talk about a bad day at work! Turns out that the patient had tried disimpacting themselves to no avail- really…?

“Looks like you’ve got a bit of a rash back here as well.”

“That’s probably from the diaper I’ve been wearing.”

Now, for the discretionary reasons, I won’t disclose the age of the patient but I will say this- there is no situation (that I could picture,) where this patient should have ever been wearing a diaper. Manual disimpaction? Wearing a diaper? Sixty days of no boom-boom? After three days, and failure of ex-lax to solve my problem- I would have scheduled a doctors appointment. Oh yeah- the patient had a regular doctor but never saw them for this problem- even when it got to the point that they could only have tiny sips of soup…

The mass of doo-doo was so bad inside of the patient that the disimpaction did nothing- no feces was removed…I was happy for that. The patient was admitted and other options were discussed- surgery was even tossed around as an idea to remove this colossal poo. I don’t know what became of the patient and there epic bowl movement…and I’d like to keep it that way.

Penny Pincher

Has our culture lost all sense of value? I believe it has. A recent experience affirmed this to me. Stand by for epic rant.

After a hard day of work, the last thing I want to do is go home and cook a meal. After 8 months of pregnancy and a hard day of work- the last thing my wife wants to do is cook a meal. Enter Costco food court.

My wife and I are regular patrons of Costco- their food court makes a great pizza that’s not only bigger and better tasting than Papa Murphy’s- it’s only $10.89 after tax. Costco serves up a sweet deal for a great- already cooked pizza.

I stand in line and chat with a gal in front of me- she’s a pediatric nurse. I reach the front of the line. The total is $10.89, as usual. Since they only take cash or check I hand over a crisp $20. My piping hot box of deliciousness is handed over the counter to me, along with my change- nine dollars and a dime.

Now I’m no math whiz- but I can pretty easily figure in my head that 20 minus 10.89 is 9.11. Something’s wrong here- where’s my penny? As I stare down at my handful of less-than-adequate change- the cashier doesn’t miss a beat and looks past me to the next customer.

I look up from my change- she must have sensed my confusion.

“I don’t have a penny,” says the cashier- almost in a sense of disgust that I hadn’t left yet.

“Okkk…,” I say…not really sure what to say…this is akward.

“Did you want your penny?” she says- again with a tone of impatient annoyance.

“Uhh- yeah…I do.”  I’m really starting to get pissed at this point- I would have long been out the door had she not assumed that I had as little concern over my finances- as she did.

“Well…you’re gonna have to wait while I get one from another register. Do you want to wait for a penny?”

Now I’m about to lose it, but I try to keep my cool- “Yes, I want to wait for my penny.”

Is that such a novel concept…I want to wait for a penny- would it be weird if I wanted to wait for a nickel? How about a dime, a quarter, a dollar? Just because a penny is at the bottom of the money-chain…it still has value- pennies add up to dollars (the last time I checked.)

I was almost shamed into walking off without what was rightfully mine- especially since I was wearing scrubs. She was probably thinking that I was some, rich, money grubber. Wrong! I’m a young, poor, husband, and soon-to-be father- trying to do all that I can to provide for my new family. I know money is important to security- so I don’t waste it.

If a few more of my peers could get on board with me- working hard, being thrifty, and appreciating what you’ve got- this country could get back on the right track. Don’t leave your change at the Costco counter and then demand that the government pay off all your debts.

In the end, I was glad I waited…it affirmed my own sense of thrift and value. Also, it was the shiniest penny I’ve seen it a long time!

Rant finished. Tomorrow will be a “normal post.” Thanks for bearing with me. Stay tuned for an upcoming series- profiling the different jobs of the emergency room.

Potty Mouth

In the emergency room, we get the pleasure of caring for many patients that are coming from the jail. Handcuffed to the bed, with a Glock-toting chaperone- they are usually well behaved. I respect law enforcement for the things that they have to deal with, but envy them because when their “clients” act out- they can put the smack down.

We recieved a patient from the jail, the dude is tweaking like no other. The officer says that he’s swallowed a bag of meth. Tweaker says that he hasn’t swallowed anything- but he’s also totally incoherent and near impossible to understand. Let’s take his vital signs- blood pressure, temperature, pulse- all while the dude is wriggling and wigging out- like he’s got a colony of ants in his jail-pants.

Sir, look at me, put this thermometer under your tongue so I can get your temperature.

We have digital thermometers and I’m watching the screen- waiting for a reading. Nothing- I get an error reading. Simultaneously, the nurse and I look down at the thermometer probe. Oh, boy…

The digital thermometers that we use can accept two seperate modules- a blue oral module, that has a probe and cord, and a red rectal module- with probe and cord. Dude had the red probe in his mouth…

Now …all of our  equipment is cleaned religiously, and when we use the thermometer- a plastic, disposable cover completely shields the probe. And although there was no physical difference between the two probes…the mental difference to the nurse and I was hilarious.

Uhh…sir, I’m gonna take your temp again…it didn’t work. I pull it out from in between his last remaining meth-holed teeth and switch the modules. I’m glad I made that mistake with him because I was immediatly more aware.

Somehow, I get the feeling that if he had known, it wouldn’t have phased him…


A Familiar Face

Months ago, on a friday- I had the pleasure of checking in a patient that I really “clicked” with. Sometimes a patient comes in and right off the bat, you get a fun banter started, and inside jokes are established that set a playful precedence for the whole visit.

This particular time, the patient was checking in with chest pain. He had a history of cardiac disease, and had previous heart surgeries. I hook him up to the monitor, do an EKG and help get him settled in. Even though he’s in some pain- he keeps good humor and we crack jokes back and forth. I get the pleasure of being part of his care for the morning- and then he’s taken upstairs to a room.

I don’t remember if I had the weekend off or not- really it’s not important- I know it was a busy monday. The emergency room was full of patients- and as usual when it’s busy…the level of chaos was high. I was dealing with a psych patient who had started out being very friendly with me- by the end of the day he was flat out cursing me and threatening me- until we tied his butt to the gurney. All in all, it was a challenge of a day.

It was about lunch time- I think I had just eaten when I hear a code called over the intercom, “code blue, cath lab.” Code blue is our hospital code for pulseless arrest and the cath lab is an area where patients go for vascular studies and cardiac intervention.Surgeons have the capability to put a wire into the system of vessels that leads to the heart, pump some x-ray visible dye in, and see plainly- where blockages are in the heart or surrounding vessels. On top of being able to see the blockage, they can place stints, use clot busting agents and a number of other interventions.

Even though I’ve already done CPR twice before lunch (yeah, it was a crazy one) I run to the code. I gown up and relieve the nurse doing CPR. To my dismay, I look down at the patient I had checked in on friday. This sucks. Usually it’s fairly easy to separate yourself mentally and stay in a “medical mindset.” When you have a personally history, it makes the whole ride a little more traumatic. We worked and worked and this patient, trying everything that the docs on scene could think of.

The surgeon kept muttering, “Damn, this is one of my favorite patients.” I could tell that this guy was well loved and it made it hard to seperate mentally when all was said and done. Soaked in the sweat of defeat, I bagged up our supplies and headed back to the ER.

As I sat, being cursed, threatened and insulted- post CPR- it made me realize something.  The things we do- really can have a lasting impact on someone. I’m sure I would have remembered the coding patient had he been kind, rude, quiet or otherwise. My medical response would have been no different, but my heart would have been in a different place.

You never know when you’ll take that last step, that final breath, or speak for the last time. I want to be remembered as someone who loves- I want people to feel like I blessed them with the way that I treated them. Easier said than done, it’s true- but a worthy goal to strive for.


What a Day

When the hospital gets too full to accept new patients, we start holding hospital patients in the emergency room- it sucks. Not only does it give us significantly less room to see “emergency room patients,” it’s uncomfortable for admitted hospital patients- and boy, do they let you know.

I make the make the mistake of going into a “hospital room” to answer a call light. It was at that point that things spiralled out of my controlled. The “sweet old lady” that I’d come to help turned out to be a very grumpy- control freak. Do this, do that, we’re gonna do things my way- she flat out started losing her cool with me while I tried to help her onto the toilet, telling me, ” would you just listen to me- we’re gonna do it my way!”

So when your iv line is on the verge of pulling out of your arm, and you have no room to move around because you were dead set on doing things “your way,” maybe it’s time to listen to the guy that’s in the emergency room every day.

The noise and chaos that comes with a full emergency room can only get worse with the addition of a “siren.” When I say a “siren,” I mean a patient that wails and whines incessantly- without pause or relief. I’m not talking about crying in pain or screaming in anguish- I’m talking a droning whine that goes on and on and only changes in script.

“Stop bumping the bed, who’s bumping the bed, oh please, oh please, stop bumping the bed!” News flash- no one is bumping the bed. Nails on a chalk board amplified by a megaphone- that’s what we’re talking about here.

It’s one thing when a patient has dementia and doesn’t understand what’s going on and is crying out for non-existent friends to turn down the tv. It’s a whole other thing when the patient is totally aware of their surroundings and continues to spew the same line over and over again like a two year old repeatedly asking- “why?”

The phrase that really got me laughing was, “what is that constant beeping noise” repeated in a whine of desperation, back to back- continuously. “Please, someone, what is that constant beeping noise?” Even though the patient wasn’t even in a room with something beeping, they were apparently obsessing over the noise. As the trauma PA walked pasted the patient, she was in the middle of another round of “someone, please, someone- what is that constant beeping sound?” Ma’am, unfortunately that’s the sound of the hospital,” says the PA as he walks past her. Apparently, she wasn’t satisfied with that answer because the non-stop whine continued.

I was happy to get out of there and unwind- I went and performed at my first open- mic. Some of the performers sounded eerily similar to the patient that whined in the hallway all day. If you watch my video of me singing Gavin Degraw– you can see a guy walk by in a camo jacket at the beginning. When he performed you couldn’t hear practically anything that he was saying- except every once in a while I could make out one phrase- “law enforcement.” I have a feeling I’ll be seeing him again…

Wiggin’ Out


Even though we work in the emergency room, health care workers aren’t able to tolerate everything. We all have things that give us the heebie jeebies…

For some people, it’s when bones are sticking out every which way and feet are poking backwards. Yeah, for me that’s a little disturbing but definitely doesn’t “bother” me.

For some people it’s the messes of bodily waste that can end up- everywhere. Some times I do need a bit of peppermint oil under the nose (it does wonders to mask smells) but I’ve gotten past the point of it bothering me.

Then there’s abscesses…when a doc cuts open a massive, infected sore and smelly puss is squirting out and you can barely keep up with the suction….Disgusting but doesn’t bother me.

For me, it’s the patients who have a tracheostomy. You know the gal who talks on tv with the robot voice and tells you not to smoke cigarettes. Smoking through a hole in the neck? Imagine mucus coming out of that thing like a vile volcano. Now imagine her coughing through that thing right in your face….that’s what gets me…

Baby Surprise!

Say What?

So there I was…sitting at the triage desk…anxiously awaiting what might come through those doors next. All of a sudden, one of the valet attendants comes running through the doors…”there’s someone having a baby out here!” Yeah, that’s what they all say- still I grab a wheelchair and run.

When I come around the corner- I see her, she’s standing in the entrance, legs slightly apart, with a look of anxiety mixed with- a strange calm. As I run to her with the wheelchair I see what appears to be a bump in the crotch of her sweats…this might be the real thing!

I run as fast as possible with the wheelchair- straight back to a room. A few nurses and a doc are casually walking into the room as we approach. The usual emergency room OB patient is- alright, let’s have a look, and then if OB can’t get down fast enough, once in a while we’ll deliver a baby.

As I get her off the wheelchair, she says, “there’s a baby in my pants!” Uh-oh…I yank her sweats and underwear down to reveal the baby’s head, fully out! Now I’m really amped up…I don’t even have gloves on, but I’m asking myself, “Do I need to pull this thing out or what?” I knew it wasn’t really my place and I didn’t really want to- but the doc wasn’t ready yet and all systems were running on overdrive. I make the right choice- standby.

The doc inserts a couple fingers and feels for the cord- it’s around the babies neck. “Don’t push!” She tells the mother. The doctor just manages to stretch the cord over the babies head and whoosh, the baby is out and crying!

I can hear someone calling for suction but I’m standing there frozen- completely useless. The whole experience was overwhelming and amazed me as I thought later- that’s the most intense thing I’ve seen in the ER.

Seeing the birthing process for the first time, combined with the emergent rate at which it occurred, further amplified by the complication- made it incredibly surreal. The miracle of life!

There’s less than two months until my first child comes into this world. I don’t know if that experience helped me prepare at all but I do know one thing- I’m glad I’ll be off the clock!

Going Mental!


We see lots of mental health patients in the emergency room where I work.

The process usually goes something like this:

Patient shows up at triage, feeling suicidal/homicidal, upset, possibly with family…wanting to check in to get  help/resources.

Patient escalates when they find out that they will be put into a hospital gown, have their blood drawn and most likely will be in a bed that resides in the hallway.

Patient further escalates as the time passes and their desire to leave/have a cigarette is overcoming their desire to stay and get help.

Patient is calmed with sandwich/juice and relaxes.

Patient is energized by their recent caloric intake and further escalates.

Patient is calmed down and discharged/sent to another facility


Patient is restrained…goes completely ape, and is detained by the state.

All in all, it can be be very stressful working to manage someone that is struggling mentally and is also becoming progressively more and more  angry.

My strategy is to try and relate to the patient and to empathize with what they are going through. It does become hard when you are personally attacked and nothing you do can distract the person from their anger. Luckily, I have learned healthy ways of dealing with my stress. I might exercise, play guitar, or write (like I’m doing now!)

We all have to deal with stressful stuff at work/school/home…how do you handle your stress? Comment and let us know!

Expect The Unexpected

I’ve just come on shift and I’ve got a good supply of energy this morning, I’m scouring the emergency room for tasks to accomplish. On our electronic display board, I see that an EKG has been ordered. I grab the machine and head to the room designated on the board. I peek in the room and see no one in the room, as I turn around, the patient comes walking past me into the room.

There must be some mistake, the patient looks younger than me (and in fact was) and they look to be pretty healthy and “normal.” I double check the board to be certain that I’m seeing things correctly…sure enough- the EKG was ordered for this patient. It’s a bit odd, but in the ER, docs have to make sure they cover all the bases. Ordering a test that checks the electrical activity of the heart on a young person isn’t usual but since it’s easy and quick, sometimes it’s just better to do it..

I tell the patient what I’m going to be doing and they seem to think it’s a bit silly too…but I explain to them that it’s pretty routine for anyone complaining of any chest pain. I get them connected to the machine and before the machine is calibrated and ready to print…I can see some serious S-T elevation coming across the screen.

I’m no doctor, nor am I an expert in EKG interpretation, but when elevation of the S-T portion of the heart rhythm is present, it usually means “acute MI.” Acute myocardial infarction is a fancy way of saying that portions of the heart tissue are not receiving blood and are dying- a heart attack. I leave the EKG connected and take my findings to the ordering doctor. The doc comes back into the room and moves a few leads around and we shoot another picture. Again- “Acute MI,” is the reading.

Up to this point, the patient has no idea, as I left the room calmly and the doc is one of our most relaxed, calm, and confident providers. “Well, it appears-from this reading, that you may be having a heart attack. This test is very sensitive though, once we get the blood work back, we’ll know for sure.” The kid is in shock…”A heart attack?”

The doc plays it safe and calls the Cath Lab team over and readies this “kid” to go have a Cardiac Catheterization. It’s not usual for someone in their early twenties to have a blocked artery- it’s more common for drugs to be the cause- specifically cocaine.

I ask the patient if they had done any cocaine, they reply that when they were younger they had, but not in the past few days. The patients blood work comes back and their level of triponin (a chemical that is released when heart tissue dies,) is 10 times what qualifies as High! They are definitely, definitely having a heart attack.

Just before they leave to go to the cath lab, they let the doc know- ” I did snort something two days ago, it could have been cocaine but I don’t really know what it was…”

The angio comes back clean…no blockage. A phenomenon known as prinzmetal angina can occur naturally but is also associated with cocaine use. Major vessels of the heart spasm so violently, that they clamp shut- simulating a complete blockage.

I still don’t know whether they really didn’t know what they were snorting or if they were too ashamed to admit- that they had given themselves a heart attack by snorting cocaine. What’s the moral of the story? If you don’t know what it is…you probably shouldn’t snort it. But we all wanna have fun right?