Trenchy has moved out…

and all he took was a toothbrush, his scrubs and the grill…

www.trenchdoc.com/trench

(sorry, no room in the truck for the recent comments…)

Drunks…

 

With the Holidays there is a predictable pattern of disease processes that make their annual haj to the Mecca; suicide attempts and depression, coronary angina from overdoing it, traveler’s flu and pneumonia, heart failure from salty ham, gastroenteritis from 3 year old fruitcake (eventually someone eats it). A lot of what we see though are simply drunks… drunks who fell off the porch, drunks with bottle rocket blasts, drunks hit by cars, drunks hit by the bottles of other drunks…

The variety is what keeps us entertained, because treating drunks, as a rule, gets really old, really quick. They yell, curse, spit, bleed on us, smell bad, piss themselves, take swings at us, grab our asses (yes, mine too), threaten to sue, cry, moan, groan, snore and worst of all they try to leave the ER while inebriated then they sue us for twisting an ankle at the bus stop.  Trust me on this… if we elected a veteran ER nurse President, alot more people would be working for their check and freely smoking weed on the weekends while the Busch’s would be out of business.

Today’s quote of the week comes from one of our obliterated friends;

Resident: “mam, we need to know your name to see if you have any medical problems.”

Patient: “stopbotherinmeyoumotherfuthr”

Resident: to registrar “just put her down as ’Jane Doe’, for now.”

Patient: “wait, wait… I’m not lossst. Don’t youuuu call me Jannn Doe youmotherfther”

Resident: “well whats your name then, have you ever been here at this hospital?”

Patient: (looks up in a moment of clarity) “I am… I am..” (furrows brow)

“ahfukit….Jan soundsssgood.”

Woohoo!

I’ve been NAMinated!

Brown Sugar…

Even after many years of sloshing through the Trenches a few things still amaze me… body art is one of those categories. I find it interesting why people have tattoos of certain things and in various places on their body. Similarly intriguing, is that many patients seem to have no qualms about my fingers in every orifice, but when it comes to questions about why they marked themselves in a given fashion I seem to have crossed over into being too intimate. I suppose that it is a problem I have had for a long time and not just in medicine…

Like when I had to perform a pelvic exam this week on a young black female in her late teen’s…

Trenchdoc: (noticing the above design adjacent to my patient’s erogenous zone… frankly I was perplexed) “alright everything seems to look OK down here. I still need to look at the sample under the microscope though. By the way, are you a Rolling Stone’s fan?”

Patient: “huh?”

Trenchdoc: “your tattoo down there… isn’t that the Rolling Stone’s logo?”

Patient: “which one you mean?”

Trenchdoc: “the lips and tongue.”

Patient: “I think you KNOW what it means.”

Trenchdoc: “I understand that but it is also a logo for an old rock-n-roll band… you know, with Mic Jagger.”

It was a very well done and EXACT replica…

Patient: “no, it’s not (disdainfully) my second baby’s daddy drew it and I had it put on there… he ain’t seen it yet cause he’s in jail till March.”

Trenchdoc: “well, they did a good job on it.”

Patient: (still terse) “I reckon they did but it aint no rock-n-roll tattoo.”(rolls eyes)

Hmmm, I reckon it ain’t.

The Five “S’s”

In medicine, we like lists; silly, perhaps even stupid lists that help remind us how to keep people from dying (ABC= airway/breathing/circulation) or diagnostic possibilities (AT-MUD-PILES= for anion gap metabloic acidoses) or just parts of neuro-anatomy that we rarely use (Cranial nerves =oh-oh-oh-to -touch-and-feel-a-girls-thighs-and-hips). Trenchy KNOWS cranial nerves.
The Five “S’s” are also a nifty reminder with each “S” signifying a common reason why a patient might have been in a single car crash. They are (with some derivations); Seizure… Sugar (as in diabetic coma)… Sauce (a common one)… Stroke… Suicide (yes it happens… I know a physician who tried it TWICE). The reason this list is helpful is that one can easily be distracted by the resultant injuries and miss a predisposing cause… not just the “S’s”, it could be anything… I have seen nearly undiagnosed gunshots, coronaries and even a lady who decided to haul ass to the hospital while lightedheaded from profuse bleeding after delivering her baby at home.

Sometimes though, patients in single car crashes are just batshit crazy:

EMT: “35 year old female, might have been hit by a train… severe damage to driver’s side… looks like an open left ankle fracture…she has been combative all the way in so we couldn’t get her intubated… heart rate 120, blood pressure 100/60.”

Trenchy: (as always easily distracted) “what do you mean MIGHT have been hit by a train?”

EMT: “well, she was at a RR crossing and had a bunch of damage… there was another patient who was ambulatory, but they are not coming in… they were calling for someone to come pick them up.”

Trenchy: “what?… so another person just walked away? what did that person say happened?”

EMT2: “we didn’t ask them… they had already called a friend on a cell phone to pick them up…”

Trenchy: (shakes head) “ok, I guess, thanks”

Resident: “she’s awake but simply not talking… she’s just staring at the cieling… ABC’s are fine… pupils equal… chest and abdomen are benign… she has an open left ankle fracture with good pulses and movement, but she mainly complains about her fingers which are fine… I don’t think we need to intubate her… but this whole thing is just wierd.”

The patient continued to stare at the cieling… wide eyed… as if she had just seen Elvis… (the real one).

Patient: “doctor… I need that light over here… can I stare at it?”

Trenchy: “mam? that over head surgery light?”

Patient: “yes… I want to stare at it and go into that light.”

Trenchy: “ooookaaay…. (to resident) let’s get that ultrasound done and get her to cat scan pronto.”

Patient: “doctor, look into my eyes.”

Trenchy: “yes mam.”

Patient: “look deeper into my eyes.”

Trenchy: “yes mam.”

Patient: “my leg is broken.”

Trenchy: “yes mam, we are splinting it and getting some pain medicine for you.”

Patient: “no my middle leg… you must move my middle leg or I will die.”

I double checked, no middle leg. People DO tuck them you know.

Trenchy: “ok… it looks fine mam… and that left leg should feel better now… are we ready for cat scan yet?”

Patient: (screaming) “NO…NO… NOT MY MIDDLE LEG! I will die if you move it again!”

“I AM TELLING YOU I WILL DIE!”

The patient then rolled her eyes back into her head and snapped her head to the left several times. Each time she faced me she counted off..
“One year… two years… three years… five years… FIVE YEARS.”

Then she stared back at me.
“Oh, no doctor… YOU will die in five years.”

Great. I was just starting a low fat diet for New Years… with an excuse like that NO WAY will I be able to keep that up for long now.

Professionalism

[from wikipedia] How to find definitions of professionalism;

Many organizations have codified their conduct, often designated “code of ethics”, and what they require for entry into their organization and how to remain in good standing. Some of these codes are quite detailed and make strong emphasis on their particular area or expertise, for example, journalists emphasise the use of credible sources and protecting their identities, psychologists emphasize privacy of the patient and communications with other psychologists, anthropologists emphasize rules on intrusions into a culture being studied.

We here at Trenchdoc have an addendum to proffer to the fine folks at wiki…

An inebriated patient presented to the ER after he and his trusty Ford pick-up lost a game of “chicken” with a 50 year old oak tree. The patient was,of course, belligerent and made every effort of the staff difficult for them. The physician then asked several staff members to aid in “rolling” the patient off of the EMS spine board, but because the patient was at high risk for spinal fracture it was a delicate procedure. An important part of the maneuver is for one staff member to firmly support the cervical spine (neck) to reduce the likely-hood of paralysis from a spinal fracture.

Upon “rolling” the patient the staff was witness to an ill-timed and inhumanly foul passage of flatus and liquid stool. While not uncommon at the Mecca, such an event is likely to cause nausea and perhaps even gagging in even the most seasoned staff member. However, when a staff member then vomits, containing the vomitus in thier mouth with one hand while stabilizing the cervical spine with the other for over 2 minutes… THAT is professionalism!

I must not…

 

Early in my elementary school career, my educators learned that ”paddling” the prepubescent version of the Trenchdoc had little, if any, positive effect on his behavior. (remember, this was the 70’s; spanking was the national past-time) They quickly realized, however, that revoking my time at recess AND making me write “I must nots” on the chalkboard was like a Ritalin Big-Gulpfor the young Trenchy.

To Mrs. Wofford’s and Mrs. Johnson’s credit, not only do I have the most legible handwriting of any physician at the Mecca; I also know how to remind the middle-aged version of Trenchy how to play nice.

I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant. I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant. I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant. I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant. I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant. I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.I must not assume that a hefty nurse is still pregnant.

OK, my hand is cramping… that should be a nice reminder… besides, it’s time for recess!

Don’t Cry…


It’s friggin Christmas… and we’ll be back at the Mecca soon enough. Have a good one Yall!!!

Merry Christmas to me!!!

I just found out that next year’s increase in my malpractice premium is only 1 1/2 weeks more pay than 2006. (If I drop my coverage by 60%…) Finally, some relief.

Catfight!

Monday was a fairly quiet morning at the Mecca, or at least it seemed that way. It was my last shift before the Christmas break and it was NOT in Pediatrics. A scenario that we in the business call being “Golden”. The best part was that I had two solid residents and an all star nursing staff; truly a treat these days.

Things continued to flow smoothly until I picked up a fairly harmless looking chart…

” 34 year old female…. needs refill for thyroid meds… no other complaints.”

Hmm… and expensive way to get a med refill, oh well, “hey intern, here’s an easy one for you”,not that my intern needed an easy case, she is a damn good resident. I was simply ready for my week off and feeling frisky.

Ten minutes later she returned. “This poor lady just left the gynecology clinic and they refused to refill her meds.”

“OK, so?”

“So, she had to come over here and sign in just to get her meds and now she’ll have a $300 bill for an ER visit.” Then she added, “and the patient said that a female GYN resident over there told her ‘I’m not an endocrinologist, you need to go to the medicine clinic’, but her appointment with them is not until February.”

“OK, well we’re not endocrinologists either, but go ahead and refill her meds.”

Unsatisfied, my intern continued, “but it is crazy that they wouldn’t refill her meds… they didn’t even do a pap smear on her and she needs one.”

“Nothing with those guys surprises me… ok, well refill her meds then until February… but we are NOT doing the pap.”

“I just can’t believe they would do this,”she pressed on, “the patient must have misunderstood what they said… I am going to call over to the gynecology clinic.”

Sigh.

I have dealt with similar issues with the Mecca’s OB/GYN residency for a decade(easily the weakest department at the facility for the entire time), perhaps it is that I have grown tired of butting heads with them or maybe just getting older; either way my reply was fateful…

“OK, you can call over there but you do NOT want to get into a shit slinging contest with them… they are the Navy S.E.A.L.s of shit slinging .” A fair warning to my intern; but I am coming to the conclusion that A&M grads don’t back down.

The Call-

ER- “yes… I’m taking care of Mrs. Smith in the ER and she just left your clinic and said that yall wouldn’t refill her thyroid medicine.”

GYN- “that’s right, I am not an endocrinologist.”

ER- “well she has her empty bottle with her and yall filled them last time.”

GYN- “so?… we are not her primary care doctor… she needs to go to them.”

Allow me to interject here as the editor of this brewhaha; unless something has changed recently, OB/GYN as a specialty has touted itself as “primary care for women” for some time now.

ER- “in February? that is her next appointment.”

GYN- “ok…so?”

ER- “so she was also there for a pap smear and yall didn’t do that either.”

GYN- “she didn’y SAY that she needed a pap.”

ER- “well, I ASKED her and it turns out that she hasn’t has one in years and she is long overdue for one.”

GYN- “we can not do EVERYTHING for people… she has a primary doctor.”

The Encounter-

1 hour later in person at the ER desk…

GYN- “so what kind of problem do you have with the way we run our clinic?”

ER- “I think it is ridiculous that you wouldn’t refill the patients basic medications.”

GYN resident (built like a brick shithouse) stands very aggressively toward the intern - “we are not endocrinologists…”

ER- “we aren’t either, but we filled them AND you didn’t even do her pap… she has to ride the bus a long way to get to these appointments.”

GYN resident gets very close to my interns face- “you need to watch what you say… you are just an intern, aren’t you?.”

ER- “yes… like it matters, even an Intern can refill thyroid medications.”

GYN resident storms off.

Yep… just another quiet Monday at the Mecca.

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