And Now, Back to the Drama

I think I have mentioned on several occasions that one of the things I like most about working in the E.D. is the patient's back story. Their presenting complaint for the most part is routine, but the way they came to be in the E.D. usually is interesting. That's why I like ECMC. Patients there are not boring by any respect. Every day is like a soap opera; there's a plethora of drama for everyone to enjoy. And, it's played out right in front of you.

So lets get started on today's episode of "As the E.D. Turns." Questions I asked the patient are in red.

Dx: Sickle Cell Crisis - "I think I am dehydrated because I have been drinking anything I can get my hands on because I am upset about my fiancee who got really sick from her diabetes and is now in a coma, and I drink from the time I get home from seeing her until I can't drink any more. And, I am changing doctors and my current doctor only gave me enough pills for a few days because they didn't know me, and now I am out of my oxycontin's and dilaudids, and now I am having a lot of pain, and I think I need a shot of something."

Dx: Constipation - "I've been having abdominal pain for the last two months, and I've been to three different hospitals. My doctor won't even see me because she's only available on Mondays, and I was having abdominal pain, but I didn't have severe pain until today, and I knew that I couldn't wait until Monday, but then she wouldn't see me anyway because I always have to go see the nurse practitioner, and I never get to see the doctor." Why didn't you go back to the last hospital that saw you and has all your tests and records? "Well, I didn't like them there. They told me that nothing was wrong, and that I was just constipated and then they admitted me and then I felt better but then my doctor didn't work there so then I wouldn't have my own doctor, and this pain is so bad and I didn't want to wake up my brother because he sleeps in the room above me but he was so worried about me and what are you going to do to fix me?"

Dx: 4th metatarsal fracture - "Well I was fighting this girl and then she suddenly came out and stepped on my foot, and I haven't been able to walk on it ever since." Well, how have you been getting around? "I've had to crawl on the floor."

Dx: Overdose and suicidal ideations - "Well, one of my kids had a scratch so someone called CPS, and then they said because of the bruises that I would have to go to court, and then my husband said that (mumbles something incoherently) so then I decided that I couldn't live in a world without my children and I took all the pills."

Dx: Multiple stab wounds - "I was fighting with this girl and then all of a sudden I felt this pain, and then I realized that I was bleeding and I couldn't believe that she would do that."

Oh... and the Award for highest blood sugar I've ever seen in a fully conscious patient goes to my homeless man who presented with a blood sugar of 1048. Yeah, that's right! Four digit blood sugar.(btw normal is around 100, most doctors recommend diabetics keep theirs below 160).

And, in my "Art Imitates Life" section: Tonight's episode of Grey's Anatomy had a storyline where one of the doctors Callie suffers a broken nose after getting clocked by the elbow of a patient... during a code today, I was placing a central line in the patient's femoral artery (in the thigh) when I bent over to get something from the kit I had to place on a chair. I was just about to turn back to the patient when one of the nurses toward the head of the bed turned suddenly and clocked me with her elbow. Not enough to daze me, but I did have to suffer through CT and subdural jokes for a part of the shift.

You have to watch out... life moves pretty fast in the E.D. Oh. yeah!