#297 to 264 - Z is for Zombie Apocalypse

Thank you for visiting my blog throughout this month.

I hope that some of you will stay and continue to follow

my blog throughout the rest of the year.

Although this month I focused on fun things

like travel and photography,

at the heart of it all, I am a doctor...

in the Emergency Department...

working in areas with high levels of

drug abuse,

homelessness,

unemployment,

and poor education.

There's a lot of trauma and drama

some of which I write about here.

I share stories and pictures when I can,

but I do work in a rural area some of the time,

so it's hard to keep HIPPA-compliant and

still give a complete story... 

Nevertheless, I do write a lot about my own experiences

and feelings.

And my beliefs on the importance of taking responsibility

for your health and that of others.

So I write about those things as well.

As for the Zombie Apocalypse..?

Well, methamphetamine abuse is high in the areas where I work.

If I could just videotape the patients that come in high on meth,

or the medical problems that meth brings

I'd have hours of tape to share to hopefully

keep someone from going down that road.

You can Google "meth mouth," "meth skin,"

"the faces of meth" to see what I see every day.

People prostitute themselves for meth.

They steal whatever they can for meth.

They come to the ED for drugs that they can then trade for meth.

I had a patient tell me yesterday that they lost their medical insurance

so they couldn't see their doctor for their chronic pain condition

so they were "self-treating" with meth.

I know they were going to take whatever prescription 

I wrote them and sell it.

Irony is, because they were homeless with no ID, the pharmacy

called to tell me they couldn't fill the script.

And, because of the effects on the brain, there's no

reasoning with these patients.

They don't understand that methamphetamines will lead to being tired

or weak or shaky because the effects are like running a marathon, full out,

without important things like eating or keeping hydrated.

They don't understand that the "worms under the skin" that they see or feel

are because of the effects on the nervous system.

So they pick at their skin to the point of causing bleeding

which leads to scarring and, worse yet, infection.

Which can lead to sepsis, possible amputation and sometimes death.

Pain management is a huge issue with these patients

as meth has fried out all of their pain receptors so now

pain which to you and I might be handled with a Tylenol now

requires large amounts of narcotics.

Don't even get me started on the dental problems...

Whew!  I thought we needed a nice pastoral scene from

the little chunk of Earth I call home...

Chickens and geese, I write about them too....

Hope to see you again soon...!

p.s. In July I do a birthday iPod shuffle where I write the whole month

about songs on my iPod, and I participate in NaBloPoMo in November

Day 12 - I Hate Everyone

Some days, this is my theme song for work.

When the never-ending stream of patients

keeps coming in the front door so that I can

"make sure this blister isn't infected"

"refill my script for pain pills that my girlfriend stole"

"find out why my side's been hurting for the last 3 months"

or so I can have 15 year old try to scam me for

narcotics for their "slipped disks."

When the chronics come in complaining of "increasing pain"

that is not relieved with their prescribed doses of narcotics and benzos.

And who tell me right off the bat that

"I need more than the usual dose because most medications

don't work on my pain"

&

"oh, by the way, I'm allergic to everything except for dilaudid."

When the borderline patient tells me to "*&^% myself"

as they're being brought in by police and EMS.

Don't yell at me when you're the one who "tried to kill themselves"

by taking an extra dose or two of your medications.

As I stated in a previous post,

if you really meant it, you'd take a LOT more medication.

Who's wasting whose time..?

Ok, let's breathe in with the blue

breathe out with the green...

and drink alcohol,

lots and lots of alcohol...

#575 - F is for Frenetic

Momma told me there'd be days like this...

Here's an example of the kind of day I DON'T like to have in the E.D...

My shift started at 0800, there were already 5 patients on the board,

4 of which my colleague signed out to me waiting for lab or xray results.

The patients I saw today:

 - patient who swallowed an entire bottle of herbal supplement after confusing it with a bottle of 5 Hour Energy Drink

 - leg pain for a week, worse today

 - I Didn't Know I was Pregnant show candidate who came in about 7 months pregnant and using meth

- patient with facial lac after a fall out of their wheelchair

- psych patient off their meds who ran out the door twice, and brought back by police once

- patient who passed out while getting out of their trailer

 - strep throat

- skin infection

- patient who passed out while doing chair exercises with their senior group

 - asthma attack

 - migraine headache

- hair coloring on beard gone awry

- dental infection

- alcohol intoxication, passed out in front of the local market

- cough for several months

- chronic headache who could only be treated with demerol which we haven't had in the ED for years

- tick bite brought in because "we didn't get it all out"

- end of life hospice patient

- patient who was second in line to be seen, but left because after waiting 30 minutes they couldn't wait any longer for the CT they knew "they just had to have" for the belly pain that had been going on for several weeks

- appendicitis

- eye irritation

- panic attack

- alcohol intoxication hit in head by spouse with head laceration that then cussed us out and ran out the door

- skin infection

- febrile illness in transplant patient

I left out identifiers like sex... the pregnant person you can figure out.

I left out much of some of the back story because this is a small town

after all, and everyone knows everyone's business as it is...

These all came in within a 12 hours period and kept my ED busy

the entire time...

Let's now even talk about how many charts I have yet to do...

Birthday Shuffle a Deux #16

I Hate Everyone - Get Set Go



I love Grey's Anatomy.  Or, I should say, I used to love Grey's Anatomy.  Mostly it was the medicine and remembering how it was to be a surgery resident.  A lot of competition, a lot of late nights and hard work, and a lot of camaraderie.  The drama and romances... well, at least not in my residency program.

This song is sometimes the theme music for my day.  I work in an Emergency Department, and there are days when I do hate everyone.  The physician's desk is near the triage window, so I get a "preview of coming attractions" throughout the day.  Sometimes, the presenting complaints just make me cringe and wish I'd gone into something else... back to surgery perhaps...?

Patients that drive me the most crazy:
 - multiple medical problem patients that don't stop smoking, don't stop drinking, forget to fill their medications on time and come in because they're on the verge of collapse.  They get admitted, all of their medical problems readjusted, sent out with scripts and follow-ups and then come back several weeks later to do it all over again.
 - dental pain.  Your teeth are bad, you continue to smoke, you'd rather spend money on meth than a toothbrush and a dentist.  And, they always seem to come in on Friday or Saturday nights or at six in the morning... funny about that...
 - as seen on WebMD.  Stop looking up differentials on your smart phone and arguing with me about diagnosis and treatment.
 - repeat customers.  I know you're a drunk, everyone in town knows you're a drunk.  Sit in the middle of your room away from stairs, porches, your cat, chairs, ladders, and car doors and maybe you won't fall down three nights in a row needing to call 911 and getting so much radiation you glow.  If the liver cirrhosis doesn't get you, cancer from all of the scans and films we've had to do just might.
 - rashes... I just don't like them...

2012 - Random Thoughts #1

Life has changed quite a bit since we got a dog.  It's like having a baby without the possibility of sending it off to boarding school once it turns five years old.  My DH and I went through a period of yelling at each other over random things during the first week mostly because we were sleep-deprived from the every hour potty trips to get the dog housebroken.  Dixie's done very well, though, so in the long run it was worth it.

But, seriously, life revolves around Dixie and her schedule.  We wake up early to take her out, then it's breakfast time.  We play for 30 minutes then it's potty time.  More play or a long walk and then it's nap time.  After our her nap, it's usually about lunch time.  Another 30 minutes and it's potty time again.  Then more playing, more walking, more napping.  Then comes dinner time.  The next 30 minutes passes, potty time, play time, snack time, then finally bedtime, with one more potty run just in case.  And, we wake up and do it all over again.

And, when I say "we" I mean my DH.  Why, because I am usually working most days of the week.  You see, I like to travel, and that means consolidating my 16 shifts into usually 20 days out of the month because I want the other 7 - 10 off for different adventures.  This month, I had to fit in a spontaneous trip back to So. Cal with a course on public speaking and our yearly anniversary trip.  And, I only had 29 days in this month's schedule to do it in.  So I am working, A LOT...!

Which means I am not available to help with important things around the house... like unpacking all the boxes we had to move from our rental or planting the trees we bought a week ago... So, my house looks like a scene out of "Hoarders" and the trees are lying on their sides in the back yard pond.  Also, I keep thinking of things I need, but I don't know what box they are in or if it's easier to just go out and buy a new one at this point...

Work is the usual combination of a few real emergencies mixed in with the plethora of non-emergencies and a peppering of crazies to make the shift just that much more interesting.  Like the guy whose chief complaint was "eating all the time."  If you want to know what makes medical care so expensive and where your hard-earned tax dollars are going, it's to support people like this.  He wanted me to give him medications to make him stop eating so that "he wouldn't get fat" because if he did then he was "going to fly to Switzerland to see the 'doctor' who performs assisted suicide on non-terminal people."  He asked me for amphetamines and anti-seizure medications to help him with his "problem."

If I can't keep a straight face during your initial exam, I don't think I can help you...

I also can't help:
 - any symptom that has been present for longer than 48 hours, that has been extensively worked up by another doctor, and for which the cure is, in your opinion, more pain medications
 - children whose parents insist on smoking (oh, I only do it outside with a smoking jacket) when their child has a cold/asthma/repeated ear infections;  I actually had one mother break down in tears at her daughter's bedside when I admitted her child with asthma, she dramatically threw her pack of cigarettes in the trash and apologized to her daughter for making her sick... funny thing is I saw her the next morning in the smoking hut where she was taking a break from visiting her daughter
 - bad teeth:  I am not a dentist, I don't pull teeth, again stop smoking...

NaBloPoMo Days 4 & 5

Ok, so I was bad yesterday and forgot to post.  After a day of meetings, errands and a last minute dinner invitation in which there may or may not have been wine involved, I simply forgot about my blog... until I was on my way to work this morning.... Luckily, my work day will provide more than enough interesting fodder to make up for yesterday.

Today I worked my first shift at an Urgent Care.  Kind of like we've discussed the definition of "emergency" let's think about the meaning of "urgent."  To say most of my patients were neither "emergent" or "urgent" is an understatement.  There were so many patients who needed basic dental and medical care that I worry about how much worse it's going to get when more people are insured and there aren't enough primary specialists for these patients to go to.

We had:

 - five back pains who all wanted medications for chronic back pain.  Most had been having pain for a minimum of 2 months.  Two of them actually had primary care physicians, but they didn't like the care they were getting so they came to UC.  They weren't happy when I referred them back to their primaries... seems getting an MRI and performing spine surgery is supposed to be on my list of services provided.

 - seven abscesses came in, some with simple early cellulitis requiring antibiotics.  No big juicy abscesses to drain, bummer.  I really wanted to cut into something after about the 4th patient of the day...

- one complex laceration after a chainsaw misadventure.  I don't know if it was funner suturing the leg or listening to the patient (an inmate) and the corrections officer exchange prison stories.  At least this was a true urgent matter.

- three dental pains who'd been having dental pain for several weeks.  When I ask if you use illicit drugs as you show me the epitomy of "meth mouth" I won't believe you when you deny drug use.  I was told dentist appointments at the MediCal clinic take about three months to get.  I still won't give you narcotics... here's some antibiotics and stop smoking.

- lots of colds and coughs, and it's not even the start of the cold and flu season.

- a chronic headache patient who came in for their fix... and left when I found out I couldn't give IM narcotics because they don't have them in UC... my mistake, but still... the patient did leave.

this along with a patient who demanded a complete workup for an autoimmune disease that they don't have any symptoms for but are concerned about because their best friend has it, and they have a similar rash... really?  Our healthcare (and taxpayer) dollars at work.

Sigh... when do I go back to the real ED?