Wednesday, November 4, 2009

Bite Me

It is absolutely essential that I have a laugh at work. For that matter, I pretty much have to laugh wherever I go. I have been called witty, but when I'm together with my brothers the zingers fly. It is nice that my two adult children have the confidence to step into that arena now. They are both VERY funny; my son J is dry as a bone. K, my daughter also has a great sense of humor. We do laugh a lot together.

The ER is just ripe for funny stuff. Not that we are laughing at the patients, but sometimes the stuff that comes out of people's mouths, well, you just have to laugh.

I often say whatever is on my mind, and I like to make the patients laugh a little when I can. I am a big Monty Python fan, and frequently I will throw out a line just to see if anyone will bite. A patient came in with a hamster bite, and I asked if the the little ratly creature was prone to such behavior or this was an aberration. As I swabbed the puncture I mumbled running commentary along the lines of "It's only a harmless hamster" (note Holy Grail reference) and the guy picked right up on it and responded in kind. Before you know it, we were bantering lines back and forth and laughing like idiots. Good thing it wasn't busy. Spam, spam, spam, spam...

Another animal bite victim comes in, this time a dog bite. We heard a dog barking from somewhere in the neighborhood; "Did they bring in the dog?" asked Cathy, my Southern nurse accomplice

"Nope. Just the head", I kidded. "Wanna know his name"?

"Ok, what is the dog's name" she said, bracing for impact.

"John the Baptist".


Dog bites are epidemic, and we get another one. This one had a chunk of skin missing from the space between the thumb and forefinger. This one struck for "no reason".

My partner loves dogs and just had to have a conversation about English sheep dogs. Dog bites to the hand are usually not sutured; risk of infection.

The other day a woman was out in her yard hanging laundry and minding her own when she was attacked by a woodchuck who tried to take a chunk out of her leg. No, they didn't catch it. My neighbor had one living under her front porch, and I tell you, they are mean. I was walking my dog and the thing sat brazenly on the front steps in the middle of the afternoon and screamed at us. Good thing the dog was on leash or she could have been killed. Scary damn creatures.

Sometimes people just go looking for Trouble. I mean, they practically out and out take an ad in the Lost and Found section of the paper they want Trouble so bad. The think about Trouble, if you go looking for it you can generally find it quite easily in Plain Sight. Here is an excellent example.

One guy came in with a farily nasty bite on his hand because he tried to PET A FERAL CAT.
He told us all about his rescue attempt of a SKUNK WHO HAD BEEN HIT BY A CAR.

Are you kidding?

"Yeah", he said, "That thing scratched me up pretty good, but as soon as I put it in my car the thing SPRAYED me!"

We really aren't supposed to say "What th fu*k?", it's not too professional. I couldn't help but ask "Um, what did you have in mind when you put that wild creature into your car?" to which he replied. "Well if we had called animal control, they would have just killed it".

Oh, of course I completely understand now.

I live in a semi-rural area; I'm not talking Allagash here, but the houses on my street are at least 3 acres apart and is bordered by woods. One of my neighbors who lives at the end of my cul-de-sac- was attacked by some sort of 4 legged critter--in broad daylight. It was first thought to be a fox, then a coyote, then a fisher cat, then a wolf. Whatever it was, it was going after their horses; they are beautiful draft horses, and let me tell you they are BIG. The family also has some unidentifiable large dog the size of a pony, but they kept that in the house. The woman went out with a stick and started yelling at it while one of the kids called 911. Whatever it was, the animal turned on her and latched on just above the elbow; she was literally beating at it with the stick but it wouldn't let go. She finall managed to pick up a rock and bashed it in the nose; it let go and ran off. She said it couldn't have been more than 15 seconds, but it seemed like hours. The whole time she was afraid one of her kids would come out to join the fracas. We cleaned her up, did some xrays, updated her tetanus, and started the rabies series. A few days later when she came back for her next dose she was a mass of bruises. And, she said, the critter had returned but they had managed to scare it off with a BB gun and her son's slingshot, but from the back porch. Whatever works I guess.

Speaking of biting critters, one of my co-workers, Sherry, goes to Alaska every summer to canoe down random wilderness rivers above the arctic circle. She and her husband are gone weeks at a time. They eat a lot of jerky and soup because they neither fish nor hunt; they are very concerned about their carbon footprint. Sherry and hubby have done these trips for years, loving peace and solitude, the beauty of their surroundings and usuallythe abundance of wildlife.

They have never had the kind of chilling close encounters with grizzly bears they experienced this year. Apparently there was some kind of grizzly bear convention because this year, not only were the bears present in unprecidented numbers but they were very curious; one might even say they were stalking my friends. This went on for days; they would make camp and bears would always be nearby. One even started running her way, far enough but still too close for comfort. Apparently, because they were without any kind of weapon except Grizzly Bear Spray in a can for REALLY close encounters, they largely deterred these creatures with a whistle or shouts. I wouldn't have closed my eyes. Ever.

"How can you go into the wilderness without a gun?" I asked.

Sherry was so completely unnerved by the memory of charging grizzlies that she told her husband that she didn't think she could do the trip next summer. Her husband thought it would be a good idea if they brought a gun next year because he really wants Sherry to go and feel comfortable. He even said he would learn how to shoott.

"Well, you need to learn too!", I exclaimed.

"Oh, I grew up around guns. My Dad still hunts. I know how to shoot", she replied. Yikes. Apparently her husband is the pacifist, and was begining to see the danger inherent in this situation in a new light.

I thought that as the weeks and months went by Sherry and her husband would take a more assertive approach to procuring a firearm. Unfortunately, the epiphany was short lived and her husband is backing off and losing his resolve. Sherry, on the other hand, just bought a can of pepper spray, which you don't need a permit to carry in this Shoot Pepper Spray and Live Free or Die state. Today pepper spray, tomorrow protection against grizzlies.

Good luck Sherry! Guess your husband will simply have to continue to use harsh language voicing his extreme displeasure in unequivocal terms while taking care not to damage the self esteem of the native ursus arctos horibilis.

Read to the bottom for full hilarious effect. Love it!

Tuesday, November 3, 2009

The Patient is the One With the Disease

The lady who rushed into the ER last night after having her forearm punctured by her cat's sharp little teeth was in the department again less than 24 hours later when I got to work. She had gotten her wish: because she neglected to take the proferred antibiotic for 15 hours she developed the cellulitis that she insisted she was going to get. This was fairly predictable since she pretty much wanted to be admitted last night when she came in. When there was no redness or swelling. She wanted to be admitted prohylactically. I don't know about you, but such individuals just creep me out. There is an alarmng population of individuals who revel in their illness, delight in their disability and can't wait for complications. It is all about the attention, either from health care workers or family and friends.

Lots of people will fake pain so they can get narcotics; some are addicted, some sell them to get other drugs. The majority of these adopt a "pitch 'til you win" strategy. They make the rounds of every ER until they get what they want. Since we close at 11 PM, unless we have patients in the department, many have figured out that if they come in at 10:50 PM we will be more likely to give them the Vicodin or Percocet. Sometimes it backfires. One of the docs will only give Tramadol, which is fairly useless to the hard-core narcotic seekers. Let me assure you, though, we do evaluate everyone individually for their pain issues; sometimes we actually get someone who has 1) legitimate pain, which we 2) relieve

Still, some people have some pretty elaborate stories; it goes like this:

"So I've had this pain in my tooth for about 2 weeks, tylenol doesn't work, aspirin doesn't work, ibuprofen doesn't work (fill in time of last over the counter pain med administration, usually sometime yesterday). I have an appointment with the dentist next (fill in the day and date) because I had to reschedule from (fill in the last 6 dates for alleged cancelled appointments). The pain is really bad, it goes into my jaw and into my neck. It's 10 out of 10, I can't eat or sleep. I had some Percocet but i finished them. Does my face look swollen? It feels swollen. If I could get some more Percocet to tide me over until I see the dentist that would be great. Did I mention my pain is 10 out of 10? It's really bad No, I didn't call the dentist to see if I could get an earilier appointment"

Because I have many years of experience and generally know how to synopsize most complaints, my triage not says simply:

"Dental pain. Requests Percocet"

That about covers dental pain. It makes me lose interest really quickly, especially when we've seen the patient 5 times in the last 3 weeks, and it's always the same story. Many times the patient will get a 'script for Vicodin AND Penicillin. Guess which 'script never gets filled?

My favorite doc is keenly interested in relieving dental pain; he will do an injection of local anesthetic just like the dentist does. Not all of them do this, but I think for the legitimate dental paineurs it is a great option to buy them some time to get to the store for one of those temporary filling kits. Alas, some people refuse this option as you can imagine.

Not all the docs have the training to do this, which is why I think my friend Debbie, who teaches this skill to hygienists and dentists, should come up and do a training session. She could clean up $$ wise. Must remember to talk to her about it, several of the docs were very interested. It sort of seperates the wheat from the chaff if you get my drift.