Not Time for Lyme

Non-stop madness, no time for anything and we get about 3 people at once for "tick bite", "I think I have a tick bite", and "is this a Lyme disease rash".  One turned out to be a mole, one was a mosquito bite and the rash?  Who knows.   Not Lyme.

You would think that if people were living in one of the biggest Lyme corridors in the country that they would educate themselves on what to do if they encounter a tick on or near their person.  Sometimes people bring ticks they have recovered from their PETS to have them "analyzed to see if it is a deer tick".  No.  We don't do that.  Mostly it's unidentifiable tick parts.  Or spiders.

Even if they have consulted Dr. Google, people seem to skim over the bits about how tick-borne illness is acquired and  symptoms to watch for.  But they still come screaming into the ER as if they had just found a black widow spider in their Underroos, paying no attention to the fact that the Lyme disease tick is quite tiny.

Just a general informational tidbit here: ticks cannot fly.  If it has wings, it is NOT a tick.
   
It depends on the doctor how much of an intervention will be carried out in the ER.  Mostly we just give them a dose of antibiotics and kick them to the curb.

The tick may be removed with a little plastic spoon with a notch cut into it.  Or a 20 gauge needle.
The area might be anesthetized and the tick removed with a scalpel

The patient may or may not have a Lyme titre done.  This is kind of useless as an indicator for Lyme if a tick has been on your body for 10 minutes.

Not to be an alarmist but there are many, many more tick borne illnesses to be afraid of.  Very afraid.  Don't even get me started on rabies exposure.

Listing and Such

Just one more reason why the fun and creativity is sucked right out the job:  I am no longer allowed to number medical complaints what with the new-fangled eeeeelectronic  medical records keeping system and all.  For some inexplicable reason any triage complaint chosen from a pre-loaded list gets immediately coded.  We are discouraged from adding multiple complaints because it opens up a couple of cans of worms.  In the past, I would simply do this for multiple frivolous complaints:

1.  Man-cold
2.  Rash x 3 years
3.  Requests psych med/pain med refill
4.  Work excuse
5.  Ingrown toenail

Succinct.  Easy to read.  Says, "I'm listening, but not very hard right now", and says a lot about the patient without really having to say anything, right?

So now I could just put it all in a free-text stream.  It doesn't look as eye-catching when I write:
Pt. states: Cold, rash x 3 years, wants medication refill, a work excuse and an ingrown toenail.

See?  Just not as effective.

Along with a litany of complaints that I am now no longer allowed to number was a female, age 30, with:

Facial pain.  Low back pain.  Knee pain.  Constipated.  "Feeling weird".  "Feeling warm" (not febrile).  Peeing less.

She did have a number of medications for anxiety, chronic shoulder pain and fibromyalgia.

Except she pronounced it Fiber Mal-Eye-Ja.

Really.  Yes, she was a native English speaking individual.  She also mispronounced Klonopin (Klonda-keen), Gabapentin (Gabro-my-pentathol), Lorazepam (Lora-pm).

Loon in a Box Indeed

I wasn't really watching some show as I drowsed on the couch after a ridiculous shift, but it had something to do with Maine (State) Warden Services.  I thought I saw a guy plowing a driveway with a plow blade on a bicycle, but I could have been dreaming.

I live in the north;  not Maine, but I can relate to Maine.   I'm not getting why one of these guys (I might have fallen asleep) was stalking an apparently injured loon across the snow, staking him/her out in an under-the-ice hidey-hole cavern in a rushing stream where he proceeded to lure him/her out with a loon...yodel.  Next the warden took what appeared to be a plastic storage box from Home Depot and attempted to capture the bird.  Oh, I thought as he waded across a snow-covered stream...this will end badly; blood and guts and feathers, everywhere, all over the ice.  And a sodden hypothermic warden for sure.

But no.  He somehow managed to get the bird corraled in the box and placed a lid on it, whereupon he proudly displayed it to the camera:

"There you go; loon in a box".

Did I dream that?  Maybe.  But all I dreamed about all night was hooting loons.

WhhoooOOOOOOOOOOOOOOOooooooooo!!

A 29 year old with a recent cholecystecomy, history of alcohol abuse etc, cirhosis, etc, comes in because he...surprise, surprise...ran out of oxycodone.

Because of the liver disease, he was careful to tell me, he couldn't take acetaminophen.  But because of the pain and no oxy's since yesterday he had had a few beers in spite of the fact that his discharge instructions clearly said "STOP DRINKING".

I couldn't help it.  I blurted, "You're a dumbass"

He looked guilty. "Well, but I didn't think just a couple of beers would really make that much difference"

I felt bad for him.  I felt bad that I called him a dumbass.

I told Mac what I had done.  He cocked his head to one side, considering for a moment.  "Well", said Mac, "he IS a dumbass".

As I was discharging him I tried to get into his head a little.  I apologized for calling him a dumbass.

"Oh, I am a dumbass, my wife says it to me too.  I know it.  I realize that even one beer is too many"

Me: "I don't say this to everyone.  But I'm an old woman with kids older than you are, and I am seriously concerned about you.  You're too young for this.  Do you have kids?"

"Yeah, two, and one on the way.  The oldest one is 6"

Me: "Those babies need their daddy.  I hope you can get the help you need to be there for them"

The saddest thing is that I don't think he will be around long.  It's sad.  He seemed like a nice kid who just went off the rails.

Son of Misqoutes

A 2 year old was brought in with a crayon stuck in her nose.

Why?  "It was GREEN!"

It was easily removed with a Katz Extractor.  Man, I wish I invented that thing.

The following dictation was not proofread by the attending:

"The patient was stabilized in an Extractor which was inserted in the right nares and a small cranium was removed".

Crayon.  CRAYON.  CRAYON!!  I'm certain she is going to be needing that cranium sometime in the near future even if it is quite tiny.

This next one, courtesy of Dr. I Never Check My Dictations, details the very minor complaints of a young man who had been in an MVA.

"This young man suffered no loss of consciousness, but reports a headache which sex has resolved"

What?!  I had to point that one out once I stopped laughing, but not before I wrote it down.

FYI he meant "which SINCE has resolved".  

*snort*