notes to self

I am fairly sure I've mentioned in previous postings that it's generally a bad idea to run from the police. Especially the great big furry ones with doggy breath. I may not have mentioned Zito in particular, but his reputation does tend to precede him; the last bad guy he bit was wedged so far into something that only his face was showing; Zito got the attack command and latched onto the guy's jaw. . .took 81 stitches to fix him up. (actually, it took more than that. . .they just stopped counting at 81.) The current bad guy Zito bit had just sprayed his stepdad in the face with a blast of shotgun pellets and was heading for a toddler when the po po showed up. His teeth numbered higher than his IQ, and that's giving him the benefit of the doubt. After I struggled through the irrigation of his doggie tooth puncture wounds ("ooooohhhh, aaaaiiigh, what's that?" he would scream, poking his filthy finger into the hole I'd just finished cleaning and yanking out pieces of adipose tissue. ""Oooohhh, it hurts so effing bad!" and he'd yank his uncuffed arm away and flail his legs around.) I went outside and loved on Zito, good Zito, sweet great big puppy Zito.

note to self #1: don't run from the po-po. and carry doggie biscuits.

So later on in the day and we're working up a psych patient who, if you didn't know her, seemed fairly lucid. But by the end of her stay she's got the people on the other side of the curtain convinced that they've got brain tumors, aneurysms, and some sort of gangrenous disease that makes their blood float around the outside of their bones instead of living in the marrow where it belongs because she knows just enough medical terminology to be convincing to people who don't know the difference. She doesn't care if you listen to her; she'll start talking like she's got a motion sensor as soon as you walk in the room and she'll just keep talking until she's winds down, regardless of whether anyone's in the room or not.

note to self #2: any information gleaned through the curtain divider of an emergency room is highly suspect.

Just about lunch time and we get a chest pain patient. The guy is in fairly good spirits, points to his inferior sternum, laughs and says yesterday he went to his mom's and had some of the worst coffee ever, and he's been feeling this weird chest pressure ever since. He's 55, fairly active, smokes less than a pack a day but that's his only risk factor. I'm ready to slip a 20g single lumen in his arm when he goes on to say that he mowed his lawn after the terrible cup of coffee and had to quit half way through because he got so worn out. Initial EKG 12 lead says normal sinus rhythm, but I just have this feeling. . .so I trade out the 2o for an 18 and a dual port lock and go to refill my IV tray. 30 minutes later and it's almost break time when lab calls with an "OMFG" troponin, the charge nurse looks up at the monitor at the nurses' station, sees v-fib and says, "is that his real rhythm?" and the wife screams "HAAAAAEEEEELLLP!" out the door of the patient's room. We called a code, as you might imagine. Crazy, though- I've never seen a patient in vfib responsive. . .the guy was obviously alert but understandably panicked. . .the first time we shocked him into a unresponsive PEA; epi shot him back into a conscious torsades that kept slipping back into vfib so we shocked again. He'd look at me with terror and then go into hypoxic seizures. Doc pushed mag and amiodarone and we shocked him one more time back into a sinus rhythm. Repeat EKG showed remarkable ST elevation, as if we hadn't figured that out already. I started two more fatty IVs, talking to him the whole time; we got him calmed down and on the table for a balloon and stent. I went and saw him later and he grabbed my hand and called me his angel.

note to self #3: avoid mom's crappy coffee. Hire a landscaping company to mow the lawn. Pull the tarnished halo out of the coat closet.

and today's job security award goes to the 25 year old male who called from the ER room of the other hospital to see if he might get better "service" from our ER. Turns out he just wanted more narcs to ease the pain of constipation; he turned down the other ER doc's offer to digitally disimpact. He called our ER 5 different times before finally making it over; each time, our doctor informed him that, as our patient, he would get the medical screening due to him by law, but the other physician's work up and treatments and his recent past visits to both hospitals would be taken into consideration. The guy showed up anyway, got his medical screening, and was offered an enema. He declined.

note to self #4: you can't cure stupid.