Be My Valentine

A guy comes into the ER because has a problem with his penis.  Having worked in the ER for many years, I thought I had seen about every problem one could have with their penis.  Infected ones, fractured ones, cut ones, ones with things shoved into them (pens, pencils, paper clips etc, etc), tattooed ones and ones I thought were on a woman.

So this guy had been in prison for a while.  Having a lot of free-time on his hands, he had taken a domino and over time using an emory board had shaped this domino into a heart.  He had carefully and with great skill slowly filed this domino into a perfect heart about this size of a nickel and about a quarter of an inch thick.  The next part is what amazed me.  He then sliced the skin on the top of his penis and slid his domino heart under the skin of the shaft of his penis and allowed this to heal.  Over time his small incision healed leaving the appearance of a heart on the shaft of his penis.  Presumably this was to be for the enjoyment of the ladies once he got released from prison.

Well I guess his penis must have been a little out of practice after all the time in prison.  The first time he used his newly decorated penis it tore.  So now here he was in the ER a couple days later with an infected wound on his penis asking to have his domino heart removed.

Is this a great job or what?  Another thing to be checked off the list of "Oh yeah, I've seen that before"!

Too Much Watermelon

People often come to the ER if they see, or think they see, blood in their stool after a bowel movement.
They are most afraid they have cancer or some other terrible disease.  So, it's not uncommon to have to do a rectal exam on people almost every shift I work.  I'm always amazed when people start acting all weird about this exam.  "Oh my! This is embarrassing!  I wish I didn't have to have this done!"  All the while I'm thinking to myself, "You know, when I woke up this morning I was hoping I was going to get to stick my finger in someone's butt-hole!"  This isn't exactly the high-light of my day either, I assure you.

It's late morning.  I go see a middle-aged professional man dressed in a nice blue business suit.

"How can I help you today?", I said.

"Well, I went to use the bathroom this morning and I noticed blood in the stool." ,  he said.

He proceeds to describe to me in much too much detail the caliber of the stool, the amount of blood, the color of the blood, etc.  What happened next was the big surprise.  He opens his briefcase and pulls out a Zip-lok plastic bag which appeared to contain a rather decent sized turd!  I could not believe this.  All I could think to myself was that this man was at a business meeting this morning with a plastic bag of shit in his briefcase!  I wonder if he would have sealed-the-deal or acquired the new account, if those in the meeting with him new what a little treat he had in his suitcase.  They probably thought to themselves, "Does this contract smell a little funny?" or "There seems to be a brown smudge on your draft proposal.  Must be something wrong with your copier.  Maybe it needs a new toner cartridge."

So he hands me his bag of excrement for me to examine.  I obviously did not want to do this, but he seemed eager and proud, so I obliged his request.  As I began to take a closer look at his goodie bag, I noticed he appeared to be getting plenty of fiber!  I also noticed what looked like several watermelon seeds along with streaks of red.  The red appeared to be the pulp of the watermelon.  I also noticed many kernels of corn.  "You must have been at a picnic or a cookout?"    "I was.  How did you know that?", he asked.  I described how I came to the conclusion by the contents of his plastic bag.  Now I'm a forensic stool examiner I think to myself.  I did a chemical test on the stool called hemoccult which tests for blood.  The test was negative, no blood.  As it turned out, the red he was noticing was the undigested pulp of all the watermelon he had recently eaten.

He was very relieved to hear the good news that he didn't have cancer or some other terrible illness.  I think maybe he was a little embarrassed, as well.

And for me.....  It was just another day in the ER!

A Phrenologist's Dream

Working one Saturday night, I walk in to see a man whose face and chest is covered in blood.  I could see he was bleeding from multiple lacerations to his scalp and he was obviously intoxicated.  Drunk people tend to fall into two classes; the happy drunk or the angry, belligerent drunk.  Luckily for me, this was a happy drunk.

"Wow, what happened to you?", I said.

"My wife caught me with my girlfriend tonight and hit me with a hammer",  he said.

"Wives are funny that way, aren't they?  Most just don't like it when you have a girlfriend too. Did you get knocked out or are you hurt anywhere else?", I said.

"Nope.  Just my head." he said.

As I examine the man I'll call Leon, I find that he has a total of twelve lacerations to various places on his scalp.  Each laceration was about two centimeters long.  His head was a large tangle of hair, blood and large knots on his scalp.

"Man, a phrenologist would go crazy with you", I said to Leon.

"A what?"

"A phrenologist.  It's a person who is supposed to be able to tell you what kind of person you are, or what your future may hold, by reading the bumps on your scalp."

"That's funny doc!  Am I gonna be ok?"

"Yeah", I said.  "We just need to clean up your wounds and repair your lacerations.  You'll be fine."

In order to repair his lacerations, I had to try to wash all the blood out of his hair and then trim a little of the hair away from the edges of the lacerations.  After this was accomplished, the wounds were repaired.  Each wound was closed with two metallic skin staples.  After I had repaired his lacerations, the nurse took the patient to a decontamination shower in the ER so he could finish washing his hair and getting all the blood off himself.

We keep a closet full of donated clothing for people to wear if their clothes are ruined from blood, urine, excrement or whatever.  Leon went to the clothes closet and, of his own free-will, chose a stunning blue polyester leisure suit to wear home.  His clothes were completely ruined by his own blood and beer.  Leon slept off his alcohol in the ER for a few hours.  When he awoke, it was Sunday morning.

I will never forget the sight of Leon walking past me as he left the ER that Sunday morning.  He was quite a sight in his polyester powder blue suit with twelve small bald spots on his scalp; each one containing two metallic skin staples.  He could be off to church with Jim Jones or to some zombie prom.

Starfish

     A typical obese woman, named Noreen, with diabetes is brought to the ER because her family noted that her foot was bleeding when they went to visit her one morning.  She lived alone with the exception of her small pet dog who I will call Daisy.  Upon further examination, the family astutely noted that three of Noreen's toes were missing.  They also noted that Daisy had some blood on her muzzle and that she hadn't touched the food in her dog-bowl that morning.  Putting two and two together it was determined that Daisy had apparently eaten three of Noreen's toes off sometime during the night as she slept in her Lay-Z-Boy recliner.  Because of the neuropathy from her diabetes, Noreen felt not a single bit or nibble.  I seemed to be the only person in the room who was shocked by this situation.  Her son, Dylon, and other family members in the room seemed not the least bothered by this terrible and gruesome injury.

"They'll just grow back, right?", says Noreen's son Dylon.

I look at Dylon in his dirty overall's and dirty Kenworth trucking hat amazed by his stupidity.  Is he serious?  So if people lose appendages, they'll just grow right back?  This is a special family I'm dealing with here.

"No they won't just grow back.  Not unless your Mom is part starfish.", I said.

"What if we were able to fish the toes out of the dogs poop?  Could they be sewn back on?",  said Dylon.

You have got to be kidding me.  This guy cannot be for real.  Does he really think these toes would be salvageable after being eaten and traversing a dog's GI tract?

"Sorry, that won't work either.  We are going to have to admit your Mom to the hospital so that these wounds can be debrided and allowed to heal, but, unfortunately there is no way to save her toes".

I don't really remember Noreen ever saying a word.  Perhaps she was just too overwhelmed by the situation or perhaps she just had nothing to say.  She was admitted, had her wounds cared for, and
after a few days in the hospital, Noreen went "weee-weee-weee all the way home" missing a few little piggies.

Blue Tubules

     Believe it or not weekend mornings are when I have seen some of the strangest patients in the ER. People usually think of the weekend nights as being the time when all the crazies are out, but this isn't always the case.
      I was working one Saturday morning when a woman in her late 20's came in for evaluation.  She was accompanied by her fiance' who waited in the waiting room.  The fiance' waiting in the waiting room is always a sign that something interesting is about to transpire.  If it wasn't weird  or interesting, the fiance' would be in the exam room with his wife-to-be, not in the waiting room.  This rule of the ER would remain in place that day.

"Hello, what brings you to the ER today?", I said.

"Well, every time my fiance' and I have sex, after we're done and I go to wash up ( she pronounced it "woorsh-up"), I notice these little blue tubules coming out of my privates." the patient says.

     Maybe it's just been my white-bread conservative up-bringing, but I've never felt the need to wash-up after having sex.  Maybe I'm doing something wrong.  Maybe I'm not doing it right.  Should you need to wash-up after having sex?  These were some of the thoughts going through my mind at that moment, not to mention the thought of "What the hell is she talking about?..... blue tubules!?" "Where do these people come from?"  "Ok, there's a hidden camera somewhere and someone is filming this for some type of TV show".

     Anyway she proceeds to describe the blue tubules.  "They are about the size of a pencil lead and about a quarter of an inch long.  I usually find a few of them when I clean up.  It's always after we have sex.  I don't know where they are coming from."  "Have you seen anyone about this before today?  Do you have a gynecologist you see?" I ask.  Of course, she hasn't seen anyone about this.  That's what the ER is for.  She doesn't enen know what a gynecologist is.  The nurse and I go do her pelvic exam, which to no one's surprise is completely normal.  "Are you sure you don't see anything?", she says.  "Pretty sure.   I can see the entire inside of your vagina and I don't see any little blue tubules."  "Well I wonder where they could be coming from", she says.  "Maybe we could give you a specimen container to take home with you so the next time you see them, you could collect them.  I'll give you the name of our gynecologist on-call that you can follow-up with."  That was the most important part.  Giving her somewhere else to follow-up other than coming back to the ER.

     As the nurse and I were walking out of the exam room, it suddenly dawned on me that the patient had said she only found these tubules after she and her fiance' had sex.  I had no idea when the last time they had sex was, and frankly I didn't want to know.  Maybe the source of the tubules was his semen.  I describe this thought to the nurse.  "She said she only saw the tubules after they had sex, right?  There was nothing that you or I saw during her pelvic exam, right?  Maybe the tubules are in his baby batter!  Nurse we need to have her fiance' go to the restroom and wack-off so we can check his jizz for the tubules!"  "Are you serious?!", said the nurse.  "No way!  I don't think I want that guy wacking-off in the bathroom.  I was just kidding, but do give her the specimen container to take home with her.  She seemed to like that idea."

     So, the patient left happy with her evaluation and the plan for follow-up.  I never heard anything about her again, so the source of the blue tubules remains a mystery.

My Grandfather's Patient

The Emergency Rooms of this country provide a large amount of care to the elderly who reside in nursing homes.  These patients may have their own doctors or the nursing home may have a doctor on staff, but when someone at the nursing home is sick they get sent to the ER.  Frequently the elderly patient is unable to provide any history as to their illness or injury due to dementia or their general frail state.  On those occasions, you have to do your best to assess the patient and determine the cause of their illness.  In many ways, it is just like a being pediatrician or a veterinarian.  You can't always get information from the patient.  You must use your clinical skills to evaluate them.  It is sometimes a very difficult thing to do with many complicating factors such as family issues, code status, comfort care etc.  These patients are not ones you always look forward to taking care of.  Much like the screaming 2 year old with a lip laceration; there are just some patients you would just rather not see.

I went in to see an elderly lady from a nursing home who was 102 years old.  She was sent to the ER because she had a fever and a cough.  When I went in to see her, much to my surprise she was perfectly alert and oriented.  Her mind was sharp as a tack.  Despite the frailty of her body, her mind was unfazed by her 102 years.  She was a living history book of the past century. I thought of all the things that she would have seen in her lifetime.  Two World Wars, space flight, TV, telephone, computers, many advance in medicine, CTscans etc.

I was reviewing her paperwork sent with her from the nursing home including her current medications, past medical history etc.  Included in her paperwork was a list of biographical information... her birthdate, place of birth, family contacts and so on.  I immediately took note of her place of birth.  It was the place of birth of my mother.  A small town in the Midwest that few people have ever heard about.

My grandfather came to the United States from Germany at the turn of the century.  When he came to the US he ended up going to medical school.  He set up practice in this small town.  He was the only physician for many miles in this rural area.  He ended up paying for his two brothers to also attend medical school and his sisters to attend nursing school.  The family established a clinic and eventually a small hospital in this small town.  My mother was the youngest of 16.... that's right 16 children that my grandfather and grandmother raised.  Surely this lady would have heard of my family.  My mother passed away when I was 16.  Trying to do the math, I figured my mother was about 30 years younger than the patient I was seeing.

"I see you are from Ironwood*."
"Yes. I spent my whole life there and didn't move here until my husband died.  I moved hear to live with my daughter, but several years ago became ill and I have been living at Green Farms Home*".
"My mother was born and raised in Ironwood*".
"What was her name?"

I proceeded to tell Alma* my mother's name and about my grandfather.  I asked if she knew them.  Her eyes lit up.  She said "Why of course!".  "Your grandfather was my doctor and delivered two of my children. Your mom used to play with my kids".

We spoke for some time about her memories of my mother and grandfather.  My grandfather died before I was born, so I obviously never had the chance to meet him.  It was wonderful to hear Alma* tell me what a kind and caring doctor he had been.
I lost my mother at the age of 16.  That was a terrible thing to go through.  I always thought my mom would have been so proud of me for following in her father's foot-steps.  It was such a touching gift for Alma to tell me of my mother's childhood. " What a happy, pretty and smart girl she was", Alma said.  It made me sad that I could not share this encounter with Mom, but I could not wait to get home and call my family to tell them of  this chance encounter.  To think my grandfather had been Alma's doctor when she was a young woman having a family and now I was here to provide her comfort and care towards the end of her life.

That was only time I ever saw Alma.  She brought me closer to my mother, my grandfather and had profound impact on me personally and as a physician.  My Grandfather's Patient.

The Anus is a One-Way Street

Working one day in the ER, I see an ambulance crew bringing in a patient on a stretcher face down with his back-side up in the air.  This is not the usual mode of transport for patients on stretchers.  I follow the crew, along with the nurse, into the room to see what is going on with this man.  He's a man who appears to be in his late 50's and smells like a dirty laundry basket onto which someone spilled a 40 ounce beer.  When I walk into the room I notice he appears to be bleeding fairly heavily from his rectum. I go up to the paramedic to get some history before going to interview the patient.

"What's going?  What happened ?"
"He was driving the wrong way down a one-way street and was stopped by the police" the paramedic said.
"Okay.  So why is he bleeding from the rectum?"
"He said he has a broken beer glass in his rectum".

Okay this should be interesting I think to myself.  Now on to interviewing the patient.  I go into the room and begin to hear the patient's version of how his injury occurred.  He proceeds to tell me how he was drinking and driving.  He tells me he was driving down the road drinking beer from a regular 16 ounce beer glass and apparently going the wrong way down a one-way street.  He said when he saw the lights from the police car and realized he was being pulled-over that he didn't want to get caught drinking and driving with an open container of alcohol, so he stuffed the beer glass up his anus.

"So you mean to tell me from the time you saw the police car you had time to pull over, pull your pants down and place the beer glass up your anus?"  I'm not buying it, but that was his story and he stuck to it.

Now the real story comes out.  It just turns out this is just a guy who drinks a lot and has a fetish for sticking things up his anus.  Unfortunately, this time he picked an object that could not withstand the compressive forces of his lower gi tract.  When his wife shows up to the ER, she is not surprised by these events at all.  Apparently, this was not his first time to the rectal rodeo.  She reported he had been to various ERs on several occasions to have rectal foreign bodies removed.  This time was different though.  This time he would end up leaving the hospital 4 days later with a colostomy because of the injury to his colon from the shards of broken glass.  Hope he had fun.

After years in the ER, the list of rectal foreign bodies I've seen is long and varied.   Candles, various fruits and vegetables, lightbulbs, curtain rods, hotdogs, peanut butter jars, ice cream scoops, beer bottles, steak sauce bottles and of course, vibrators.   Never have seen a gerbil, though.   I've heard about it, just never have seen it.

This seem to be more of a problem with men.  When a woman comes in, it's usually just the garden variety vibrator.... and half the time she didn't put it there.   With men though, it's a different story.  You just never know what it will be.  It's usually the story of how it got there that is the most exciting.  I always wonder what the insurance company thinks when they receive the bill from the hospital.  Of course, most of the folks doing this type of thing don't have insurance.  Another cost of healthcare pushed off onto the insured.

So remember, the anus is a one-way street!