The Poker Face

Never play poker with Emergency Medicine doctors. Our patients may show up in scary predicaments or with unusual piercings, but part of my job is to not participate in panic or react and make faces at gangrenous toes, etc.

The other day, I had a "surprise" while performing a pelvic exam. The story was typical: suprapubic pain in a 30's female, with her last menstrual period being in December. So we checked her urine for infection, and the tech got her all set up in the pelvic exam room.

Oh, did I mention she was from Somalia?

As I started to do the exam, I realized that she was missing all of her uh, external genitalia. Now, I had heard of this, but had never actually encountered it in person before. I think I kind of did a double-take, but didn't want to make her uncomfortable. The rest of the exam was unremarkable. In medical school, they told us to never say that everything "looks good" when doing pelvic/breast exams, so I usually say something about everything being "healthy and normal". I think this time I just settled on everything being healthy. In the end, she turned out to be pregnant, with no infection. After confirming that it wasn't an ectopic pregnancy, we sent her off on her way.

It has been interesting relocating here. Even though I am in a much smaller city, I am exposed to a much broader range of cultures and practices than I was back home. It's pretty cool.

... Pants On Fire

One of my favorite things about working the Emergency Department is that you never know what you are going to encounter.

The other day, I pulled back the curtain in Room 5 to find a couple of paramedics sliding over an elderly gentleman onto the stretcher. A quick survey of the room revealed that there were several police officers there as well. The guy kind of smelled funny, so I thought maybe he had been picked up off the street.

As it turned out, the guy had gotten into an argument with his girlfriend. Apparently, he tried to shoot her with a shotgun (and missed). When the police officers got on scene after being called for shots being fired, they noticed that the house smelled like there had been a fire. Upon further questioning, it turned out that the guy had caught the cuff of his pants on fire while he was burning some leaves in the yard a couple of weeks back. He had trouble putting out the flames, and suffered some pretty severe burns to the back of his legs. Not liking to waste time with the doctors, the guy decided to treat his burns himself... by applying a home remedy of boiling water and Vaseline! The entire back side of one of his legs was one big, black scab, and his foot was now swollen.

To the officer's dismay, there was no way this guy was getting medically cleared to go to jail, especially as he turned out to be septic, and it looked like he had an arrhythmia as well. Apparently, he hadn't seen a doctor in over 20 years. When I asked him what his daily medications were, he answered "90 proof alcohol"! I had expected this guy to be from some rural area, given the shotgun use, and lack of healthcare. However, oddly enough, his address was right in the city!

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As for my ICU rotation, I now have survived two nights on call. During each one, I only slept about an hour of the twenty-seven hour shift. The first call night was an admission-palooza with just constant work to be done. Last night, there were a few breaks here and there, but I didn't manage to catch much sleep as I always seem to have trouble sleeping in foreign surroundings. I suppose this will get easier throughout the month as fatigue kicks in.