To Like Or Dislike

I was shocked by her appearance. Although she was in her early 50s, she looked closer to 80.  Matted peroxide hair.  Dull, lifeless eyes.  Sagging skin and deep wrinkles.  Protruding cheek bones.  Cracked, dry lips with a hint of yesterday's lipstick caked in their corners.  Gray and yellow-stained teeth, some chipped. In her prime and before alcohol and cigarettes became her every thought, I could imagine an attractive, lovely woman.  Now, sadly, what sat in front of me on the hospital cot in Room 12 was nothing short of a shell of a human being.  This was a woman who lived a hard life.

She had presented to our ER in respiratory distress.  Although she already had an established diagnosis of emphysema, she continued to smoke two packs of cigarettes a day.  On top of this, she had just finished a ten-day drinking binge, the last five of which she spent either passed out or drinking.  She claimed to have not eaten in that time.  I was called to her room because she was in such dire respiratory distress.

"Maam," I said after introducing myself, "how long have you been having trouble breathing?"  She was gasping for air, her nasal folds flaring with each struggle to breath deeply in.  Through her thin hospital gown, I could see her ribcage and diaphragm heaving, compensating for her non-compliant lungs, trying to pull that extra oomph of air into her body.

"I...don't...know," she managed to answer, each word a struggle for her.  Her hands, I noticed, were pale, their spidery veins popping through her thin transparent skin.  They gripped the top rail of the cot for dear life.

Immediately, I ordered breathing treatments.  Steroids.  BiPAP (a machine with an attached mask that would force supplemented oxygenated air into the patient's lungs every time she initiated a breath).  Blood work.  A stat chest x-ray.  The rapid intubation kit and ventilator for stand-by.  I asked more questions, questions she could answer simply by nodding her head.  "If you get worse, maam," I spoke, asking the most important question of all, "we may need to insert a breathing tube into your lungs, hook you up to a ventilator, and do your breathing for you.  Do you want that if it comes to that?"

A "yes" nod.  She tried to speak.  "I've...had...that...before," she gasped.  "You've been intubated before, maam?" I repeated.  She held up two fingers of her left hand in a peace-sign.  "Twice," she said.

Within the half-hour, surprisingly, she began to turn around for us.  I spent considerable time in her room during this period, making sure she would not decompensate before our eyes.  With the additional attention of two stellar nurses and a respiratory therapist at bedside, she thrived and slowly improved.  Finally, as her lungs began to fill with more air, her nasal flaring and ribcage retractions subsided.

After stabilizing her breathing, we began to treat her other problems.  For malnutrition and dehydration, we gave her several liters of normal saline and a "banana bag," a liter of fluid supplemented with thiamine, folic acid, and multi-vitamins, giving it a yellowish-color.  For her withdrawal tremors, we gave her Ativan, a longer acting valium-derivative.  We fed her ice-chips.  We gave her anti-nausea medicine and several low doses of pain medication for her evolving alcohol-induced pancreatitis.  Her chest x-ray revealed pneumonia in both lungs, and we began antibiotics to cover her for the common community-acquired organisms as well as for aspiration organisms (only God knew if she swallowed some puke into her lungs).

Finally, after a lot of attention and energy given to her, she was at the point where I could sit down a few extra minutes with her, making sure I understood all of her history and didn't miss anything.

"Maam," I started, "have you ever tried to quit smoking?"  "Yeah," she said, her voice now a little stronger, more gruff, "but I don't really want to.  I like it."  She looked at me with challenging eyes as she said it.

"And maam," I continued, "do you consider yourself to be an alcoholic?  Have you ever had treatment for it before?"  She answered immediately.  "No, I'm not an alcoholic.  I like my booze, but I don't drink nearly as much as my husband.  Now he's an alcoholic.  But I'm not."  She enunciated "he," spitting out the word like it was poison.  Her denial was remarkable.  And expected.  "Do you want help while your hospitalized for your drinking, then?"  "Why," she asked me, "if I don't have a problem?"

I asked her about abuse.  She denied physical abuse but claimed "that he yells at me a lot."  Again, she refused to accept any counseling.

Finally, as I was finishing, she said "Can I ask you a question, Doctor?"

"Of course you can, maam," I said.  "What can I do for you?"

"Well," she said, "I don't understand why doctors can't take care of my problems.  I don't like coming here all the time for belly pain and breathing problems.  Why can't they just get it right the first time I come in?"

I was shocked.  Completely and utterly thrown off my game.  Hackles up.  The nurse, standing at the room counter with her back to us, writing on her chart, turned her head around to face the patient, her mouth gaping and shoulders tightening.  I'm sure mine were, too.  Although we don't expect appreciation, we certainly don't expect to be blamed for a patient's medical problems, either.

"Maam," I said in my calmest , most respectful voice, "you have emphysema and, yet, continue to smoke two packs a day.  You have pancreatitis and, yet, continue to drink.  You completely ignore your body's needs, not drinking water or eating food for five days.  You are hacking up phlegm and don't use your inhaler or pursue treatment of these symptoms, resulting in pneumonia.  You've been intubated twice and have come to the ER multiple times.  And you can't understand why your doctors 'can't take care of your problems'?  Have you considered that your problems might be from your own poor decisions?"

I stopped and stared at her.  She stared back.  I waited for her to speak.  I was going to stand there all day if I had to.  Finally, with the nurse now standing along her other side, the patient spoke.  "I guess you are right.  Some of these problems are my own fault."

"Not some of them, maam," I said, "all of them.  By accepting personal responsibility for them, though, maybe you can move on and start treating yourself and your body a little better."  Although I'm sure my words fell on deaf ears, I still needed to have my say.  Especially when we all worked so hard to turn this unappreciative patient around from her multiple medical problems, some life-threatening.

I grabbed the patient's hand.  "Listen, maam," I said, "I wish you well.  I want nothing but the best for you.  But if you don't change your habits, I am sure I will see you in our ER again.  And again.  And, one of these times, I fear, we won't be able to undo your problems."

I let go of her hand and turned to walk out the door.  She was admitted to the ICU and was going to be transported up shortly.  Before leaving, though, she called out.  "Doctor!"  I paused and turned around.  "Yes, maam?"  She hesitated before speaking.  "Thank you for your help today.  I'll think about the counseling, okay?"

I nodded to her.  "Good luck," I said before continuing out the door.

One of the most frustrating parts of my jobs is dealing with patients' frustrations of their medical problems, simply because of their lack of personal responsibility.  It's rampant, too.  I cannot cure patient's who do not put their own effort into their health.  None of us in the medical field can.  We are here to help you along your journey, to walk sided-by-side with you in your, hopefully, healthy path.  Of course, some people do everything right, by the book, and still have medical issues.  That's different. But if you want to eat profuse and bad meals, please don't expect us to cure it with a simple "sugar" pill. If you want to eat fatty and greasy foods, please don't get pissed at us when your cholesterol pill isn't helping.

I love my ER patients.  Seriously.  I have met some very cool people over the years, from both different and similar walks of life, simply from what I chose to do for a living.  I appreciate and enjoy learning the diverse stories that rest behind their faces.  Sometimes, though, I get frustrated.  We all do in the medical field.  At the end of the day, we are all human, whether we perch ourselves on a pedestal or not.  And, regardless, we want the best for you, the patient.

To my patients that have made my job rewarding, a simple thank you...it has been my pleasure learning about you and helping you on your healthy path.

As always, big thanks for reading...I hope this finds you all well.  Enjoy the weekend...

The Thong Expert

I had no idea that I, a small-town, naive, aah-shucks kid, would become a thong expert. For better or worse, though, thanks to my job as an ER physician, that's exactly what I've become. Just don't look for that entry on my resume!

I was attending medical school, in Philadelphia, the first time I walked into a Victoria's Secret. I was with two of my buddies and we were on the hunt for something sexy, something hot, something that would tell our girlfriends that yeah, we might be medical students, but we were hip medical students. Good luck trying to find the nerd in us that Valentine's Day!

I had never been in a Victoria's Secret before but, because my buddies seemed real comfortable about the whole thing, I tailed them through the front door. "The secret," they confided, "is not to touch anything."

I lasted less than five minutes. Okay, I'm lying. It was more like five seconds.

I felt like I should have paid a cover charge, my bobble-head taking in all the life-like mannequins modeling the newest underwear trends. I could have sworn one of them winked at me as I was checking out the intricacies of her lace borders. Easily my lowest point ever on the wishful thinking scale.

Not paying attention to where I was walking, I knocked into a table loaded with skimpy undergarments. Luckily, though, I was able to catch myself and right the table before we both hit the ground. Like a klutz, I tried to straighten a few piles of panties before giving up, realizing that never again would I hold ten thongs in my hands at one time.

My face felt flush. Ebbs of desperate sweat trickled down my back. I took a deep breath and recovered slightly. Keeping it cool, I continued walking down the aisle, pausing here and glancing there, sure that I was looking more and more at home.

My confidence, however, was short-lived. Directly in front of me, approaching, was a pretty girl with a Victoria's Secret pin on her lapel. Brandy, it said. I turned and looked behind me, hoping I wasn't the one in Brandy's line of fire. No such luck.

"Hello, sir, what can I help you with today?"

"Um, well, I um, well--I'm looking for a Valentine's Day gift for my girlfriend," I stammered.

"That's easy enough," Brandy said enthusiastically. "What size is she?"

What size is she? What size is she? WHAT SIZE IS SHE? Shit, I had no idea.

"Um, I think, well, um...I'm not sure," I said, now definitely feeling a little woozy.

Sliding her hands down her hips, Brandy asked innocently, "Is she my size?"

What??? Was this an open invitation to check her out? Did I need a coupon for this?

I passed on Brandy's invitation. "Yeah, well, I think she is," I said, eyes downward, feet pacing side-to-side. "I'm not feeling all that great, though," I mumbled, trying to escape, "so I'm going to go out in the hallway and sit down for a minute. I'll be right back." Yeah, right. Liar.

Thus, my history with Victoria's Secret. Needless to say, Karen (my eventual wife) did not get a VS outfit. I'm good for chocolate and jewelry and wine, but if she wanted a guy to buy her those skimpy outfits, she married the wrong one.

How does this relate to my life in the ER? Well, with as many thongs as I have seen in the ER, sometimes I wish I had been born in a Victoria's Secret. Then I wouldn't be so caught off guard, so queasy, each time I saw one.

Especially on a guy!

Recently, after hearing a trauma alert called for Room 29, I ran into the room to find a very belligerent middle-aged male, quite intoxicated, with multiple contusions and abrasions to his face. A victim of a barroom assault, per the paramedics. He was being both verbally and physically abusive to our staff, aggressively swinging his fists and kicking his legs at several of us. Another drunk tough guy talking big and hitting low.

We were unable to calm him down, despite our best efforts. Not knowing if he had any life-threatening injuries, we chemically sedated and paralyzed him before emergently intubating him, hooking him up to a ventilator. This ensured our safety from his flagrant behavior while we got a more thorough physical exam and ran the appropriate tests, all in a calmer manner.

After stabilizing this gentleman, one of our newly-hired aides began removing this patient's clothes so we could do a fully-exposed physical exam.

Now, picture it. Balding, middle-aged man. Scruffy, ruddy face. Gold-plated incisor. Carhartt jacket. Flannel shirt. Wrangler jeans. Steel-toe boots. All coming off.

The aide cleared his throat. I looked up to find him blushing. "Does this come off, too?"

Everybody stopped what they were doing and our eyes followed his. Oh no! This patient had on one of the skimpiest candy-apple red thongs that any of us had ever seen, frilly-lace included. And although I didn't know what size this patient wore, I would bet the thong was too small, evident by both of his testicles hanging out on either side of its sparse fabric.

I know, fricking gross. That's what I thought, too. I imagined connecting a cable between them so they could catch up with one another. Can you imagine that conversation?

"Hey, Leftie," his right testicle would say, "can you believe this asshole? Packing and suffocating us in this thin, red snatch of flimsy fabric! I'm pissed!"

"Hell, yeah. This better be the last time or I'm outta here. It's nice to breathe again. That damn thing was pressing me right low to the brown hole."

Needless to say, after the appropriate gawking was done, we cut the dainty, delicate undergarment off this patient and placed it in its own clear plastic garment bag to give to his family. The nurse placed it smack on top of his pile of possessions, no less. Accidentally, I'll assume. (Side note here--always be kind to your nurse and never, ever spit at them!)

Based on his wife's expression when the nurse handed over his clothes, this patient had some serious explaining to do. I could only imagine his testicles' flagrant screaming for mercy when she got done with them. At least, to this guy's credit, he didn't have a matching "tramp stamp" tattoo in the small of his back.

Soon after that day, I was at our local mall and passed by Victoria's Secret. Sadly, despite all the skimpily clad mannequins, all I could picture was a near-naked guy in a red thong sitting on a rickety bar stool guzzling Budweisers and slamming back shots of Jim Beam.

And they wonder how we in the medical field get jaded!

As for my wife, well, she'll just keep getting chocolate. And jewelry. And wine. And a pair of Hanes granny panties. Again.

As always, thanks for reading. Next post will be Wednesday, February 24. See you then. Big thanks for all your support and votes in the recent Medgadget Medical Blog Awards!