Tuesday, October 28, 2008

Why it sucks to be a postal worker...

The charge nurse from the ER calls me and says she is sending over a patient who has come from an Urgent Care center.  "She's chopped off the top of her finger and she's got the finger with her".  

Well, that sounds exciting.  I get everything ready in anticipation.  A bowl of ice, some saline solution,  a ton of gauze and IV stuff.  The patient comes in with her hand wrapped up and a cardboard box.  I get her settled, make sure she is not in pain (the urgent care had properly medicated her), and eagerly open the box.  (Wounds, to me, are like unwrapping Christmas gifts.  I can't wait to see what is underneath the bandages.)  The box holds ice packing and, in a small plastic bag, the tip of her finger, from the knuckle to the tip.  It's pale but properly packed.  I set it aside and begin to unwrap her bandages from her hand.  She turns her head away as I get to the bloody end and there it is:  a chewed up stump at the end of her middle finger.  So cool.

Here's the story:   She's a Filipino lady who works at the post office.  Apparently, they keep their stamps in a locked safe.  It's big and heavy duty.  She is closing the safe and before she can pull her finger out of the way, the safe closes on her finger.  On instinct, she pulls her finger away and realizes that the tip is missing and blood is gushing out of her little stump.  Her co-workers are alerted to her distress.  Problem is, they can't find the tip and realize it must be in the safe.  So they have to have her tell them the combination so they can open it and retrieve it.  The tip is retrieved and sent with her to the urgent care.  (They sent her to an urgent care because it is a "workman's compensation" claim and must go through their affiliated care provider first.  Another glitch in the medical/insurance system.)  

I must say I totally respect the urgent care for their appropriate handling of the "body part" and the fact that they contacted a hand specialist and told him to meet the patient at our facility.  It was successfully (so far) reattached right in the exam room.  Kinda surprised he didn't have to take her to operating room.  We of course gave her proper pain medication as well as prophylactic antibiotics.

I hope she is doing well.  I think she is lucky that this injury occurred at her federal job and she will be completely taken care of as far as bills and compensation go.  I see so many partial amputations from illegal immigrants that never claim it as workman's comp because they are not legally employed by the company.  I even had one guy leave without telling us, his partially amputated finger still dangling.  

Saturday, October 25, 2008

101 uses of a carrot...

A patient came into the ER with the complaint of "something stuck in my rectum".  His story was that he was "impacted" (meaning hard stool is stuck in the rectum and regular poo can't get by).  To solve his problem he decided to insert a carrot to dig out the offending hard poo.  Well, the carrot got away from him and lodged itself so deep that he was unable to get it out.  The doc who examined him is this cute little Asian girl who looks all about 14 years old but is a fabulous doctor.  She told us that she attempted to retrieve the carrot with forceps.  Unfortunately, once something is lodged in the rectum, a vacuum seal is created, making extraction difficult.  She tried to pull out the carrot, just to have it sucked back in.  She tried again to pull it out and once again it got sucked back in.  This happened about 5 times when the man turned around (imagine him  on his hands and knees) and said, "Just pull it out already!".  Appalled, she said "What do you think I'm trying to do?".  For god's sake, did he think she was just pulling it out and pushing it back in for fun?!?  

She realized she could not get it out on her own and called the GI (gastrointerologist) specialists.  Basically they performed a lower endoscopy which entails putting a rubber tube complete with a camera up the rectum to pull out the offending object.  After two hours of trying they were unsuccessful.  They even tried to burn holes into the end of the carrot to get a better grip.  No dice.  What they were successful at was taking photos of the carrot.

The decision was made to send the man to the operating room.  Poor guy, I saw him sitting outside his ER room, slumped shoulders, looking so defeated.  And he looked like a regular guy, not like what you might imagine.  I felt sorry for him.  I read the operative report the next day:

Patient was placed in the lithotomy position. (On his back, legs bent and spread wide open, much like getting a gynecological exam.)  Medications were given to relax the muscles.  (The rectum is just a nice, tight muscle).  Spreading devices were used to open the orifice as much as possible.  Reaching in with a special clamp, the surgeon was able to remove the carrot in its entirety.  All 13 inches of it.   

Do I believe his story?  Not really.  Do I feel bad for him?  Absolutely.  Maybe just a fetish gone wrong.  His paperwork said he was married.  Did he have to explain to his wife why he spent over 8 hours in the emergency room and accumulated a gigantic bill?  Maybe she already knew...  Does she do the grocery shopping????

Tuesday, October 21, 2008

Last minute weekend!

Had to plan a last minute weekend to get out of town. I'm so burnt out on work right now. Every little irritation seems ten fold. Noah has also had a hard go of it at his job. Economy is slow so his bosses are up his ass about every little thing. So we decided to drive an hour and a half to the sleepy little seaside town of Carlsbad just a little north of San Diego where Noah spent a lot of time as a kid.

We get to our hotel room and try to decompress as the sun starts to set outside our room.

I've never liked when people took pictures of the inside of their hotel room but we had this amazing light coming in off the patio.

Our view from our patio. So serene and calming. The funny thing about this hotel is that they had all these "activities" for people to participate in like "Bingo at 7pm in the library". I felt like Patrick Swayze was going to be offering mambo lessons on the veranda at 4pm.

Hung out with Noah's friend Chris who still lives there. Both avid surfers. Noah got to surf while here. It makes him so happy!

Of course, Noah continued to work.

But we had so much fun and a much deserved break from La La Land. Back to work tomorrow of course...