A.4 Gosh, I've seen so many whackos and weirdos. Rarest diagnoses I've ever made on the same day: Acrodermatitis Enteropathica secondary to Zinc deficiency on a little baby, and Copper deficiency due to excessive zinc ingestion (Zinc-induced copper deficiency) on a different patient. I was studying for my board exam that day during a slow shift in the Pediatric ER and was just flipping through the dermatology atlas when this Hispanic infant was brought in for a chronic rash that hadn't gone away after application of antifungal cream, etc... This was their 5th visit and my first time seeing the kid. The rash was so pathognomonic to the point that I said, hey Hey HEY, I just saw that in a book! Later that shift after I had read up on zinc metabolism and deficiency, a sick looking adolescent was brought in by his mother for lethargy and a litany of nonspecific complaints. Turned out the kid had been having a flu like illness and had been pounding down over-the-counter zinc supplements repeatedly. A Zinc deficieny and Zinc overdose all in the same day. Talk about serendipity favoring a prepared mind!
Freakiest, craziest, most insane cases I've seen? Well the guy who swallowed a bunch of pennies that I blogged about (and posted the xrays) was pretty crazy. Then there's also this schizophrenic guy who wanted better reception with the mother spaceship so he stuck hundreds of pins into his scalp and all over his body. The xrays were quite bizarre. Then there's that story of "The Two Jesus" when 2 guys in the psych. holding area of the ER beat the crap out each other after each claiming that they were the real Jesus. That was pretty hilarious. And who could forget the guy who walked into the ED with a kitchen knife sticking out of his forehead between his eyes (I still have the xrays and pics). And also the guy who walked in from triage with a meat cleaver stuck to his head. And also through triage, the guy who walked in with an ax stuck to his back. They all survived, BTW. I've already posted on my blog about the guy who walked in with a kitchen knife in his back buried to the hilt but it turned out to be all subcutaneous as the blade bent when it struck his spine. Then there was the guy who was tied by the foot and dragged by a pick up truck for several miles. That was quite gruesome.
The Monica Lewinsky scandal was so hilarious for us as it brought out a bunch of old schizophrenic ladies claiming to have had "sexual relations" with Bill Clinton.
Near misses? Lucky was the guy who got shot in the face at point blank (The Single Bullet Story). He had his mouth open so it went in one cheek (slightly subzygomatic) and out the other missing his teeth, but he turned his head and ducked, the bullet exited and hit his shoulder shattering the clavicle exiting near the scapula. Missed the subclavian vessels entirely. No pneumothorax. He got discharged from the ED after a few hours. Then there's also the guy who got shot in the ass during a drive-by gang shooting. The guy heard shots rang out, he ducked and started running. The bullet strucked him in the ass and exited…at the top of his scapula. All subcutaneous soft tissue injury! No retained bullet fragments. He, too, was discharged from the ED after a short period of observation. Lucky dog! Perhaps the luckiest of all was the guy who was shot in the chest but the bullet hit the rivet button of his jacket right over his sternum. All he had was a little bruise.
Oh, I could go on with this for days. However, the story that gross people out the most involved these 3 schizophrenic guys and their testicles (I saw each of them at different times during my career, BTW). All three guys had a problem with…excessive masturbation. All three guys thought that one of their testicle was "possessed" because it hung lower than the other and they couldn't stop masturbating because of it. One guy took a kitchen knife and lopped it of. He was brought in by ambulance in hemorrhagic shock. The second guy took a nail gun and nailed his possessed ball to a wooden plank. The third guy took a hypodermic needle and injected his scrotum with all sort of stuff, lime juice, orange juice, bleach, Mr. Clean, soap, tomato juice, etc…He walked into the ED with a trail of pus dripping on the floor. His had developed a huge abscess and his scrotum hung down to near his knees. Stunk up the whole ED, one of the nurses ran to the sink and hurled. Anatomy quiz: In over 85% of men, which testicle hangs lower, left or right? And why? Don't tell me the ol' "so they won't knock together" answer either. [I'll be expecting answers to this question~MA] I have many stories of miraculous saves but we'll save that for another day.
Q.5 You wrote "ER docs are easily expendable, and that's a fact, jack." Would you advise medical students against going into emergency medicine? Do you regret your years as an ER doc, or your decision to become a doctor?
A.5 ER docs are easily expendable, that's the truth. The law does not require residency training and board certification to work in the ED. To my knowledge no state medical board or governing body thus far has ever required residency training and ABEM certification to work as an EM physician. There are hoards of family doctors, internists, etc… who would jump at the opportunity and "whoring themselves" to work in the ED for lesser pay than a residency trained and board certified EM doc, and many are already doing it. A few of them (very few) are decent, but the majority of them are dangerous and completely inexperienced to handle the acuity. That has been my observation over the years and I'll just leave it at that. Plus, there are many mega-corporations out there (EmCare, for instance) willing to low-ball the contract bids against the private groups, mainly because they can afford to be self-insured. And most of these corporations have no qualms or problem at all with staffing the ED with unqualified, inexperienced and non-ABEM certified physicians either because they are cheaper.
Would I recommend medical students against going into Emergency Medicine? Mommas don't let your babies grow up to be…hospital based physicians! I say this because there is a complete lack of autonomy at the administrative level in EM. Two scenario exist, you are either an employee of the hospital, or you are part of a group that has a contract with the hospital. In both instances, you are at the mercy of the hospital administrators, as very few hospital contracts are longer than a year or two. So much for job security, heh? Contract renegotiations are almost always very contentious and frustrating as the administrators will do their very best to deny you the revenues that you deserve or play mind games with you by interviewing other groups and corporations bidding for the same contract. They will use all sorts of erroneous benchmarks, spurrious statistics, invalid data and flawed patient satisfaction survey scores to bullshit you. Here's the real scoop. The ER is a huge money drain on the hospitals because of paltry reimbursements (Remember, EMTALA is an unfunded mandate.) Thus, it is the aim of the hospital administrators to limit the loss as much as they can. Since they can't control the patient census, they'll go after the ED physician's reimbursements. Very, very, very few ED's are profitable for the hospitals. As a result you approach the bargaining table already in a hole. If a medical student can accept this downside of EM, then go for it.
Though I've always wondered what would happen had I stayed in engineering and not go to medical school, or stayed in neurosurgery and not switched to Emergency Medicine…I don't regret my decisions at all. I've taken care of tens of thousands of patients in my career. And every day at work, I'ved saved someone's life and made a difference. Not too many people can say the same about their job. I've saved countless of lives in my career, so no regrets. Absolutely not. It's a pretty awesome feeling to walk away from a successful case, whether it's a crash thoracotomy, chest tube for a tension pneumothorax, pericardialcentesis for a cardiac tamponade, defibrillation for a ventricular fibrillation, securing a difficult airway, or just as mundane as making a diagnosis of appendicitis or scarlet fever. Definitely, no regrets!
Q.6 I think I've been reading too many disillusioned ER Doc blogs. Time to have some fun. This is the Valentine's edition of Calendar Docs, so we need answers to some personal questions, maybe even some love questions. So, what do you like to do when the scrubs come off?
A.6 I have this wicked addiction to windsurfing and have been doing it since 1982. My garage is filled with windsurfing equipments. I own more sails, masts, booms, fins and boards than I do clothes. I started taking up kite surfing a few years ago, but haven't had much time to devote myself to it to be any good. I'm a great windsurfer, however. Damn good at it, I must brag. Duck jibe, laydown jibe, 360, spock, vulcan, heli-tack, you name it, I can do all the tricks. [I tried to find a half nekkid guy windsurfing, but had to settle for the above. ~ MA]
When there's no wind, I go running. Got a couple of marathon under my belt already. Finished the 2004 Boston Marathon under 4 hrs.
My oldest brother taught me how to play classical guitar when I was 7 so it's another passion of mine that I'm passing on to my son.
Q.7 Describe the worst date you ever went on.
A.7 My date wasn't the problem. It was the cop who pulled me over and had my car towed. Long story. But short version goes like this… Speed trap, cop said I was driving 55 in a 35 zone. No I wasn't, I was going 45. Yes you were. No I wasn't, she's my witness. You're still over the speed limit…Oh what do we have here, Ohio driver license, Texas tag, how long have you been living and working in Louisiana? Car towed. Whuh?? My date (now wife) and I had to walk 8 miles in the rain to the nearest gas station to call a cab. Lesson: don't argue with the cops in Louisiana. Just accept the ticket and go on your way. (BTW, I no longer live and work in Louisiana. That was many years ago. I did however, volunteer for 4 wks. during Hurricane Katrina. Went there with our ambulance crew.)
Q.8 How old were you when you lost your virginity? [It's the Valentine's Day edition, I'm allowed to ask nosy questions~MA]
A.8 I saved myself for marriage (my wife's reading this, ya know). Honest, my wife is the only person I've ever been with. Cross my heart, it's the truth. I met her in chemistry lab during freshman year of undergrad. We ended up being lab partners because we were both late and there was no one else to pair with. We've been together ever since. Fate. But as I recalled, it was she who asked me, "You wanna be partner?" But she said otherwise.
My wife is the only person I've ever dated. I got it right the first time around. But we didn't get married until 12 yrs later. She went to grad school to pursue her PhD, then I went to med school, then residency...We stayed together through it all. When I was in high school, I was too busy working my ass off to help out my parents and family. My family fell on hard times and we ended up in the housing projects. Those were rough years but wouldn't trade them and the lessons learned for any gold in the world. Kinda hard to go on dates when you're still riding a bike and working your ass off every night. Plus, deep down inside, I was always consciously aware and somewhat too embarrassed about my family's poverty to ask any girl out on a date.
Q.9 Name five bloggers you would like to have dinner with.
A.9 You, of course! (Note: always play suck up to the interviewer) As for the others, the real question is, would they have dinner with me?
Q.10 If you won the lottery, what would be the first thing you'd buy?
A.10 Depends on how much the jackpot is! Probably some equipments for my free clinic. Xray machine, U/S machine, lab equipments etc… I would love to be able to do some labs/blood works and xrays in my clinic. Dang, if it's the lottery, how about a 64 slice CT scanner! I have a radiologist brother who's willing to read the films pro-bono over the internet.
Q.11 Well, we know about fingers and tubes. Tell us the most unusual thing you have removed from each orifice.
Ears – tooth, maggots
Nose – hookworm
Mouth/throat – Sandspur stuck at vocal cord
Urethra/Penile – Electrical wire (see my blog, the guy actually had to go to the OR)
Vaginal – bullets (.45 caliber), Scope bottle cap, seashells, crack pipes, drugs, pill bottles
Rectal – door knob, flash light, etc...The largest object, however, was a ceramic flower vase. Huge one, too. Still leaves me wondering…how?. You've seen the xrays of the beer bottle I sent ya, this was several times larger. It was humongous, monstrous, even. OMG, I'm still wondering… how?
Q.12 Quickfire Questions:
Favorite book? Sans Famille by Hector Malot (French novel), highly recommended
Favorite drink? Ice latté
Favorite meal? Anything Cajun
Any tattoos or piercings? Nope, unblemished as the day I was born.
Any pets? Got some gold fish (orandas and lionheads), do they count?
Any kids? Son 7, Daughter 5, Daughter 2
Any heroes? My father.
TV shows: Ninja Warrior
Junk food: Jalapeno Cheetos, Chili dogs, long trips to New Orleans just for Begnets and Café du Monde
Q.13 In your first post on FATIEO, you wrote:
I want to find joy in medicine once again. I never want to refer to it as a job. Things usually cease to be satisfying once it becomes a job. Burned out? I hope not. I hope that I never stop seeing the practice of medicine as a privilege entrusted to me by patients and their family members. It is my sincere desire that this sojourn into the blog space can somehow help me find that enthusiasm that I once had in medicine.
Do you consider your sojourn into the blogosphere a success, i.e., did you accomplish what you set out to do by blogging?
A.13 When I left the ED of "Crack City", I felt that a chapter in my life had closed and there was nothing interesting left to blog about. A case of congestive blog failure, you might say. However, I did find myself, and medicine is once again a privileged joy. The free clinic is quite busy since I'm doing everything by myself on most days without nursing help. But folks are mighty appreciative for every little thing I do for them, even if it is just to make a phone call to Crack City ER telling the staff that I'm sending someone who's got a more emergent and acute problem than what I can offer to help them in my li'l rinky dink clinic.. Not soon after opening up the clinic, which I affectionately named The Fistula (after a legendary landmark at the place I trained at), I had a moment of self-discovery that all along, this was something that I had yearned for, just a little bit of recognition and appreciation, an arm around the shoulder, a firm handshake and the words "thanks, doc." I never needed a big paycheck.
Q. 14 You were on one of those ER shows on the Discovery Health Channel. They still rerun some of the old shows. Can you give us a hint about which one is you? At least tell us what color scrubs to look for?
A.14 I think I was wearing green scrubs. I haven't seen those episodes in years. The only 2 scrub colors I had those days were green and blue. Wait, there's the off-gray scrub I stole from the VA Hospital.
[I recently learned that Dr. WhiteCoat was also on one of the Discovery ER shows! Hints. We need more hints. ~MA]
Q.15 Are you ever going to finish your story about how you got into medical school?
A.15 OK, I'll do it next week.
Thank you, Charity Doc. ~ MA