I am used to gross stuff.  I see it every day.  But still, there are times I just do a double take and almost throw up a little in my mouth.  The other day a youngish woman came with “sores on the leg”. Much to my horror, when I asked to see the sores,  she obliged. She spread open her legs to reveal a 4cm circular, necrotic, ulcerating abscess about 1 inch below her vulva on the inner thigh.  To add to that, she had severe psoriasis all over her body.  The stuff coming from the wound smelled like a freshly killed corpse rotting in a World War I trench.

Of course after a few seconds to compose myself, I ordered a few things then went off to eat my Chicken Tarragon I had for lunch…..

I understand cultural sensitivity. I know some people consider their cultural heritage and traditions to be very important to them - religious based or not. However, there are times when people have to decide what is more important. Attending a special event or performing some culturally-ordained task, or taking care of one’s self.

The other day an older man came in with chest pain. He looked kinda bad. Sweaty and uncomfortable. His EKG was abnormal (although it did not show an acute heart attack). He had a lot of cardiac risk factors. He needed to stay in the hospital. End of story. However, during almost the entire history and exam, the patient’s supremely irritating wife kept interjecting with “He is NOT going to be admitted, he has a briss to go to tomorrow!!!!” about a dozen times. The man seemed to not be wearing the pants in this relationship and pretty much just looked sheepish- and uncomfortable.

It was only after an annoying amount of discussion of risks - such as “YOU ARE GOING TO HAVE A HEART ATTACK!” and finally “If you keel over and die at the briss, I am sure it will cast a dark pall over the normally joyous occasion” did his wife agree to let him stay in the hospital.

I was almost going to look up the name of the Mohel and call him asking if he knew CPR if this guy had signed out AMA…..

WhiteCoat here again. More medical news from around the internet brought to you courtesy of ER Stories. See more at my blog if you’re interested.

I thought he was a piece of steak! Man opens door to his hotel room and is beaten with bottle of Worcestershire sauce, then “tenderized” with a fire extinguisher. Ends up in the ED and then admitted to the hospital for “curing”.

The big get bigger. LA County spends $322 million to replace Harbor-UCLA Medical Center’s emergency department.

Man sues law firm for malpractice after law firm dismisses his medical malpractice complaint and he is not permitted to re-file it.
The man initially alleged that a surgeon missed diagnosing an anal fistula and also damaged his anal sphincter. The things that struck me odd were all the allegations of damages in the complaint, to wit: “Because of the incident, [the patient] claims he became sick, sore, lame and disordered; experienced fecal incontinence, pain, suffering, disfigurement, disability and a loss of his enjoyment of life; and incurred medical costs.” Wow. Remind me never to have my hemorrhoids out if this can happen.

This news article notes that more and more uninsured and underinsured are going to emergency departments because they don’t have any other choice for medical care.

Increasing numbers of people on state assistance for medical care are having their benefits cut. Utah cuts stipend to poor and disabled that patients were using to help cover their medical costs. If patients get subsidies for purchasing insurance in the current health care plan, I foresee the same thing happening to federal subsidies once the plan is in place.

Utah also passes Senate bill to cap medical malpractice awards for pain and suffering at $450,000. Part of the legislation is a “stand down” agreement to create a 4 year moratorium on any further tort reform efforts. Four years. Isn’t that the length of an election cycle?

Speaking about medical malpractice caps, Illinois lawmakers plan their next move after medical malpractice caps were shot down in that state.

Man I know it sucks.  You came in for cough for several weeks and feeling “like crap”. You were told you had a sinus infection (which you probably did) but are not better.

The x-ray I did shows a nasty -assed thing in your lungs (see it on the x-ray?) which as it turns out is lung cancer as confirmed by its appearance on CT scan.  It also looks like it has spread to your liver.  This means you have stage four lung cancer and are dead.

I know you are only 42 but no one said that smoking for 20+ years was not bad for you.

Hurrah! I had the pleasure of watching a psychiatrist discharge a patient despite the pathetic protestations that he was going “jump off a bridge. Another clear case where a guy showed up with his suitcase (and his lack of insurance) to just spend a few nights in hospital to “feel better”. He had a vague history of anxiety and depression but is a known manipulator (can anyone say personality disorder?) and gets admitted all the time, only to sign out a few days when it is convenient to go back home. He never fills his Rx’s and claims to always lose them (of course Percocet Rx’s included) . Previously, I blogged about such a patient but the psychiatrist then had no balls and admitted her. This time with the assistance of the town’s finest, he was escorted out of the dept to go “kill himself”. Yeah right. Good job dude.

BTW, I was interviewed for an article for Reader’s Digest about the Emergency Room - I am quoted as “Emergency Doctor in the Northeast”.  Pick one up at the newstand today!

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Sometimes life deals you a bad one-two punch. For this unfortunate elderly lady it was in the form of falling on her left side and smashing both her hip AND her humerus.  Talk about some rehab time.

Patient: My doctor sent me in to see a neurologist.

Me: OK, why?

Patient: I don’t know, he just said I should.

Me: OK, who is your doctor?

Patient: I don’t remember.

Me. When did you see him?

Patient: I have no idea.

Me: OK, who did he say you were supposed to see?

Patient: I don’t know, I think it is supposed to be a neurologist.

Me: OK, we’ll take care of you.