Remember the old saying, “Don’t put anything in your ear except your elbow”?  You can’t do it!  In other words, don’t stick stuff in there - technically not even Q-tips. Although if you are really careful and don’t go in very far, they are usually OK.

Anyway, I had a guy who was using a Q-tip like that - but I guess was a little too enthusiastic about it. The cotton swab tip broke off and got stuck in his external ear canal. This is not the end of the world but he decided on an aggressive approach for its retrieval. He straightened out the a paper clip and JAMMED IT IN THERE to try and snare the cotton. You can see a bad ending here…..

Well, guess what? Laceration of ear canal and perforation of his tympanic membrane. Dude, follow what your momma told ya!!!!!!

So, for the most part standing on the sidelines, I have watched for some time the frequent verbal jabs between Nurse K and Happy Hospitalist. She has stated that Happy has done some medically questionable things, (which I agree that he has some perplexing ideas about how to treat patients and how our health care system should be reformed) in his treatment of sick patients. Ergo, I read today with interest this article in the NY Times about a Texas nurse who is about to stand trial for reporting a physician for improper and possibly dangerous treatment of patients to the Texas Medical Board. She has been charged with “misuse of official information” which translates as “she had a vendetta out against Dr. Rolando G. Arafiles Jr and reported him solely to destroy his career”. Interestingly, Texas whistle-blower laws would protect her in civil court presuming she had only a reasonable belief that the conduct being reported is illegal. However, this being a criminal charge, this law does not apply so the jury will have to decide if Nurse Anne Mitchell acted in good faith when she reported this doctor.

Adding fuel to the fire is the fact that the doctor has been reprimanded by both the hospital ( he had been reprimanded on several occasions for improprieties in writing prescriptions and performing surgery and had agreed to make changes) and the Texas Department of State Health Services for some questionable actions including “suturing a rubber tip to a patient’s crushed finger for protection” (which in my opinion might actually not be a bad idea in the short term). Also, the physician appears to have a unique friendly relationship with the local sheriff Robert L. Roberts Jr (who the hell names their kid Robert if their last name is Roberts?) since he reportedly saved the sheriff after he had suffered a heart attack. Who knows how far this would have gone if they were not buds?

Anyway, I personally think this is some serious stuff. On one hand, it is obviously libel for a nurse to write inflammatory anonymous letters about a physician JUST to destroy his or her career but of I believe it is also a nurse’s (as well as other staff) ethical and official duty to report physicians for dangerous behaviour that puts patients’ safety in jeopardy.

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Me: “OK, Ma’am, it looks like everything came back fine. I think you can go home and follow up with your doctor next week.”

Patient: “Great!”

Patient’s Husband: “Doc, can’t you keep her for a few days, she is driving me NUTS!”

Husbands, keep an eye on your wife after she delivers your baby. Watch out for signs of post-partum depression - it can be devastating. Recently we had a woman who in retrospect had obviously been suffering from it for two months (bouts of uncontrolled crying, disinterest in the baby, locking herself in her room), put her 4 month old in the back of her car - in an unrestrained car seat and then took off into the night, lit up on ETOH and prescription drugs. When she went off the road, someone called the police. Thankfully there were no major injuries but when she got out of the car, she preceded to cut her throat (luckily superficially) and then brandished a knife at her little boy. The police managed to wrestle it from her and bring her into custody. The child was fine and was let go with her husband after a 4 hour child protective service evaluation. Still, the sad bit is that the woman was still catatonic after sobering up and is likely to be institutionalised for quite some time. Very sad.

Hey all, I posted on White Coat’s Blog today over at EP Monthly. Check it out!

Listen, if you are going to stumble around intoxicated in a nice, upscale community, there are proper ways to be behave. I am sure some of the residents there also overindulge on occasion but they follow some simple rules. One very important one is to avoid the urge, no matter how strong, to relieve yourself on a parked police car. I cannot guarantee you will not be arrested if you urinate behind a tree, but soaking a cop’s new Crown Vic is a sure-fire way to end up in my shop, sedated and sleeping it off, citation in hand.

In ironic coincidence with the 50th anniversary of the Woolworth lunch counter sit - in down in Greensboro, NC (the counter and stools are part of the Smithsonian now), I had a patient who staged his own sit - in, albeit under less noble circumstances. He marched into a local diner and plopped himself down at the lunch counter and demanded to be served. He was refused. He then broke into loud protest and the police were called. When they arrived he was passed out face-down on the counter, retching and sinking up the place. See, this place had a segregation policy. They would not serve drunks who slobbered all over the counter and yelled curses at other customers. Personally I am in favour of such policies.

When I got him, he was in full protest mode. I served him myself. With a delicious cocktail of Haldol and Ativan!