Category Archives: intern year

really?

“Until I get there,” the urology resident instructed me, “you must apply direct manual compression to mechanically disperse the penile and preputial edema.  This will hopefully minimize the swelling and allow for manual retraction by the time I get there.”

So in other words, as my attending so eloquently directed me “grab that thing and hold on tight.”

There are a lot of awkward moments in the emergency department.  Many of them have to do with interactions with nurses (I am really sorry my patient threw up on your leg AGAIN yes he can have some Zofran), paramedics (last time I saw you, I am pretty sure you were making out with one of my co-residents in the middle of a bar), and even correction officers (um, please, just un-handcuff him for the lung exam. Fine, you can keep his feet chained to the bed).

My most awkward moment of late, however, had to do with one particular patient with one particular penis problem.

Paraphimosis is when, in an uncircumcised or partially circumcised male, the foreskin gets retracted behind the glans penis, starts to swell, and gets stuck in that position.  The reason this is an emergency is that this swelling then cuts off blood flow to the head of the penis.  The head will start to turn dark and eventually may become necrotic.  It’s usually iatrogenic in nature, meaning, we cause it.  In this case the patient has a foley catheter in his urethra (secondary to a recent surgery).  He resides at one of the homeless shelters that also provides some medical care, and the nursing staff inadvertently forgot to replace the patient’s foreskin after the most recent foley catheter change. This is actually a great case for me, it’s one of the few urologic emergencies and a case up until now I had only read about.

As great of a case as it may be, the treatment is nothing short of mortifying. Very reluctantly I pulled a chair into the room, and for the next fifteen minutes I sat by my 65 year old patient’s side and “mechanical dispersed the penile and preputial edema,” AKA, I very firmly held his penis in my hand.  For fifteen freakin’ minutes.

Really? I am really doing this right now? Please, just for a moment, put yourself in my shoes.  What are you going to talk about to make this less awkward… football? The weather?

I am a doctor, and this is what I do at work.  Really.

Leave a comment

Filed under emergency medicine, intern year

by the way, it’s sunday

I think was feeling a bit nostalgic tonight. I got out of work early and for the first time in what feels like 9 months, it was still light out for my walk home.  I also may have hallucinated the smell of spring in the air.  Not entirely sure what day it was or what to do with a whole extra one hour of free time, I decided to read through some of my old posts and I– as I have said to myself many times before– realized I need to write more.  I have so many stories from this year.  Some are disturbing, some are sad, most of them are just dumbly entertaining.

As I try to get my act together, allow me to refer you to a post I wrote almost exactly two years ago about what was, in retrospect, maybe one of my favorite days of medical school.

Leave a comment

Filed under emergency medicine, intern year, med school, medical school, medical student

the wheels on the bus go…

I need a new method of transportation.

Sitting in front of me, alert, oriented, and chatting away on her cell phone was a patient I treated the Friday before.  I saw her last week when I was working triage on the Labor and Delivery floor.  She was high as shit and annoying the piss out of me.  She was complaining of leg pain but wouldn’t answer any of my questions.  It was an imposition that I needed to know about her leg pain, that I needed to know her medical history, and that I not only did I need to know her daily dose of methadone I needed to know what other drugs she took today. I lightly touched her leg and she started wailing uncontrollably and making a scene.  While everyone else on the floor was freaked out about this, I actually felt like I was at home, in my element back in the ED. She is status post c-section, post-op day 8, and is boarding at the hospital because her baby is withdrawing from methadone.  At this point I am tired, annoyed, and have about a million other things that needed to be done 20 minutes ago.  The trouble with this though, as an emergency medicine physician, is that as much as people piss you off, and as much as you think they are full of shit, people can still be sick.  This woman was recently hospitalized, had recent surgery, is an IV drug user, smokes cigarettes (all risk factors for a deep vein thrombosis), and is now having unilateral lower extremity pain and tenderness (which may or may not be real). Those of you who read this blog who are in the medical field (none of the three of you), will understand this: I recommended a lower extremity doppler to my attending.  He, who had the benefit of knowing this patient well (perhaps there’s something to be said for continuity, or maybe just experience), nodded politely at my “emergency medicine” work-up, and discharged her with some Tylenol.  A week later on that bus she was still annoying me but I was relieved to see she was not tachypneic, DVT and pulmonary embolus free.

On that same bus ride, sitting directly next to me was another lovely gentleman I ran into two weekends earlier.  Two weeks prior he was asking for money on the subway.  “I just need $6.75 for the commuter rail. I already have a dollar.  I can’t get into the shelter tonight and have nowhere to stay and really need money for the commuter rail.”  There was no response from the passengers and next thing I know he’s making a scene, screaming, swearing, punching the walls, and scaring the crap out of those from whom he was just begging for money. Before my experiences working as an intern at the hospital where I work I think I probably would have been frightened, or maybe felt bad for not giving him money. I think it’s also important to note, however, that I know this guy.  During my first month as a doctor I saw him come into our trauma bay two times over the course of one twelve hour shift.  The first time he left angry and AMA (against medical advice) as soon as he was able, the second time he was admitted for a heroin withdrawal. During his outburst on the subway I was neither frightened nor felt compassion for his plight. Mostly because he turned into a jerk and started scaring people. Needless to say, yesterday the same dude, in the same red sweatshirt, hopped onto my bus.  “I just need $6.75 for the commuter rail. I already have a dollar.  I can’t get into the shelter tonight and have nowhere to stay and really need money for the commuter rail.” And as luck will have it, there was a seat open right next to me.  I was about to get a bit nervous, I didn’t want to be between him and the window when no one offered him money.  Luckily, there was a nice gentleman with one of those classic heroin toothless smiles (who also looked vaguely familiar) in the front of the bus who gave him five bucks.  My buddy in the red sweatshirt got off at the next stop.

And then, no joke, toward the front of the bus on the right there was another familiar face.  It was an overweight 28 yo male who I have treated on numerous overnight shifts.  He lives in a shelter and has a multitude of mental problems and likely a very low IQ.  He abuses the system, but has no idea what that even means.  He likes coming to the ED.  We give him sandwiches and we’re nice to him.  Last time I saw him it was at 3am because he had a cut on his foot.  It wasn’t infected, though with his lifestyle and medical history, it easily could have been.  It was just a little cut.  I cleaned it and gave him a band-aid and wrote him a doctor’s note so the shelter would let him back in at such a late hour. Twenty minutes after he left I called the shelter to make sure he arrived, it was a slow night.  I walked by him on my way off the bus and we made eye contact, there was no recognition on his part.  And I’ll probably see him again next week.

Oh how I love taking the bus.

Leave a comment

Filed under emergency medicine, intern year

kickin’ it

Just about four months in, and I still get a kick out of being called Doctor.

Thus far I’ve spent 2 months in the ED, a month in the MICU, and am now finishing up my month on OB.  All four months have been utterly exhausting. But I can’t believe how much I’ve changed in such a short amount of time.  You really only realize it when you compare yourself to the med-students.  Once every few days, for survival purposes, it’s necessary to listen to them present on rounds and realize that you are not the total asshole that everyone else makes you feel like. You’ve actually come a long way. God I love med students, especially the third years.

Intern year sucks and there is no way around it.  Sometimes I wonder how anyone makes it through, and then I realize that everyone makes it through.  It’s a year of being perpetually tired, shit-on, abused, uncomfortable, and anxious.  That being said, I’m at an amazing program, working with awesome people, and I see  fascinating/hilarious/upsetting stuff on a daily basis.  As much as it sucks, and as much as I complain, I really do love what I do. I love what I’m learning, I love my crazy-ass patient population, I appreciate the strange group of people that are drawn to emergency medicine in one form or another, and I most of the time love the raw emotion that I get to be a part of every single day.

Leave a comment

Filed under emergency medicine, intern year, medical student