The Big Guys
Have you ever noticed that your night has a theme? You go in and everything looks normal. You get settled and start working and things take a turn for the WTF path. I went in the other night and picked up my zone. A couple of non-compliant diabetics, a kidney transplant (2004) with belly pain and a para with a UTI. Sounds like a nice little variety, doesn't it?
I admitted one of the diabetics, sent the para home on antibiotics, and discharged the other diabetic. Then one of the triage nurses started bringing me the weirdos. As I have mentioned, I am short. Quite literally 5'0. Maybe 5'1 in the Danskos if I really stand up straight. This nurse brought me a HUGE black guy. When I say huge, I mean linebacker big, 6'4, 280lbs. This guy started with chest pain while drinking gin in the club. He really thought he was dying and was having one HELL of a panic attack. He was in the wheelchair next to the bed flailing and swearing that he was going to kill whoever "spiked his drink." I tried to get him to move over onto the stretcher and he refused. Actually, he said he hurt too much to move.
Buddy if you can yell FUCK loud enough to be heard in the trauma room then you can most definitely scoot over. He literally looked at me like I was crazy. Then he decided that he needed to go to the bathroom. Well drunkie-poo if you can't walk then you sure as hell can't go pee. Here's a urinal.
Sidebar***** Why do men always look at me crazy when I hand them a urinal? This is not rocket science guys. It's not THAT difficult a concept to grasp!***
He managed to stand and pee on his own. Then he made it to bed where he was so anxious that I had to explain EVERY LAST THING I DID. This is the blood pressure cuff...its going on your arm... these are stickers for your heart (no I'm not going to shock you)...etc etc etc. He managed to be seen by the resident, got a chest x-ray and then decided he was better and left AMA.
Even before this guy left the same triage nurse brought me another linebacker contestant. This one was 22 and she didn't know what was wrong with him except that he refused to talk above a whisper. I brought him alongside the bed (again) and told him to scoot on over. He whispered, "I can't move." Ok, he isn't paralyzed, his vitals aren't unstable. He was JUST seen at a local Doc-In-The-Box and diagnosed with gastroenteritis. He hasn't filled any prescriptions, he just came straight here. Ok dude, again, I'm 5'0, I'm NOT moving you. He wanted the charge nurse and I to move him... or for us to get his sister out of the waiting room so she could. (Unless she is an amateur bodybuilder she AIN'T moving him) This discussion went on for almost 10 minutes. Finally the attending got involved. He and one of the guys literally had to roll this kid onto the bed. Still speaking only in whispers to the attending the kid was very uncooperative.
So, IV, labs and fluids.... thats whats on tap. I seldom whip out the big guns on the non-traumatic, non-intoxicated souls, but if he's 22 and can't move then its fluid resuscitation time! I was originally going for a 16, until the fucker refused to even move his arm for me. Then I asked the medic (who was dropping off a patient) to go get me orange. The upside of having your boyfriend show up every now and then... he knew EXACTLY what I meant and knows me well enough to know that I was pretty damn pissed to be asking for that. He actually stayed to watch. Orange in the AC without difficulty, labs sent, fluid up. Per the attending... keep giving him fluid until he pees.
My only hold-out was that this kid MIGHT have a low K and that was the issue. Trying to keep SOME faith. Yeah, no. K was perfect, in fact ALL of his labs were perfect. The attending started taking bets on whether the kid would get up and go to the bathroom or pee on himself. I was on the pee yourself, manpants team. 5 liters later he was doing the mad peepee dance the whole way to the bathroom with a steady (and rather swift) gait. I think he had been holding it since about liter 3. So adios kiddo. Way to be a man. He spoke just fine when he asked for my name. The attending has my back if he complaints. This was just RIDONKULOUS!
I admitted one of the diabetics, sent the para home on antibiotics, and discharged the other diabetic. Then one of the triage nurses started bringing me the weirdos. As I have mentioned, I am short. Quite literally 5'0. Maybe 5'1 in the Danskos if I really stand up straight. This nurse brought me a HUGE black guy. When I say huge, I mean linebacker big, 6'4, 280lbs. This guy started with chest pain while drinking gin in the club. He really thought he was dying and was having one HELL of a panic attack. He was in the wheelchair next to the bed flailing and swearing that he was going to kill whoever "spiked his drink." I tried to get him to move over onto the stretcher and he refused. Actually, he said he hurt too much to move.
Buddy if you can yell FUCK loud enough to be heard in the trauma room then you can most definitely scoot over. He literally looked at me like I was crazy. Then he decided that he needed to go to the bathroom. Well drunkie-poo if you can't walk then you sure as hell can't go pee. Here's a urinal.
Sidebar***** Why do men always look at me crazy when I hand them a urinal? This is not rocket science guys. It's not THAT difficult a concept to grasp!***
He managed to stand and pee on his own. Then he made it to bed where he was so anxious that I had to explain EVERY LAST THING I DID. This is the blood pressure cuff...its going on your arm... these are stickers for your heart (no I'm not going to shock you)...etc etc etc. He managed to be seen by the resident, got a chest x-ray and then decided he was better and left AMA.
Even before this guy left the same triage nurse brought me another linebacker contestant. This one was 22 and she didn't know what was wrong with him except that he refused to talk above a whisper. I brought him alongside the bed (again) and told him to scoot on over. He whispered, "I can't move." Ok, he isn't paralyzed, his vitals aren't unstable. He was JUST seen at a local Doc-In-The-Box and diagnosed with gastroenteritis. He hasn't filled any prescriptions, he just came straight here. Ok dude, again, I'm 5'0, I'm NOT moving you. He wanted the charge nurse and I to move him... or for us to get his sister out of the waiting room so she could. (Unless she is an amateur bodybuilder she AIN'T moving him) This discussion went on for almost 10 minutes. Finally the attending got involved. He and one of the guys literally had to roll this kid onto the bed. Still speaking only in whispers to the attending the kid was very uncooperative.
So, IV, labs and fluids.... thats whats on tap. I seldom whip out the big guns on the non-traumatic, non-intoxicated souls, but if he's 22 and can't move then its fluid resuscitation time! I was originally going for a 16, until the fucker refused to even move his arm for me. Then I asked the medic (who was dropping off a patient) to go get me orange. The upside of having your boyfriend show up every now and then... he knew EXACTLY what I meant and knows me well enough to know that I was pretty damn pissed to be asking for that. He actually stayed to watch. Orange in the AC without difficulty, labs sent, fluid up. Per the attending... keep giving him fluid until he pees.
My only hold-out was that this kid MIGHT have a low K and that was the issue. Trying to keep SOME faith. Yeah, no. K was perfect, in fact ALL of his labs were perfect. The attending started taking bets on whether the kid would get up and go to the bathroom or pee on himself. I was on the pee yourself, manpants team. 5 liters later he was doing the mad peepee dance the whole way to the bathroom with a steady (and rather swift) gait. I think he had been holding it since about liter 3. So adios kiddo. Way to be a man. He spoke just fine when he asked for my name. The attending has my back if he complaints. This was just RIDONKULOUS!
posted by jeepgirl at 10:02
1 Comments:
I tend to call these patients the FONs. Otherwise known as the Freaks of Nature. I see a lot but not nearly as many as you do.
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