Tales from the ED, Part 1

14 03 2013

Story time!  I promised in my previous post to relay some patient vignettes, so here they are.

The first story today centers around an older gentleman; we’ll call him “Ron.”  Ron originally came in for rectal bleeding, which is a fairly routine complaint.  What wasn’t routine was walking into his room to do a history and physical and see that he had a glaringly obvious erection.  I had to do a double-take but ultimately collected the H&P without acknowledging it.  After all, this sort of thing happens from time to time and most men are embarrassed by the lack of control over their bodies.  No biggie.

When I went back into the room 30 minutes later to do a rectal exam, Ron still had a boner with a hospital gown and sheet doing a very poor job of hiding it.  His wife and two adult children were still in the room, and none of them said a thing.  At that point, I was a little more concerned, but he didn’t bring it up even after his family had left the room.  In retrospect, I really should have asked him about that bit of wood, a simple “how long have you had that erection?” would have sufficed.  But hey, he didn’t seem worried about it.

In the bustle of the evening, Ron’s condition slipped my mind until his abdominal CT scan came back (yes, friends, almost all of the abdominal/gastrointestinal complaint patients I’ve seen have had CT scans).   There, on the computer screen, was a glaringly obvious erect penile prosthesis.  Being a medical student, I really should have thought of that sooner, but you live and learn.  A bit of Googling and several inappropriate pop-up ads later, I can say that I definitely learned something I hadn’t expected in Emergency Medicine.  Why he allowed the prosthesis to remain erect, however, remains a mystery.

penile

Story #2 pertains to a very nice older gentleman, “Rick,” with heart failure whose complaint was massive testicular swelling (a symptom not uncommon to men with heart failure).  I put on gloves and did a full history and physical exam.  Aside from having marked swelling from the feet up to the boys, he had a lot of scratch marks on his arm, including one area that looked infected and swollen to the size of a golf ball.  I started to ask him about them, when he spoke first.

“Hey, doc, could you grab that?”  He gestured toward his leg.  I turned and saw a little black dot moving down toward the foot of the bed.  Things like flies and spiders don’t bother me at all, and I reached into the nearby cupboard for a specimen cup to capture and later release the insect.  Except that once it was in the cup with the lid sealed, it was clear the insect wasn’t a fly or a spider, it wasn’t even a millipede or a louse.

“Yeah, I’ve got bedbugs really bad at my house,” Rick said nonchalantly.  At that point his torn-up arms and complete nonreactivity to harboring a stowaway on his body made sense.

I won’t lie, it was easily the most freaked-out I have ever been during a patient encounter.  It took a lot of self-control to smile and politely excuse myself with my critter friend in hand (shutting the door very tightly behind me) instead of jumping ten feet away from Rick and making a snide comment about how it would have been super if he had told anyone about the bedbugs when he first arrived.

In case you are wondering about the protocol, the patient’s room (they had put him in a trauma room) and the CT scanner which he’d been in (the main one) both were shut down, along with all of the equipment each contained, until the following morning when the hospital’s exterminators could deal with the potential infestation.  As for me, I changed my scrubs and finished the remaining 7 hours of my shift with the discomfort of psychosomatic itching all over my body.  Even though my shift finished at 2am, I took a very long shower the second I got home.

The third story is about a diabetic woman named “Anna” who came in originally because of self-reported hypoglycemia (low blood sugar).  When her sugar was checked at triage, it was in the 100’s, a perfectly fine level for a diabetic.  After telling me that she had a sugar in the 40’s earlier, I figured “great, problem solved, a little counseling and she can go home.”  Easy patient.  Before I had a chance to say anything, she said “I’m also pregnant.”

A few things didn’t make sense.  The most obvious was the negative urine pregnancy test collected when she was brought in.  She was also on a diabetes med that is terrible for pregnant women.  I didn’t want to act like I knew more about her health than she did, so I excused myself to look at her records again.

Anna had been to the ED 7 times in the previous 2 months for various complaints, each time receiving a pregnancy test (all negative), and had also had 2 ultrasounds and a CT scan that would have likely shown something.  One test was positive: an MRI from almost 2 years before, which showed a small tumor on her pituitary gland.  Her primary doc had charted that she had an elevated level of prolactin, which causes periods to stop and stimulates lactation.  Those symptoms had started in October, and no matter how many times her primary doctor, several emergency medicine staff members, and 2 OB/GYNs explained this, she still believed she was pregnant with a child that was conceived in October.

Eventually, after a few attempts at convincing her otherwise, the ED doc did what ED docs do best: get the patient out of the ED.  I have no idea how her story turned out—a theme of my rotation in the Emergency Department.

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2 responses

15 03 2013
Miss L

Thanks for sharing these – I’m shocked someone can act so nonchalant about having bed bugs crawling on their body. Jesus.

15 03 2013
Red Stethoscope

Oh man, these are great! I’m itching a little too over the bed bug guy, though. Ugh!

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