The Condom Technique

It's 3 AM on a summer night the board has a new patient and the complaint is condom.

I walk into the room and introduce myself to an African American Female who is 25 years old with apparently no psychiatric issues.

Me: "How can I help you?"
Her: "It's stuck up there"
Me: "What is stuck up there?"
Her: "The condom you idiot"
Me: "Did you try to get it out?"
Her: "I don't know how"
Me: "Well I'll show you"

Place gloves on.

Me: "I prefer the finger approach although some of my colleagues consider me old-fashioned for this"

Finds condom immediately pulls out and throws away.

Me: "The nurse will grab your discharge instructions.  Try to remember the maneuver"

The Tobacco Press

Patient presents to ED 46 y/o white male with L arm pain that began 3 days ago when his arm got stuck in a tobacco press. 

Checking nearby hospitals the patient has been to several other EDs stating the exact same, literally the exact same story occurring at different intervals sometimes receiving pain medications and a negative work up.  He had been to 4 EDs in 5 weeks and had been here before and flagged for drug seeking behavior.

I enter the room and discuss the patient's history and perform a physical exam trying to find signs of an injury but there are none.

Me: "Sir I don't think that you have an emergent injury at this time and it will go away with ibuprofen or other non steroidal pain medication"
Him: "Oh doc thank you but the pain is killing me! Are you sure you can't give me something.  Are you sure there is nothing wrong?"
Him: "Doc are you sure there's nothing you can give me for the pain?"
Me: "Well you've had so many injuries that you I'm more concerned about your ability to operate a tobacco press".
Him: "What do you mean?"
Me: "Well it looks like your arm has been stuck in a tobacco press 5 times in the last 4 weeks according to our records at other emergency departments"
Him: "Well I...um"
Me: "Great welp see you later"

The Diabetic Coma

A lack of understanding is the root of most problems.  It's difficult as a specialist in any field (computer science, medicine, automotative, etc) to understand the lack of knowledge by others.

A 72 year old well appearing woman was brought in to the emergency department because she is diabetic and had recently had a blood sugar of 250.  250 is elevated but by no means constitutes an emergency.  After talking with the patient and performing an exam her sons come in to the room.

I told her sons that their mother was doing well and that although her sugar was elevated that she appeared well an could go home. We were just going to wait for a urinalysis to make sure that she didn't have a UTI.

"But what about a diabetic coma?" a son says.

I stated that she was neurologically fine and that her blood sugar wasn't within a range that she would be in a coma with all her other tests being normal.

"But she is old" the son says.  "She might go into a diabetic coma because of how old she is".  I said if she ate regularly and took her insulin that those risks were extremely low.

"I don't think you understand" one son says.  "I'm a vice president of a company" he stated for no no reason.  "She could go into a coma at any minute and your not going to admit her because her sugars are normal now, we are leaving?"

He picked up his mother stating that he wasn't waiting for any tests and left the ED.  I tried to stop him but my supervisors wanted to let him go.  They new the patient was fine and they could be called with the results of a positive urinalysis.

I had really liked his mother and I think that he was just very worried but I still am confused about why he mentioned his vice presidency.  I wish he knew how much time I think of him in additional scenarios stating he was vice president and picking people up and leaving.

Monkey See ED Do

The complaint on the board was HIV exposure, a serious concern.  I walk in the room to find a 38 year old woman slightly disheveled with loose clothing and a cage.

I turn to the patient: "Hello my name is Dr. Anonymous I heard from the nurse that you were concerned about HIV exposure.  Can you tell what happened to you recently"

The patient looks up: "Oh it's not me I'm concerned about"

There is some rustling in her coat and I take a step back. 

"Well there better be another person in this room" I said.

She pulls out a monkey.  Not a picture, stuffed animal, or drawing, but an actual monkey.  The patient states that her neighbor has HIV and that the monkey was in the apartment building and bit him.  The patient is concerned that the monkey might have HIV.

I ask a few questions about what changes have you noticed in the monkey when I realized the stupidity of that venture and go back to my attending.  After a deliberation with two HIV PhDs and the center for animal control for our state I find out it is unlikely if not impossible for HIV to go back to our simian counterparts.

I've got a feeling we aren't in Africa anymore

Altered elderly woman who I assume has a septic presentation trying to assess mental status she is from Africa and doesn't speak english her son is translating.

Me: Does she know what year it is
Son: In African: What year is it?
Woman: 2000
Me: Okay can't orient to time. Does she know the city?
Son: In African: Do you know where you are right now?
Woman: The land of the white man
Me: I'll probably have to count that

Coochie Mama and the Man with the Golden Speculum (First)

This blog is about the people that I have encountered in the emergency department.

I am by no means a competent writer but I thought I'd post stuff up here from time to time and maybe someone will like it.


My first week in the emergency department was in July of 2013 in what must have been the summer of love because I seemed to be performing 4-5 pelvic exams a shift.   I'm editing this post from the future because I realize I no longer ask about what had happened but at the time the patient encounters always come with interesting stories.  About how "he's a dog", "I wanted to twerk it", or whatever. 

It was a averagely busy July evening when a 250lb woman came in tearing up about how she was getting "yelled out" by her boyfriend for "popping the pussy with some G".

I remember her eyes were darting around the room like he might show up so I calmed her down I told her we'd do a pelvic and make sure she didn't have any STDs.  I had to see some other sick patients so she was waiting for about half an hour. 

While talking to another patient I hear her in the background on the phone "I'M GETTING FUCKING CHECKED!  I AINT GOT SHIT! JUST WATCH! I'LL BRING THAT PUSSY BACK TO YOU CLEAN!".  One of the nurses said she needed to keep it down.  The woman bursts out of the curtain covered only above her waist and starts slapping her ass dancing in a circle screaming "I NEED TO GET MY COOCHIE CHECKED!!! I NEED TO GET MY COOCHIE CHECKED!!!".   Everyone was process what they were watching unable to do anything before she receded back behind the curtain. 

After that she quieted down.  I went in did my exam and got her out.  I went to present my findings and my senior asked me about my Coochie Mama.  I told him he was right she needed to get it checked because it turned out she had trichomonas (a common STD).  

 After those first 5-6 days my speculum exams quieted down but got the nickname as the man with the golden speculum.