Superlative: “Most likely to be the victim of a freak accident”

I wouldn’t necessarily say that I am accident prone, but as far as freak accidents go I have had a couple.  The most notable of such occurrences happened when I was a senior in high-school.  It was our last football game of the season.  I remember that it rained heavy that day–there were two to three inches of standing water on the field by halftime.  The game was a blowout: we must have beat the other team by 40 or more points. By halftime I started to notice a burning sensation in my rain-soaked pants.  My initial thought was the burning was a result of chaffing from all the wetness.  As the pain worsened my next thought was that scorpions had somehow found their way into my football pants.  Although that sounds impossible, I assure you it was not–scorpions were prevalent where I lived, and I remember shaking them from freshly laundered clothes on more than one occasion.   I pushed the pain aside, and after the game remember the team celebrating by diving headfirst into and sliding through the large puddles of water on the football field.  I also remember the puddles eerily bubbling, almost as if they were boiling.  After an extended period of celebration, I went home to shower.  I remember stripping of my football attire and writhing in pain.  I looked down at my thighs and almost collapsed at the sight.   Both thighs had rows of deep flesh wounds that were a mixture of blood and green pus.  It looked like a tiger had sunk its claws into me.  Upon further examination I noticed that I had similar  injuries to the back of one leg and my err, umm…unmentionables.  I got in the shower in hopes that by rinsing the areas off, the pain would decrease.  I collapsed in pain as soon as the water hit my skin.  Confused at what could have caused this, but not willing to miss out on hanging out with friends that night, I dried off with my towel, and threw on some clothes.  As the night progressed the pain intensified and by midnight I was in the emergency room.  As it turns out 22 football players were treated in the emergency room that night.  After investigations took place over the next several months it was determined that the injuries were actually chemical burns.  Football fields are normally lined with calcium carbonate–on that day the field was accidentally lined with calcium hydroxide, aka caustic lye.  To help visualize the process by which calcium hydroxide burns flesh, watch the movie Fight Club.  There is a scene where Brad Pitt pours the chemical on Edward Norton’s hand and his flesh instantaneously begins to dissolve.  Excerpt from the movie:

Tyler and Narrator are making soap from the fat of human bodies
Tyler: Yeah with enough soap one could blow up just about anything
Narrator Voice Over: Tyler was full of useful information
Tyler: Ancient peoples found that their clothes got cleaner when they washed them at a certain point in the river. Do you know why?
Narrator: No
Tyler motions to come over. Narrator leaves his job of stirring the fat to face Tyler across a table. Tyler begins to put on safety gloves, glasses
Tyler: Because human sacrifices were once made on the hills above this river. Bodies burned, water seeped through the wooden ashes to create lye. This is lye
Holds up a bottle containing white flakey substance
Tyler: The crucial ingredient. Once it mixed with the melted fat of the bodies, a thick white soapy discharge crept into the river. Can I see your hand please?
Narrator gives him his hand. Tyler grasps onto it, licks his lips and kisses the back of Narrators hand
Narrator: What is this?
Tyler looks at him, sprinkles the lye on the narrators hand and says:
Tyler: This is a chemical burn.
Narrator screams in pain, staring at his hand as it begins to burn, reeling while Tyler grasps it tightly
Tyler: It will hurt more than you have ever been burned and you will have a scar
Narrator: What are you doing?!!! [screams]
Narrator Voice Over: Guided meditation worked for cancer it could work for this
Narrator closes his eyes, cut to scene of green forest in his mind. Cut back to Tyler.
Tyler: Stay with the pain, don’t shut this out
Narrator: No, no [screaming moving violently, trying to escape tyler’s grasp]
Tyler: stay with the pain, don’t shut this out. The first soap was made from the ashes of heroes, like the first monkey shot into space. Without pain, without sacrifice we would have nothing
Narrator closes his eyes again, trying to shut the pain out, trying to be calm
Narrator Voice Over: I tried not to think of the words searing flesh.
Tyler: Stop it! This is your pain. This is your burning hand it’s right here
Narrator: I’m going to my cave, I’m going to my cave, I’m going to find my power animal [sobbing]
Tyler: No! Don’t deal with it the way those dead people do. Come On!
Narrator: I get the point okay please!
Tyler: No what you’re feeling is premature enlightenment
Narrator closes his eyes, cut to his mind’s eye in his cave. Cut back to Tyler. Tyler hits Narrator across his face
Tyler: this is the greatest moment of your life and you’re off somewhere missing it
Narrator: I am not! [sobbing and grunting in pain]
Tyler: Shut up. Our fathers were our models for god, if our fathers bailed what does that tell you about god?
Narrator: [grunts, eyes closed still fighting the pain]
Tyler hits narrator across the face again. Narrator still reeling, moves his hand, attempting to reach for sink, for water. Tyler holds fast.
Tyler: Listen to me. You can run water over your hand to make it worse, or, look at me. Their eyes meet. Or you can use vinegar to neutralize the burn
Narrator: Please let me have it!! Please!! [sobbing]
Tyler: First you have to give up. First you have to know, not fear, know that one day you are going to die.
Narrator: You don’t know how this feels!! [angrily, rage in his eyes looking at Tyler]
Tyler stares back at him and lifts up his right hand to reveal a massive scar on the back of it.
Tyler: Its only after we’ve lost everything that we’re free to do anything.
Narrator: Okay [still painful look on his face but accepting]
Tyler slowly lets go of narrators hand finally where the flesh is melting, fizzling, smoking and burning. Narrator stares intently at his hand. Holding it out in front of himself on his own, feeling it. Not trying to run from it or trying to minimize the pain somehow. Tyler then reaches for a bottle of vinegar and dumps it on Narrators outreached hand. Narrator, with the final relief of the pain clenches his hand towards his chest and drops to the ground. Tyler looks down at him.
Tyler: Congratulations, you are one step closer to hitting bottom.

I don’t even remember how long it took to heal, but I still have the scars to remind me of that day.  Anyway, that was a really long intro to tell you about what just happened to me at work.  In the CT scan room we have an IV pole  that sits on a round base with six wheels so that it can easily be moved.  From the IV pole hangs a bag of saline and about three feet of extension tubing.  The extension tubing has a hard plastic hub on one end and a sharp plastic spike on the on the other. As I was preparing to scan a patient, I attempted to move the IV pole.  Thus began a series of unfortunate events.  The pole got stuck, causing the extension tubing to swing up and poke me in my eye (the same eye that coincidentally has been red and inflamed for three days because of a corneal abrasion that I received from getting fit for hard contact lenses.  Note: I need contact lenses because I am legally blind in that eye as a result of the chemical burns I mentioned earlier).  In a knee-jerk response, I reached up and grabbed the tubing that had just assaulted me, and yanked at both the tubing and the IV pole.  The tubing became dislodged from the bag of saline, simultaneously allowing the spiked end to jab me in the eye again while the entire contents of the bag spilled onto the floor.  Now off-balance and standing on a tile floor covered with water, my legs fail me, and I fall violently to the tile, somehow twisting both of my knees (one of which was just recently surgically repaired).  Next the IV pole falls on top of me with such force that four of the six plastic wheels shatter.   The scene had to have looked like something from a movie.  It reminded me of something from Final Destination, or something.  Although if it were Final Destination, I would have had to have died.  Oh I got it, the IV pole would have bumped a switch on the CT machine so that it started emitting radiation.  I am unable to move because I am pinned under the IV pole which has lodged itself between the CT scanner and a cabinet, and I am radiated to death.  Geez, I should have been a screenwriter…

Twenty-five inches

Snow begins to fall

The mountains are turning white

Tomorrow I ride

I am so excited for tomorrow that I crafted that nifty little Haiku for you.  Yes tomorrow is the day.  Well technically today–I just noticed that it is after midnight.  A quick look at the weather forecast shows me that by morning Loveland Ski Area is expected to have 10 to 14 inches of fresh snow.  In addition snow is expected to fall all day with total accumulations of up to 25 inches.  Life is good.

Oh and a special thanks to my wife.  Today I bought a new Thule ski/snowboard roof rack.  I spent time in the garage this evening in a state of bliss as I mounted the racks to the top of my SUV.  There is something about a roof rack on an SUV that makes it look more rugged, aggressive, and mean.  After carefully adjusting every nut and bolt, I tested it out by loading my new snowboards up and locking them in place.  I stepped back to admire my mean SUV and I was proud.  Later as I prepared to leave for work, my wife stepped into the garage.  Her keen sense of detail pointed out a minor problem with my studly new roof rack–there was no way it was going to clear the garage door.  So I did what any man would do in this situation.  I took the garage door off its track and used my sledge-hammer to create an extra foot of height.  Okay, Okay.  I took the roof rack off and boxed it up to take back to the store.  Bummer.

Speaking of “bummer,” I inappropriately used this word the other day.  It had been a hectic morning at the hospital and I was the only tech in CT/MRI.  A patient in the ER was being discharged and requested that we put his CT images on a CD, so he could take them with him.  The system that we use to burn CDs for patients was not working, nor was the backup system.  After about 30 minutes and multiple attempts to create a CD for the patient, a nurse from the ER called to ask what was taking so long.  I told her we were having problems with the system.  She said, “Well it would have been nice if someone had told us. The patient has been waiting.”  I responded, “Bummer.”  I ma not sure why I said it–it just sort of slipped out.  The nurse wasn’t very happy with me.  Bummer.

Did I mention that in about 8 hours I will be snowboarding in over a foot of fresh snow?

A letter to my patient…

Dear Drunk Guy,

             You must have had a pretty rough night.  I am glad that I had the opportunity to meet and care for you this morning at 3:00 a.m. I just wish you had not made my time with you so difficult.  Take for instance the ten or so minutes that I tried to obtain a history from you.  You were so evasive and short with me.   I asked you, “What brought you in to the emergency department tonight?” Your response was, “Police department.”  In your defense my question was not very specific.  You do have a valid point, in that, it is true that a police officer brought you to the emergency room, although your response would indicate that the entire police department brought you, which I am fairly certain was not the case.  So then I asked you, “Well, why did the police bring you here?”  Remember you told me,”I didn’t quite make it to my hotel.”  You kind of got me on that question too.  I still was not very specific.  I assumed that you would realize that I was asking you these questions to try to figure out why I was about to perform a CT scan of your head.  In most cases if a patient’s only symptom is not quite making it to their hotel there is not a clinical indication to perform a head CT.  I did try to be more specific with you though.  Remember I asked you, “What specific problems brought you to the emergency room? Did you fall and hit your head? Were you in a motor vehicle accident”?  To which you responded, “No.”  That was pretty much your best answer, but I have to be honest–it was still not very helpful.

             Oh and remember after we were done with your CT, and I said you could get back onto your stretcher.  You instead decided to stay laying on my CT table and salute me.  It was even better when I asked you again to get up and this time you stayed laying flat but this time reached for the sky with both arms outstretched.  It reminded me of when I change my one year-old daughter’s diaper.  She always reaches her arms up for me to pick her up and give her a hug.  Wait! You weren’t expecting me to…

             Well at any rate I just wanted to tell you that all you had to do was tell me that you fell and hit your head.  You could have even said that you had been drinking a little too much and were not sure what happened.  I can appreciate that being brought to the emergency room as a result of having too many drinks can be embarrassing.  Out of respect if you had been a little more forthcoming I could have simply wrote down your history as: Patient presents with unknown injury to head.  Done.

             I want to be transparent with you, mostly because you were not transparent with me.  Because you chose to make things more difficult for me, your permanent medical record, courtesy of me, now includes the following:  Patient unable to provide accurate history.  + ETOH.  Per PD report, patient was found down outside of liquor store with pants around his ankles and abrasion to his left ear. 

             Now everybody knows.

Regards,

C. Langston R.T.(R)(CT)(MR)

 

You want to put it where?

Working in the medical field you think you see and hear it all. Clinicians can, and most often do, become de-sensitized after constant exposure to disease, trauma, death, and the sometimes raw truth of healthcare. But every so often something a patient does or says catches even the most veteran clinician off guard.

The following story was told to me about an incident that happened recently at a local hospital. I am glad that I heard the story as a third-party, because the freudian slip involved, and the laughter it caused, made it hard for me to maintain much professionalism.

A female patient had been admitted to the hospital and was found to have a large fluid collection in her pelvis that required a drainage tube to be placed. A percutaneous drain was placed by making a tiny incision in the patient’s pelvis, and inserting a small tube into the area of the fluid. Typically a drain like this stays in place for a few days or until all, or at least a majority of the fluid has dissipated. In this case after a few days, it was discovered that the drain was no longer working and the attending doctor requested another drain be placed by the radiologist under CT guidance. The patient was brought to CT, and an attempt was made to place another drainage tube. Shortly into the procedure the patient began complaining of gluteal pain and it was decided that the patient could not tolerate the procedure. The patient was bandaged up and transported back to her hospital room. It was now up to the attending doctor to think of PLAN B. To the surprise of techs and the radiologist involved with the procedure, the attending doctor felt PLAN B should involve attempting to place the drain via the patients vagina. (For the record I specifically chose the word “via” in that last sentence because it flows nicely with “vagina.” Your thoughts and feedback on my choice of words are appreciated.)

The radiologist was adamant that this approach for a drain placement was not going to happen. The attending physician, and apparently the patient, were adamant that the drain was placed in her vagina. The radiologist ultimately won this battle, but not before the following phone conversation took place:

Telephone rings.

CT tech answers: “Cat Scan, this is (insert tech name here).”

Nurse: “Hey (insert tech name here). This is (insert nurse name here). I am taking care of (insert vagina patient’s name here). Dr. (insert attending doctor’s name here) is adamant that this patient gets here drain placed today, and he says it has to be placed in her vagina.”

CT Tech: “The radiologist is not going to place a drain in the patient’s vagina.”

Nurse: “The doctor says it has to be done.”

Vagina patient (in the background, loudly): “I AM NOT GOING DOWN UNLESS HE PUTS IT IN MY VAGINA!!!”

It has been a few days since the patient made that comment, and I wonder if she has yet to realize how her words came across.

Now audience it is up to you to put that the patient’s quote into whatever context you would like. I think this post would have been sufficient if I had simply made that line the quote of the day and provided no background information at all.

Until next time…

Deliverance…Up close and personal!

I literally just finished the scanning the strangest/most disturbing patient I have ever encountered.  Think Deliverance (the movie)…

In the movie:

A few friends decide to take a canoe trip to the deep backwoods of Georgia where they encounter some friendly hillbilly locals. This movie contains what in my opinion are some of the best pick up lines ever, including: “You got a real purdy mouth” and “I bet you can squeal like a pig”.

Enough said.

In the ER:

A few clinicians decide to show up for their scheduled shift at a small Denver area hospital and encounter the same “friendly” hillbilly locals (in female form….I think).  This scenario contains insane peri-orbital swelling/cellulitis, facial scabs, stained and mis-matched pajamas,  and incoherent speech which I can only liken to the dialogue of one of my new favorite shows Swamp People.

Enough said.

Are you a student?

Amidst a recent Facebook post suggesting that “my wheels are falling off” as I approach 30, I have found my saving grace.  Despite any physical ailment that makes you feel old, a compliment, whether intentional or not, makes it all go away, if only for a little while. 

Background Info:

Yesterday on a Facebook post I mentioned that I felt like I was getting old, citing back pain, upcoming knee surgery, and the fact that I have been put on thyroid medication.

Picture retreived online from the Journal of the American Academy of Physician Assistants website.

At about 1:00 a.m. I am called to the ER for a patient with suspected appendicitis: a 22 year-old female with RLQ pain, fever, and loss of appetite today.  As I walk into her room to introduce myself, I find a relatively attractive brunette in pink sweats, slippers, and hospital gown lying on her stretcher, and her knight in shining armor boyfriend at her side.  She smiles.  He tenses up.  As I finish explaining who I am, and that I will be taking her down the hall for a CAT SCAN, I ask if there are any questions.  Only one:

Jealous boyfriend: “Can I come with?” 

(At this point I realize that this guy sees me as a threat, which is a compliment in itself I guess, because I am definitely not a threat.)

Me:  “Of course.  I can’t let you in the room during the scan, but you are welcome to come along.  There is a sitting area outside of the room.”

We walk down the hall to CT.  Boyfriend takes a seat in the waiting area and I roll the patient the rest of the way into the CT room and close the door.  As I get the patient positioned on my table, she asks, “So are you a student?”

I initially think to myself, “Crap.  Am I acting like I don’t know what I am doing or something?  Why would she think I am a student?”  I push the thought aside and say, “No, I have been doing this for like 7 or 8 years.”

Patient: “Wow!  You look so young.”

Me (smiling on the inside, and probably on the outside, too): “Thanks, I guess I’ll take that as a compliment.”

I suppose if an attractive 22 year-old female thinks I look young, the wheels aren’t falling off just yet.  Then again she had just been given morphine for her pain.   Crap!  I hadn’t thought of that until now.

Don’t judge a book by it’s cover…or?

Last night we finished a series at Flatiron’s Community Church entitled “Flatirons Ink: Marked.”  Essentially it was the story of Jonah and the whale, and the overall theme was that we have all been “marked” by the things that have happened to us in our lives.  The analogy used was that we have been” inked” or “tattooed” by those experiences, and despite what “tattoos” someone has, it is not our place to judge them.  Those of you who know me personally, know that I am not short of tattoos.  I don’t know when or where , but somewhere along the way I lost count, and now some of my tattoos have started to merge with others.  For me the tattoos are my story.  Each one represents something. 

 Despite the take-away from this series of “not judging,”  in the medical field you sometimes use previous experience to, for lack of a better term, “judge” your patients.   So was the case last night.  A 41 year-old male presents to the ER for the fourth time this week with multiple complaints.  He has reportedly fallen multiple times, has debilitating back pain, and can’t “think straight.”  When I arrive at his bed side to obtain a history before his cat scan,  I almost immediately categorize him as a drug seeker.  He is has a glassy eyes, is somewhat unkept, and before I have a chance to introduce myself, he begins complaining about his pain.  He is unable to give me an accurate history, but I start rolling him down the hall towards cat scan.  There is a small bump where the vinyl flooring of the ER meets the carpet of the hallway that leads to Medical Imaging.  As I push the gurney across this threshold, the patient is jolted ever so slightly, and begins “writhing in pain.” 

It takes me about 15 minutes to get the patient onto the CT table because: 1) He is not alert and oriented, 2) is complaining about all his pain, and 3) is over-dramatically wincing and flinching with each minor movement.  This patient is well-built and is sporting what appear to be “prison tats”, and I can’t help but think, “Dude, you are being such a douchebag for someone who at least looks like he should be tough.”  I keep my comments to myself.  I finish the exam and return him to his room in the ER…

Fast-forward an hour or so…

I get a call requesting that I come to the ER to help control a combative patient in the ER.  As I walk through the double doors of the ER, I see security standing outside of the room of my friend the douchebag.  Security tells me that the patient is mad because he wants to leave, but is loaded up on narcotics and we won’t let him drive home.  He has a ride on the way.  About two minutes pass, and my patient (who an hour ago would barely move for me) jumps up out of his stretcher, and announces angrily, “My ride is here.”  He proceeds to strut down the hall at a rapid pace with no signs of pain or impairment.  Security and I follow the man to the parking lot where his “friend/1st ex-wife that he is still ‘close’ with”  are waiting in a rusty 1990’s Ford Taurus.  The patient, unable to open the passenger door, and in true Joe Dirt fashion, easily jumps up and slides feet first into the vehicle through the open passenger side window.  They leave skid marks as they peel out of the Emergency Room parking lot…

I wish this story had ended with the patient actually having a real problem, and me learning a lesson about being judgemental.  It doesn’t always work out that way.  So in the words of Kanye West “Let’s have a toast for the douchebags.”

 Check out Flatirons Community Church…last night’s opening “hymn” was ACDC “Thunderstruck.”  I kid you not…Check it out…  http://www.flatironschurch.com/

He’s the one they call Dr. FeelGood…

There is something to be said about old friends:  They can always be counted on…for something.  One of the rules I learned in researching how to create an effective blog was to post frequently, but make sure that each post was relevant…Don’t post just to post.  I will try not to over do this whole blog thing, but I am posting for a 2nd time today for the following reasons: 1) I got my first comment, 2) This is new, and I am excited, 3) an additional posting will allow me to respond to my first comment and tie it in with the Colorado lifestyle which is allegedly one of the themes of Rammin’ the Clam. 

So back to the old friends being counted on thing.  Kevin Peters:  He’s the one they call Dr. FeelGood.  I couldn’t have asked for a better person to chime in with the first ever Rammin’ the Clam feedback comment.  A true comedic genius hides behind  the tie and white lab coat that he wears to work.  We met in radiology school; Kevin probably got the award for best dressed, despite the fact that everyone in our class was forced to wear the same green scrubs.  I also think Kevin got the award for clinical excellence, which may have been an indication of things to come.  After graduation Kevin was hired and quickly promoted into management.  I think he is like a hospital C.E.O. or something know.  But as Kevin alluded to there is one thing missing from his high society corporate world.  No snowboarding.  At least no snowboarding worth mentioning. 

Kevin is a natural leader.  He had a knack for getting events planned.  One thing I miss most about my time in Sioux Falls, SD, with Kevin and the rest of our friends was our recurrent Poker Night.  It seemed almost weekly that we were up until 3 a.m. drinking cheap beer and playing Texas Hold’em, knowing full well that in 3 or 4 hours one of us would be performing a gastrografin enema on a 73-year-old lady, while others would be trudging up and down hallways pushing a portable x-ray machine, while yet another of the group would be scrubbed in assisting with a stent placement or emboliztion.  It didn’t matter though, we were committed, and when our group of friends made plans, they almost always stuck with them.

Now I transition into the Colorado lifestyle.  I am not sure what it is about Colorado, but for the most part I have found that people here are generally non-committal.  I’m not saying anything is wrong with that, it is just a different dynamic than I am used to.  Organizing poker night here seems like pulling teeth.  Of 30 people invited, 10 will say “Right on.  I’m in.  Sounds dope.”  10 will say “Let me check with wife/husband.  I’ll let you know”  The last 10 will say “Sorry man.  I gotta work/play hockey/train to be a ninja.”  Now of the 30 people invited 7 will show up.  3 of them from the “Right on” crowd.  3 from the “Let me check” crowd.  Lastly one idiot will show up in a ninja costume. 

 Hold on a second, Ava has something to say. “I gotta go poop, but I can do it myself.  Okay?”  Cool, she’s good, but I should probably end this soon or I will be interupted in a few minutes to enter Ava’s most likely next sentence,  “Look at my big poops.”  I don’t know what the non-committal atmosphere is all about. I would like to think that it is because Colorado is so full of awesomeness that it would be foolish to commit to anything, because something more awesome could come up last-minute…