I quickly made the incision into the abscess and the nasty smell of anaerobic infection filled the air. The patients boyfriend asked what that awful smell was and I jokingly said, I thought it was you. His girlfriend laughed and I then explained why the infection smelled. Anaerobes are bacteria that thrive on lack of oxygen and can be found in abscesses and usually have a rotten smell associated with them. Once the incision was completed I inserted my surgical forceps and bored out the abscess. A cottage cheese like substance bubbled out of the incision. I nursed the wound to make sure to get all of the rotting tissue out. I then packed the wound with iodinized strips of packing material. I started her on some antibiotics and told her to follow up with her primary care doc or to come back to the ER to have the packing removed. She was so grateful and felt so much better once the pressure was released from the abscess.
I quickly ran out to see what the commotion had been about only to find a police officer and several nurses / techs and 1 doctor trying to hold the patient down and get him to quit fighting everyone. I had a 67 year old male with SOB (shortness of breath) that I had to see and could not get in on the action. Once I finished the SOB patient I asked the attending doc what was up with the drunk. He explained that the guy had passed out and cut his head open. He was brought in via ambulance and wanted to be immediately released. The problem was that because his blood alcohol was 250+ we could not release him out of liability. So if we released him and he went out and fell down and injured himself he could then sue and we would be found liable for this wonderful individual's poor decision making ability.
Now we had a dilemma. He did not want to be there and we did not want him there as he was rude loud and generally a pain in the ass. The doctor explained that 10 different people had tried to calm him down and get him to accept treatment for his laceration and everyone had failed. I sheepishly offered my assistance trying not to offend the doctor who had just failed at his attempt. The doctor said "good luck, this guy is impossible!" So I grabbed some cookies and made my way to the patient's room. I entered the room and tried to sum up the situation. I noticed the patient had a burberry suit on and name tag from a local bank branch. I quickly asked the police officer to uncuff the patient from the bed and I asked everyone to leave the room. The cop said "Doc, this guy has attacked everyone and is a complete asshole. Are you sure you want me to unlock him?" I smiled and nervously told him to uncuff the guy and then wait outside of the room.
The officer uncuffed him and then left the room. I offered the patient a cookie which he reached for immediately. I commented on what a bummer it was that his amazing suit now had blood all over it, I then said "life's a bitch, isn't it" to which he laughed and sat up. I sat next to him on the bed and begun to talk about some of my frustrations with life. He kindly offered some advice and thanked me for the cookies. I continued to break all the codes of professionalism and enjoyed a cookie myself. This was the first time I had sat down the entire shift. We continued our conversation about life and I maneuvered the conversation into a discussion about his problems.
He was fired from work that day and was out drinking his sorrows away and the next thing he knew he was in an ambulance. He had no money and was in debt already and was nervous about how he would pay for all this medical care. He asked to be released and because he was considered a danger to himself and others, not to mention his 3.0 cm bleeding gash on his head, his request was denied. He then admittedly became belligerent and was soon manhandled into submission which led to more A-hole speak and then more manhandling and the cycle continued as both party's egos were bruised and insulted.
I listened as he explained the calamities of his life. I then asked him if he would let me put staples in and fix the wound on his head. I explained the risk of infection if he chose to leave the wound unrepaired. I also explained that if he may be able to negotiate a deal with the hospital once he gets his bill. I continued to explain that many times due to all the "no pays", the hospital and other medical fees can sometimes be negotiated. He appreciated this but still only wanted to go home and put hydrogen peroxide on the wound. I told him he would have a blond spot on his head which would require other blond spots to be bleached in to make it look like he was going for the spotted cat look. You can't really wear a Burberry suit with dignity with 1 blond spot on your head. We had a good laugh and he finally gave in when I explained that the practice would help me out.
I quickly put 7 staples in the wound after I irrigated and cleaned the wound. No one would assist because they were all still fuming over their wounded egos. The entire process took me 18 minutes. I came out of the room and told the doctor to document that I had put in 7 staples. He asked me "how in the hell did you get him to allow you to do that" I replied by saying "I promised to show him photos of your momma and that the patient jumped at the opportunity" The doctor chided back with you mean the picture of my mom and your mother making sweet, sweet..."
Many hours later after the patient had sobered up and we discharged him, on his way out the door he yelled "Everyone in here but Doctor J, can go F&*%%^ yourselves! Dr. J you my man!" I replied with "thank you" and then told the doctor that the customers always right and the he should get on the patient's request immediately and that bathroom 4 was vacant. He laughed and we both went to see our different patients. 1 overdose and 1 suicide attempt.
1 comment:
More! More! More!
Post a Comment