Where Did It Go?
Like a lost sock in the washing machine, some objects seem to defy the laws of physics as we understand them.
Some examples are the retained tampon or sex toy, the persistently perceived contact lens or corneal foreign body, the dreaded fish bone in the throat, and the mystery pebble or insect in the ear or nose. Something unnatural is in one of their orifices and they want it out. And yet occasionally the object is nowhere to be found.
How long do you look? Is it worth a referral, and if so, how urgently? Perhaps I didn't look closely enough, so I'll have another look. Nope, it's still not there.
"How can that be?" the agitated patient may ask. "Where did it go?"
Some mysteries are simply unexplainable by the laws of nature. That's when I turn to the cartoon laws of physics.
Or perhaps we should review some of the ER Laws of Physics:
1) Following equivalent applications of force, the more intoxicated patient will suffer fewer injuries.
2) Given two patients with a headache, the nicer one will always have the brain tumor.
3) A disheveled patient can easily walk 5 miles to the Emergency Department for a dressing change and a refill on his vicodin, but he will need a cab voucher to get home.
4) One dood is never sufficient to overpower a given intoxicated male, but two doods are more than enough.
5) The mere act of bringing a feverish, fussy, vomiting toddler to the ER is often enough to transform them into a smiling, happy, juice-guzzling, cookie-eating cutie-pie. Want a sticker?
6) The time it takes to be seen in the ER is inversely proportional to the actual severity of illness. But the perceived time is exponentially so.
7) The likelihood of finding a foreign body is completely unrelated to the certainty of the patient regarding its presence.
Got any more?
Some examples are the retained tampon or sex toy, the persistently perceived contact lens or corneal foreign body, the dreaded fish bone in the throat, and the mystery pebble or insect in the ear or nose. Something unnatural is in one of their orifices and they want it out. And yet occasionally the object is nowhere to be found.
How long do you look? Is it worth a referral, and if so, how urgently? Perhaps I didn't look closely enough, so I'll have another look. Nope, it's still not there.
"How can that be?" the agitated patient may ask. "Where did it go?"
Some mysteries are simply unexplainable by the laws of nature. That's when I turn to the cartoon laws of physics.
Or perhaps we should review some of the ER Laws of Physics:
1) Following equivalent applications of force, the more intoxicated patient will suffer fewer injuries.
2) Given two patients with a headache, the nicer one will always have the brain tumor.
3) A disheveled patient can easily walk 5 miles to the Emergency Department for a dressing change and a refill on his vicodin, but he will need a cab voucher to get home.
4) One dood is never sufficient to overpower a given intoxicated male, but two doods are more than enough.
5) The mere act of bringing a feverish, fussy, vomiting toddler to the ER is often enough to transform them into a smiling, happy, juice-guzzling, cookie-eating cutie-pie. Want a sticker?
6) The time it takes to be seen in the ER is inversely proportional to the actual severity of illness. But the perceived time is exponentially so.
7) The likelihood of finding a foreign body is completely unrelated to the certainty of the patient regarding its presence.
Got any more?
posted by scalpel at 1:44 PM
16 Comments:
The frequency and volume of the complaints about the waiting time is inversely proportional to the actual severity of the illness.
Although the perceived time is exponentially so.
If you are staffed, equipped and prepared for the worst, you will have the quietest night ever.
BUT
If three nurses have gone off sick, two of the monitors have gone missing, one of the vents isn't working, you only have the most inexperienced A&E docs on, the department is full and the orthopaedic surgeon on-call is an arrogant-yet-incompetent arse, you will have a major trauma patient. Or five.
The more separate the body parts or systems are that are involved in the chief complaints, the less likely either is a real emergency.
How many people with osteomyelitis of the big toe JUST HAPPEN to have an intracranial bleed...("headache/toe pain" on the CC)?
I'm sure someone else can word it better, but....
You only get ____________ 'ed on when you just put on clean scrubs, and usually right at the beginning of a shift.
The mere act of ordering a stool sample is better at stopping diarrhea than immodium ever thought of being.
The size of the vein and ease of obtaining access is inversely proprtional to the need of the size of the catheter and importance of having said access.
The more ER visits a patient has the less likely s/he is to have private party insurance.
The number of members of a family that check in together is inversely proportional to the severity of the illness.
The number of tattoos a patient has is inversely proportional to the number of teeth said patient has.
The number of drug allergies a patient has is inversely proprtional to the statistical probability that the patient is a drug seeker.
If you need to get off on time, no matter what, you will be guaranteed to have a night from hell.
When you really, really need a consult it will be the one night when no specialist is available anywhere in the county.
If you are rude or "have an attitude" with a patient it is almost certain they are good friends with hospital administration.
The very first time you and your super nurse neglect to review med allergies will be the one patient who goes into Anaphylaxis.
I've actually heard that inebriated people do better in crashes and such precisely because of the alcohol... apparently they relax more.
ladies please explain, since i don't own the equipment, how you can lose anything up your hoo-ha? really, can you really not tell or are you just not wanting to explore? me, i'd explore my nether-regions all the time but i have an x and a y so that's not fair.
911Doc- my doctor told me a woman only had feeling about 2 inches in; beyond that there weren't so many nerves. So if it got in past that point, unless the object was unusual in size or shape,she probably wouldn't feel it. It also proves that length does not matter, guys.
Your doctor is wrong.
More of an ambulance issue, but:
The more vital a piece of equipment, the more likely it will roll under the stretcher when dropped.
The larger the moon, the crazier the people.
The colder the weather the more transient pt's with emergencies
The people with the worst vomiting are the ones eating chips/ cookies drinking soda when brought to a room. Or immediately ask for water
Scalpel, I worked in an emergency room for two years as registration…so I REALLY enjoy reading this. :) :) It made me miss my job. :o(
Trade a day with your coworker out of the goodness of your own heart, expect patient visits in ER to triple the day that you work. (Anger from the trauma g-ds at your adjustment.) Inevitably followed the next week with a declaration from your coworker that their day was “such a pleasant day to work!”
The day that you cash your check and stupidly decide to get a cup of coffee before paying some bills (I was 21 and my bank account was always negative :-D), expect to run into the belligerent homeless guy (who you‘ve seen about twenty times in the ER)…who has chest pain today and is clutching it in front of you...all while staring at your purse.
The cutest, most articulate, intelligent child you ever met will have a horrible injury/illness.
The normal 60ish year old woman you will ever see will invariably be the one that comes in every two weeks for a mandatory rectal exam.
Great post! :)
My (then) nine month old son pulled #5 on me one cold winter night in December. He had lost %10 of his body weight, had vomited etc.. for 5 days. Would not keep one single thing down (or in) while at home. I took him in to the ER and he guzzled down Pedialyte and flirted with the nurses, while trying to walk and talk to them. Little punk. RE: the tampon thing - sometimes the string breaks off.
The perceived urgency of the condition is inversely proportional to the number of years the observer has spent as an ER professional. For most patients, that's 0. Try to remember that. It's your job to understand them, not the other way around.
People forget most doctor interactions, with 2 exceptions, which are never forgotten. 1) The doc that dismissed what turned out to be a serious problem. And 2) The doc that really cared.
Want me to look again?
Nope, still not there.
911doc, I'm sure unwillingness to explore can be a factor, but there are also logistical constraints -- it can be difficult/impossible to reach -- especially something pliable like a condom. And I don't know that most households have appropriate equipment for an, ah, fishing expedition. I know I sure as hell would not let any partner of mine near my nether regions with the kitchen tongs or needlenose pliers!
And while most women do have some sensation all the way up, once something has been there long enough to get used to (especially something blunt and/or designed to be somewhat comfortable like a tampon) it can be really difficult or impossible to tell that it is there. I've never had any problems losing anything myself, but I do have a highly intelligent research scientist colleague who was distracted at a very hectic time (submitting three grant proposals) and she forgot to take out a tampon before putting another in. Was in pain etc. and finally went to the doctor a few days later, and surprise! More evidence for the non-correlation with patient certainty, since she was sure their was no chance of a foreign body.
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