Mr Fecal Mouth

Just got off work after another fun loving twelve hours in the local ER. I’m sitting here trying to decide if I want to drink this nice glass of white Grenache or snort it. Why would you snort a glass of wine, you ask. If you had to deal with what I had to deal with you’d be asking the same question.

The day started off well enough. The patients arrived in little gaggles of twos and threes. Manageable but not overwhelming. My shift started at 3 PM. At 7 PM the doctor went in to care for a patient who had a few problems. The short list consisted of: liver failure, resp failure, GI bleed, altered LOC, ESRD, COPD, hypokalemia, and acute MI. She had been lying on the floor of her apartment for at least four days before she was found by a neighbor.

I did my best to keep up with the patient load but by the time the doctor came out of the room I was behind so many patients I knew the rest of the night would be hell. I was able to get the lady with the PT of 69 and INR of 15.3 admitted. If you are not a medical person those values are not good. This patient was taking her coumadin but not eating for the past four days. Four units of plasma and 20 mg of Vit K later she left the ER.

One 10-week pregnant patient with hyperemesis gravidarium  and an intractable headache was supposed to get two liters of NS wide open. I checked on her after 3 hours and asked if the bag of NS she was just finishing was the second. No, it’s just the first one, I was told.

I went out and stalked about until I found the nurse and asked if he could hang a bag of NS from the ceiling so this patient could have a hope of going home before her child delivered?

I went back to the patient/staff member who was miscarrying, and went over the lab work and told her she was no longer with child. I could see the tears form, but just didn’t have time to cry with her.

Back to the elderly woman who was allergic to “every drug known to man”. Why the hell come to the ER and then complain that you can’t take any medication because all medications cause a rash and itching.

Now to the patient with a nephrostomy tube and illiostomy, fever, pain, nausea, and chills. Please god let the attending be willing to admit without a fight.

I got the lady with the 20,000 white count and diverticulitis admitted and then went in to see the 79-year-old man with abd pain and vomiting.

Nine days? I asked. Yes, his wife responded. He has been vomiting 9 days. I was trying to figure out why this nice woman was sitting in the hallway knitting, while her husband was in the room. I spoke briefly with her and then entered the room. Ok, now I know why she is sitting in the hallway. Fecal  matter, poop, BM, shit. But not from the usual places. The patient was vomiting fecal matter. The emesis basin contained about 500 CC fecal matter the patient had vomited. God the smell, I choked back my own bile.

Quickly I left and buttonholed the RN. NG, Phenergan, and IV I told him.

Three hours go by. I speak to the wrong OB doc to get the vomiting pregnant lady admitted. I speak to the correct OB to get the vomiting pregnant lady admitted. I speak to the vomiting pregnant lady and she wants me to get her transferred to a hospital where her OB doc can see her.

Fine I say. We’ll load you into an ambulance and you can bump around and sway for 40 minutes in the back of an ambulance on the way to the other hospital. The patient weighs her options and decides she doesn’t want to vomit in the back of a moving ambulance and agrees to admission to our hospital.

I perform a very awkward pelvic on a staff member and send her home without child after speaking with her doctor at 2 AM at the insistence of the ER doc.

After 3 hours I am told the patient who is vomiting fecal matter does not have an IV and they can’t get it started. I give report to the ER Doc and try to go home. The chem is normal, I say , except for the NA which is 122. As I am leaving the tech says she ran an autochem. The BUN is 150,  and the creatinine is 5.2. Tell the doctor I say, I’m going home.

I’m still trying to get the smell out of my nostrils. Maybe if I snort some White Grenache I can get the smell out of my nostrils?