Night Shift – The Aftermath

Dr. Cranky knows he told his readers he would require some down-time following his battle with the Armies of Darkness, but he thought his readers might be interested in a brief accounting of the bloodshed (both literal as well as figurative) which occurred. Interestingly, just before he set out on his adventure, Dr. Cranky watched a fascinating show on the History Channel entitled “Hooked: Illegal Drugs and How They Got That Way.” One of the comments made was that in the early years of the twentieth century certain drugs were regarded as the scourge of society: alcohol, opiates and cocaine. All three were evident as part of the evening’s festivities.

A quick word regarding location: the Cranky Group, Greatest Emergency Physician Associates, PA (GEPA), staffs five different hospitals in Big City, USA and the surrounding area. Last night, Dr. Cranky found himself ensconced in the emergency department of one of these hospitals located in a small town about 45 minutes drive from stately Cranky Manor. This rural hospital makes for an interesting change of pace (and a brutal drive home after a difficult night) but some of the pathologies seen in emergency medicine seem to be universal no matter where one finds himself. Approximately 24 patients checked in between 11:00 PM and 7:00 AM, and this doesn’t count the “hold overs” who had checked in earlier but were still waiting to be seen when Dr. Cranky arrived. A brief list of the patients included, but was not limited to, the following:

  • Suicidal ideation: 45 year-old woman who had been “wanting to die” for the last two weeks. Had a history of similar episodes in the past. History of alcohol and cocaine abuse. Brought in by the family because they figured that, after two weeks, something ought to be done.
  • Chest Pain: An 83 year-old woman who lived by herself called EMS complaining of chest pain. No previous heart history. Exceptionally poor historian (a fancy way of saying she was evasive and vague in her answers to Dr. Cranky’s questions). The son was a local minister and stated the patient did this sort of thing often, especially when she got upset. She had become perturbed with the son earlier because he had asked her to consider the option of moving to an assisted living center (he was concerned she was becoming more frail and might fall during the night and hurt herself when no one else was around). The patient did not want to even consider this. A full workup was performed and the results were completely normal.
  • Intoxication #1: A 24 year-old man had engaged in heavy drinking with some friends earlier in the day (vodka, wine and beer) and had vomited shortly afterwards. No complaints upon arrival. His friends advised him he should get “checked out, just in case.”
  • Intoxication #2: A 32 year-old man got in a fight with his girlfriend and, in a fit of anger, punched out a plate glass window. Sustained numerous lacerations to his right hand and left forearm.
  • Intoxication #3: A 56 year-old woman came in with left-sided back pain for 3 weeks. Well known to ED staff, she had a history of both alcohol and opiate addiction. She had seen her local physician and was told it was just a pulled muscle. Dr. Cranky examined the patient and concurred with the local physician’s diagnosis. Judging from the degree of clinical intoxication, Dr. Cranky was suprised the woman had any sensation in her body at all.
  • Intoxication #4: A 26 year-old man became heavily intoxicated during the evening and presented himself to a local Waffle House. Once there he hurled various invectives toward other members of the local gentry, who then proceeded to “body slam” him onto the ground (rasslin’ is quite popular in this area). He came in accompanied by the local constabulary, handcuffed with his hands behind his back, lying face-down on a stretcher with his head and face a bloody mess. Although he was awake, alert and conversant, a Computed Tomography scan of his head and face showed a skull fracture, pneumocephaly (air in the brain), a nasal bone fracture and a very small small eipidural or subdural hematoma (arterial or venous bleeding in a space surrounding the brain – the radiologist wasn’t sure which). The patient also had a fractured left wrist. The rest of the workup, including cervical spine X-rays, CT of the abdomen and pelvis (the patient also complained of left and right upper abdominal pain) and sundry other plain-films were negative. He also had a nice, jagged five centimeter laceration on his face. The laceration was repaired and, after stabilization, was transferred to BCMC to see the neurosurgeons.
  • Several patients with headaches
  • Several patients with toothaches
  • Several pediatric patients with earaches and sore throats.
  • A nice, 57 year-old woman with appendicitis.
  • A young woman about 21 years-old with gastroenteritis and dehydration who required IV fluids.
  • A 6 year-old boy with a scratch on his hand he had received at 4:00 PM the day before. Mom decided he should be “checked out” at 1:30 AM.
  • A 31 year-old man who had been bitten by fire ants 20 hours earlier. He came to the ED at 2:30 AM because he said he “felt weird” and thought the ant bites might have had something to do with it.
  • A sweet, elderly 83 year-old woman who had fallen out of bed and broke her hip.
  • A young 20 year-old man who fell out of a pickup truck and sustained an open fracture of the collarbone (complete with bone sticking out).
  • A woman in her mid-forties who claimed she had stepped on a bee while barefoot and was suffering from severe pain. She had no evidence of a sting to her foot, with no swelling or redness, and was well-known as a patient to presented frequently looking for narcotic pain medication.
  • A 24 year-old woman with a rash to her legs for one week.

All in all, just another night in paradise. Dr. Cranky shall now take a day or two off for some R&R; and will return to his faithful readers next week.

Until then, be safe and take care.

About Dr. Cranky

Dr. Cranky is a residency-trained, board-certified emergency physician who has been fighting in the trenches of American medicine for far too long. Each day he tries to stay one step ahead of burnout. Despite his best efforts, burnout seems to be closing in fast.
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