Went in at 8 yesterday to the UVC, O Best Beloved, and had a bit of a slow start. Sutures that needed removed - I can do that. But the 19-month-old boy was whipping his head around so violently that eventually they got R, the other ER doctor, to come and get them out while Dr. R held the kid down for him. "Don't feel bad," I was told. "Those were hard. And that kid is strong."
The staple removal with Dr. F later went much better. She cried and squealed while we were doing it, then perked right up as soon as they were done.
Little girl who had a bad case of viral gastroenteritis, which I managed to differential appropriately, much to Dr. F's approval.
Boy who'd stepped on a nail. Took an X-ray that showed no foreign bodies. Note that you have to worry about Pseudomonas infections whenever someone has a puncture wound that goes through the sole of a shoe, and since he was complaining about increased pain from yesterday we started him on prophylactic antibiotics.
And then there was the capstone of the day. I went into the room to find two patients, a 4 1/2 year old boy and a 5 1/2 year old boy. The younger had a history of abscess behind his ear as an infant, and was developing a bump back there again. Mom was worried. I examined it. I thought it looked like a bug bite. He had them all over his scalp, this one just looked a little itchier. She didn't like that answer, explained the abscess story again, and how he'd had no symptoms last time either. It was before he had his teeth; you wouldn't have been able to elicit symptoms. But I didn't say it. I told her I'd have the staff doctor look at it.
On to the elder, who had been exposed to ringworm. He had a little scaly patch on his cheek. Mom was convinced he had ringworm. I looked him over. It looked like eczema or dry skin; I told her so. It didn't look like ringworm. She told me it was in the exact same place as his cousin's ringworm. And this makes it more likely to be ringworm? Plus he was complaining about his ears, and they needed lavaged (irrigated, O Best Beloved). I peeked. "Yes, they do." Completely blocked with wax.
Went and staffed. Gave my differential. Satisfied Dr. N, apparently, who pimped me on why I didn't think the bump was an abscess or a lymph node, and what we were going to do about it. Came back in with him and staffed.
He agreed with me on all three counts: bug bite, dry skin, wash the ears. She wasn't pleased, so he promised to write her for ringworm cream anyway. It won't hurt, it's not like antibiotics. Went back in with the nurse to lavage the ears. This is where things went downhill.
While the nurse was doing it, I was fine. We got more shit out of this kid's ears than I've ever seen, all of it wax, even I think the white papery stuff. And I kept looking in and saying "get more out", and the nurse kept saying "Lord have mercy, boy..." And she finally had to go back out and take care of more patients, and left me the stuff in case I needed another go. I needed one more go to make sure his one ear was clean. I filled the water cup and set it on the exam table beside the syringe. Mom asked me if there was a gown or something that he could have, because we'd taken his shirt off and he was cold. I said sure, and went to get one. It was an adult gown, so I wrapped it around his shoulders - and in doing so, forgot how close the cup of water was and knocked it over onto the table, drenching a leg of his jeans.
I apologised, picked the kid up and scooted him down to a dry section of table, got a towel to prop his leg on so the jeans would dry more, mopped up the mess, and finished irrigating. Mom is now giving me the Glare of Death. I'm making small talk with the child, trying to ignore her obvious antipathy - It was only water! - and finish my job. I apologise again, and go to get Dr. N to re-staff, since the nurse noticed a dry patch on the kid's scalp and asked if he had ringworm. And Mom got all huffy about how she knew he did.
Warned Dr. N in advance that she was miffed. He looks at me. Did you apologise? Yes, sir. Twice. It was an accident. Accidents happen. Don't worry about it. And so there I am, grab a new patient chart and go see someone else. When I got back to the staffing station, he's shaking his head. Don't worry about that woman, he says to me. She's got something wrong with her. That was all the story I got until later, when he was at the nurses' station, and the nurse asked about the irrigated ears.
Me: Oh, don't even ask me about that room.
Dr. N: She had something seriously wrong with her.
Nurse: Oh? Why?
I explain that I tipped a cup of water over when I was irrigating, and got his jeans wet. She laughs a bit, looks sympathetic. "It happens."
Dr. N: And when I went in there, she gets up and says "I don't know what the fuck that girl thought she was doing, throwing water on my fucking kids. See her walk around with fucking wet jeans, see how she fucking likes it..."
I almost got into it with her right there, he says. I told her she had no reason to talk that way about my medical students and left.
Talk about a psycho.
Got to hear a few good stories from the docs too, yesterday, and had some nice quotes from roleplaying, but I need to get ready for lunch and Pirates now. So more later, O Best Beloved.