He's in jail, you see. Jail, as differentiated from prison, because that's very important to people who are only in jail. I've been corrected by more than one inmate. And his dad died last month. And he's in jail, so he couldn't go to the funeral, so he was sad. So he swallowed two razor blades and a Pepsi tab. Well, to be perfectly honest he told us two razor blades and we found out about the Pepsi tab on the other end.
We've been following him with serial X-rays of the abdomen (razor blades show up quite nicely) and a bedside commode. He passed one of them (and the Pepsi tab) yesterday. We thought we were almost done with the ordeal. This morning, Jenny comes up to me looking like the wrong end of a Mack truck.
"You know Mr. R down in Detention? He's shoved a couple of wires into his stomach."
Prisoners, for some reason, like to insert sharp objects into themselves. Paperclips are a particular favourite, and seem to work well with the lungs. Paperclips are not sterile. Bullets are sterile, but the clothes they usually go through are sadly not. Our inmate had begun thinking about his father last night, it seems, and been so overwhelmed with grief that he had removed two sharp wires from the bed and inserted them into his abdomen. Crosswise, at a shallow angle, so that they lodged in his rectus muscles but didn't perforate anything. They're quite nicely placed according to the CT scan.
We went in to see him. He's livid that we have him restrained, so mad that he urinated all over the floor. Way to act like a thirty-something. That was how the guard greeted us - "Watch it, there's piss everywhere." Nurse said "Here, have a sheet to keep your feet clean." He swore at us and complained that we all come in and stare at him in the mornings. The team all comes in for teaching.
Jenny is carrying 5 patients, and three of them are crazy. There's a husband-and-wife team who came in together with dyspnea, and now neither will leave without the other. It used to be cute, Jenny says, but the more I hear them talk about how they can't function without the other one, the creepier it gets.
My girl with the pancreatitis is not doing well. She has fevers, and her CBC came back normal-looking, due to the low number of lymphocytes and the abnormally shifted neutrophil count. She has an infection. And a lot of one, seeing as how her count is 22% immature cells and 1% very immature cells. Repeat CT and hope we find something. Pray we don't find necrotizing pancreatitis or an abscess. She's only 21.
Whereas the lady with the CHF who was on 50% oxygen yesterday is on 2L via nasal cannula and looking 10 years younger. She's going home soon, I can feel it. Hallelu. There are two little boys, the youngest with Duchenne's, who depend on her to raise them. She's not that old...less than sixty. And maybe she'll need oxygen for a while, but hopefully not forever. Especially if she quits smoking. She has to quit smoking or she'll blow her face up.
My Dubin's EKG book is at home in Fort Wayne. I suppose I'll cope without it.
I need a new patient to read about - someone I can do an NG tube on would be particularly nice, and I requested that O assign me one such patient. "We'll see what we can do." I need to place two NG tubes. I have procedures missing from my book that I'm certain were signed off on. But I have my quota on everything I should. I just need to place two NG tubes.
I think other things, funny things, happened today. But I don't really remember them. My good mood has become as stable as a patient on pressors, buoyed by the Thai Noodle Bowl, sunken by realising I have done nothing to edify myself. I feel bad about this. But not badly enough, it seems, as I think it's time to go to bed and sleep off my headache. I will print off some UpToDate articles for reading tomorrow, and this will make me feel better.