Night shift: midnight – 8:00 AM. My resident is a 28-year-old whiz kid with slicked-back hair. An ED nurse rooms our first patient and drops off the paperwork. She teases, “Have fun, he’s here for bugs!” My resident sends me in there alone. “Good luck!”
The 55-year-old is presenting from home complaining that there are bugs crawling all over him. He wants us to write a note agreeing with him, so he can sue his landlord. “The bugs are everywhere. They are crawling inside me now.” I ask him where they are. “Everywhere. See.” He pulls out a zip block bag with a q-tip with ear wax on it. “See the bug.” He denies any drug use except marijuana. He is so convinced that he is convincing. Searching for the bugs, I am almost as confused as he seems to be.
I present to my attending and resident. Within a few words, my attending has already figured out the problem. She states, “MJ is laced with meth around here. These delusions can be so strong that nothing will change their mind. I’ve had people bring in zip-lock bags with tampons claiming there are bugs. I just hope there are not any bed bugs on him.” We go in to see him together, and try to explain that there are no bugs on him but he may have taken meth. We offer to do a UDS [urine drug screen].” He becomes combative. He storms out of the ED.
My attending summarizes, “EM would be amazing if not for the addicts and psychotics. They suck out your soul.”
[Editor: Maybe she would be happier practicing medicine in a country where the government-run health insurance system doesn’t purchase opioids in tractor trailer quantities?]
My resident asks me what I want to do. I respond that I am not sure. “Well, if you’re debating between EM (emergency medicine) and IM (internal medicine), it’s easy. If you like to perseverate on stuff that probably doesn’t matter and will get better with time, do IM.” He continues, “EM is for people who have ADHD and want to fix things quickly and do procedures. We deal with putting out the fire. I’m not going to be great at everything, but we get the job done. We do eye procedures and central lines. We’re not as good at eye stuff as the opthamologist and we’re not as good at central lines as the intensivist. I had to put in a suprapubic catheter to drain 3 liters of urine [the bladder ordinarily holds no more than 0.5 liters]. I’ve never done that so I looked up the procedure steps and watched it on youtube. I got the job done.”
After a slow few hours, a neighboring resident comes over to our pod and asks if I want to do a lumbar puncture (LP)? A 45-year-old female presented with a several-week history of worsening headaches, gait disturbances, and visual changes. Neurology evaluated and is concerned about the possibility of a rare encephalitis. Neurology is busy so they asked if the ED wanted to perform the LP. After we consent the patient, the attending and resident help me prep the patient and numb her up with lidocaine. We lay her on her left side and ask her to bend over, thereby flexing her spine to open up the lumbar vertebrae. I insert a long spinal needle into her back, slightly off midline, while aspirating on the plunger. I keep hitting bone. After 3 attempts, the resident takes over and also struggles. The attending gets it on the second attempt. “That was hard, she must have some bad arthritis.”
After the last clinical day of M3 year, our entire class gathers in the medical school lecture hall for the M4 lottery. We are each assigned a number and go in order selecting M4 rotations. Straight-Shooter Sally is stressed because she would like to do “Acting Internships” at other institutions. “If I get the wrong order, I won’t be prepared when I have to do my AI.” (For example, someone interested in a cardiology AI would try to do the cardiology rotation at the home institution just prior.)
Statistics for the week… Study: 12 hours. Sleep: 7 hours/night; Fun: 2 nights. House party at Buff Bri’s house to celebrate the conclusion of M3 year. Sarcastic Samantha talks about her job distributing new admissions among the hospitalists.. She explains, “I have to fight with the hospitalists. They act like children. When we get a new heart failure exacerbation in the ED, they whine, ‘Why is it my turn?’ Because you haven’t taken one all week.”
The rest of the book: http://fifthchance.com/MedicalSchool2020
> MJ is laced with meth around here.
I knew a place once where they drizzled embalming fluid on it. About nine years ago, a neighbor (property owner/landlord) rented his (very) small house next door to a young couple, who started fighting on the first night with loud hollering you could hear 75 yards away. Soon thereafter it looked to me (judging from the cars) that at least two more people had moved in or were crashing there and it was being used as a party house. This was a TINY place – less than 500 square feet, just like a lot of today’s new, hip, “micro houses.”
One night I was awakened from my slumber in the upstairs apartment of my building at around 2:30 in the morning on a Saturday night. Someone was downstairs BANGING on the glass of the front bay window and front door screaming incoherently at the top of his lungs. I could make out one word: “BUGS!”
He kept banging and running into and out of the single streetlight – he was young, white, tattoos on this torso, no t-shirt, wearing shorts and a baseball cap. He appeared to run up the road and things went quiet for a minute and then BANG on my door, in the back of the building on the second floor! He’d gone up the back stairs!
Screaming: “Aaaagaghghaaaghghg! Bugs! Bugs!” and banging on the doors.
I was armed. I took my .40 Smith and Wesson 4040PD Airlite from its location and ran through the Rules of Engagement in case he managed to break a window and get in somehow. “You can’t shoot him unless he charges you and you have nowhere to go, and fear that you are in danger of imminent death or grave bodily harm.” I picked up my cellphone and dialed the police. Connect with the dispatch line. On duty cops are currently dispatched to another location, we’re summoning the State Police and advising. Are your doors locked?”
“Yes. And I am armed. Tell the SP that I am licensed and armed.”
They rolled up about eight minutes later. By that point our Space Cadet friend had left the premises for elsewhere. A search was conducted and I could see a scuffle happen a few hundred yards up the road.
He was arrested. Three days later, I think the exact same guy was back – this time sober – walking up and down the sides of the road. I think he was looking for his wallet that he realized he must have lost to the insects.
That house was mass-evicted about three months later. The new neighbor, who has been there since then, is a single mother with a young girl. She does all her own lawn-mowing, decoration, snow shoveling, leaf blowing etc., and is a fine neighbor and apparently a good mom. She has a flair for decorating the little place during various holidays.