Injection
Still groggy from being woken up at 3 AM, I reached for the phone after grumbling out a few four-letter words and returned the page. The ER was calling.
When the ER doc said the name of the patient, it sounded vaguely familiar. Like the name of a distant high school friend. As he continued to tell me more about this patient's arm, my mind wandered back and forth, trying to match a face with this patient's name.
All of a sudden I realized I was only listening to about every 5th word the ER guy was telling me. No matter. All I really needed to know was where this patient was and his name. The rest of the information I'd get myself when I get to the ER.
I know that sounds like it's the wrong thing to do, but ever play that game Telephone? Or Grapevine, or whatever it's called? Where someone says one thing (like the sky is blue), it gets passed down the line, and by the time you hear it, it's something completely different (like Joe's mother's a gorilla). Anyway, something similar happens in medicine as well. The patient tells the ER nurse one thing, she tells the resident another thing, he goes and tells the ER staff yet another permutation, he processes it, and then he calls me for a consult and tells me something related to it, but not quite correct. So I always make it a practice to just get my own history when I get to the ER.
So I get up, get dressed, and drive to the ER. The whole time trying to figure out why this guy's name sounds so familiar.
But the minute I walk into the room I recognize him as the kid I took care of about 6 months ago. I remembered him because he came in as a trauma after rolling his ATV, and while examining him for life threatening injuries, I found a marijuana pipe in his pocket. The kid lucked out and left the hospital without surgery, despite suffering a fractured spleen.
Turns out he started crushing up the Vicodins I prescribed him for pain control and shooting it up his arm. After he ran out of the Vicodins I prescribed him, he went around weaseling prescriptions from one ER to another. And since he had a legitimate reason for his pain (4 broken ribs and a fractured spleen), the various ER docs gave him refills. Which he then continued to shoot up.
Well, considering a 17-year old knows nothing about surgical sterility, he never disinfected the needle between uses. Being young, his body easily overcame the small subcutaneous infections caused by the needle. But 4 days ago, he accidentally injected the crushed Vicodin into his brachial artery.
This bled and caused a hematoma to form under his skin. A large blood clot. This then became bacterial growth medium. His arm swelled up with the infection, and when pus started to drain out of it, he came to the ER.
And so here we were.
As I started to drain the pus and start the debridement of dead tissue from his arm, I asked him if he was still doing dope. To which he vehemently denied.
Kid: No man, I told you I was going to quit.
I checked his urine drug screen. Surprisingly, he wasn't lying. He only tested positive for opiates. So it looks like the talk I had with him about stopping marijuana before he left the hospital last time worked.
It's too bad I didn't mention anything about shooting up crushed Vicodin.
When the ER doc said the name of the patient, it sounded vaguely familiar. Like the name of a distant high school friend. As he continued to tell me more about this patient's arm, my mind wandered back and forth, trying to match a face with this patient's name.
All of a sudden I realized I was only listening to about every 5th word the ER guy was telling me. No matter. All I really needed to know was where this patient was and his name. The rest of the information I'd get myself when I get to the ER.
I know that sounds like it's the wrong thing to do, but ever play that game Telephone? Or Grapevine, or whatever it's called? Where someone says one thing (like the sky is blue), it gets passed down the line, and by the time you hear it, it's something completely different (like Joe's mother's a gorilla). Anyway, something similar happens in medicine as well. The patient tells the ER nurse one thing, she tells the resident another thing, he goes and tells the ER staff yet another permutation, he processes it, and then he calls me for a consult and tells me something related to it, but not quite correct. So I always make it a practice to just get my own history when I get to the ER.
So I get up, get dressed, and drive to the ER. The whole time trying to figure out why this guy's name sounds so familiar.
But the minute I walk into the room I recognize him as the kid I took care of about 6 months ago. I remembered him because he came in as a trauma after rolling his ATV, and while examining him for life threatening injuries, I found a marijuana pipe in his pocket. The kid lucked out and left the hospital without surgery, despite suffering a fractured spleen.
Turns out he started crushing up the Vicodins I prescribed him for pain control and shooting it up his arm. After he ran out of the Vicodins I prescribed him, he went around weaseling prescriptions from one ER to another. And since he had a legitimate reason for his pain (4 broken ribs and a fractured spleen), the various ER docs gave him refills. Which he then continued to shoot up.
Well, considering a 17-year old knows nothing about surgical sterility, he never disinfected the needle between uses. Being young, his body easily overcame the small subcutaneous infections caused by the needle. But 4 days ago, he accidentally injected the crushed Vicodin into his brachial artery.
This bled and caused a hematoma to form under his skin. A large blood clot. This then became bacterial growth medium. His arm swelled up with the infection, and when pus started to drain out of it, he came to the ER.
And so here we were.
As I started to drain the pus and start the debridement of dead tissue from his arm, I asked him if he was still doing dope. To which he vehemently denied.
Kid: No man, I told you I was going to quit.
I checked his urine drug screen. Surprisingly, he wasn't lying. He only tested positive for opiates. So it looks like the talk I had with him about stopping marijuana before he left the hospital last time worked.
It's too bad I didn't mention anything about shooting up crushed Vicodin.
posted by THW at 12:30 PM
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