If you have read some of my previous posts, you know how important I think it is that we all remain grateful for how fortunate we are. For most of us, our lives are fantastic. Some days certainly are worse than others of course. For some people watch them strike out, things can be really bad. On rare occasions, one can receive news that changes his or her life forever. Stay tuned.
I thought I would share a few recent cases that I’ve had in the emergency department. I will describe these in what I consider increasing seriousness.
Case number I is not too bad. This was a much older lady who was on Eliquis which is a blood thinner. She has coronary artery disease with stents. While being pushed in her wheelchair, her extended leg simply rammed into the bumper of a car. She came in three days later with an infected hematoma (collection of blood) that required incision and drainage with several days in the hospital for IV antibiotics. She ended up coming in several weeks later for an unrelated issue and her leg looked much better surprisingly. This serves as a great example as to why we ER doctors take head injuries so very seriously when the patient is on a blood thinner. Relatively minor head trauma can result in a life-threatening brain bleed.
The guy for Case number II tried to fend off “some dude” with a knife who was attacking him. Paramedics were able to retrieve the end of the finger and put it on ice for us. The hand surgeon on call attempted re-plantation knowing that it likely would not heal. I don’t know what ultimately ended up happening, but the guy probably would need a skin graft for delayed closure.
The photo for Case III shows what’s called a trimalleolar fracture of a lady who twisted her ankle very forcefully while out hiking. She was simply trying to get a little exercise in the outdoors and now she had to have surgery. She’ll be out of work for at least a month. Hope she doesn’t have any complications such as infection, hardware problems or blood clot. Wouldn’t that be a bummer?
I felt bad for the 35-year-old father in Case IV who was out jet skiing in Mission Bay with his daughter on the back. He hit a wave and they were thrown off the jet ski. His daughter was unharmed, but he landed very awkwardly with his legs in the split position. Somehow, he was able to swim to shore with this absolutely nasty midshaft femur fracture. Yup, major surgery for him.
For the last two cases, I don’t know which is worse. I will let you decide.
A 72-year-old lifelong smoker came in with six hours of left-sided chest pain. A rather stoic gentleman, he didn’t seem to be in that much pain. But for crying out loud, look at the EKG image! For nonmedical people, he is displaying what is known as “Tombstone” ST segment elevation. When we see that finding, the patient has an extremely low chance for survival, due to a massive heart attack in progress. Time to buy the cemetery plot!
We got him to the cardiac catheterization lab as soon as possible. I heard that as the cardiologist was opening the 100% clogged coronary artery, he went into ventricular fibrillation/cardiac arrest but fortunately was defibrillated and survived… at least temporarily.
The final image may be hard for some of you to interpret, understandably. This super pleasant 66-year-old guy came in having not had a bowel movement for a week. He didn’t have any abdominal pain, blood in his stools or recent weight loss. It always strikes me as odd when anyone, especially someone older, presents with constipation. Why would someone not be able to poop without a good reason? Experience has taught me to work these patients up as much as possible in the emergency department before sending them home. Sure enough, this guy’s CT scan showed a large colon mass that had spread throughout his abdomen including his liver. Stage IV colon cancer. He will need to have a large part of his colon removed and will probably have a colostomy. He’ll be able to poop but for the near future it will be into a bag.
Giving him this devastating news broke my heart, knowing what laid ahead for him. To make matters worse, I had to tell him without any loved ones at his bedside, due to the Covid 19 no visitation policy that is in place almost everywhere. He asked me to call his wife which of course I did. Let’s just say she didn’t take it quite as well as her husband did. This case struck me because my father had colon cancer also. It sucks. It really, really sucks.
So next time you think you're having a bad day, remember these patients. Stay well. And go run. It will make things better.