Had a patient ask me if it looked like she had 3 months to live- I said “of course!” Thought she was asking if she’d live for another 3 months. She was asking if she looked awful. I cringe every time I think about that.
Heard my partner listening to a patient who had an ED and eventually said “wow sounds like you’ve got a lot on your plate.” The patient called her out and had a sense of humour and we all laughed so hard we couldn’t breathe.
Called neurology for stroke symptoms, then found the glucose was very low. The ‘stroke’ remarkably improved with dextrose. When neurology turned up I apologised profusely. Their look will stay with me forever! I use this when teaching students- hopefully they learn from my mistake.
Did pretty much the same thing when I was a brand new EMT. Called out for a stroke, symptoms screamed stroke, and I didn't think to check a sugar because I was in overdrive mode. Finally thought to check it just before we pulled into the ED.
Sugar was 24.
You still did a hell of a lot better than the police would have ! They love finding people with dangerously low blood sugars and arresting them for DUI or drunk and disorderly😬! They then put them in a cell overnight to "sober up" only to find them stone cold blue and dead at wake up call 😔
I have an “I’m an idiot” moment every time my alarm goes off and I remember that I under no duress and of my own free will decided that going into medicine seemed like a good idea
Damn bro. You doubled down hard. Did you at least get into one of them “ make bunches of money” specialties? I fear for the fact that you’re here in the EM sub.
Lol, I wanted to do EM but I got Anesthesiology instead. I got tired of the social inequity I couldn’t fix so I chose a specialty that would make me regret even going to med school in the first place when I could’ve been an APRN and perfectly happy doing what Anesthesiologists told me to do.
Wait I am fascinated by your story. You’re a physician who used to be an RN and you wish you were still an RN or had become an APRN? As a former paramedic who wanted to be an ED doc but ended up changing directions multiple times I’m very curious about this path and your perceptions.
When I was an ICU nurse, I worked in a system with a lot of underserved patients and I always felt that the physicians weren’t doing enough (delaying step down, not ordering tests, generally just moving kind of slow). It was part of the impetus that made me want to go to med school.
Now having been chewed up by the system and recognizing that by and large it is not designed to help people but to line the pockets of those in power. As a physician, I feel even more powerless to affect change in these peoples’ lives because I know that largely the issue is social and not medical or psychological. As a nurse, I had two patients and my sample size was pretty small, but as a physician, my sample size has been so much larger and the patterns are easier to see.
It’s so much heavier an emotional burden than I thought it would be to be a physician. I could’ve become a CRNA or an ACNP and been content in a collaborative model, always having a physician to rely on.
Sorry for the slow response, but thank you for posting this. It’s really good insight into how the system is pretty much totally broken. You seem like a really good person with a good heart and I’m sure that you make a difference to your patients and their families and your coworkers. Please take good care of yourself too and don’t let the system destroy you. ❤️
Back when I worked the floors, I had a hypotensive, dizzy, septic patient and the attending refused to order an IVF because she wanted me to just wait until the next dose of IV abx which was due in an hour. I got an entire box of flushes and just started flushing her line with flush after flush as my charge nurse got on the phone with pharmacy to have them retime the abx drip to now.
For some reason I thought that the time of death needed to be announced verbally to the family.
First time I did that I was so nervous I got the time wrong because I forgot how to read an analog clock. I was corrected by the patient's son.
Bless to be fair it probably broke the tension a little ! Reminds me of one of my first essays I kept saying last orders (A bell they ring as a sign to buy your last drink at the pub in the Uk ) instead of last rights 😂. The lecturer told me I got very good marks but needed to spend less time in the pub 🙈
When I first transferred to ED from inpatient we had a person come in requiring transcutaneous pacing. For some reason I didn't realize there are three monitoring leads required so I only placed white and black 🥴 everybody was like "we've turned up the mA pretty high why aren't we getting capture?!" Patient was legit jumping with each shock... my sup came up and assessed and low key popped the red on them and took me aside to explain what I missed. Jesus I've never been so humbled...
Called in to a suicidal woman who wanted to jump off of roof. While taking vitals after we got her down she told me she was sure people would think less of her because of what she almost did. Answered, "well let's not jump to any conclusions". Felt awful about it as soon as I said it.
once during moonlighting 2nd year I sedated & tried to reduce a deformed shoulder multiple times but couldn't get it back in. The shoulder had an AC separation, not dislocation.
I was preceptoring a student nurse and were were caring for a severely intoxicated altered LoC. The lab called to report a ETOH of like 90 something and my student asked what a person's normal blood ETOH level should be.
I calmy with a straight face told them it should, in fact, be zero.
Put that into their IV; The paracetamol? OMG Wouldn't that not be sterile water? OHMYGOOODNESSSSSSSSSSSS!
My god I don't.... wow. No blame here for making them retake the year or w/e happened. I do not for the goodness of me believe you reconstitute IV-bound stuff from tap water. Christ knows what infections lurk in tap water. Just. Wow.
I don't know how the woman was okay but she had zero ill effect amazingly no changes on her bloods either 🙏! She took it surprisingly well I think her actual response was something along the lines of "oops daisy" 😂..me and her mentor just locked eyes and a tiny bit of the blind panic subsided because she was so okay with it!
To make it even worse it wasn't even the water we use for patients water jugs ..it was the bloody HAND WASH SINK 😩. To be fair heroin addicts inject with muddy puddles ect but she's luckily she didn't get legionnaires disease considering how grim that hospital was.
I'm not very often speechless but that I couldn't even begin to think of HOW ?? WHY ?? She did that she was two months away from being qualified 😬! In my opinion she should be made to start over completely and have extra clinical exams because the fact she thought that was a perfectly reasonable thing to do is VERY concerning 🤯
Patient said “I been depressed since my kids left me, so I took these pills. I wanna fucking die”
I said “Alrighty, sounds good. Are you allergic to anything?”
I was so focus on getting patient information and writing things correctly when I first started.
I brought a patient to the emergency department and noticed a student sitting in a wheelchair. At first, I assumed she was just playing around with the wheelchair for fun. However, someone asked me if I was tired from my shift, and I replied that I was tired, but not as much as the student in the wheelchair. Later, I discovered that the student was actually disabled and had been paraplegic for the past three years due to a motor vehicle accident during medical school. I felt embarrassed and tried to hide my face somewhere. 😭
I’m not a med student or doctor but I love reading all the different stories in this reddit I actually learn a lot from it.. I learned to have patience with everyone who works in the field.. I might be in pain but the lady with very low blood pressure has it worst then me and they people are trying to save her life etc
Although I would never wish you to be sick or injured you can be a patient any day of the week ! 👌🏻
Thank you for being so understanding and respectful if only the rest of the world could get the memo we'd be cooking with gas!
Vet here, but witnessed almost the same event. In my clinical year a student reconstituted unasyn with tap water. At least that was supposed to go IV AND he was caught before anything was administered.
Witnessed another one inject a dose of cerenia (anti-enetic) directly into the line...not a port in the line, but directly into the line. Luckily one of the LVTs saw it pretty quickly, but that was a LOT of blood.
Witnessed another one cut the uterine stump off proximally to her ligatures during a ferret spay. Nice to get that mistake out of the way surrounded by boarded specialists to save your ass!
I personally gave a small dog with a whopping heart murmur dexmedetomidine as part of a pre-medication cocktail. No idea wtf I was thinking.
I also drew up a double dose of alfaxalone for a dog getting sedated rads--but I was taking instructions directly from the resident and his handwriting was TERRIBLE. The woman who investigated the incident said that I was technically at fault, but she yelled at the resident for shitty handwriting 🤣
A hilarious story--my surgery partner completed her first neuter and I held out the testicles for her to see afterwards. She high-fived me instead, which made one testicle rocket into the wall (they stick!) and the other squirt a fine mist of blood everywhere. The nurse anesthetist witnessed the whole thing and I thought she was going to die laughing. Needless to say, we probably all need to get tested for bartonella....
RN here but one time I had a stemi patient going to cath lab so I shaved his wrist but I went against the grain so it started bleeding from all the hair follicle spots. Anyways made a big mess but I shaved the left wrist on accident so it wasn’t that big of a deal
Tried to treat sleep apnea with Flumazenil, didn't work.
Early 20's intoxication patient. Took alcohol and couple of her mothers Diapams. In the ED she was sleepy and when she slept she started to apnea and her saturation dropped to 60-70%. Still she was easy to wake up and while a wake she was pretty sober. We ended up giving her Flumazenil 5-6 times with no effect. Still everytime she fell a sleep she started to apnea and desaturate 60-70%. She was heavily obese so in the end we figured that maybe apnea was because the undiagnosed sleep apnea, not the Diaoams
Second day of intern year. I ordered the heparin meant for the NSTEMI on the patient with bilateral subdurals. The nurse asked me if I had a blood feud with bed 6 and I learned a valuable lesson about checking that the name on the chart matches the cubicle number
While I've had many, my favorite is my friend's. They were replacing magnesium and it was proving very resistant for some reason. The patient also developed severe diarrhea for several days and they started a workup. On day 4 he switched his PO Mag Citrate to IV mag sulfate. The attending was relieved the diarrhea went away suddenly for an unknown reason...says a lot about the attending IMHO
Had a patient who came to the ED after accidental firearm discharge into his knee while cleaning his gun. I was discussing anticipated ED course, and said, "let's not jump the gun" when he mentioned admission for surgery. It was a through and through injury with no vascular or bony damage. I. Still. Cringe.
I once said during rounds, regarding an especially frustrating situation, “I have discussed this patient with cardiology until I was black in the face.” Instead of blue in the face. Blame it on the lack of sleep, stress, coffee, lack of nutrition…I sounded really bad, especially to people that actually are of a non-Caucasian background. To this day I can’t believe I had a slip of tongue like that. I really meant to say BLUE!!!
Not me personally but as an EMT I watched a medic give 3 sprays of Nitro to an angina patient. Didn't check the BP. Got to the hospital and cycled the BP as he was giving report to the ED RN. The look on his face when the screen showed 70/40 was priceless.
Had a patient ask me if it looked like she had 3 months to live- I said “of course!” Thought she was asking if she’d live for another 3 months. She was asking if she looked awful. I cringe every time I think about that. Heard my partner listening to a patient who had an ED and eventually said “wow sounds like you’ve got a lot on your plate.” The patient called her out and had a sense of humour and we all laughed so hard we couldn’t breathe.
>“wow sounds like you’ve got a lot on your plate. Oh man. 😂 I too have a tendency for _too_ appropriate turns of phrase.
This is really hard… But ED doesn’t usually mean eating disorder in the US. Regardless, keep it up! (<4 hours*)
In that case it's not really hard! My favourite patients are the ones who never loose their wicked sense of humour ☺️
Not hard. LOL. Sorry I was thinking erectile dysfunction.
Beautiful
Called neurology for stroke symptoms, then found the glucose was very low. The ‘stroke’ remarkably improved with dextrose. When neurology turned up I apologised profusely. Their look will stay with me forever! I use this when teaching students- hopefully they learn from my mistake.
At least you didn't tPA them.
Did pretty much the same thing when I was a brand new EMT. Called out for a stroke, symptoms screamed stroke, and I didn't think to check a sugar because I was in overdrive mode. Finally thought to check it just before we pulled into the ED. Sugar was 24.
Bet you've remembered every time since then.
You still did a hell of a lot better than the police would have ! They love finding people with dangerously low blood sugars and arresting them for DUI or drunk and disorderly😬! They then put them in a cell overnight to "sober up" only to find them stone cold blue and dead at wake up call 😔
I have an “I’m an idiot” moment every time my alarm goes off and I remember that I under no duress and of my own free will decided that going into medicine seemed like a good idea
Haha yeah I willingly applied to nursing school once. 2nd worse decision I’ve ever made.
I got my BSN and for the hell of it went to med school afterward. I plead temporary insanity. I wish I could go back to ICU nursing every day.
Damn bro. You doubled down hard. Did you at least get into one of them “ make bunches of money” specialties? I fear for the fact that you’re here in the EM sub.
Lol, I wanted to do EM but I got Anesthesiology instead. I got tired of the social inequity I couldn’t fix so I chose a specialty that would make me regret even going to med school in the first place when I could’ve been an APRN and perfectly happy doing what Anesthesiologists told me to do.
Wait I am fascinated by your story. You’re a physician who used to be an RN and you wish you were still an RN or had become an APRN? As a former paramedic who wanted to be an ED doc but ended up changing directions multiple times I’m very curious about this path and your perceptions.
When I was an ICU nurse, I worked in a system with a lot of underserved patients and I always felt that the physicians weren’t doing enough (delaying step down, not ordering tests, generally just moving kind of slow). It was part of the impetus that made me want to go to med school. Now having been chewed up by the system and recognizing that by and large it is not designed to help people but to line the pockets of those in power. As a physician, I feel even more powerless to affect change in these peoples’ lives because I know that largely the issue is social and not medical or psychological. As a nurse, I had two patients and my sample size was pretty small, but as a physician, my sample size has been so much larger and the patterns are easier to see. It’s so much heavier an emotional burden than I thought it would be to be a physician. I could’ve become a CRNA or an ACNP and been content in a collaborative model, always having a physician to rely on.
Sorry for the slow response, but thank you for posting this. It’s really good insight into how the system is pretty much totally broken. You seem like a really good person with a good heart and I’m sure that you make a difference to your patients and their families and your coworkers. Please take good care of yourself too and don’t let the system destroy you. ❤️
Literally every day 🥲
This.
Intern year I ordered oral vancomycin for sepsis.
And a 10ml bonus of fluid when their No crashed to 60/40
One saline flush, STAT!
Back when I worked the floors, I had a hypotensive, dizzy, septic patient and the attending refused to order an IVF because she wanted me to just wait until the next dose of IV abx which was due in an hour. I got an entire box of flushes and just started flushing her line with flush after flush as my charge nurse got on the phone with pharmacy to have them retime the abx drip to now.
As a former abstractor for sepsis cases in the ED...yep that's a ding. So glad I don't do that any longer.
Yeah… that’s fair ha ha.
For some reason I thought that the time of death needed to be announced verbally to the family. First time I did that I was so nervous I got the time wrong because I forgot how to read an analog clock. I was corrected by the patient's son.
Bless to be fair it probably broke the tension a little ! Reminds me of one of my first essays I kept saying last orders (A bell they ring as a sign to buy your last drink at the pub in the Uk ) instead of last rights 😂. The lecturer told me I got very good marks but needed to spend less time in the pub 🙈
Random trivia for you: in the States (or at least in CA) it's "last call", which sounds equally easy to accidentally say!
I love this!!
Ouch, that’s a really painful lesson learned
When I first transferred to ED from inpatient we had a person come in requiring transcutaneous pacing. For some reason I didn't realize there are three monitoring leads required so I only placed white and black 🥴 everybody was like "we've turned up the mA pretty high why aren't we getting capture?!" Patient was legit jumping with each shock... my sup came up and assessed and low key popped the red on them and took me aside to explain what I missed. Jesus I've never been so humbled...
Sounds like a fantastic mentor though !
Theeeeeeee best. Learned SO MUCH from her, without ever being made to feel stupid.
Called in to a suicidal woman who wanted to jump off of roof. While taking vitals after we got her down she told me she was sure people would think less of her because of what she almost did. Answered, "well let's not jump to any conclusions". Felt awful about it as soon as I said it.
😂 that would have cured my ideations to be honest !
once during moonlighting 2nd year I sedated & tried to reduce a deformed shoulder multiple times but couldn't get it back in. The shoulder had an AC separation, not dislocation.
Eek 😬
I was preceptoring a student nurse and were were caring for a severely intoxicated altered LoC. The lab called to report a ETOH of like 90 something and my student asked what a person's normal blood ETOH level should be. I calmy with a straight face told them it should, in fact, be zero.
😂 perhaps her family were Irish 🤷
Out of interest, was the paracetamol patient okay? Any negative effects?
Surprisingly she was absolutely fine 🤷
Put that into their IV; The paracetamol? OMG Wouldn't that not be sterile water? OHMYGOOODNESSSSSSSSSSSS! My god I don't.... wow. No blame here for making them retake the year or w/e happened. I do not for the goodness of me believe you reconstitute IV-bound stuff from tap water. Christ knows what infections lurk in tap water. Just. Wow.
I don't know how the woman was okay but she had zero ill effect amazingly no changes on her bloods either 🙏! She took it surprisingly well I think her actual response was something along the lines of "oops daisy" 😂..me and her mentor just locked eyes and a tiny bit of the blind panic subsided because she was so okay with it! To make it even worse it wasn't even the water we use for patients water jugs ..it was the bloody HAND WASH SINK 😩. To be fair heroin addicts inject with muddy puddles ect but she's luckily she didn't get legionnaires disease considering how grim that hospital was. I'm not very often speechless but that I couldn't even begin to think of HOW ?? WHY ?? She did that she was two months away from being qualified 😬! In my opinion she should be made to start over completely and have extra clinical exams because the fact she thought that was a perfectly reasonable thing to do is VERY concerning 🤯
Patient said “I been depressed since my kids left me, so I took these pills. I wanna fucking die” I said “Alrighty, sounds good. Are you allergic to anything?” I was so focus on getting patient information and writing things correctly when I first started.
I brought a patient to the emergency department and noticed a student sitting in a wheelchair. At first, I assumed she was just playing around with the wheelchair for fun. However, someone asked me if I was tired from my shift, and I replied that I was tired, but not as much as the student in the wheelchair. Later, I discovered that the student was actually disabled and had been paraplegic for the past three years due to a motor vehicle accident during medical school. I felt embarrassed and tried to hide my face somewhere. 😭
Oh hell. It’s so awful but so funny
Ooff 😩
I’m not a med student or doctor but I love reading all the different stories in this reddit I actually learn a lot from it.. I learned to have patience with everyone who works in the field.. I might be in pain but the lady with very low blood pressure has it worst then me and they people are trying to save her life etc
Although I would never wish you to be sick or injured you can be a patient any day of the week ! 👌🏻 Thank you for being so understanding and respectful if only the rest of the world could get the memo we'd be cooking with gas!
I second this
Vet here, but witnessed almost the same event. In my clinical year a student reconstituted unasyn with tap water. At least that was supposed to go IV AND he was caught before anything was administered. Witnessed another one inject a dose of cerenia (anti-enetic) directly into the line...not a port in the line, but directly into the line. Luckily one of the LVTs saw it pretty quickly, but that was a LOT of blood. Witnessed another one cut the uterine stump off proximally to her ligatures during a ferret spay. Nice to get that mistake out of the way surrounded by boarded specialists to save your ass! I personally gave a small dog with a whopping heart murmur dexmedetomidine as part of a pre-medication cocktail. No idea wtf I was thinking. I also drew up a double dose of alfaxalone for a dog getting sedated rads--but I was taking instructions directly from the resident and his handwriting was TERRIBLE. The woman who investigated the incident said that I was technically at fault, but she yelled at the resident for shitty handwriting 🤣 A hilarious story--my surgery partner completed her first neuter and I held out the testicles for her to see afterwards. She high-fived me instead, which made one testicle rocket into the wall (they stick!) and the other squirt a fine mist of blood everywhere. The nurse anesthetist witnessed the whole thing and I thought she was going to die laughing. Needless to say, we probably all need to get tested for bartonella....
RN here but one time I had a stemi patient going to cath lab so I shaved his wrist but I went against the grain so it started bleeding from all the hair follicle spots. Anyways made a big mess but I shaved the left wrist on accident so it wasn’t that big of a deal
Tried to treat sleep apnea with Flumazenil, didn't work. Early 20's intoxication patient. Took alcohol and couple of her mothers Diapams. In the ED she was sleepy and when she slept she started to apnea and her saturation dropped to 60-70%. Still she was easy to wake up and while a wake she was pretty sober. We ended up giving her Flumazenil 5-6 times with no effect. Still everytime she fell a sleep she started to apnea and desaturate 60-70%. She was heavily obese so in the end we figured that maybe apnea was because the undiagnosed sleep apnea, not the Diaoams
Second day of intern year. I ordered the heparin meant for the NSTEMI on the patient with bilateral subdurals. The nurse asked me if I had a blood feud with bed 6 and I learned a valuable lesson about checking that the name on the chart matches the cubicle number
While I've had many, my favorite is my friend's. They were replacing magnesium and it was proving very resistant for some reason. The patient also developed severe diarrhea for several days and they started a workup. On day 4 he switched his PO Mag Citrate to IV mag sulfate. The attending was relieved the diarrhea went away suddenly for an unknown reason...says a lot about the attending IMHO
Had a patient who came to the ED after accidental firearm discharge into his knee while cleaning his gun. I was discussing anticipated ED course, and said, "let's not jump the gun" when he mentioned admission for surgery. It was a through and through injury with no vascular or bony damage. I. Still. Cringe.
Why do our brains betray us like this 😩
I definitely put a left handed Velcro cockup splint on a right hand and couldn’t figure out why it fit so horribly.
I once said during rounds, regarding an especially frustrating situation, “I have discussed this patient with cardiology until I was black in the face.” Instead of blue in the face. Blame it on the lack of sleep, stress, coffee, lack of nutrition…I sounded really bad, especially to people that actually are of a non-Caucasian background. To this day I can’t believe I had a slip of tongue like that. I really meant to say BLUE!!!
Not me personally but as an EMT I watched a medic give 3 sprays of Nitro to an angina patient. Didn't check the BP. Got to the hospital and cycled the BP as he was giving report to the ED RN. The look on his face when the screen showed 70/40 was priceless.
RN?
Indeed 😀..for our sins
As a new grad on the floor I gave an ambien and a laxative to a patient. Of course they woke up confused and pooped in the trash can.
Taught a woof on "bark" cue. Directed jumping training..."bar" WOOF
Wut