Plastic Jesus, Plastic Surgeon

S: Adorable 2-year-old girl frantically rushed by her mother to the pediatric ER after falling from the top bunk bed while clutching a ceramic statue of the Virgin Mary. The statue shattered, slicing open the girl's right temple.

O: T 98.4 . . BP 85/50. . HR 115. . RR 24. . O2 sat 99%
5 cm laceration on R temple approximately 1cm in depth with no discernible ceramic fragments embedded. Subcutaneous tissue and temporalis fascia exposed. Bleeding well controlled [that is to say, until I started stitching...]

A/P:
1. Patient placed under conscious sedation with ketamine.
2. Laceration vigorously irrigated with 0.9% saline solution, sterilized with betadine, anesthetized using 1% lidocaine with epinephrine. Subcutaneous closure with 5-0 vicryl. Skin closure with 8 interrupted stitches of 6-0 nylon.
[Have you ever experienced the delight of using super super thin nylon suture the same color as your squirming pediatric patient's hair??? Exhale a little too enthusiastically and the suture blows all the way across the room. But the results were gorgeous. I could have been a plastic surgeon]
3. Mother advised to keep the wound clean & dry, have stitches removed in 7 days, and strongly urged to use plastic religious icons instead of ceramic.

Let's Order a Round of Pulmonary Emboli

Insanely busy day on call with rapid-fire admissions:

Admission #1: An affable 80-year-old man from a nearby island, s/p hip replacement surgery, on coumadin with a subtherapeutic INR and a right pulmonary embolus. We increase his coumadin, start him on lovenox and run off to...

Admission #2: A 53-year-old attorney recently recovered from a sprained ankle, admitted for chest pain and shortness of breath, found to have small bilateral pulmonary emboli. Really! Lovenox, anyone? Let's throw in some coumadin and a little oxygen by nasal cannula before we head toward...

Admission #3: A 27-year-old G1P0 who is 7 weeks pregnant with a cough and some swelling in her left calf. Are you kidding me?? She, too, has small bilateral pulmonary emboli in addition to a DVT in the left popliteal vein. More lovenox! (but coumadin is verboten, being a teratogen and all...)

I could horrify you with more sordid tales of admissions for pulmonary emboli, but let's quit while we're ahead, shall we?

All About Eve

You do not truly understand the addictive properties of heroin until you take care of a patient who continues to shoot up despite being hospitalized repeatedly for Strep viridans endocarditis, Enterococcus osteomyelitis, methicillin-resistant Staph aureus abscesses, HIV nephropathy, and a dash of Hepatitis C.

The social workers avoid him like the plague because of his outer coating of surliness. He rolls his eyes whenever you enter the room. He refers to his brilliant infectious disease specialist as "that Oriental dude".

But one day you catch him watching "All About Eve" on cable and he admits that he love love loves Bette Davis. A week later he describes an episode of "20/20" about Broken Heart Syndrome and wonders aloud if he has it after all the grief he's experienced in the last 2 years.

Soon you feel like an old married couple when you find him back in his room after an interventional radiology procedure, still wearing the bouffant scrub cap that resembles a glorified shower cap, eating half a watermelon with a spoon. "Look at my pee," he says, pointing to his plastic urine container. "Does that look normal?"

The next time he's admitted to the hospital, you breathe a huge sigh of relief when it's just run-of-the-mill community-acquired pneumonia.