Bizarre Emergency Cases 2007 - first quarter

Back......due to popular demand are Bizarre Emergency Cases which presented at our emergency department.

But I'm Innocent....
A gunshot victim was rushed to our trauma centre while maintaining the fact that he was "just an innocent bystander". Unfortunately the bullet had hit his spinal cord and he arrived a paraplegic. As we log-rolled him and and the physician stuck a finger up his rectum to check for rectal tone, a gram of cocaine was removed. Innocent bystander my a_ _!

A homosexual male presented in an obvious drug and alcohol state very concerned that he had ripped all his stitches inside his mouth from a jaw fracture surgically repaired one week ago. He was all weepy that he couldn’t feel the stitches anymore and after prodding admitted that the reason he felt he had ripped them out was because of aggressive oral sex (he was the initiator not the initiatee). After letting him sweat it out for awhile I gently reminded him that he would have had dissolvable sutures.

An HIV +ve male was conducting safe sex with the use of a dildo when his butterfingers partner accidentally let go of the toy in his rectum. This man was mortified at having to come to emerg and, as in many of these cases, was seen by a surgeon and scheduled to have the dildo surgically removed in the morning (the rectum creates a type of suction which makes extraction of anally-inserted objects almost impossible without sedation and surgical intervention). Well, by morning he complained to me that he felt like he needed to defecate. I told him to go for it and PUSH. Much to his, and the taxpayers delight, he excreted a 7inch red rubber dildo.

A young male HIV +ve male presented with a one week history of fatigue and sudden jaundice. His family doctor had done a blood test and sent him straight to Emerg. This poor man had extremely elevated liver enzymes (suggesting liver damage). On examination he confided to me that he had injected anabolic steroids as a weightlifter. He had also doubled his dose of an herbal liver toxin flush and kidney toxin flush. He was admitted for further investigations/treatment so I am not aware which of the above substances may have caused this state. His case was also referred to the Poison Control Centre for analysis. He was an interesting but sad case.

An executive presented to emerg with jaundice and strep throat for one week. This man said he had been too busy to see his family doctor for his sore throat so he had been taking Tylenol tablets every 2 hours to help with the pain. Now he had been dragged in by his partner who had noticed that he was jaundiced (the man was as yellow as a post-it note). Liver function tests confirmed that his Tylenol blood levels were toxic and that he was in a state of severe liver dysfunction. What was bizarre about this case was that, when presented with this information, the man said he was too busy to stay for treatment (i.e. 24-hours drug therapy to remove the Tylenol from his liver). The man was warned that he could actually die within one week as his liver was extremely compromised. It took a lot of coaxing but I finally had him convinced to stay for 2 hours, then 4 hours, then 8 hours (and then I had to leave).

A Case of Mistaken Priorities...
A 53 year old male presented with 24h of upper back pain and left sided chest pain. He had come to the emergency department requesting analgesics for the pain. An ECG and blood test showed that he had had a large myocardial infarction (heart attack). And, the concern was that on top of the heart attack he may be having an aortic dissection. He was moved to in front of the nurses's desk and referred to cardiology for a stat ICU admission and for a stat CT scan of the chest. Much to our surprise, when he learned that he was being admitted he took off all his ECG leads and said "I wasn't planning for this and I don't have time to come into the hospital. Just give me my painkillers and I will go." The cardiologist, the emergency doctor and myself BEGGED him to stay stating that if he left he risked sudden death within the next 48 hours. All the of the risks and concerns were explained to him but he insisted that he wanted to leave. On top of this we had to revoke his drivers license because the risk was too great that he would die driving. In the end, he tore out his IVs and left by taxi. There was nothing we could do because he was of competent mind and could form his own decisions. I wonder what happened to him......

A Love Story...
A 26 year old black female ex-hooker presented to the emergency department for a blood test. She was a previous heroin user but currently on methadone to quit her addiction.

Sasha didn't "look or act" like your typical ex-heroin users. She was well dressed, articulate, humourous, cheerful and not at all manipulative. She had been sent in by one of our ER doctors who also works at the methadone clinic for drug users. She needed a pregnancy and potassium blood test. As she jokingly guided us as to where one her last usable veins for venipuncture existed (iv drug users are notorious for having sclerosed, unusable veins) she told us a bit about her story. She was a honours high school student who made some bad choices out of school. She became a hooker and took heroine to help her deal with her clients. One day in her apartment elevator, a man asked her if she wanted to "visit the roof with him" (there was a rooftop patio). Naturally she assumed he wanted a trick and she was shocked to discover that he just wanted to talk...have a date. It turns out he was a widow with two small children. They are now engaged and she is fully committed to kicking her heroin addiction. I must admit, I tend to be very pessimistic about ex-drug users but my gut (and my hope) truly feel that she is on the right path. Best of luck Sasha!