More ER stories

"19-year-old man presented after an injury suffered while swordfighting." I was expecting a stab wound, but it turns out that he just dislocated his shoulder while thrusting and twisting. Kind of an unusual mechanism for a shoulder dislocation.

"42-year-old man was riding his skateboard while carrying 20 dollars worth of eggnog. He accidentally tripped and lost all the eggnog on the street. He became angry with himself and hit his head with the metal skateboard, resulting in a laceration to the middle of his forehead."

"57-year-old man was at home, got 'bored,' and shoved a pencil up his urethra." Ouch! He wound up with a lot of blood in his bladder, and a severely bruised ego. He was embarrassed to talk to me about the injury, as he should be - he is old enough to know better, especially since this is not the first time he has injured himself this way. Unfortunately, he is mentally ill, which explains why he has this bad habit.

I had another patient the other night who has chronic bipolar disorder. He came in with a vague history of having been assaulted, with no feeling or movement in his legs. He seemed a lot less concerned about this than I was - I offered to do a lumbar puncture to help investigate what could be causing his illness, and he declined because "I just need to take my medication and my legs will get better." He then said, "Dr. X says that the more I walk, the more paralyzed I become, so there is nothing I can do to make it better. I just have to keep on keeping on, you know." He was not making much sense. Fortunately, we were able to talk him into getting the study - I hope that he has received the surgery he needed to restore feeling and movement in his legs.

A lot of my patients are mentally ill, and the mentally ill are at high risk of bad medical care for the following reasons, among others:

• It is hard to get a reliable, believable history from a patient who believes that aliens have implanted probes in his brain, for example.
• The mentally ill do not necessarily cooperate with physical exams.
  
• Mentally ill patients do weird things to themselves and thus suffer weird injuries.
• The mentally ill often do a poor job of following instructions after care (taking medicine, etc.)
• Doctors kind of feel uncomfortable about treating the mentally ill, because of concerns that the patient will be dangerous, and because it is kind of icky to talk to them.
• The mentally ill often fall down the socioeconomic ladder as a result of being unemployable and making poor economic decisions, and thus wind up compounding the medical disadvantages of mental illness with all the medical disadvantages of poverty.