Sunday, April 3, 2016

Children of the Candy Corn

I may have studied for longer than I should have yesterday and last night, and am probably paying for it today. I'm not up to studying at all today, but it's OK because all of the study guides and study methods recommend studying just six days per week for Step 1 of the USMLE. For the most part I plan to take Mondays off rather than Sundays, as it's nice to have one's day off be a business day, plus I like the idea of sleeping late on Mondays. I'm not exactly sure why, as sleeping late is sleeping late no matter what day of the week it is, but somehow it just seems more decadent to do so on a Monday than on a Sunday.

Matthew and I are having company later this afternoon and this evening. A few people from school are stopping by to visit. It will be Matthew's job to entertain them. I'll come out of hibernation only to the extent that I feel up to it.

I didn't say a whole lot about this at the time, but during the last two quarters, all of us in my cohort were required to fulfill several stints of physician-shadowing. I did two here -- with my PseudoUncle Scott and with a neuro-ophthalmologist who is a close friend of the family. I did four more at school, including a 24-hour stint in the emergency room.

One of our professors was trying to warn us that what we would see to a small extent in the shadowing assignments and to a larger extent in our clerkships and internships would challenge anything  and everything we have ever come to believe about how society as a whole functions. She expressed an opinion that most of us have led relatively sheltered existences as children and adolescents and that most of us had relatively high-functioning parents, surmising that most of us would not have made it to medical school had we not had functional parents. Raptor Jesus II offered a slightly dissenting opinion when he said to the professor that I [Alexis] would have made it to medical school even if my mom had been a crack ho and my dad had been any one of 100 of her johns in months near my presumed date of conception. God, how I love that guy.

Anyway, the professor said that we would see -- particularly in the E.R. -- some examples of parenting that would make us question how our species  had survived up to this point and would give us a very dismal outlook for the future of the human race. I don't know if such has been or will be the case for everyone in the cohort, but it has certainly rung true for me.

One of the standard complaints almost everyone who works in an E.R. expresses is that a segment of our population treats the emergency room as their family physician's office. The Affordable Care Act was designed at least in part to put a stop to or at least to make a significant reduction in this practice, but I can't see that it's made much of a dent.

I shared a story in an earlier blog about a fifteen-year-old girl whose parents had her transported by ambulance to the E.R. because of what ended up being menstrual cramps, and probably not even a very serious case of cramps. She carried on as though it was a gall bladder attack or kidney stone (her mother was sure the girl was plagued with one of those two conditions) as long as any medical personnel were looking, but was sending relatives to the vending machines for snacks when she thought the nurses weren't looking. I was never quite sure what she hoped to accomplish with her E.R. visit, as she seemed a bit young to be an opium addict. Then again, one never knows.

I can't remember if I shared this incident from one of my shadowing assignments, but a grandmother brought her thirteen-year-old grandson to the E.R. because he had a small asymptomatic discoloration about the size of a Rice Krispy on one of his testicles. He'd had the discoloration for maybe three weeks according to the grandmother.  I don't know what force motivated the grandmother to all of a sudden bring the kid to the E.R. at 1:00 a.m.  on a Saturday for a 21-day-old testicular discoloration of 1.5 by 2 centimeters presenting neither pain nor even itching. I'm all for checking out testicular abnormalities, but this particular case probably could have waited until clinic hours the following Monday.

The E.R. case I witnessed personally that showed me just how directly society is going to the dogs is one you will not believe. i wish I had been allowed to videotape it, but anyone who has been to an emergency room or even to a physician's office in the past ten years or so knows all about HIPAA regulations and how medical school students cannot violate patients' privacy to film even the most unbelievable of cases even if it would serve the public to know how their tax dollars are being squandered by submoronic parents with public insurance. I'm confident  that sooner or later this particular case will end up being shown on one of those cable network real-life E.R. reenactments. Please let me know if you see it. 

Anyway,  two boys came to the E.R. via ambulance -- a four-year-old and a five-year-old -- accompanied by their mother. She had been shopping with them earlier in the day. This was in November, and  Halloween candy had been priced for clearance sale. The mother bought each of her four children his or her own bag of candy corn. The five-year-old ate his own bag of candy corn, his one-year-old sister's bag, and had started in on his two-year-old brother's bag of when he began to suffer from acute gastric distress. Meanwhile, his four-year-old brother presumably ate at least a few candy corns, but also managed to lodge one up each nostril and into each ear canal. the mother used the tweezers from an Operation board game (she did a bit of damage because she thought that as long as the Operation tweezers weren't making a buzzing noise, she wasn't actually hurting the child) to attempt to remove the candy corns from the child's ears and nostrils, but had only succeeded in lodging the candy corns even more firmly into their respective cavities. 

Instruments were used to removed the candy corns from the four-year-old's nasal cavities and ear canals. The kid predictably screamed the entire time. The mother wanted to know why something couldn't be prescribed to make the little boy feel better or at least to calm him. The doctor said, "Because he needs to know that if he sticks things up his nose and into his ears, having them removed won't be a pleasant experience." Removing the candy from the kid's nose should not  have been particularly painful (except for his nasal cavities being a bit tender from his mother rooting around inside them with the Operation tweezers), though it's not pleasant to have objects stuck up one's nose, which would have been a great reason for the kid not to have put the candy corns there in the first place. The doctor did put anesthetic drops into the kid's ears.

The physician checked out the five-year-old to ensure that his vital signs were OK, that appendicitis wasn't being overlooked, that there was no evidence of a blockage or rupture of any kind, or that such was not impending. There wasn't and it wasn't. The diagnosis was "ingestion of too much candy," for which there is an actual ICD code (WX46.887, if you're interested). She told the kid and his mother that if he eats two entire bags of candy in a single sitting, he should expect to feel lousy. The mother was insistent that her child be given something to make him feel better. The doctor said she couldn't recommend even Pepto-Bismol because it might constipate the kid, which is the last thing in the world anyone should want at that point. She said that if the condition turned into diarrhea, Pepto-Bismol would be fine, but it shouldn't be given to the child until or unless he actually experienced diarrhea. The mother wanted the E.R. physician to provide her with the Pepto-Bismol that the child might eventually need. The physician gave her a list of pharmacies with addresses. The physician told me afterward that she would have provided the pink bismuth medication to the parent except that she really didn't want it to be given to the kid if he didn't have diarrhea, and that the mother probably wouldn't go to the trouble of acquiring the medication and giving it to the little guy needlessly if she had to go to the pharmacy and pay for it herself.

If you had any doubt that your tax dollars are being wasted in our nation's emergency rooms by irresponsible parents, doubt no more. Don't blame the E.R. personnel, however. They're doing the best that they can to minimize the damage.


  1. This is not unique to the USA. I could write a book on comedy/tragic episodes in the ER. The sense of entitlement and learned helplessness sure gets ER staff down. In spite of this I loved working in ER for several years.

  2. My dad works two 12-hour ER shifts each month. He really likes it.

    1. I would think working in the ER would be fascinating. Too bad I'm so squeamish.

      As for people using the ER as a doctor's office, that was one topic that often came up when I was getting my MPH. It's the 7 Eleven of healthcare and some people will keep using it because they can. I think some folks simply enjoy the drama of the place and it doesn't occur to them that it costs a lot of money to run an ER. They don't care, so the rest of us end up paying.

    2. It's my belief that if of the people who use ERs as family doctors or use ambulances as taxi services were charged even a nominal co-pay, it would drastically reduce the incidence of overuse.

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  4. My brother used to stick frozen peas up his nose. My mom got really good with the little bulb thing because she didn't want to pack up four kids and drive 45 minutes to the doctor every time.

    I am sure lots of people abuse the er. When I was in undergrad it seemed that the campus's health center's policy was to use the er as an extension of their services. If they couldn't fix you with Tylenol or condoms they had the campus police drive you to the nearest er to be treated.
    I had to go a couple of times, the worst being when after days of being sick, I couldn't sleep at 3 am and my then boyfriend, now husband insisted he needed to take me in. I somehow had mono (even though I couldn't sleep) and the male nurses thought it would be fun to talk about how I must have been making out with my boyfriends housemate who was also afflicted. Never mind that I had never so much as shaken his hand. Anyway luckily the services at the farm in grad school were much better!