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Wow! I can’t make this stuff up (Part 2)

This article is the second in a two-part series from Sonya Sloan, MD, who shares a few of the many unbelievable patient encounters she’s had as a locum tenens physician.

The practice of medicine is unpredictable. As a locums orthopedic surgeon for nearly two decades, I have taken care of some out-of-the-ordinary injuries. I’ve categorized some cases as “I can’t make this stuff up.” Here are some of my most memorable encounters.  

*Note: These stories have been slightly altered to protect my patients’ identities.  

We are not in Kansas anymore

Unfortunately, my occupation deals with a lot of trauma and misfortune. But one assignment I will never forget.

I had a contract with a nearby hospital for orthopedic coverage after Joplin, Missouri, which had been devastated by an F-5 tornado. A few weeks after the devastating tornado, I arrived for my assignment. There are no words to explain the utter devastation this small city had endured, only tears to express my heartfelt empathy.

The central hospital and surrounding area looked like a war zone. I saw a car crumpled like a piece of paper on one street. Bark and branches had been forcibly sucked off trees. There were remnants of houses strewn everywhere: roof tiles, jagged wood pieces, and broken glass. Some homes were just a slab of concrete with stairs leading to basements. I found myself repeating the phrase “I hope they survived,” over and over again.

On my first night on call, I saw a patient whom I will call Dorothy. She had multiple shards of glass embedded in her feet and had tried to remove the pieces of glass as she walked around barefoot. Even though she had shards of glass in her feet — which she tried to remove herself as she walked — she told me she wanted to help those in her community before she sought medical attention. And she had lost everything.

Her foot had become infected, and I had to take her to surgery to remove the remaining embedded glass and wash out her wounds. The following day I rounded and shared the good news that she would be ok. She became very visibly anxious, wanting to leave as soon as possible. I told her she’d need to stay for wound care and intravenous antibiotics, but she wanted to leave right away.

There was a predicted forecast of strong afternoon thunderstorms which could produce strong tornadoes. I saw the fear in Dorothy’s eyes. How to deal with trauma triggers is not something we are taught in medical school, but I did my best in consoling her and prayed for a quiet afternoon. I told her to change the channel and stay away from weather stories or movies like the Wizard of Oz.

Dorothy agreed!

One-armed bandit

“Ms. Cherry” was a lively patient. Because of her graceful aging, you would never know that Ms. Cherry was a 60-year-old grandma who had a passion for the slots. Specifically, she loved the nickel slots at the casino in town.

One particular evening, Ms. Cherry got up from her stool at the slot machine a little too quickly after a “few” drinks. She fell, twisting her ankle. She heard a loud cracking noise and felt instant pain. Upon arrival to the ER, her X-rays confirmed she had an ankle fracture-dislocation that was unstable. I took Ms. Cherry to the OR urgently. I fixed her bi-malleolar fracture with open reduction and internal fixation (plate and screws).

As Ms. Cherry is getting ready to be discharged, she realized she had dropped her phone at the casino near the slot machines. She didn’t know any contact numbers by heart, so she couldn’t call anyone to come pick her up. And no, there was no next of kin or in case of emergency on her chart. A hospital case manager was consulted to assist with a medical Uber to take her home.

But instead of being taken home, Ms. Cherry asked if she could be dropped off at the casino.

Shiny new pennies

It was a beautiful sunny summer day in the Deep South. A gentleman, whom I will call “the pool guy,” was cleaning the skimmer baskets of his pool.

He spotted something shiny and thought his kids had perhaps lost some new pennies in the pool. As he reached inside the basket to clear it out, he felt a sharp, piercing blow to the dorsum of his hand. He realized in that split-second that the unfamiliar searing pain was probably the bite of a local venomous snake called a copperhead.

I was called to be present upon the arrival of the patient. This was in anticipation that “the pool guy” would need emergency surgery to debride the local venom and possible fasciotomies (an emergency surgical procedure to relieve pressure, so the vasculature is not cut off) of the hand and forearm. Unfortunately, he was hemodynamically unstable after being given antivenom, which is very expensive. He was intubated in anticipation of pulmonary edema and other post-antivenom side effects. I monitored his hand and arm every 15 minutes for two hours to ensure he didn’t need emergency surgery to release the compartments in his arm.

As I was leaving the hospital, I spotted one of the EMS workers who had brought the pool guy into the ER. He had a plastic container with a lid to keep it closed. As I got closer to the counter, I was curious if he had brought cookies since medical professionals love snacks. Or — he wouldn’t — had he actually placed the snake in a container and left it on the counter unmarked?

No sooner had I thought it, a nurse grabbed the container and nearly opened it, not knowing what was inside. I asked why he would bring the snake into the ER. He said some doctors and even insurance companies want proof of what type of snake bit the patient before administering antivenom due to morbidity and cost. When I looked at it I thought, “this really does look like shiny new pennies!”

This article is the second in a two-part series from Sonya Sloan, MD. >> Read part one <<

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