I'll get you for that...

It's time for another story from my med school days. This one, although funny, is just not as good as The Toe Story. In this case, I was a 3rd year medical student, in my 3rd rotation of the year -- Internal Medicine. I did part of my Internal Medicine rotation at a community teaching hospital about 65 miles away from my medical school. It was a very valuable experience, because everything was so different from what I was (sort of) used to. The patient population, the nurses, the hospital situation (my med school is in the heart of one of the larger East Coast US cities), and even the medical equipment were different. However, grumpiness and crabbiness will occur in any hospital patient population and did so there, although to a lesser degree than I was used to. However, one patient really stands out in my mind.

This story takes place when I was about halfway done with my 6 weeks at the community hospital. The patient was a man in his late 40's at the time. He was admitted for something potentially bad (Hepatitis C, it turned out to be). But he really didn't want to be hospitalized at all. He, however, did understand that he needed to be in hospital and thus did not try to sign out AMA (against medical advice). But he was a total crabapple and took his seriously bad mood out on the staff, especially the nursing staff. I dreaded going in there everyday to ask how he was feeling ("Crappy. It was crappy yesterday, crappy today, and will be crappy tomorrow.") and check his heart, lungs and all the rest. But apparently I didn't annoy him too badly -- I probably appeared suitably scared out of my wits and so was left alone.

One day I happened to arrive for my dreaded visit at the same time that the nurse was in the room to check his vital signs. She checked his pulse ("stop bothering me, nurse") and his blood pressure ("Ow, ow, ow. That's too tight! Why do you come in and torture me every freaking minute?") and his temperature. By the time she had pulled out the thermometer, he had had enough. Now, this hospital still used glass mercury thermometers to check rectal or oral temps. In this guy's case, he needed his temperature checked orally, so it really wasn't that big a deal. But some medical personnel had to stay in his room while his temperature was taken, because he'd been caught putting his thermometer in his cup of coffee ("just to see if anyone was paying attention."). So the nurse said (in the chipper way that many nurses do) "Now Mr. X, let's open our mouth and put in the thermometer." He clearly didn't like the Royal We, and said he didn't want his temperature taken "again". Without missing a beat, she popped the thermometer in his mouth, while he was complaining. Then she asked if I could stick around until it was done, record his temp and bring the thermometer back to the nurse's station. I said fine and thought "Great. Now I'm stuck in here with Mr Crabapple for 5 more minutes. Grrr."

He glared at her as she left and then got this I'll get you look on his face. Immediately after she was no longer visible, he bit down on that thermometer, breaking it in half, and swallowed the half that was in his mouth, as well as the mercury inside it. I think my eyes bulged out of my head (not literally, but close to it) at that very second. He had a satisfied look on his face, as if to say See what you made me do. Not surprisingly, I thought "Oh shit, now what do I do?" I grabbed the half of the thermometer that had fallen on his blanket and ran out of his room to the nurse's station. When I told the nurse, she didn't believe me -- she thought I had dropped the thermometer and was trying to blame the patient, somehow. As if I would have (or even could have) made that story up. I called up the attending physician and in between hyperventilating and having a cow, I managed to tell him what happened. He came on over and calmly ordered an xray. The patient, not surprisingly, was not apologetic and seemed actually quite proud of himself.

We sent him for daily x-rays over the next couple of days and watched the thermometer's passage through the GI tract. And yes, it all came out the other end. The amount of mercury that he swallowed didn't kill (or even harm) him. Oddly the amount he swallowed might have caused problems if absorbed through the skin...

Here is a picture found out on the Intarweebs of a woman who purposefully swallowed a mercury thermometer. It gives you an idea of what we saw.

The Toe Story

Medical school is a combination of book-learnin', apprenticeship, hazing, and trial-by-fire. Therefore, it is the source of some great stories. Probably my favorite med school story is the "Toe Story". Not the Tooth Fairy or Toy Story, but the Toe Story. I haven't written it down, so I am not sure if it will work verbally as opposed to vocally.

This story takes place during my 4th year of med school, when I was doing an elective rotation during the fall -- Infectious Diseases. I adored that rotation, to the point that I strongly considered bagging neurology and applying for a medical residency so as to be able to do a fellowship in ID. It was mostly because of the attending physician on the service that month. I will call her Dr. C. She was amazing. She was 10 years older than I and 8 freaking months pregnant and could walk faster and for longer than I could. She knew an enormous amount about medicine, ID, and how to take care of sick-as-shit patients. I didn't want to grow up and be like Dr. C, I wanted to grow up and be Dr. C.

Anyway, on any given day, we would round on established patients in the morning, then be assigned new patients that we would have to see prior to rounds in the early afternoon. That day I was given a patient with possible osteomyelitis to evaluate. Osteomyelitis is infection (or inflammation) of the bone. She was a 50-something year-old woman with juvenile-onset diabetes, who has a non-healing wound on her foot that wasn't responding as well to the wound care as the docs had expected. So I was instructed to evaluate her for the possibility of osteomyelitis, which would most likely require her to have her foot amputated.

I went in and introduced myself to her. "Hi Mrs. X, my name is Neuron Doc. I am a student doctor working with the Infectious Diseases service. Your primary doc asked us to come take a look at your foot."

"Sure, dearie, come one in and take a look," she replied. "You know that I can't see you". I had read her chart prior to coming in, so I knew that she was blind from diabetic retinopathy and had pretty severe neuropathy of her hands and feet.

I went over and did the usual poking and prodding, listened to her heart lungs and belly with my stethoscope ("flea collar" in MedSpeak), etc. Then I went to the end of the bed to look at her foot. It was wrapped up all nice in a big white gauze bandage. I kinda felt bad about messing up the dressing, fully well aware that her nurse was going to be pissed about that. But I carefully unwrapped all the gauze and very daintily removed the pads. It was pretty gross. There was an open wound on the top of the foot, sort of at the base of the two toes just adjacent to the big toe (2nd and 3rd toes). The 2nd toe was almost black, and the 3rd toe was a darkish purple. “Eeuuuw,” I thought. I gingerly reached out and touched the 2nd toe. "Does this hurt?" I started to ask, as I moved the toe up a little. But then the toe came off in my hand. Literally. I was holding this woman's toe.

The look on my face must have been something to behold, but she was blind and couldn't see. And she was basically numb from the knees down, so she couldn't feel. "No, dearie, I can't feel a thing on my feet. Good thing, because my foot should hurt like the devil." But I was still holding her toe as she said this. There was no blood. Just a little slot where the toe should be. And it was in my (gloved, thank goodness) hand. I thought "oh fuck, now what do I do?" Then I very carefully, put the toe back in that little slot, wrapped the foot back up in clean bandages. And left. Quickly.

I went straight to Dr. C's office, hoping she would be there. She was. I knocked and went in. As soon as I got into her office, she could tell something was up and asked if anything was wrong. I lost it and started to cry. I wailed out my story. And she tried. She really tried to hold it in, but she couldn't. She burst out laughing. She asked me if I wanted to go back and finish that consult, or if I wanted to hop to it and see a different patient in time for rounds. Needless to say, I saw a different patient (a nice simple hospital-acquired, multi-drug-resistant pneumonia). When we met for the pre-rounds discussion, Dr. C couldn't resist and told the team the story. In hindsight, it really was hilarious.

The woman's toe had basically auto-amputated due to severe peripheral vascular disease, and that – combined with the poorly healing wound and underlying osteomyelitis – did require a below-the-knee amputation. Which went well. I always wondered what the woman thought when I ran out of her room and am ever grateful she couldn't see the look on my face, when I pulled her toe off. And I never became an Infectious Diseases doc...