Patient seeks amputation of healthy lower extremity

One of the top 5 craziest things I've ever seen occurred tonight. A 30 year old law student arrived via EMS. This particular young man had put his left lower extremity on dry ice for 8 hours with the intent to have it amputated. He just might get his wish, as the leg is completely rock hard and (duh) frozen and likely has zero blood flow. The patient denied any psych issues, and claims that his desire for the leg to be gone is "neurological."  Patient stated that he has wanted the leg gone for many years but didn't have the financial means to fly to Asia for an elective amputation.  Um..... What? Would love to hear what ultimately happens to this guy as well as read a report from the psychiatric eval he will inevitably have. 

I would imagine flying to Asia for elective surgery would be cheaper than the cost of a trauma activation plus surgery (and psych treatment) he's likely going to have here. 

5 o'clock dead guys

In the ER, we have a term called, "5 o'clock dead guy." It's reserved for the last few hours of a slow nightshift where we all find ourselves twiddling our thumbs, yawning enormously, and checking the clock all too frequently. 5 o'clock dead guy likes to come in, as the name suggests, at around 5 am and bring us all out of our nearly catatonic states.

This morning we had 5 o'clock dead GUYS.

I was actually off duty at 0500 and waiting for my husband to get off at 0600. There's a good chance we were scratching our heads over a crossword puzzle. The EMS phone rings, and most of us wait to hear what's coming in with bated breath. 90 year old ground level fall. Snore. We resume current activity (or lack thereof). Suddenly, we hear a different ambulance crew contacting us via radio alerting us that a patient had just arrested during a transport, and they were currently doing CPR. 5 o'clock dead guy!!!!

I help my husband draw blood on a 5 o'clock abdominal pain (not an "actual term" but still a common phenomenon), and we hear the overhead page go off: "code trauma, alert one, code trauma, alert one". We were kind of baffled- was the arrest a traumatic arrest? All we had heard was the patient was being transferred from one facility to another. Our confusion is cleared up: there are two separate patients coming in. One is the full arrest, the other is a gunshot wound to the abdomen. It's about 0545. My husband and I divide and conquer the phlebotomy duties, despite the fact that I'm clocked out. Here we go.

The arrest was in bad shape. He was obese, and physicians were having some difficulty intubating him. The GSW was awake and talking...and extremely inebriated. He kept requesting that we, "just stitch it up so I can go home". Unfortunately, I have no idea what the final prognosis was for either patient! My husband and I got our replacement, and off to our glorious bed we went. Welcome to life in the ER!

Parenting fail

Mom leaves 12 y/o daughter in charge of dying grandmother throughout ER stay. Claims she is unable to come, because she is fighting with her boyfriend. Grandmother is to be admitted to the hospital. Ambiguous DNR/hospice status. Hello, DCFS.