There are so many things I should never write about. I cannot describe patients too accurately lest their identity be revealed. I dare not expose my weaknesses and challenges to the plaintiff bar. I can speak with no specificity regarding my experience of the ABEM board examination process. I will tell what I can.
25yo male, severe headaches for two weeks. He got his jaw broken and a specialist wired it months ago. The wires were supposed to come out, but according to the patient, the specialist refused to take them out because he did not have $250. I have no idea if that is true, but there were some big wires there alright. He also has old abdominal stab wound and history of a skull fracture.
We may have diagnosed von Willebrand’s disease (a bleeding disorder), but the labs won’t be back for a while. Young lady with a bad bruise. (Truth, the off-going doc who signed out to me called it and sent the labs.) Patient with a panic attack after running out of Ativan.
These elements of cauda equina (acute spinal cord compression): chronic back painer with 4 days fecal incontinence, 3 days urinary retention (post void residual of 700cc), 2/5 strength in both legs. But, he could walk, had +2 DTR’s (deep tendon reflexes), and was a monstrous opiate consumer at baseline. Rectal tone was pretty good and there was no saddle anaesthesia. What would you do – considering that there is no way you could get an MRI or CT myelogram and do not have a neurosurgeon? Thanks be, the neurosurgeon at the nearest big famous tertiary care academic center took him. I really think the patient knew what to say and played me like a fiddle. But what could I do?
Lady didn’t get the finger stitches out on time and now way too late it hurts like hell to get them out.
Pale 49yr old lady with pneumonia (looked like PCP), anemia, renal failure, and hyperglycemia. Not know to have any retrovirus. Looking rough.
One year old with pneumonia/bronchiolitis – admitted.
One year old with pneumonia/bronchiolitis – sent home.
Grand mal seizure on 4 seizure meds with therapeutic levels.
And many, many more.
Sixty year old lady with gallstones.
Seventeen year old obese girl with gallstones.
47yo man with history of exploratory laparotomy for pancreatitis (?) in Mexico 6 years before comes with acute abdominal pain and vomiting bile with a partial small bowel obstruction. He got a tube down his nose.
5 yo girl with abdominal pain. Inconclusive CT.
Babies and toddlers, lots of them, with cough or vomiting or fever or diarrhea or some combination.
Young woman with mono.
Shooter with an abscess.
Schizophrenic who was fighting aliens at the Safeway with a toy light saber. She was trying to save the world from aliens.
Two guys got tasered. One had been smoking crack all week.
Foot injury. No fracture. Little bruising and an abrasion.
And lots more.
The biggest deal to me is my wife’s PUPPP – Pruritic Urticarial Papules and Plaques of Pregnancy. She has a red itchy gravid belly and it is driving her mad. A quick search tells me that it is common at the end of pregnancy, and may be due to male DNA! She is so very pruritic (itchy). It will go away and is not serious, but is not good!
She is 2 weeks out from her due date. Our first came right on time.
I passed oral boards.
I really was not sure that I had. I re-took the oral exam in November, and it was again a huge discomfort to me. I did not want to tempt fate, as unsuperstitious as I might like to think I am, and talk about it before I got the results. All I can really say about it is that I am glad it is over, and I hope that it makes me a better emergency physician. I am returned to the land of the living, just in time for my wife to have our new baby boy. It feels good. I feel happier at work after passing boards.
I get paid to be a partner observer at the board meetings. I get paid the same as an eight-hour shift in the pit to sit around and listen to the high mucky mucks of my partnership (the largest democratic group in emergency medicine) jaw. I am served regular, free meals, and bottomless coffee. Heaven. Actually, I learned a lot about my group, emergency medicine, and politics. My year-long stint is up, and I will miss it.
So, the year ended with me passing boards, ending my year as board observer, almost having a baby, and being asked to consider becoming assistant medical director at work. As far as science is concerned (I know there is damn little of it in this blog), my old research team got back at it at the end of this year, and we are working on an article we will submit to one of the bigger journals in a month or two. More on that soon.