Friday, September 18, 2009

It's raining crazy at work

So usually our unit just gets little old people with CHF, COPD, GI bleeds. Stuff like that. Rarely do we get anyone under 50.

Tonight we got two, both with psych issues. They came to our unit within 5 minutes of each other (around 2030). One was an admit from ED/PACU, the other a transfer from stepdown.

First one was a mid-40s male who came to ED with "penile pain." I'm thinking, there's got to be something more to this. Penises don't just hurt without a really good story. So here it is:

"Patient placed 5-6 kidney beans in his urethra last night for sexual pleasure. He has been unable to void since 10 PM last night."

Kidney beans? Seriously? I have to wonder at what point it seems like a good idea to place small, irretrievable objects into ones urethra. Didn't he know they make toys for that? Hell, if you want the lumpy feeling, at least use beads on a string or something! Someone should make a PSA (a la Scrubs) about not sticking things where they don't belong.

So the poor guy had to be put under general anaesthesia for a cystoscopic removal of the kidney beans. He must've had some sort of complication, because post-op he ended up with us. Either that or they were out of med/surg beds. *shrug*

Unfortunately, I was just Resource, not his primary nurse. So I didn't get to hear it straight from the horse's mouth. I'm sure it was an interesting story...

Our other crazy patient was in her late 40s. Attempted suicide 4x in the last 3 months or something like that, because she felt like a failure as a wife and mother. (Aside: killing yourself is the *ultimate* in failing as a wife and mother.)

Anyway, she had expressed suicidal ideation, so her husband took her to the ED. While in there, she went to the bathroom. When she came out (after an unknown amount of time) she told one of the nurses that she had taken "about 60 pills" which she had smuggled into the ED in her vagina.

I checked *all* the subsequent notes in the computer. *None* of them mentioned whether the pills were in a bottle, or just shoved up in there. For the sake of "ewwwww" I hope to god they were in a bottle.

Anyway, the woman was a terrible historian, and couldn't remember if they were Cymbalta or Klonopin or what. All the notes had different meds listed. But by my accounting, if you take 60 of *anything* you'll probably get sick.

So they dropped an NG and did gastric lavage, bringing up "no pills or pill fragments." I find that odd, cuz pills take awhile to dissolve fully. So either she took the pills earlier than she said she did, or she didn't take any at all. But she became fairly non-responsive and lethargic, so they brought her up to stepdown for monitoring. When she got a little better, she came to us. She had at 1:1 sitter that came with her, so that was nice.

Both of them are to be evaluated by psych when they're a little more "with it." I wish I could be a fly on the wall for those conversations....

UPDATE: I asked one of the RNs who took care of kidney bean guy, and she said that the reason for the beans is that if they stay in long enough, the body's natural moisture makes them swell, which apparently feels good. So there you have it. :)

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