Tooth

A dumpy-looking low-IQ chick from down the street in Hood Epicenter comes in with what could quite possibly be a real emergency. She hadn't been to our ER before (under that name), had a BP of 210/130, had a 10/10 headache,  no history of severe headaches nor hypertension, and was puking uncontrollably all over the place.  Could this chick have a head bleed, I pondered.

Then I drifted off into another dimension.

As she described her symptom onset, the quality of her pain and all that, I was fixated on the fact that she had a nastyass loose front tooth.  This was a rare moment in my 'hood medical career where I got to see the intermediate step in tooth loss that comes in between when a tooth is stable in the mouth and missing.  Usually either teeth are der or dey ain't.  This chick had like the missing link of missing teeth.  Or some shit.

This tooth was mere hours from falling out for good.   And I had a front row seat.

When she talked, the pyridiumy-orangish-yellow-colored rotten front tooth moved forward and backward with every slither of the tongue.  Back and forth, in and out.  It was positioned next to a toothless hole and another rotten something peeking out from the gingivitis.  The fact that it was near a toothless hole made it so there was nothing to re-distribute the pressure from the tongue (sort of like how people can lie on a bed of nails and not stab themselves---same concept); ergo, the loose tooth took a direct hit with every word and every bit of dinner flying into the emesis bag.

Any moment that motherf'er was going to fall out and it would be a cold day in Hell if I missed that event.  Would she just spit it out like gum?  Swallow it?  Put it in a Kleenex?

I pictured her as a tooth-losing 8-year-old.  Was she pretty?  Was she fugly?  Did her mom and dad take her to the dentist or was she neglected in favor of nights with pulltabs while she fended for herself?  Did anyone ever teach her how to use a toothbrush or did she just not really care to use one?  One always wonders how someone can let their teeth get this bad.

Then, somewhere on the 3rd emesis bag, the patient's sister shows up, looking just about the same, only even more low-functioning with a lisp that caused her tongue to noticeably press on her front teeth as well.  Despite being more slow than her sister, her teeth were in slightly better shape.  As she lisped and rambled on about her own medical problems and tried to put the spotlight on herself as the more ill person in the room, I hypothesized if the pressure from the lispy tongue would---in my presence--cause one or both of the front teeth to loosen enough to make her front tooth match her sister's tooth.  Could she possibly talk enough to loosen the front tooth?  I didn't cut her off during her self-centered ramblings about her IVs and trips to the hospital.  I carefully monitored her front teeth too.  Could this be a two-fer in the world of intermediate-stage tooth loss observational sciecne?  Like finding husband and wife neaderthals in some cave in France or something?

Oh, she didn't have a head bleed.  Reglan and Benadryl worked.

FMLA: A Rant

So as a manager back in the day, I had to deal with peoples' Family Medical Leave Acts (FMLA)s.  For the foreign or unindoctrinated, this is a Federal law that allows people time off/job protection for "serious" illnesses of longer than three days in duration or intermittent time off for chronic serious illnesses.  It involves filling out paperwork, having a doctor write something saying you're a sick bastard, and then getting the leave approved by an independent company.

So what are "serious illnesses?"

Oh, I'm so glad you asked.  Every little whiny girl who has a migraine can qualify for FMLA.  So, they might get approval to call in ill up to 24-36 times a year (yes, 36 absences a year) for migraines before it starts counting against their absenteeism.  Fuck you not.  Obviously, when they have a cold or stay out too late partying, these "trigger" migraines, so, hey now, it's not a hangover, it's a hangover with a migraine, so it's covered.  Car not start this morning?  This stress OBVIOUSLY triggers a migraine, so even your car not starting is covered under FMLA.

I hate migraine chicks with FMLAs.  Suck it up, girls.   Take your fucking Imitrex and Topamax and show up to work like everyone else.  None of our lives are pain or symptom-free either.  Oh, and riddle me this.  Why do your migraines always occur on the Friday before your weekend off?   Hmmmmm?

Newsflash: There aren't oodles of people signed up to work Friday evening shifts, so when you have owie head (or a hot date that you get covered under FMLA), we end up working short a lot of the time, so we, those who show up, hate you.

Asthma is a serious illness, even when you weigh 400 lbs and refuse to take inhaled steroids.  Yes, it doesn't matter if you're non-compliant, you can still get time off when your noncompliance causes symptoms.

And, yes, girls, fibro flares can be covered under FMLA as a "serious illness".   We're working short because you have fibro-owies?  Tell that to my friend who shows up to work with swollen hands from rheumatoid arthritis and just asks people to start her IVs every once in awhile when she can't hold the catheters or volunteers to work charge.   She could take a day off, but she doesn't.  You can see the pain in her face, but she doesn't complain like you.  Be inspired.  Get your fibro ass to work, all 275 lbs of it.

Influenza can be covered, even if you refuse to take a flu shot and giggle with that "ohh the flu shots always make me sick, so I never get them" crap and you're otherwise young and healthy.  Since when is influenza a "serious illness"?  If that's a serious illness, everything that causes a fever is a serious illness.  That's called a "call in sick like regular people" illness.

Just like anything else, a law meant to keep people with appendicitis or cancer from losing their job now covers any little chronically-minor inconvenience.  It's like EMTALA for whiny employed people.

Come to think of it, it's been awhile since we took Grandpa out for steak

One of the diagnoses that always causes this hardass cynic to grow a touch of empathy is rhabdomyolysis.  Usually, it's as a result of a frail elderly person falling in their house and lying there helpless in a pile of their own urine and feces for many hours and sometimes many days until a family member or UPS man or burglar or someone finds them as their muscle fibers break down and enter the bloodstream and wreck a bunch of shit (namely their kidneys).

So, an old man who was normally independent and actually quite active (skier and all that) falls down, probably due to a heart attack, and lies there weak with a broken wrist for a few days without food or fluids.  Finally, after phone calls went unanswered, the man's family comes and discovers him on lying on the floor.  

Concerned that he hasn't had anything to eat in awhile, the three adult grandchildren pick Grandpa off the floor, drag him to their SUV and rush him to the nearest....steakhouse for treatment of his rhabdomyolysis, heart attack, and broken arm.  Apparently he had a medium-rare ribeye, some potatoes and a glass of milk along with some water.  Obviously if your relative has been on the floor in a pile of their own urine for a couple of days, the first thing you should think is "steak topped with a bleu cheese crumble and a side of sauteed onions".  

Of course, later on, they figured out that maybe Grandpa's persistent lack of urination coupled with a mis-angled wrist and constant whining about being thirsty should necessitate a trip to the hospital, and they brought him in.  

Dr. No Bullshit on crocodile tears

Me: Just as an FYI, your patient in room 6's fake crying is annoying me enough where I'm feeling compelled to stand here as far away as possible.
Dr. No Bullshit: Oh, that's nothing.  [Dead well-known former frequent flyer] was the worst.  Her fake crying sounded like a wounded cow in an echo chamber.  This guy isn't even top 10 annoying.