You swallowed a what?

Yesterday was an especially brutal shift in the ER. We have been short a doc on the schedule for the past 4 days. Since there are only 4 docs covering a 24hour period in a our community ER, losing 25% of our coverage is a pretty big hit and we were all working overtime. Anyway, I’ve been busting my butt, skipping the gym, going into intense work-mode to get through this short period of work-hell, and I was actually doing pretty good. Aside from a brief melt-down in the middle of my shift when I somehow managed to use the f-word 6 times in one sentence (it can function as a noun, verb, adjective, and adverb) I mostly held it together. Everything was rolling along Saturday afternoon with the typical assortment of young women complaining of vaginal bleeding and elderly men presenting with chest pain when one of my nurses yelled out the thing I never enjoy hearing “doctor, there’s a baby who can’t breathe!”. No hesitation, no drama. I got my ass in that room and found a 2 month-old boy gasping for air and turning blue. Quickly activating my team, we got an IV in and I intubated the kid which quickly stabilized his condition. A stat chest x-ray revealed bilateral pneumonias which were the underlying cause of his respiratory failure. After starting antibiotics and arranging critical care transport to the children’s hospital ICU I walked back to my work station, sat down, and then it hit me – this kid was the youngest patient I had intubated. My eyes actually started to tear-up when I realized how close he had come to dying, and the full gravity of my position hit me. It’s one thing to resuscitate adults and elderly people who have lived a long life, but being responsible for the life of a 2 month-old in critical condition is a whole different experience. I took a deep breath, said a silent thank-you to the doctors who had trained me, and got my butt back to work.
Unfortunately during the 30minutes I had spent stabilizing the 2 month-old a tour bus must have unloaded into our ER because suddenly there were about 16 new patients clamoring to be seen by the doctor. Sometime after seeing a 45 year-old guy with chest pain who was as white as sheet after he unknowingly crapped out most of his entire blood supply presumably from his stomach ulcer and diagnosing an unfortunate 1month-old with bacterial meningitis I got a call from medics in the field who were bringing in a women who called 911 after swallowing her toothbrush. Yes, you heard me right – she swallowed her toothbrush. WTF? How vigorously does someone have to be brushing their teeth to ram their toothbrush down into their esophagus? Why didn’t her gag reflex kick-in before she ended up with dental products invading her GI tract? And most important, was it an electric toothbrush? I had a thousand questions, and I couldn’t wait until she got to the ER so I could find what had happened. After several anxious minutes of anticipating this patient’s arrival, she showed up and it quickly became apparent that the biggest factor contributing to her foreign body ingestion was some liberal ingestion of ilicit chemicals. No surprise in our ER. This patient was sitting on the medics’ gurney zoned out on benzos or opiates or probably both, and she calmly explained to me that she had eaten too much for dinner earlier and had decided a little artificially-induced purging would be a great idea. Unfortunately she must have abolished her gag reflex years ago, god only knows how, and thanks to her inebriation things quickly went south, literally. One minute she’s happily tickling her tonsils and then oops- where did my toothbrush go? Oh shit, that’s not going to feel so good when it comes out the other end. My GI specialist was thrilled when I called him in the middle of the night to come to the hospital and retrieve the toothbrush my patient had misplaced. He wasn’t too surprised. Apparently this was the second ingested toothbrush of his career. Not that I ever doubted there would be two similar idiots in the world, maybe they were twins separated at birth. The extrication went well. The Reach toothbrush that went were no toothbrush was intended to go was recovered and unfortunately released back into the custody of the patient. She gratefully reclaimed it and was appropriately amazed that it had almost made it into her stomach. Undoubtedly she will resort to more shenanigans involving toothbrush-induced vomiting next time she takes valium and eats too much dinner.