Farewell, X-ray File I Used To Take Out At Parties

Thanks to order to shelter in place, spring cleaning has arrived in our household with a rarely seen vengeance. Consequently, my office is in the thick of a massive decluttering effort. One of the casualties is the x-ray file I used to take out at parties.

When you are an eligible resident in emergency medicine, you bring a certain cachet to group gatherings. After a few drinks, people at parties all seem to a) hear from others that there is an ER doc in the crowd, and b) collectively lose inhibition.

The result is, people you don't know seek you out in hopes of hearing stories about strange things people put in their butts.

It's an uncomfortable topic (pun intended). But you know deep down, dear reader, that once upon a time you attended such parties and either asked or fielded such questions.

At those parties where I played host, I had a special x-ray file I used to take out after midnight - hard copies of printed x-rays on heavy . Allow me to invite you on a trip down memory lane, where voyeurism and nostalgia perform a final tango together.

A stomach ache?

A well-mannered young woman comes to a county ED late at night accompanied by her boyfriend, both in their early twenties.

After speaking to her alone, to ensure she is not a victim of domestic abuse, she asks that her boyfriend be allowed back into the exam room. She then insists that he explain to me the circumstances of the "stomach ache" complaint noted at triage.

His narrative is meandering, but boils down to the following:

• They were experimenting with a novelty battery-operated item to revive their romantic life.
• He tried a posterior approach, which seemed to be achieving the desired result.
• He unintentionally let go of the device.

His girlfriend looks some combination of angry and sheepish after the telling. To restore a sense of order I proceed to perform my routine physical exam. As I palpate the left lower quadrant of her abdomen, I encounter a pressure-sensitive response that feels like a joy buzzer.

The surgical resident, a friend, returns to the ED a few hours later to show me the large purple vibrator he removed under anesthesia.

My son thought it might help my arthritis.

Sweet fifty-something lady presents at our academic ED - she could be my mother. Her son lives at home and uses cannabis on a regular basis, often touting reported benefits in pain reduction and suggesting she try it as a treatment for arthritis. This is in the days before legalized cannabis use, so she had declined his numerous prior offers to try a hit.

As she was cleaning his room one day when he was away at work, she stumbled across his poorly-concealed pipe and a plastic baggie of marijuana. Her osteoarthritis was acting up that day, so she decided to give it a try in private, just to see if it might work.

Bad news, she put the wrong end of the pipe in her mouth and aspirated the small metal screen.

Good news, it ended up in her stomach and not her lungs, which would have been a much bigger headache.

Nailed it!

Forty-something male patient, asymptomatic:

Swallowed a nail I was holding in my mouth while doing some DIY carpentry a couple of days ago. Wanted to make sure everything was okay after my girlfriend said it could cause problems.

Me:

Good news. We can see it in your rectum, about to pass. Maybe hire a contractor next time?

Minding my own business.

In this case, a 22 year old male presented 24 hours after being assaulted with a baseball bat to the head. You can guess what he told me he was doing at the time.

He had a totally normal neurologic exam, but raccoon eyes and significant areas of scalp swelling. His head CT showed multiple subdural and subarachnoid hemorrhages.

The worst injuries we see in the ED always result from minding one's own business.

Where'd the bullet go?

This 3o year old did not get to tell us what had happened - he arrived, hypotensive, and was rapidly intubated following a single gunshot wound to the left chest. He underwent an ED thoracotomy with cross-clamping of his thoracic aorta before trauma surgery took him to the OR.

The paramedic report said it was a single bullet, and we found a single entry wound on his body, yet we saw two bullets on films in the ED - the first on a chest x-ray and the second on the AP pelvis film.

The patient survived surgery and, once meta-stable, was taken to CT - where the bullet was identified floating within the aorta!

A very talented interventional radiologist was subsequently asked to fish it out before it could wreak more havoc.

Helluva sneeze.

A young male got into an altercation during which he was punched in the nose by another young male over the previous weekend. Other than a black eye and mild soreness that responded to tylenol, he'd experienced no other symptoms.

A couple of days later, he sneezes, after which his left eyelid suddenly swells up like a balloon!

My radiology colleagues educated me as to the explanation: The lamina papyracea, a bone so named because it is as thin as paper (papyracea comes from the latin papyrus, which students of history will recall was derived from reeds in ancient Egypt), forms the medial wall of the orbit.

A punch to the nose can cause an orbital blowout fracture, where the weakest wall of the orbit breaks.

In his case, the punch subtly disrupted this bone, opening a communication between the ethmoid sinus and the tissues surrounding the orbit. As a result, his forceful sneeze caused air from the ethmoid sinus to insufflate the eyelid. His eyelid became a human balloon of sorts.

I took a little betadine and a sterile 18 gauge needle and carefully popped his human balloon - releasing the air trapped in the eyelid so that he could once more see well enough to safely drive. Since there was no evidence of entrapment of the ocular muscles, I prescribed keflex on the advice of our ophthalmologist and sent him home to follow up outpatient with ophthalmology.

Two year old who can't walk at all today.

This one broke my heart. It was kept together with the other films from habit, but never came out during parties. A two year old male was brought in by his parents with new onset trembling in his hands and increased difficulty walking over the past few days. His head CT showed what would later be confirmed to be an astrocyoma, a type of primary brain malignancy.

I felt deeply invested in his clinical course, and visited the patient on the pediatric floor a week out from his neurosurgery. I still remember the young father describing his son's recovery with a surreal calm.

It's been over 20 years since it happened, and I can still remember the patient's name.

The end of an era.

There you have it, folks, the last hurrah for the xray file I used to take out at parties.

A weird party trick that I used to pull out of my hat, captured for posterity.