Yesterday's shift

Yesterday I worked from 8am-6pm. It wasn't a bad shift; at one point we "won the game", meaning that we cleared the board and there were no patients. It happened at the perfect time, too--right at 11:00, when the drug reps were scheduled to bring in lunch (shh... don't tell Ohio State that I ate the evil drug rep's food--it's against the rules).

Nothing too exciting all day. We had a few of the typical abdominal pain patients, with nothing to diagnose. They always felt better after some IV fluids and a dose of Reglan (anti-nausea medications). At one point, every patient we had was not only related, they all lived together--a 14-year-old getting stitches removed (which should be done at the primary care physician, not the emergency department), her fifteen-year-old brother in for vomiting, and their eighteen-year-old cousin with abdominal pain.

Late afternoon/early evening on the weekdays during football season usually means the middle and high school football injuries start coming in. During my first shift last week, we had two broken arms. Today, only one football injury, a twelve-year-old who wouldn't straighten his elbow and sporting a bruise that went from his wrist to his shoulder, swollen and everything. I assumed something would be broken, and when I looked at his x-ray, I thought for sure it was broken. It looked something like this:

Although the piece on the right wasn't quite so distant from the rest of the bone. So I proudly showed it to the attending stating that it was broken, and he said, "Actually, that's the growth plate. Get a comparison film on the other elbow to see what his normal growth plate looks like." When we got the comparison films, it looked identical to the first--down to the label on everything of "left". So I thought they screwed up and x-rayed the bad elbow twice. I went in to talk to the patient, and he assured me that they x-rayed his good elbow the second time, so I called radiology, and they said they'll fix the films to have the right labels. Anyway, cutting to the chase, his elbow was not broken, he just had enough of a gap in his growth plate (as twelve-year-old boys do) that it looked like a fracture to my untrained eye.