While examining a man, I asked his daughter to step out of the room so that I could check his genitals. He said, “It's OK, she can stay. She's seen them before.”

The daughter exclaimed, “Daddy! I thought you said we'd never talk about that in public!”

To ensure that no injuries are overlooked, it is important to inspect all areas of a patient who has been the victim of a traumatic injury. To facilitate this, the patient is completely disrobed.

Alyssa had been the driver of a vehicle struck head-on by a drunk driver. His only injury was a cut from a broken beer bottle, but Alyssa was in a coma. The solemnity of this moment was interrupted as the nurses removed the patient's clothing. Apparently immune to the effects of gravity, two distinctly large breasts projected straight up. An intern began staring, as if he had never seen such a thing before. One of the nurses said, “You can quit staring. They're not real.”

One of the ICU nurses was moonlighting in the ER, and we were sitting around waiting for a pizza I'd ordered. “You wouldn't believe what happened yesterday in the ICU,” she said.

“What's that?” I asked.

“We have a 19-year-old patient in a coma, and his girlfriend was visiting. She seemed kind of ditsy, but nice. Anyway, I walked in his room last night and she was masturbating him, so I told her to stop it. She told me that the doctor had suggested it, but I told her that she must have been mistaken. She said, ‘The doctor said that stimulation might help him, so I'm stimulating him.'”

A group of inebriated college co-eds accompanied one of their friends to the ER after she cut her hand at a party. It has been my experience that people become more zany when they're in a group, especially when they've been primed by the social lubricant, alcohol. This group was no exception.

“Is it true what they say about a man's hands?” one of them inquired, followed by a round of nervous giggling from her friends.

I decided to play innocent. “I don't know. What do they say about a man's hands?”

“You know. That their size is an indication of the size of his . . . of his . . .”

“His thing!” another chimed in. More giggling.

I thought to myself, just think of all the fun and hijinks I would be missing if I'd gone into one of the dry specialties, like dermatology.

A young woman was in the ER after being involved in a car accident. Sensing that I was going to ask her about the alcohol on her breath, she decided to address this matter forthrightly. “You think I'm an alcoholic, don't you?”

“I don't know,” I said. “Are you?”

“I don't think so. I don't drink for the usual reason.”

Hmm, I didn't know there was a usual reason; I thought there were many reasons. “Why do you drink?” I asked.

“So that I can have multiple orgasms. Without alcohol, sex is just so-so. But with it? Oh my God, it's great! It's so much more intense. I only drink before I go out with my boyfriend, so I don't think I'm a boozer. It's not because I have any hang-ups about sex, either. I'm not at all inhibited, so it's not as if I'm drinking to reduce my inhibitions. I'm just after the pleasure. I don't know why alcohol does this to me, but it does. I wish that I could get the same effect without drinking, but I can't.”

I knew many things that can increase libido, sexual pleasure, and orgasmic ability, so I told her about some of them. (If you're curious what they are, I described them in The Science of Sex. Counseling a patient on how she could increase her sexual pleasure is ordinarily something I wouldn't do in the ER, but in this case I thought it might curb her drinking, and hence her chance of a future accident.

One of the things ERs are noted for is a lack of privacy. In many emergency rooms, including this one, the “rooms” are separated only by curtains. Not exactly an effective noise barrier. A 50-ish woman in the adjacent room raised her voice and said, “I wish I would have heard this 30 years ago!”

This next story does not deal with the ER, but it is bizarre enough to earn a place in this site. I have a friend, Shannon, who works as a nurse at the local hospital, which is the regional referral center and a teaching hospital, too. Shannon told me about a student nurse who was caught having sex with a patient in his hospital bed. That led to two things: pregnancy, and her expulsion from school. We thought that would be the end of the story, but the student nurse was somehow readmitted and continued training at that hospital. I bet she had a good attorney!

As I walked into the patient's room, I noticed he was trying to making himself vomit.

“Oh, hi, Doc,” he said after extracting his finger from his mouth.

“Not feeling very well?” I said.

“I'm trying to make myself puke.”

I'd noticed. “Why are you doing that?”

“Because I ate something that's really gross,” he explained.

“What's that?”

“Last night I had sex with my girlfriend for the first time. Before we did it, I went down on her. The smell kind of gagged me, but I did it anyway ‘cause I was so horny. I got up before she did this morning, and I wanted to tidy up the place before she awoke. I picked up her underwear, which had been lying in front of the fireplace, and noticed that there was shit smeared all inside it. Not just a brown stain, either—hey, I've done that before, and this was no stain. It was like she took a huge dump and squished it all over. No wonder why it smelled the way it did. Now I'm wondering if I'll catch some disease, since I must have eaten some of her poop. She told me she had eaten lunch yesterday at a Mexican restaurant. Maybe that's why she did it. You think I'm going to be OK?”

I explained that while some diseases can be spread by the fecal-oral route, he would most likely not contract any of them.

Another man told me a somewhat similar tale, except it had a different ending. Although he was feeling as if he may be coming down with the flu, his girlfriend was begging for oral sex, so he obliged her. She didn't have any obvious hygiene problems, but her smell was not as appealing as it usually was. In fact, he said, it was downright rank. A sudden wave of intense nausea overcame him, and he vomited all over her abdomen. Their relationship was a bit chilly for a while, but she eventually forgave him and they were married.

A man requested to stay in the room while I did a pelvic examination on his wife. Since this was OK with her, I had no objections.

Before I performed the exam the husband went on and on about how tight his wife was, and how it would be impossible to use even a pediatric speculum on her. I found this difficult to believe, but I assured them that I would be gentle. I inserted a well-lubricated finger inside her and suddenly realized that he was not exaggerating. Her vagina was extremely tight and it remained that way (women usually tense their vaginal muscles for a few seconds during insertion of a finger or speculum during a pelvic exam). Once inside, the circulation to my finger practically being cut off due to her tightness, the husband hunched over my shoulder and said in an animated voice, “See? See what I told you? Isn't she tight? Tighter than a virgin! You ever see a woman that tight, Doc? I sure haven't!”

“RALPH!” she screamed as she rocketed up. “You told me you've never done it with anyone else before!”

Oops.

I explained to the patient that I wanted to obtain an x-ray of her knee, but that it would likely be an hour or more until she would be taken to the radiology department since they were so busy. “Do you want a magazine to read?” I asked.

“No, I'll just exercise in the meantime.”

“Exercise? I don't want you moving your knee.”

“I won't. They're Kegel exercises.”

As I examined a man who came to the ER for removal of a splinter, he asked me, “Doc, can you raise my blood pressure?”

“Your blood pressure is fine. Why would you want to raise it?”

“I was listening to G. Gordon Liddy on the radio, and he said that his high blood pressure is the reason why he is so well-endowed.”

That surprised me because I've always been impressed by Mr. Liddy's intelligence and knowledge, and there is no correlation between blood pressure and penile size. “G. Gordon Liddy said that? Are you sure it was him?”

“Yeah, it was him. I bet he has a thousand women chasing after him. Famous, rich, and hung like a horse—I mean, what more could a woman want?”

After I ask a question, some patients give a direct answer while others tell me a story. I asked one man if he drank alcohol, and he responded, “Not any more. The last time I drank any was about three years ago. I'd had quite a few drinks that evening and when my wife and I were about to have sex she turned off the light. I asked her to leave it on, but she protested because she was worried about the way she looked. That's when I put my foot in my mouth and told her not to worry because I'd be thinking of Rodi, not her. Well, you can imagine how that went over. She accused me of cheating on her, but I never did. I'd fantasize, of course, but what guy doesn't? Anyway, we went through a pretty rough period, but things are better now and I don't want to mess things up by saying something stupid when I'm drunk. So, no, doctor, I don't drink now.”

As I sutured a cut on a young man, he casually told me that he had fathered approximately 100 children.

“One hundred children? How do you support so many kids?”

“I don't.”

“Then who does?”

“I guess their mothers get assistance or something.”

Stunned by his callous attitude, I said, “Do you think it's fair to leave the responsibility of raising children to the mothers and to the taxpayers?”

“Heck yeah.”

“Why do you think it's fair?”

“Because I've got too many kids to support, that's why.”

Decades before cellular phones came into widespread use, many American drivers used citizen's band (CB) radios for entertainment and to obtain local information as well as to call for roadside assistance. Most CB users were upstanding people, but some were not.

A case in point. One of my patients told me that she had used her CB radio to ask someone to help her change a tire after she developed a flat. A man who seemed to be a Good Samaritan responded and said he would help, so she gave him directions to where she was parked. Instead of helping her change her tire, he raped her.

I suppose that most people who use cellular phones blithely assume that their messages are private, but it is very easy to intercept calls made from certain types of cell phones. Of course, eavesdropping is a crime, but anyone who is intent on rape is not likely to be deterred by laws that prohibit interception of private radio transmissions. Therefore, it's a good idea to be circumspect while using a cell phone. If you call your husband to tell him that your car conked out in the middle of nowhere, keep in mind that some thug may reach you before he does.

After spraining his ankle, John presented to the ER accompanied by his wife, Marta, and her sister, Brittany. Just before I left to order an x-ray, Marta asked me a question.

Marta: I would like your opinion, doctor. I am expecting my first baby, and in the event it's a boy we've been discussing whether or not he should be circumcised. I don't want to have him circumcised, but John says it is better for a man to be circumcised.

Brittany: Why do you think that, John? You're not.

Marta: Brittany! How do you know?

Brittany ran out of the room, so I never had a chance to hear her explanation. John denied doing anything with her, of course, but Marta seemed skeptical.

A 17-year-old woman had intercourse with her boyfriend and the condom slipped off inside her. She could not reach it, so she called the ER for advice. The nurse told her to have the boyfriend try to extract it, since his fingers were probably longer. She felt this would be too embarrassing, so she came to the ER for assistance.

As she walked into the ER, a police officer asked her why she was in the emergency room. The officer was her father, in the ER for an unrelated matter.

I was eating pizza with the nurses when one of the residents asked me if semen is normally acidic or alkaline. Believe it or not, but that can actually be a useful diagnostic clue. Plus, it makes for interesting conversation, especially when student nurses are within earshot. Apparently not giving much forethought as to the implications of her question, one of them asked, “If it's normally alkaline, then why does it taste kind of bitter?”

A split-second after she said that she realized how she'd revealed an intimate matter that is usually not mentioned in a room full of strangers, and ran out of the ER. I never saw her again. Darn. She was cute . . . and, well, you can guess the rest.

A 24-year-old woman came to the ER complaining of abdominal pain, accompanied by her mother. During the course of taking her history, I routinely inquired if she were having sex. She paused briefly, gave me a funny look, and then said, “No.”

After her Mom stepped out of the room so that I could do the examination, the patient told me, “Doctor, I am having sex. I just didn't want to say anything in front of my Mom. She'd kill me if she found out.”

“Why? You're an adult,” I said.

“Yeah, but I'm sleeping with my Mom's boyfriend.”

While speaking with a man and his wife at the nursing station, an obese woman walked by with greasy, unkempt hair and filthy clothes. The man looked at his wife and said, “If you ever look like that, I'll kill you.”

I initially thought he was kidding, but he wasn't smiling, and neither was his wife.

A man was dancing on an elevated dance floor at a disco when he fell off and injured his leg. Since he was in severe pain and couldn't get up, paramedics were called to the scene. They saw what appeared to be a deformity of his upper leg, so they suspected a fracture of his femur (the thigh bone). Acting in accord with standard protocol, they used scissors to cut through his spandex pants. No broken bone—he had a zucchini strapped to his inner, upper thigh.

So much for truth in advertising.

During my training, I worked in a hospital in which the obstetrical ward entrance was located immediately in front of an elevator. I was waiting to use the elevator when its door opened, revealing a teenager who was obviously in labor. In fact, I wasn't certain if she would even make it out of the elevator before the baby plopped out. I yelled for a nurse to bring me some gloves so I could deliver the baby.

“You're a liar, Doctor,” the teenager's mother told me. “My daughter never had sex, so she can't be pregnant.”

I wondered if she were serious, but I didn't have much time to think. A couple of pushes later she delivered the baby. The mother then said, “That couldn't be no real baby, ‘cause my daughter never had sex.”

It's called denial.

Kate and Donald were staying at her parent's cottage for the weekend. While packing for the trip, Kate forgot to bring along their sexual lubricant so she rummaged around her parent's home and found a substitute gel. Alarmed at its effect, they came into the ER.

“Something's wrong,” Kate said.

“What seems to be the problem?” I asked.

“We both can't feel anything down there. It's numb or something.”

“Did you do anything unusual tonight?”

“Nothing out of the ordinary, except we used a new lubricant.”

“Which one did you use?”

“I brought it with me. Here it is,” she said as she handed it to me.

No wonder, I thought. “This is lidocaine jelly,” I explained. “Lidocaine is a local anesthetic—a numbing agent, similar to what dentists use to numb teeth.”

“That explains that,” Kate sighed. “I know I shouldn't ask you this, doctor, but why do you think my parents have it lying around?”

I rattled off the common reasons why lidocaine jelly might be used at home. “Nope, my parents don't have any of those reasons to use it, at least as far as I know.”

What I couldn't tell Kate is that I'd seen her father as a patient before, and I knew why he used it. Men with premature ejaculation can benefit from it by rubbing a small amount onto their penis, waiting for it to take effect, and then washing it off before intercourse. This can significantly prolong their sexual performance without inducing numbness in their partner. Given the number of women who would love to have intercourse prolonged, I am surprised this tip is not practiced more widely.

Ethan was driving to pick up his date for the evening. Since he was unusually nervous, he stopped by a bar to have a drink to calm his nerves. After leaving the bar, he was involved in an automobile accident and was taken to the ER.

I checked him over, and found only a few minor injuries. As I was discharging him, Ethan asked if he could use the phone to call his date. As he hung up the phone, he said, “Oh, shit!”

I asked him what was wrong.

“I got my days screwed up. I was going to take her to a concert for our date, but the concert is scheduled for tomorrow night.”

After I examined a young woman with abdominal pain, I told her and her mother that I would order some tests, including a pregnancy test. The mother protested, “She couldn't possibly be pregnant, because she hasn't yet had her first period.”

I responded, “But she said that she's been having sex for the past few months, so she might be pregnant.”

The mother sounded somewhat apoplectic. “How could she get pregnant without having her period? Doesn't that mean she's not yet able to get pregnant?”

“No, that's a misconception. Approximately two weeks before a woman's first menstrual cycle would have occurred, she ovulates and can get pregnant if she is having sex. Therefore, we need to check her pregnancy test.”

Which was positive, of course. Another 11-year-old mother.

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