Wednesday, 9 January 2019

Falling down

Of all the trauma alerts I get, the most frustrating has to be "FALL". These are usually elderly patients who fight gravity and lose, and their cases are seldom (if ever) satisfying. They typically are uninjured beyond bumps, bruises, and lacerations, though due to their age their recovery from such minor injuries can take several days or even longer. But if they do sustain serious injuries, they tend to be isolated to hip fractures, which I don't treat. The other types of falls (off a ladder, off a roof, off a bar stool etc) usually are from heights of 3-4 metres and are thus mostly uninjured (zzzzzzzz) or have broken ankles, which I still don't treat. All of this adds up to a very sullen me as I trot down to the trauma bay for yet another fall.

So when my pager alerted me to a fall recently (my third one of the day by 10 AM already), I got not a bit excited and tried my best to avoid the trauma bay entirely. I had only had one coffee by then, so I figured maybe the caffeine would elevate my heart rate even if the complexity of the trauma didn't. My Inner Pessimist, however, forced me to walk down to the trauma bay despite my efforts to ignore him.

The bustle when I got to the trauma bay confused me. Normally for low-level traumas the nurses and other staff sort of mill around chatting prior to the patient arriving, but in this case everyone was rushing around getting equipment. For a fall? What the hell is going on?

And about 30 seconds later, Xavier (not his real name™) arrived, and that question was quickly answered.

"Hey there Doc, this is Xavier. He fell off a cliff and . . ."

Wait, wait, wait. He fell off a what? Where the fuck is there a cliff around here??

"Yeah, you know the {Redacted} Cliffs."

Uh . . . no I really don't. I had no idea there were any cliffs in this area.

"Anyway, Xavier fell off a cliff about 30-40 metres. He woke up at the bottom and doesn't remember anything. 

No but seriously, where the hell is there a cliff?

"Ahem. Vitals have been stable though he's breathing a bit fast. He's complaining of pain all over his body."

Yeah, after falling 40 metres down a goddamned cliff I would be stunned if he weren't.

Normally the first thing I do is a full assessment, but my Inner Pessimist was insisting that I google where the fuck this cliff was. I resisted that urge and instead decided to, you know, examine my patient, an idea which seemed only slightly more important at the time. Xavier looked completely miserable. His blood pressure was fine but his heart rate was in the 140's. The most common reason for a high heart rate in trauma is bleeding, the second most common cause is bleeding, and third most common cause is fucking bleeding.  It could also be due to pain or heart injury or drugs, but bleeding is always my first concern. My concern was somewhat higher because his oxygen saturation was in the 80's (normal is 95-100%). 

On my initial head-to-toe assessment he was tender in his head cervical spine, thoracic spine, lumbar spine, chest, left hip, and left arm, though other than some rather crunchy ribs he had no obviously broken bones. His breath sounds were diminished on the left side, indicating that he likely had a pneumothorax (collapsed lung) under those fractured ribs. That concern was confirmed about 60 seconds later when I saw his chest X-ray.

His workup, which included X-rays and/or CT scans of pretty much every single body part (I think I skipped his thymus and right foot), showed that he was fucking broken. Think of a body part - go ahead, just think of one (other than the thymus and right foot, obviously). Yup, you got it, that was broken. He had fractures in his skull neck, upper back, lower back, ribs, hip, arm, and leg, along with his pneumothorax. He would need a chest tube for his lung, surgery for his hip, arm, and leg, and a neck brace and full back brace for his spine, which would not need surgery.

But the main question I had (other than "What cliff?") was, How the fuck do you fall off a cliff? And seriously, what goddamned cliff??

After several rounds of IV narcotics finally successfully controlled Xavier's pain (because of course he had a longstanding history of oral narcotic abuse), I got a chance to ask Xavier what happened. He very groggily told me that he was trying to show his in-laws the {Redacted} Cliffs while they were visiting that morning, and he simply got too close to the edge, lost his footing, and toppled.

This, I thought, is why I will never be out of a job.

As I contemplated the amount of human stupidity that it takes to get that close to the edge of a cliff (which, I learned later, has no guard rail on it), I looked at Xavier's blood work. While there was no major abnormality in either his blood counts or chemistry, his blood alcohol was about 3 times the legal limit to drive, which a quick calculation told me is approximately infinity times the amount of alcohol one should have in one's system while walking near a fucking cliff at 9 in the morning.

Xavier spent about two weeks with me before going home in a wheelchair, but it took me far less time than that to find out where these cliffs were. The moment I got in my car to go home the next morning I whipped out google and discovered that these cliffs are less than an hour's drive from the hospital. I briefly considered checking them out, but instead I decided to drive straight home and give my kids a big hug.

That seemed much more important. The cliffs can wait.

Friday, 14 December 2018

RFO time yet again

WARNING: NSFW PICTURES BELOW

Seriously . . . very NSFW pictures DO NOT read this in the presence of children. 

YOU HAVE BEEN WARNED.

Several people have emailed me over the past two months to ask if I'm ok because my blog has been silent. I thank you good people very kindly for your concern, but I assure you I'm fine. But good lord, you people are right! It's been over two months since I've written anything. Well, that isn't exactly true - I've tried to sit down and write several times, and I now have 10 (!!) posts partially written and sitting abandoned in my "Drafts" folder. And by "partially written" I mean "a paragraph or two". And by "a paragraph or two" I mean "a sentence". Or a title.

Sigh. Writer's block sucks.

It isn't that I don't have material, it's just that lately I don't seem to have the desire to sit and do it for whatever reason. It isn't mentally exhausting to write and it isn't terribly difficult. Hell, I could sit in my car and dictate a blog post if I wanted to. It's just that I didn't want to.

Until now. Because it's rectal foreign object time again!

If I seem excited, it's because I am. Call it macabre or bizarre, call it weird, call it really fucking disgusting if you prefer. But these cases are, well, fun. There's no way around it - they're just fun. And lest you think it's just me, it isn't.

I always worried that it was just me until yesterday, because yesterday I had the opportunity to have an RFO Battle Royale with one of my colleagues, Dr. T (not his real name™).

And I lost.

I lost.

I told Dr. T about my latest RFO, which happened to be a small pill bottle. Wrapped in a condom. Wrapped in yet another condom. Unfortunately the bottle had slipped up way too high and could not be extracted from below. Normally we can reach up (yes, really) either with our fingers or some surgical grasper, grab the . . . thing, and then pull it out the way it went in. But this bottle was so high (like 25 cm high) it could not be reached. So I was forced to enter his abdomen the old fashioned way ("Never let the skin get between you and a diagnosis"), and squeeze the bottle down his colon into his rectum. As I pushed it through, I said to the assistant who was waiting down below to catch it, "Ok, it should be crowning".

If you aren't laughing right now, then you don't have kids, because that's fucking hilarious.

As I related this story (and my infamous Coke bottle story) to Dr. T, he merely stood there impassive with a slight smile on his face, because he knew that he had already won. Apparently those stories didn't even come close to Dr. T's best (worst?). He then told me not his best story, not his two best, but his three best stories, any one of which could beat any one of mine.

Yeah, I lost badly.

3) The third best story starts with "He was bored". Normally when I get bored I read a book or something, but not this guy. Nooooooo. This guy (yes, it's always a guy) put an enormous dildo in his rectum and then lost it. It could be felt from below, but it could also be felt from above. WAY above. Like at his umbilicus (navel (belly button)). Because this wasn't just a normal dildo, it was one of these:
I warned you there were NSFW pictures. I fucking warned you.

Anyway, Dr. T took him to the operating theatre, put him to sleep, and grabbed it from below with a surgical clamp like we always do. There was one problem - if you look at the bottom of that, uh, device, you'll see a little dial. Dr. T, unfortunately, couldn't, because he didn't yet know it was there. I'm sure by now you see where this is going. Dr. T grabbed the dial, twisted to try to extract the object, and turned the damned thing on. Apparently this one didn't just vibrate, it also rotated. After the initial shock and panic, the rotation actually helped free it from its environment and it slid back out to freedom.

One loss.

2) The objects we remove are mostly phallic, for obvious reasons. Mostly. The second best story Dr. T told me involved a bone cutter.

What?

You heard me. Indeed, this man had inserted a pair of metal cooking tongs. I'm sure you've seen them before. You know, one of these:
If you're wondering, he inserted the small end first, "small" of course being a relative term. If you look carefully at the grasping end you'll see a very small gap between the end of the metal and the body of the tongs. As they were being removed, that little gap had been able to trap a tiny ridge of rectal mucosa and was unable to let go, so Dr. T had to use a bone cutters to snip off the tip of the tongs, being careful not to snip anything else by mistake.

Loss #2.

1) Dr. T was almost in tears as he told me this last story, his best. It was another guy who was "just bored". But when he got to the hospital he refused to tell anyone what it was, just that "it" had been there for several hours. An X-ray showed . . . something round. A CT scan also showed something. Round. I looked at a picture of the scan and could not figure out what the hell it could be. It looked to me like the head of a toilet brush:

Dr. T just laughed harder and had to stop to wipe his eyes. No, not a toilet brush. Not even close.

He took the patient to theatre, and once he was under anaesthesia he was able to feel the object. It felt rough though somehow also smooth and supple. Organic, one could say. He couldn't get his fingers around it, and regular graspers kept slipping off. So he tried a larger grasper and was able to gain purchase on it, but then the thing tore.

Shit.

He grabbed it again and tore it again. And again. Finally after several attempts he managed to spear the object, and was able to extract it in its entirety:
If you're wondering, this wasn't a little clementine or tangerine. No, this was a big orange. A really big orange. According to Dr. T, the only thing that allowed him to remove it was the fact that the patient was "a professional".

And with that, tears streaming down his face, Dr. T defeated me soundly.

But I will have other opportunities.

Until next time, Dr. T. Until next time.

Monday, 1 October 2018

No good deed

I'm sure you've all heard the phrase "No good deed goes unpunished". If you haven't, you really need to get out and/or read more. Seriously. Anyway, it is typically said in a sarcastic way after something bad happens after you've done something nice ("I raked my neighbourss leaves and then watched as they were strewn all over the yard by their obnoxious children"). Sometimes, however, the phrase can be taken literally.

Like with Ted (not his real name™).

Ted is an auto mechanic and the nice guy of the neighbourhood. Though he had a large beard and unkempt hair and generally looked like my usual Friday night assault victim, Ted was quiet, kind, and respectful, proving once again that you shouldn't judge a book by its cover (read: I shouldn't be an idiot and prejudge people based on their looks because I'm too often wrong).

Ted is the guy who would fix your blender if it stopped working, clean your gutters when they got clogged with leaves, and change your tyre while you were at work. You know, just because. He is a true Nice Guy, that one-in-a-million fellow that you hope to find next door when you move to a new house.

So when one of his neighbour's needed a new engine for his car, of course Ted volunteered not only to buy him a new engine at his cost, but also to install it for him at no charge. All he asked was for his neighbour to reimburse him the cost of the engine.

Apparently that wasn't good enough.

After the job was finished, Ted presented his neighbour with his now-functional car and asked him to pay him for the engine. Not for labour and not for his time (which would normally be approximately an arm and a leg), just for the engine. The neighbour bafflingly said no.

Ted was confused, as I think anyone in his right mind would be. Still being a Nice Guy, Ted asked again, nicely. The neighbour refused again (somewhat less-than-nicely) and stormed off.

Ted was still confused. Obviously.

The neighbour returned a short while later with several friends in tow. I have no idea what the neighbour could have possibly told them ("This fucking guy actually wants me to PAY for my new engine that he bought and then installed for me for free! What an asshole!"), but I suspect Ted was expecting him to be bringing payment.

Ha. No. The group of men proceeded to beat Ted half to death resulting in:

  • fractured mandible
  • seven fractured ribs
  • two punctured lungs
  • fractured nose
  • forehead laceration
  • knee laceration
  • ear laceration
Ted needed surgery for his mandible and bilateral chest tubes to reinflate his lungs, and he spent nearly two weeks in hospital recovering. But no matter how much pain he was in, regardless of the fact that he couldn't open his mouth after his jaw was wired shut, he always took the time to say "Thank you, Doc" and tell me how a great a job the nurses were doing.

Yes, Ted truly was a Nice Guy.

I saw him in my office a week or so later for follow up. The first thing he did was give me a bear hug (again, despite his broken ribs) to thank me for saving his life, which I didn't really do and tried to explain to him. He was never in a whole lot of danger of dying, though I suppose if I hadn't put in the chest tubes that was possible. Regardless, Ted looked great and was feeling great (relatively speaking), and though I didn't ask, that's when he told me the whole story of how he got hurt.

The neighbour is behind bars. The friends are behind bars. And Ted is back to being Ted, fixing refrigerators and painting fences. And just before leaving (and after giving me another bone-crushing hug), he said he would invite me to his house next time he brews up a batch of beer. And I absolutely believe he will.

And I believe I will take him up on that offer.

Sunday, 23 September 2018

Really REALLY over?

I am not a lawyer, nor do I claim any specific expertise in any field having to do with law. But I do know what the word "dismissed" means, and I do know what the phrase "with prejudice" means, so when I saw these words in a Request for Dismissal, written by Bruce Brusavich (who happens to be the lawyer representing Jahi McMath's mother Nailah Winkfield), and submitted to Alameda County Superior Court on September 7, 2018, my eyes got a bit wide.

In case you aren't quite following, it appears that the Jahi McMath saga may finally finally FINALLY be over. Professor Thaddeus Pope posted this document to his website:
Again, I claim no expertise in law, but this certainly appears to me to be a request by Nailah Winkfield to dismiss all complaints against Dr. Rosen with prejudice. This means case closed, never to be reopened, etc.

If that is in fact true, I have no doubt that the two sides reached a settlement, which I (and everyone else) have predicted from the very beginning. I am also not surprised that there has been no media coverage of this whatsoever. I am also not the least bit surprised that no autopsy results have been produced, as I highly suspect Ms. Winkfield would never have let an autopsy happen. As the world learned with Terry Shiavo, autopsy results can refute family members' claims better and more soundly than any expert.

If any lawyers happen to come around, I would appreciate some verification on this. But to my untrained and extremely amateur eyes, it appears the Jahi ordeal is finally, actually, really, and in all other ways over.

Until the next one happens.

Tuesday, 4 September 2018

A tale of two patients

It's been over two months since I wrote anything, which is by far the longest interregnum I've ever taken.  And by "interregnum" I mean "I've been too goddamned lazy and/or distracted to sit down at my computer and get some writing done".  Sure, I've seen many blog-worthy patients in the past 8 weeks, but I've just had some trouble framing them into what I thought would be an interesting story.

Until now.

I'd like to present a pair of patients whom I admitted on the same date just a few hours apart.  Both were seriously injured and both spent considerable time with me recovering.  But I found the differences between the two rather startling.  So for this post I've decided to do something a little bit different and see who can spot the differences.

Ready?

Let's begin.

Patient 1: Ivan (not his real name™) was the victim of a hit-and-run pedestrian accident.  He was walking home from work when a car struck him at high velocity.  He suffered a complex fracture of his left tibial plateau, a right humerus fracture, an open right ankle fracture, several broken ribs, and a ruptured urinary bladder.  I performed an exploratory laparotomy and repair of his bladder laceration, and an orthopædic surgeon performed a surgery for his humerus, two surgeries for his right ankle, and 3 surgeries for his left knee (so far).  He had an external fixator on his left knee for several weeks while his œdema improved before his final two surgeries, he had an uncomfortable urinary catheter in his penis for several weeks while his bladder healed, and he was unable to bear any weight on his right (dominant) arm and both legs for 2 months.  In short: he was broken.

Patient 2: Tera (not her real name™) was driving her car down a dark road at night with a blood alcohol level over twice the legal limit when she went off the road and struck a tree.  In the process she fractured her left acetabulum (the socket of the hip) and a bone in her right hand.  She required one surgery on her left hip and was unable to bear weight on her left leg for 6 weeks (no surgery was required for the right hand).  In short: she was mostly fine.

Every day that I went to see Ivan, he was kind, respectful, and polite despite his multiple injuries and significant pain.  "Thank you, doctor" was his closing statement each morning as I walked out of his room.  Even though I had cut him open and inserted a large, uncomfortable tube into his penis, he thanked me.

On the other hand, every day that I went to see Tera, she had nothing but complaints.  The nurse took too long to get my medicine (20 minutes), the nurse took too long cleaning me up (15 minutes), it's too hot (it wasn't), my leg is swollen (it's broken, of course it is), my splint on my hand is too tight (it wasn't), it took too long getting back from getting X-rays (30 minutes), no one is telling me what's going on (yes I was), I want to be transferred to another hospital.

Anyone see the difference yet?

I sure did.  As I walked from one room to the other day after day, the difference in their attitudes astounded me.

Tera (who you will remember caused her own injuries by driving drunk) did nothing but complain.  She even refused physical therapy on multiple successive days because of pain despite the fact that it was the only thing keeping her in hospital.  I wanted to suggest to her nicely (read: scream in her face) that she had a team of people whose entire job was to take care of her so she could try showing some basic gratitude, but I didn't.  No, I just listened.  Standing there and listening to her many grievances was a far, far better thing that I did than I had ever done.  And yet she never once said "Thank you".  She showed no appreciation or gratitude at any time before I finally was able to send her to rehab.

Ivan, on the other hand, who was much more severely injured through no fault of his own, who was completely unable to walk, who had a catheter hanging out of his penis, who had three broken limbs, and who had a huge incision on his abdomen, was still able to smile and cooperate and participate with his own care.  No matter what was asked of him, no matter how much pain he was in, Ivan simply gave a weak smile, said "Ok", and then did it (or at least tried).

Look, I understand that no one wants to be in the hospital.  My patients are in pain and I'm asking them to get out of bed and walk.  I get that.  But all I ask for is a little civility and a little gratitude.  Trust me, I don't want to be seeing your obnoxious drunk ass in the trauma bay at 2 AM either or repairing your bladder at midnight, but here we both are.  So let's try our damnedest to make the worst of times into the best of times.

Friday, 29 June 2018

Finally over

It's over.  After nearly 5 years, the Jahi McMath saga is finally over.

Almost.

If you aren't aware of the Jahi McMath story, then you obviously have not been reading this blog very carefully, because I have written about her rather extensively, first here, then here, here, here, here, here, here, and most recently here.  The short version is that Jahi was a 13-year-old girl who underwent a series of upper airway procedures for sleep apnoea in December 2013 which was complicated by bleeding, cardiac arrest, anoxic brain injury, and brain death.  Jahi's family refused to accept the diagnosis, and thus began a battle between Jahi's mother, Nailah Winkfield, and Children's Hospital Oakland over whether Jahi was really brain dead (she was) and what should have been done with her (nothing).

Eventually Nailah and CHO came to an agreement that Jahi would be released from the hospital to her mother's care, and after moving from California to New Jersey (one of only two states where brain death can be refused on religious grounds), Jahi has remained on a ventilator, completely unresponsive, still brain dead, at a private apartment.

Over the ensuing years there was a report that she had started menstruating, despite evidence to the contrary that she had already had her first period prior to surgery.  There was a video supposedly showing her breathing over her ventilator, despite the fact that in April while she was in hospital she never did.  There were videos released by the family purportedly showing Jahi moving her finger or a foot to voice commands despite radiologic evidence that her cerebral audio pathways were completely destroyed and she had no anatomic mechanism by which that could be possible.  A neurologist rather ludicrously claimed, based solely on these videos, that Jahi was not brain dead, but rather severely disabled.  Despite these claims, Jahi never woke up, never opened her eyes, never showed any sign of life other than a beating heart.

Ever since this adventure began, I've been rather adamantly averring that Jahi was dead and that delaying her burial was unethical and nothing short of cruel to her and her siblings.  There have been a multitude of deniers, people full of hope and wishes and thoughts and prayers, that claimed Jahi would wake up.  Through it all I have continued to maintain that brain dead is dead, that Jahi would never wake up, that no one in human history who was properly diagnosed as brain dead had ever recovered from it, even a little bit.  While that may on the surface seem callous and uncaring, it is in fact quite the opposite.

And though sometimes I don't want to be right, I was right.

On June 22, 2018, over 4 1/2 years after she lost her life, Jahi finished passing on.  For the sake of simplicity, I will refer to this event as her death, even though she actually died on December 9, 2013 and was declared dead on December 12, 2013.  I have known about her final death since it happened, but I decided not to write about it until it was reported in the news out of respect for her family and what they are going through. 

Jahi had been hospitalised several times for various issues, including January and April of this year for some kind of undisclosed "intestinal issue".  I suspect it was intestinal ischaemia (decreased blood flow to the gut), though I cannot confirm this.  She was treated with antibiotics both of those times, and the surgeons seemed unwilling to operate on her.  Finally in early June she was taken to surgery, where they apparently found nothing grossly wrong.  Nailah and her supporters of course declared this as some kind of miracle.  I, on the other hand, knew that it was simply the beginning of the end. 

Jahi started a slow but steady decline since then, including renal failure and lactic acidosis, culminating in disseminated intravascular coagulation, multi-system organ failure, and fulminant liver failure causing uncontrollable bleeding.  She was apparently brought back to the operating theatre for "one last look" on June 22, got back to the intensive care unit, promptly coded, and died.  Again.

It's finally over.

I suspect Nialah will continue her legal battle against CHO, though I would be shocked if CHO doesn't immediately settle the wrongful death lawsuit out of court just to get it over and done.  But Nailah plans to pursue a federal civil rights lawsuit to get the date of death on the death certificate changed from December 12, 2013 to June 22, 2018.  I haven't a clue what she thinks that would accomplish nor how much time and effort this would take away from her caring for her three other children.

I don't know details of Jahi's various illnesses or operations, nor can I divulge how I know this information, nor is that in any way important.  What is important is that Jahi can finally be laid to rest after being abused for so many years.  And her siblings can finally move on with their lives.  And I can finally stop writing about this case. 

Until the next one comes along.

NOTE: I realise it has been over a month since I have written anything here, and for that I apologise.  It isn't that I haven't had any interesting cases, because I have.  However, it has become increasingly difficult to frame my stories in a way that I have not before, and I don't want to risk becoming boring and/or repetitive.

Wednesday, 23 May 2018

Likely story

I read a little story on the internet some time back (and because it was on the internet, it simply must be true) about a young man who was brought to the trauma bay (not mine) after being shot, and though he definitely looked like he was up to no good, he claimed he was shot while waiting for his grandmother to pick him up to take him to church.  No one in the trauma bay believes his ludicrous story, of course, until Grandma shows up a short while later in her Sunday Best, looking for her grandson to take him to church.

We often joke about what nefarious deeds our trauma patients have been perpetrating immediately preceding their injuries, and I have no idea if that vignette is true, but whether you believe it or not, it makes for a great fucking story.  This story is kind of like that.

Not really.

Mondays are supposed to be slow, easy trauma days.  After all, the Call Gods should be exhausted after harassing the unlucky weekend trauma surgeons for 72 straight hours (Friday counts as a weekday in the Call God Calendar for some damned reason), but this Monday was most definitely not easy.  The chaos started exactly 2 minutes after I walked through the door (fall), and it continued with a new fall or car accident or motorcycle crash every 30 minutes or so for the next 10 hours.  For a while it appeared that I would break my personal record for trauma patients in one shift, but finally right around dinner time it slowed down, giving me just enough time to shovel a cold hamburger (leftover from lunch) into my face before my pager started screaming again:

level 1 GSW 5 minutes

God damn it.

Exactly 12 minutes later (damned rush hour) Ryan (not his real name™) rolled through the door.  Screaming.

Sigh.

"Hi Doc, this is Ryan.  19 years old.  We've found 3 gunshot wounds - one to the right upper chest, looks like an exit wound in the right upper back, and one in the right hand.  Vitals stable, decreased breath sounds on the right.  Got two large bore IV's in his AC's."

"AH GOD DAMN MY HAND DAMN GOD DAMN"

I knew at once Ryan and I would get along swimmingly.

On my initial assessment, his breath sounds sounded clear and equal to me (I don't know how the hell the medics hear anything in those ambulances with the sirens wailing), so I doubted he had a pneumothorax (collapsed lung).  He indeed had a gunshot wound to the anterior right shoulder and a corresponding wound (entry? exit?) in the back of the shoulder.  Fortunately he was moving his shoulder and arm perfectly and had a bounding radial pulse, so I seriously doubted the bullet hit his humeral head or the neurovascular supply to the arm (which is much closer to the armpit).  His hand, on the other hand (har har har) was Seriously Fucked Up.

X-rays confirmed that he had no injury to the bones of the shoulder and no pneumothorax, but what he did have were several broken bones and lacerated tendons in his hand.  As I was consulting the hand specialist, I overheard Ryan giving his story to the police:

"I was sitting in my kitchen eating dinner when I heard a bunch of shots outside, and I guess a couple of them hit me."

Yeah, sure you were, Ryan.  I wonder if they actually expect anyone to believe this bullshit story.

After I patched Ryan up temporarily until the hand specialist could come in, I went back to reassess the last 172 traumas (or so it seemed) who had come in that day, suture up some lacerations, and discharge a few who had managed to sober up.  About 3 hours later I was finally nearly caught up when my pager went off again:

level 1 GSW 7 minutes

GOD DAMN IT.  IT IS FUCKING MONDAY, CALL GODS!

We cleared the trauma bay and readied ourselves for the next young man who was about to arrive.  Or at least we thought we did.

The 67-year-old woman who rolled through the door was not what we were expecting.  Nor did she really look like she had been shot.

"Hey Doc, this is Doris (not her real name™).  She was sitting in her kitchen eating dinner with her grandson a few hours ago when a bunch of bullets came through the window.  I think her grandson was brought here earlier, wasn't he?  Anyway, she has one gunshot wound to the left buttock.  No exit wound.  Bleeding is controlled."

Uh . . .

Ahem.  Hm.

I assessed Doris while eating some serious crow, and all I found was a single wound with the bullet retained in her rather voluminous left buttock.  A CT scan confirmed no serious injuries, and a short while later she was walking upstairs to visit her grandson.  I, on the other hand, had several days of making rounds on Ryan and Doris (who was always there visiting) to remind me just how stupid and wrong my stupid and wrong preconceived notions usually are.

If you're wondering about the three hour delay, Doris initially decided to forgo medical treatment when the medics arrived to pick up Ryan because, as she explained it, her wound wasn't really bleeding, she was walking normally, and she thought a few paper towels would do the trick.  And she was probably right.

Anyway, I guess this story proves once again what happens when you make an assumption: it makes an ass out of you and umption.  Or something.  Whatever, I just need to get some goddamned sleep.  Fuck you, Call Gods.