Friday, 30 December 2011

Last night

Truth is stranger than fiction.  Have I said that before?  Well it's true.  I can't make up some of these stories, because I'm just not creative enough.

Three of my four trauma patients from overnight deserve special attention here.  The first is a 16 year old kid who was skateboarding at midnight.  In freezing temperatures.  In the woods.  How the hell does one skateboard in the woods?  Poorly, apparently.  He fell and hit his head, and he fractured his skull and bled into his brain.  He will most likely be fine, but chalk it up to the stupidity of youth.

The next patient was around 1 AM, a young motorcyclist who passed several cars on the interstate like they were standing still.  A few minutes later they came upon his motorcycle lying in the middle of the highway on fire.  He was found about 75 feet away, pulseless and not breathing.  He stayed that way, unfortunately.  Coincidentally (and quite amazingly) I actually saw him in my trauma bay about two years ago after he had had a much more minor motorcycle accident.  It seems he failed to learn anything from past experience, and he paid the ultimate price.

The final patient deserves a special spot here because he's a double-whammy.  Dumb patient, dumber paramedic.  A woman brought her 25-year old husband to the fire station after he deliberately cut his forearm.  They took a look at his abdomen and saw some fluid coming out, so they thought he had stabbed himself in the abdomen also.  Had they actually asked him what it was, they would have easily found out that he had an abscess (a boil) there about 8 months ago which was lanced, and he had been draining a bit of pus ever since.  When I told this to the paramedic, he actually said, "I'm going to leave now before I feel any more stupid," and he walked out.

But here's the really strange part - I saw a lot of dried red stuff on his forearm all around his scratches (that's all they were...scratches).  "It's just blood, Doc!" I hear you all screaming.  No, it was actually hot sauce that he had poured on the scratches so he could feel the pain.

Hot sauce.

Thursday, 29 December 2011

Self-inflicted

Self-inflicted trauma is some of the worst.  These poor people are trying to kill themselves, and I'm trying to prevent them from getting their wish.  I've seen self-inflicted gunshot wounds and stab wounds, people who try to slash their wrists or thighs (don't try this - it never works), a drowning, and several jumpers.  It's always sad, but this next kid was one of the saddest ones.

The call came in a few days ago as a self-inflicted stab wound .  A level 1 trauma, the most severe kind, a patient that has a good chance of dying any second.  The preliminary report from the ambulance was a young man who stabbed himself in the abdomen five times.  Oh boy.

A few minutes later, in rolls in a 17-year old kid with tears running down his cheeks and his hands cuffed behind him.  Uh oh - that's never good.  The police accompanying him described it thusly: he got into an "altercation" with another person, and he decided instead of arguing, stabbing the other guy would be a good thing to do.  Dumb idea #1.  The police were notified, and when they showed up, he ran.  Dumb idea #2.  When they caught up to him, he decided to just end it all rather than go to jail.  Dumb idea #3.

When I actually examined him, he had only managed to nick his skin five times.  That was it - no deeper injuries.  I sent him for a psychiatric evaluation before he went off to police custody.

I always feel sorry for these people, because obviously something has gone terribly wrong in their lives.  But I'm sorry, you're not dying on my watch.

Friday, 23 December 2011

Mechanism of injury

"Trauma by mechanism" is my least favourite phrase I hear in my trauma bay.  That just means that the mechanism of injury ought to be severe enough to cause some harm.  Even if the patient is found walking around the scene of the accident with no complaints whatsoever, if the EMT deems that the mechanism is severe enough, that patient will be called a "trauma" and it'll drop into my lap.

Don't misunderstand me - I have a tremendous amount of respect for the emergency response personnel.  They save lives, they get people to the hospital quickly, they do some amazing things.  But I've met a few who aren't the sharpest tool in the shed.

I always try to keep in mind that these hardworking people are not doctors.  I can usually assess someone and determine if that person is critically ill and/or will need surgery in about 15 seconds.  But I've had 9+ years of formal, rigorous medical training, so it's an apples-to-rutabaga comparison.

The emergency medical technicians have to make a judgment when they first get on the scene - is this person injured to the point of requiring an evaluation by a trauma surgeon, or can we take him to the ER where he or she will likely sit in the waiting room for 3 or 4 hours before an ER physician can do the initial evaluation.  It's doubtless a difficult determination, but in some cases it should be much easier than others.  And sometimes, they just make boneheaded decisions.

The ambulance dropped off a patient this past week after he was in a car accident.  He was wearing his seatbelt when he lost control and his car rolled over.  He didn't lose consciousness, he was able to get out of the car by himself, and he had no complaints whatsoever when EMS arrived.  They still slapped a cervical collar on him, strapped him to a backboard, and shipped him to me.  I discharged him about 10 minutes later, no doubt with a headache and frustration of being sent to the hospital for no damned reason.

Even worse was a lady whose car was hit on the passenger side, again wearing her seatbelt.  She appeared to have no injuries, and indeed when I asked her, she had no pain at all.  I asked the EMT why she was called a trauma, and he told me it was by mechanism of a head-on collision.  I tried to explain that she was T-boned, not hit head on.  He told me that it was a "trauma by mechanism" (my blood started boiling) of the other car involved...not hers.  She was actually upgraded to a trauma based on the amount of damage to the car that hit her car, which was minimally damaged.  I had to control my rage or else he would have been my next trauma patient after I kicked him in the shin.

I discharged her about 10 minutes later too.

Wednesday, 21 December 2011

Know your body

There's very little people should know more about than their own bodies. It's your body. You should know every little thing about it, including what's wrong with it. If you've had surgery, you'd better damn well remember what was done, who did it, and when. Seems pretty obvious, right?

Wrong.

I had a "gentleman" who was in the wrong place at the wrong time and got shot in the abdomen. We stripped off his clothes to assess the damage, and to my surprise and chagrin he had a long vertical midline scar on his abdomen.

Uh oh. Signs of man. Surgical archaeology.

"What's this scar from, sir?" I asked him.

"Oh that's from the last time I got shot."

Of course it is. "And what did they do in there?"

"Fuck, I don't know, doc. They fixed me up. They didn't tell me shit."

Right. After a big surgery like that, you didn't think to ASK WHAT THEY HAD DONE?? You must have been in the hospital for at least 5 days, and you must have seen the surgeon for at least one postoperative office visit to get your staples out, and you never thought to ask the guy what he did while he was rummaging around your abdomen?

He had a few holes in his small intestine which I once again "fixed up". I could tell that he had had a portion of his small bowel removed during his prior surgery, but that was it.

I made sure to tell him what I had done in the OR at least 3 time before he left the hospital. And again at his postoperative visit.

Wednesday, 14 December 2011

Quickie

Hope and pray that you never have to be treated at this next hospital. I hate this certain hospital. If I had a dog, I wouldn't allow it to be treated here. I only practice here under duress, and I'm dropping it next month. Here's an example why:

The ER at this certain death trap hospital paged me tonight while I was in surgery at a different hospital. I called them back when I was done, and the receptionist said "Oh, that was Dr. X who paged you, but he's already left. Dr. Z is supposed to be here, but he's stuck in traffic."

So...the doctor left without signing out to another doctor? Who the hell was responsible for his patients? In what universe would this be considered good medicine??!

This is why I'll no longer be practicing there as of next month.

Saturday, 10 December 2011

Close calls

When it's not your time to go, it just isn't your time. It seems there's no rhyme or reason behind it, but if you're destined to live, no bullet or knife will kill you.

Sound far-fetched? Keep reading.

A guy got in a domestic dispute with his brother, and a fistfight escalated quickly to a knife fight. Well, it wasn't so much a fight as a one-sided assault. One of the brothers was brought to me with the other brother's steak knife embedded in his back. The handle was broken off. The guy seemed uncomfortable but not actively dying. Here's what his CT of his chest looked like:




That bright line going from bottom right towards upper left is the knife blade. The dark grey circle less than 1mm away from the knife tip is his spinal cord, and the white circle towards the top of the picture about 1cm away from the blade is his aorta. The black area on the right about 2mm from the blade is his lung. The bottom line here: nothing was injured. I pulled the blade out:



...and he went home the next day.

I had another gentleman who broke into his ex-girlfriend's house to confront her new boyfriend. He shot him dead, and then the girl grabbed the gun and shot him in the chest. He ran out and hid in the woods in sub-freezing temperatures for over an hour until the police captured him and brought him to me. He had a transmediastinal wound, meaning the bullet had gone in one side of his chest and all the way through the other side. This is a highly lethal injury, but all he had was two collapsed lungs. I put in chest tubes to re-expand both lungs, and the police hauled him off to prison a few weeks later.

It just wasn't his time.

Thursday, 8 December 2011

What...why...um...

What happened to Amelia Earhart?
Why can't the Cubs win?
How did Paris Hilton and Snooki ever get famous?

Some things are just inexplicable. You want to know the answers but you may be afraid to ask the question. An important thing to remember is never ask a question that you don't want to know the answer to.

For example, when I was in medical school I was doing a history and physical examination on a prison inmate who was admitted to the prison ward at the hospital. After I was done, my curiosity got the better of me and I asked him why he had been incarcerated. He looked around, leaned in close to me, and whispered,

"It was for sexual crimes, but please don't tell the nurses."

That's the last time I asked that question.

Other times, it's clear the question just shouldn't be asked. I had a car accident victim come into my trauma bay recently, and we are supposed to disrobe everyone completely to do a full exam. Sometimes things get skipped, and this guy's underwear stayed on while his pelvis Xray was shot. Here it is:


That ring on the bottom of the picture is outside his pelvis. Outside his body. But it's right at the base of the penis. Have you guessed yet what it is?

It's a cock ring. He was driving alone...wearing a cock ring. Why, you may ask? I didn't ask the question.

Sunday, 4 December 2011

Alcohol

I like a drink or two every now and then. I'm a big fan of Belgian ales and dark stouts. But I know when enough is enough, and I would never be stupid enough to drink and drive. Unfortunately, that's not the only activity that one can do while drinking that can get one into trouble.

I've had three very intoxicated patients just in the past 3 hours all get injured by different mechanisms.
- One guy with a blood alcohol level of 0.47 walked into a bus. He WALKED INTO A BUS. He was fine.
- Another guy with an alcohol level of 0.39 was hit by a car. Also fine.
- A third guy with an alcohol level of 0.27 fell down the stairs. Again, no injuries except a broken shoulder blade. The kicker here is that he weighs (according to him) about 600 pounds, or roughly 272 kg. So doing the math and considering his size, he had to have approximately 30 drinks in an hour to get his blood alcohol level that high.

What the hell is wrong with people?

Thursday, 1 December 2011

Reality versus fantasy

Have you ever noticed how people die immediately after getting shot or stabbed?  Or they have their last few gasps before saying the name of their killer or "Avenge me!" or something equally dramatic and stupid.  And have you ever noticed that the people who DON'T die immediately after getting shot just need to have the bullet removed so that everything is ok.  They can go to a back-alley doctor or a veterinarian or anyone with a pair of pliers, and as soon as that nasty bullet is extracted, everyone sighs a big sigh of relief, because "He'll be ok!"

Well, I have some bad news for you - TV and movies are NOT reality.  This shouldn't come as a shock to you, but it does to everyone else.

You see, I usually don't remove bullets from people who have been shot.  Once they go through you, the damage is done.  After it stops moving (if it's still inside you), it doesn't do anything.  It just sits there.  There is simply no reason to remove it, unless the police really need it to help find the shooter.  Make sense?  It seems to be common sense to me.  However, whenever I tell this to someone, they look at me like I'm crazy.

"YOU AREN'T GOING TO REMOVE THE BULLET??"

No, I'm not.

"OH MY GOD!  WHY NOT??!"

I try to explain what I just said above, but they still look at me like I have two green heads with antlers.  Removing the bullet usually does more harm than good.  Digging around for it can damage the surrounding tissues, and there's no benefit to removing it anyway.

Don't even get me started on the TV show "House" and all the mistakes they make. 

Wednesday, 30 November 2011

Good saves

Ok, I'll apologize in advance - there will be no stupid stories today and no stupid patients.  Today is all about great saves.  I'll start by saying that 95% of all my trauma patients do not end up needing surgery by me.  They may need orthopaedic surgery, hand surgery, plastic surgery, etc.  But the vast majority do not have life threatening injuries.  Those that do often do poorly, but every now and then I have what I consider a good save - someone who may well have died if not for my intervention.  I'm not trying to pat myself on the back...ok, maybe I am a little.

Last night, I got two trauma patients at once - a woman who had T-boned another car, and the driver of the other car as well.  Neither was seriously injured.  The husband of the first woman was sitting in the back seat during the accident, but he wasn't brought in as a trauma patient - he walked in and started complaining of some chest pain.  He was immediately upgraded to a trauma, and a CT scan of his chest and abdomen showed a fracture of his sternum (breast bone) as well as some blood in his abdomen and evidence of active arterial bleeding from the mesentery (the blood supply to the bowel).  He was initially stable, but his blood pressure began to drop even though I transfused 4 units of blood.  I took him to the operating room where I found a small bowel laceration and about 5 liters of blood in his abdomen due to two large lacerations of the mesentery with active arterial bleeding.  I got the bleeding under control, repaired the mesentery, and repaired the small bowel laceration, all in under an hour.

This morning he is awake, alert, his vital signs are all completely normal, and his blood counts are also normal and stable.

My best save is from about 3 years ago - a young woman was shot in the abdomen by her ex-boyfriend while she was holding her two-year old daughter.  Her parents were also both shot, but they were ok.  I took her to the operating room where I repaired her diaphragm, repaired her liver, repaired two holes in her stomach, removed the tail of her pancreas, and removed her left kidney.  She essentially walked out of the hospital about two weeks later.  I've seen her in my office several times over the past 3 years, and she's doing great - she's remarried and back to work full-time.

THIS is why I do trauma.  It isn't to take care of the idiot drunk driver who puts everyone around him at risk or the criminal who gets shot in a shootout with police.  It's to take care of these innocent victims and get them back to their normal lives.  THAT'S what makes it all worth it.

Monday, 28 November 2011

Two beers

Two beers.  It's always "Two beers."

Me: How much did you have to drink tonight, sir?
Idiot patient who reeks of alcohol: Two beers

It's almost ALWAYS two drinks.  No one ever admits to getting plastered, but everyone feels the need to lie to the doctor in order to look better, I suppose.  Even when I tell them that I'm not the police and that we're getting a blood test so I can see their exact blood alcohol level, they continue to lie.

Same goes for drug users - people readily admit to using marijuana, but no one likes to admit to using heroin or pills or cocaine.  People on PCP are too doped up (and stupid) to admit anything.

Look people, I'm just the guy trying to take care of you.  If you've hurt someone, you better believe I'm going to find the police and make sure they know about you.  But I'm trying to make you better, and lying to me isn't helping.

Tuesday, 22 November 2011

Don't bullshit me

DISCLAIMER: I WILL PROBABLY LOOK LIKE A POMPOUS ASS IN THIS POST

I've said before that I don't claim to be the smartest guy in the world, but after 4 years of college, 2 years of graduate school, 4 years of medical school, and 5 years of surgery training, I think it's safe to say that people like me are some of the more highly-educated people in society.  There are some other very highly-educated people in this world as well (Ph.D.s, lawyers, educators, pharmacists, dentists, etc), but that doesn't give them any insight into medicine or physiology.  Some highly-educated people just don't seem to get that.

A patient of mine introduced himself as "Dr. Suchandsuch" (not his real name), so I naturally assumed he was a medical doctor.  Now my conversations with other physicians are on an entirely separate plane as compared to non-physicians, because there is a reasonable assumption of medical knowledge no matter what the field.  Even a psychiatrist knows most surgical jargon.  This guy nodded and went along with me through my whole talk with him about his condition.  When I was done, I asked him if he had any questions.

"Just one - what did you just say?"

Turns out the guy isn't a doctor at all - he has a Ph.D. in mathematics.  He's a SMART guy, don't get me wrong, and I would have no problem calling this guy "Dr. Suchandsuch" if I were a student in his class as a sign of respect for someone in his position.  But I'm sorry, if you are a Ph.D., you do NOT introduce yourself as a doctor to another doctor when you are the patient.  I don't think of myself as better than this guy, but that's nothing short of arrogance.

I've had chiropractors pull the same bullshit with me.  Chiropractors are NOT doctors, despite their "DC" tag that they give themselves.  When I've been a patient, I've introduced myself as my first name.  If the subject comes up, I'll tell the doctor that I'm a physician as well.  That allows us to communicate a lot easier.  But when I'm a patient, I'm a patient.  When you're my patient, don't bullshit me.

Sunday, 20 November 2011

Losing patients

I lost a patient today.

Losing patients sucks.  I've lost two this week.  One of them was nearly dead by the time I was consulted on him, and he ended up finishing himself shortly after I operated on him.  The second one went well, but despite the fact that we did everything right, he still bled to death.

Life isn't really fair sometimes.  I've taken care of some scumbag gangbangers who got shot in the chest and survived, and this hardworking family man suffered an injury that could have been survivable, but he died.

I can't tell you how many patients I've lost, and you may think I'd become immune to it after a while.  But each and every one stings like hell.

Wednesday, 16 November 2011

RFB

If you don't know what "RFB" stands for, I highly suggest you do a Google search.  No, it isn't a type of rifle (since that what Google will come up with for you).  In medicine, RFB stands for Rectal Foreign Body.  I'm constantly amazed at what people will insert in their rectums far enough that they can't retrieve it.

About 2 years ago I was asked to see a guy who had this impacted in his rectum: 


Fortunately for him, I was able to grasp it with a surgical clamp and take it back out the way it went in.

Another gentleman came to the ER complaining of severe abdominal pain, and on questioning him he admitted to putting this in his rectum:


Why did he do that, you ask?  He was preparing for a fisting party.  Yes, preparing for a fisting party.  He managed to perforate his colon and required a colostomy.

My favourite story will be familiar to anyone who has viewed my profile on fmylife.com.  I got called to the ER to see a guy who had something "stuck up there".  The nurses were all snickering about it when I arrived - "Did you hear about the guy in room 15?"  I walked in to the room, and after I introduced myself, he said, "Doc, I'm not gay, but my wife is out of town with the kids, and I did a stupid thing."  Yes he did - here is his Xray:

After I told him that I wasn't interested in his personal affairs, he pulled these out of his bag:






He told me that he figured there was a vacuum behind the bottle that wasn't allowing him to remove it himself, so he had used this bit to drill a hole in the bottom of another bottle.  He then handed me the drill bit...and a spare bit, just in case the first one broke...as he expected me to drill a hole in the GLASS BOTTLE IN HIS RECTUM.

"Sir," I said, "I assure you I will not be drilling a hole in the bottle."

I took him to the operating room and put him to sleep, and when the muscle relaxants kicked in, his rectum and anus relaxed enough for me to get the bottle back out the way it went in.  He signed himself out of the recovery room, and I never heard from him again.

Monday, 14 November 2011

Mondegreens

Legend has it that writer Sylvia Wright misheard the lyrics to "The Bonny Earl of Murray" when she was a child. The actual lyrics are "Thou have slain the Earl of Murray and laid him on the green", but what she heard was "Thou have slain the Earl of Murray and Lady Mondegreen". And the mondegreen was born.

Fortunately, these aren't limited to songs ("'Scuse me while I kiss this guy"). Medical mondegreens abound. Some like Old Timers' Disease (Alzheimer's) are quite descriptive, but wrong nonetheless.

Yesterday a patient told me that his legs always swelled because of his very close veins (varicose veins).

Another patient came to my office complaining of pain at her biblical hernia (umbilical). Fortunately the fireballs in her eucharist (fibroids in her uterus) didn't bother her.

Some are a bit harder to decipher. It took me a good 5 minutes to figure out that the lady with "65 roses" actually had cystic fibrosis. And the little girl with Smilin' Mighty Jesus really was suffering from spinal meningitis.

Friday, 11 November 2011

Excitement!

My heart always beats a little faster when my trauma pager goes off.  Then when I look at what's coming in and I see "GSW" or "stabbing", my heart beats a little faster still.  Is it a stabbing to heart?  A gunshot wound to the abdomen?  The anticipation is exciting, but the results are often...underwhelming.

At 5PM I found out we would be getting a stabbing victim.  I rushed down to the trauma room where the nurse told me that it was a prison inmate who was stabbed in the abdomen.  That's always nerve-wracking - what did the psycho use?  A knife?  A sharpened toothbrush?  And what did it penetrate?  Intestine?  Colon?  Stomach?  Liver?

About 5 minutes later, the patient was wheeled in wearing his traditional orange prison jumpsuit, handcuffed to the gurney.  He looked like he weighed about 450 pounds.  They move him over to the hospital gurney, and the guard just sort of looked at me and grinned.  "He stabbed himself, Doc.  You just have to see it to believe it."  So I pulled back the sheet to see...

...a spoon.  Yes, a spoon sticking out of his abdomen.  A plastic spoon.  I looked up at the guard again, and he smiled at me as if to say, "I told you!"  So I asked the patient what happened, and he told me very matter-of-factly that he inserted the spoon into his abdomen (he had already had a wound there).  And why did he do that, I asked him.

"The voices told me to."

Of course they did.  Fortunately this guy's abdominal wall was so thick and his exam was so benign that I immediately knew there was no way the spoon did any real damage.  So I reached for the spoon to pull it out when he said, "There's a pen in there too, Doc."

Of course there is.  So I pulled out the spoon, fished around and pulled out a regulation prison-issue safety pen, and released him back into the wild.

Thursday, 10 November 2011

Let my people go

When relatives are sick, you want them to get better. I get that, and I support it. When someone is critically ill, you want the doctors to do everything possible, right? Well, most of the time. You have to look at the whole picture, not just a snapshot in time. Sometimes doing everything isn't the right thing to do. Sometimes it's ok to let people go.

The gentleman I was asked to consult on this evening is just one of those people. He's in a nursing home, bedbound, nonverbal. He developed an "acute abdomen", meaning he needs emergency surgery for some intra-abdominal catastrophe. He was near death, and I told his next-of-kin that he would likely die with or without surgery. She wanted everything done, and on exploration, his entire small bowel was dead. Gangrene. Not compatible with life. Cases like this make me feel helpless because these patients are unfixable.

Sometimes the humane thing to do is nothing.

Monday, 7 November 2011

Vaccines

I had chicken pox when I was 8.  It sucked.  I had a belt of pox around my waist that itched so much it made me want to crawl out of my skin.  If I had had the opportunity to have a vaccine rather than go through the intense itching, I would have jumped on it.  Now there IS a vaccine for chicken pox.  Huzzah!  It's 85-90% effective, and even if you do catch chicken pox after getting the vaccine, you'll only get a very mild case of it!  That's great news, right?  Right??  Well...

Unfortunately, some blithering idiots have something against vaccines because another blithering idiot falsified his data to make it look like the MMR vaccine was linked to autism.  That wasn't just a little bit of data-massaging, it was outright, bald-faced FRAUD.  But some parents still believe that vaccines are bad, so they turn to, well let's say other methods of getting their kids immune to the chicken pox virus.

Some geniuses on Facebook have started forming groups that either look for pox parties (to share the virus, thereby purposefully infecting everyone) or to MAIL A LOLLIPOP THAT AN INFECTED CHILD HAS LICKED.  Yes, seriously.  What the ever-loving fuck is wrong with these people? 

Fortunately, sending diseases through the mail is illegal.  I hope these morons go to prison and pick up some colorful diseases of their own.

Friday, 4 November 2011

Drugs are bad


I don't think I can stress this enough.  Drugs make you crazy, stupid, and insane.  And they make you lie.

A patient of mine that I have been seeing for several weeks with an ulcer on her leg had herself admitted to the hospital because of severe pain in her leg.  She had admitted to me that she used to use crack cocaine and PCP, but she swore up and down that she was clean for several months.

I looked at her ulcer, and it was pristine.  There was no sign of infection, an MRI showed nothing except a superficial ulcer, and her labs were all normal...except for a urine drug screen which was positive for (dramatic pause) COCAINE AND PCP.

I love it when people try to claim that the test was a false positive or that there simply MUST have been a mix up in the lab.  The lab equipment doesn't lie, folks.  Why can't people just be honest with me?

Thursday, 3 November 2011

Nothing to do with medicine

Even though this has nothing to do with medicine, it still has to do with stupid people.  Welll, stupid person.  It just pisses me off more than I can even start to describe.

A judge in Texas (yes, a judge) was taped beating his 16 year old daughter with a belt several years ago, and she posted the video to Youtube a few days ago.  The fact that she's disabled is almost irrelevant.  I'll warn you that the video is disturbing, and that means a lot coming from a guy who regularly sees people stabbed in the heart and shot in the head.

As a parent, I was absolutely horrified watching this.  I wanted to reach into the computer screen, grab this guy by the ears, and yell, "WHAT THE FUCK IS WRONG WITH YOU!??!"

http://news.yahoo.com/family-court-judge-caught-beating-ill-daughter-videotape-183647572.html

I promise I'll get back to more stupid patients next.  I just couldn't let this go.  There's a special place in Hell for people who abuse children.

Tuesday, 1 November 2011

Learning from mistakes

I've said before that life is a series of learning opportunities, and who we are is defined by how we react and learn.  Some people, unfortunately, either choose not to learn or are too stupid to realise a learning opportunity when they see it.

An older gentleman came to my trauma bay having suffered severe burns to his face and neck.  Now burn victims have a rather unique odor about them (much like cooking beef or pork have distinctive smells...disgusting analogy, I know), but this guy smelled more like cigarette smoke.  Plus, the distribution of his burns was a little strange.

It turns out that he had severe emphysema from smoking and was on home oxygen, but he just continued smoking...while the oxygen was flowing.  Free flowing oxygen plus ignition source (lit cigarette) plus fuel (facial hair) = big boom.

While I'm on the subject of burns, another older lady came in having sustained third degree burns to her shoulder.  She admitted to falling asleep while smoking, and the lit cigarette set her blanket on fire.  When I examined her shoulder, the burned area seemed to have a strange checkerboard appearance to it, which I thought may have been transferred from the blanket.

Nope.

Said the lady, "Oh, that's a skin graft from the last time this happened."

Monday, 31 October 2011

Truth is stranger than fiction

I know that "The truth is stranger than fiction" is a cliché, but it's completely true.  I can't make this stuff up - I'm just not that creative.

Last time I was on call, I got a call at 3 AM (I HAAAAATE those) about a level 1 trauma (that's generally a person who is very close to dying), a woman who had fallen down the stairs and was unconscious.  Even at 3 AM, my heart starts beating a little faster when I hear the patient is "level 1".  However, my palpitations soon changed to amusement. 

The woman arrived a few minutes later without a scratch on her.  The second I laid eyes on her, I knew that something didn't exactly add up.  And then the paramedics launched into her history: she was drinking at home and passed out, so her husband (also drunk) decided to carry her upstairs to bed.  Halfway up the stairs, he dropped his cell phone.  Now what would you do:

A) Ignore the phone and continue carrying your bride towards her peaceful slumber
B) Bring her back downstairs, get the phone, go retrieve her, and start over
C) Grab the phone and risk dropping her

I think by now you've guessed he chose "C".  And he dropped her.  She landed in a jumbled mess of inebriated unconsciousness at the bottom of the stairs...still passed out drunk.  The paramedics didn't know if she was unconscious because of the alcohol, massive bleeding in her brain, or both.  Of course, it turns out that she was completely fine, except for her blood alcohol level of nearly 0.2. 

Don't drink and walk.

------

This one may be a few years old, but it makes me giggle every time I think about it.  A young guy covered with tattoos (in my neck of the woods this usually indicates a gang member) came in shot in the buttock.  Nothing is quite as amusing as a grown man crying like a schoolgirl because he was shot in the ass.  I usually ask these rock stars what happened, and here's this guy's explanation:

"I was gonna shoot this asshole, but he grabbed my gun before I could shoot him and that motherfucker shot me in the ass!"

Yes, yes he did.

Friday, 28 October 2011

Drug seeking

ATTENTION ALL DRUG SEEKING MORONS. ATTENTION. PLEASE READ.

I'm smarter than you. Have I said that before? I think so, but it bears repeating. You may think you're very clever and have it all figured out. You can try to claim you're allergic to ibuprofen, aspirin, naproxen, Toradol, Ultram, Tylenol/paracetamol, and everything except Dilaudid. But you can NOT fool me. I'm amazed that people are so arrogant that they think they can trick me into giving them narcotics.

Last night, two 22-year olds were in a car accident, and both claimed to have severe, crippling back pain. Red flag #1. I was suspicious, so I pulled up the driver's prescription record (didn't know I could do that, did you, smarty pants?). In the past few weeks, he had prescriptions for codeine, Vicodin, Percocet, 2 benzodiazepines, Ambien, and Viagra. Yes, VIAGRA. Red flag #2. Oh, and his arms were covered in track marks. Red flag #3.

After a CT of both their spines were normal (please, control your surprise), I watched as both were propping themselves up in bed and twisting and turning - all things that people with back injuries can not do. Red flag #264. I accused them of drug seeking, and the driver immediately threatened to sue me for malpractice (ha!!). I happily gave him my hospital ID and a pen and told him to write my name down and have his lawyer call me. Not the best idea, threatening to sue the guy who you're trying to con some narcotics from.

The driver's father, who is an oncologist, came and picked them up, and they amazingly were able to get up and walk out. It's a miracle!!!

You're both cretins. And you're busted.

Thursday, 27 October 2011

Seatbelts!

There is a reason that many countries around the world (including mine, thankfully) have laws requiring seatbelts to be worn: China, Russia, Australia, EU, UK, United States (WHAT THE FUCK ARE YOU WAITING FOR, NEW HAMPSHIRE??!).  They save lives.  Unless I'm moving my car from one position in my driveway to another position in my driveway, I put it on (and even then I usually automatically reach for it).  I have to consciously try NOT to put it on.  It takes 4 seconds and it doesn't hurt, although it may hamper your ability to get your cell phone that you accidentally dropped while you were texting while driving.  That's a whole other rant I'll get into some other time.

Three friends were coming back from a party at 1 AM.  The driver was a bit tipsy, the other two were flat-out drunk.  The driver and the front seat passenger were wearing their seatbelts when the driver lost control and flipped the car several times.  The rear-seat passenger wasn't.  The driver walked away with scratches and the passenger had a few broken ribs and a broken sternum.  He went home in a few days.  The rear-seat passenger wasn't wearing his seatbelt.  For comparison, here is what a relatively normal cervical spine looks like:
And this is his.  That his 6th cervical vertebra completely impinging his spinal cord.  He's now paralyzed from the neck down, forever, because he didn't put on his seatbelt.

Wednesday, 26 October 2011

Requests

Like many radio stations, I take requests.  Someone yesterday noticed that I have some stupid patient stories, but no stupid DOCTOR stories.  Well, you asked for it...

I was on general surgery call at one of my hospitals yesterday, and I got a call from an ER physician about a young lady with right lower quadrant abdominal pain.  The first thing general surgeons always think about in a young patient with pain in that location is appendicitis.  It's incredibly common, and very easy and rewarding to treat.  The ER doc had ordered a CT scan of her abdomen which failed to identify the appendix.  There wasn't any inflammation in the area of where the appendix should be, but there was a recently-ruptured right ovarian cyst which surely was causing her pain.

But why couldn't the CT scan identify her appendix?

She had an appendectomy 4 years ago.
---
On a completely unrelated note (and having nothing to do with medicine whatsoever), PETA (in the US) is asking a federal court to give constitutional rights to 5 employees of SeaWorld.  Doesn't sound like such a big deal, until you realize that these employees are WHALES.  Yes, PETA wants constitutional rights extended to orcas, and they are claiming that the whales' captivity violates their 13th amendment rights banning slavery.

"By any definition, these orcas are slaves — kidnapped from their homes, kept confined, denied everything that's natural to them and forced to perform tricks for SeaWorld's profit," some PETA whackjob said.

Animals in captivity aren't slaves, you moron.  They are animals in captivity.  I am offended on behalf of all those people who actually were in slavery.  Fuck you, PETA.  Fuck you.

Monday, 24 October 2011

You can't fool me

I always find it fascinating when people think they can outsmart me.  I'm not claiming to be the smartest person in the world, but I'm pretty damned sharp.  Tonight a 22-year old schmuck who REEKED of alcohol drunkenly rolled his golf cart at the country club tonight and then tried to claim he only had 2 beers...nice try, stupid.  Even after I tell these idiots that I am NOT the police and that I WILL be checking his blood alcohol level, they all stick with their story.  It's almost always "2 beers".  Were these 60 ounce beers?

Friday, 21 October 2011

Don't judge a book...

I always try to believe the best about my patients, but a few experiences have severely curtailed my faith in humanity.


I have a guy now who was shot in the abdomen multiple times, and he suffered injuries to his small intestine and colon.  That's nothing new - it happens regularly, and these patients tend to do quite well.  This guy seemed like a nice enough guy - very polite, courteous, etc.  When I was making my rounds yesterday, I noticed he had been moved to the ward upstairs...the corner room with the locked door that can only be unlocked from the inside.  I figured the guy was under police protection, and I was right...sort of.  After being buzzed in by the police guards, I noticed he was handcuffed to the bed.  Turns out the guy has an outstanding arrest warrant.  For murder.

How the hell can I trust any of these people?

Thursday, 20 October 2011

Motorcycles

Can I talk about motorcycles for a minute?  Wait, it's my blog.  I can talk about anything I damn well please!

Motorcycles suck.  They really suck.  On a scale of 1 to suck, they SUCK.

If I hit someone at 60 mph/100kph, there is something rather comforting about having 1.5 tonnes/3000 pounds of steel, aluminum, and fiberglas surrounding me, not to mention the crumple zone, seatbelt, and multiple airbags that are designed to protect me.  If you're on a motorcycle and you hit a car (or a concrete barrier) at 60 mph/100kph, no combination of helmet, leather jacket, and armored pants are going to save your sorry ass.  It's just you and the road.  The road ALWAYS WINS.

What pisses me off even more are the idiots who defend their murdercycles to the death.  Literally.  I've had several patients tell me that their horrific motorcycle accident was their last and they are giving up riding.  But I had one guy a few months ago who had his leg nearly amputated at the knee.  He adamantly told me that he would get right back on his bike as soon as he was able, because the accident wasn't his fault.

Wasn't your fault?  What the hell does that matter?  Whether it's your fault or not, you almost died, and you almost lost your leg.  Life is a series of lessons from experiences.  LEARN SOMETHING FROM THIS ONE.

Wednesday, 19 October 2011

Tragic

Surgery has its share of tragedies, but I seem to see more than my fair share.


I was scheduled to do a colectomy a few weeks ago on a guy with a large colon polyp which couldn't be removed without surgery. He showed up for surgery 2 hours before his procedure, right on time. So what's the problem?

His wife died last night.  And he still came for his surgery on time.

He told me he'd be willing to go through with surgery, but he'd have to go home right afterwards. This is NOT outpatient surgery - people have to stay in the hospital for about 4 or 5 days after a colectomy.  Poor guy - I told him to go home and take care of his affairs. I wish all of my patients could be compliant like this guy, even though he took it several steps too far.

Tuesday, 18 October 2011

Stupidity

Ok, more stupid patient stories.  One of my favourites is a 33 year old woman who jumped out of a second story window.  Why?  Because the guy she was with told her she had to go.  So she went...out the window.  Of course she was high on cocaine, why even ask!

She broke several bones in her back, but that's not the best part.  I was doing a FAST (Focused Abdominal Sonogram for Trauma) to check for any signs of internal bleeding, and when I put the ultrasound probe over her pelvis, I saw something move.

"Any chance you could be pregnant?" I asked her.
"No, I just had my period 2 weeks ago," she replied.

The fetus was actually 24 weeks along and probably just as high on cocaine as she was.

------

Stupidity isn't limited to trauma - it carries over to general surgery, too.  I finished doing a hernia repair on a guy a few days ago, and as we all know, patients who undergo hernia surgery should avoid any heavy lifting for 3-4 weeks after the operation. I reminded him of this, and he looked at me askance and said, "But my leading lady weighs about 21 stone (300 pounds)."

I thought he must be kidding. But he wasn't smiling or laughing.

"Just don't pick her up," I replied, thinking he must be joking.

"I mean in bed."

He's 71 years old.  His wife is too.

Friday, 14 October 2011

More stupidity

What the hell is going on with PCP?  There's a major revival going on in my area, and more and more idiots are coming in so screwed up that they can't see straight.  These are just stories from this week:

A 55 year old guy was doing something on his roof while high on PCP.  Who the hell knows what...probably trying to fly.  He fell off, hit his head on the concrete, and had a major bleed in his brain.  He's on a ventilator now and probably will be for the rest of his pathetic excuse for a life.

A 24 year old guy decided it would be a good idea to go car surfing while high on PCP.  Much to the surprise of NO ONE, he fell off, hit his head, and bled into his brain.  He'll probably be a vegetable forever.

I find it difficult to have sympathy for self-induced trauma.

Life is cruel sometimes

This happened a few months ago, and it's just a sign that the world can be a cruel bitch.

A man came in having been involved in a high-speed rollover car accident.  He was unresponsive in the field with no pulse.  CPR was started.  By the time he got to me, he was still pulseless.  Massive chest trauma, flail chest, etc.  We continued CPR for 20 minutes before I declared him dead.  I got the really bad news a few minutes after that -

It turns out he was on his way from out of state to attend his wife's funeral.  She had died a few days before, also at my hospital, having hit a deer with her car.  The impact with the deer didn't kill her - the deer went through the windscreen and kicked her repeatedly in the head.  That's what killed her.

They had a 1 month old child.

Thursday, 13 October 2011

First post...again

Well goddammit, I started this blog 2 damn years ago, and I can't remember the password to access it. I didn't like the name of it anyway, so to hell with it. I'm starting over. I'll steal some of the stories from that one.

Anyway, I'm a surgeon. Specifically, I'm a trauma surgeon, and as the name suggests this is about my patients who do stupid things. Once or twice a week I stay in the hospital for a 24 hour shift to see the worst of the worst. One of my hospitals is in a rather poor suburb of a rather large metropolitan area, and the other is in a rather affluent suburb. No, I'm not going to divulge which city. The patients at the first hospital tend to be hopped up on PCP, drunk, shot, stabbed, or some combination. Those at the second hospital tend to be teenagers who crashed Daddy's Mercedes. Almost all of them are stupid, have done something stupid, or have made a really bad decision just before coming to me.

The first stupid story - a couple was involved in a car accident, and as they were wheeled into my trauma bay, she was wailing in pain and he was yelling "NO DON'T WORRY ABOUT ME! TEND TO MY GIRLFRIEND!" I asked him if anything hurt, and he yelled, "Yes, my heart! It breaks for my girlfriend!"

Ugh. She was still wailing uncontrollably.

I worked them both up and they were fine. No injuries, just bumps and bruises. I walked into their room in the ER to see his WIFE and her HUSBAND yelling at them, along with her 2 sisters who had no idea she was cheating. Shockingly, they were both drunk at 8 AM.

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