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


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


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  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 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


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


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


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!??!"

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.


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