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 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?


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


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 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


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.


No, I'm 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.