Hypocrite?

I feel like I've been letting the readers down lately, posting inspirational stories and thank-yous and such.  BUT NO MORE!  I'm getting back to stupid patient stories, and this one certainly qualifies.  I'm not really sure what to make of this next patient though.  Maybe some of you can help me.  I'm truly at a loss for words.

A 30 year old woman was brought to me having fallen down the stairs.  She apparently struck the front of her neck on the banister and passed out briefly.  When she arrived she was awake and talking normally, and she was complaining of a headache and neck pain.  She also said that she had just found out a week ago that she was pregnant.

And she also admitted to having several vodkas that night.  And to smoking marijuana.

She must have seen the ire rising in my face, because she quickly explained that she didn't even like the taste of the vodka, so it was ok.

That's when the steam started to shoot out of my ears.

In my mind, I started beating the shit out of her for being such a clueless cretin.  In reality, I quickly and firmly explained that alcohol is extremely dangerous at this early point in the pregnancy.  Despite the pregnancy, I told her that we needed to get a CT scan of her brain and neck to make sure she hadn't seriously injured anything, and we could shield the fetus with a lead shield to minimise any risk.

"Oh no, I can't expose my baby to radiation!  I won't get those scans.  Uh uh, no way!"

But dousing the embryo in vodka is ok??  

I just asked the nurse to have her sign "Against Medical Advice" papers and leave.  Then I walked out of the room without another word.

NEVER give up

What's the first thing that comes to mind when you think about a trauma surgeon?  Patience?  Good hands?  The ability to stay calm under pressure?  Perhaps.  Persistence may not seem like an obvious attribute of a good trauma surgeon, but it should.  Just when all seems lost, the willingness to keep going under the direst of circumstances despite overwhelming odds against you may mean the difference between life and death.

There's a certain "look of death" that some patients have - they just look like they are about to die.  It's impossible to describe, but trust me when I say that it scares the shit out of me.  I had such a patient roll through the doors a while back.  He was a 16 year old kid who was stabbed once in the upper right portion of his abdomen.  The medics called in and said he was stable, but as they rolled through the door, the boy looked at me, his eyes rolled back, he went pale as a ghost, and he slumped back against the bed.  He had that look.

Uh oh.

We quickly transfered him to our gurney and looked over him quickly - all he had was a tiny 1cm stab wound just below his right ribs.  But he had no pulse - he was dead.  I assumed he had bled to death in his abdomen, so I quickly made the decision to perform a resuscitative thoracotomy - so-called "cracking the chest".

"But Doc, why open the chest when he was stabbed in the abdomen?"

An excellent question!  The idea in this situation is to preserve blood flow to the brain, and the best way to do that is to clamp off the aorta to shunt blood upwards.  The quickest and easiest way to do that is through the left chest.

When we opened his chest, his heart was empty and still.  He had bled to death internally.  We had started pumping blood into him, and I started internal cardiac massage - basically CPR directly on the heart.  After a few minutes, my assistant looked at me, frowned, and motioned for me to stop.

No.  NO.  This kid had just died a minute ago, and I was NOT about to give up yet.

About a minute later his heart started beating...weakly.  But that was enough for me.  As we continued transfusing him with as much blood as we could get our hands on, we wheeled him quickly down to the operating room.  When we opened his abdomen, his entire blood volume was in there.  As I suspected, there was a 1cm laceration to the liver, but no other injuries.  I quickly sutured his liver laceration, but his heart stopped beating again.

GODDAMMIT!

I did internal cardiac massage again and shocked him, but during all this my assistant again tried to convince me that it was a lost cause.  I realised at this point that this boy's chance of survival was around 1%.  That's it.  But my stubbornness had the best of me, and I kept massaging his heart and transfusing him as fast as possible.  A minute later his heart restarted again.  This time, it started for good.

A week later the boy walked out of the hospital.  A week after that he walked into my office.

"Thanks for saving my life," he said with a shy smile.

My wife likes to call me stubborn sometimes.  She's right...and I think it's one of my best traits.

The ER

ER stands for "Emergency Room".  Yes, I understand you know this already.  And I used to think that was common knowledge.  The key word here is EMERGENCY.  If you have acute pain or trouble breathing, if you're bleeding, if you can't move your arm, the ER is the place you should be.  However, if you have the sniffles, a sore throat, or some vaginal discharge, go see your doctor.  The ER is NOT the place for you!  It is NOT a walk-in clinic to serve your every need and whim, and all you're accomplishing is making the person with a real problem wait for 4 hours to be seen.  Unfortunately, too many people these days just don't get it.

On my last trauma call, "the box" went off around 11PM.  This is the emergency medical response system that is connected to all the local hospitals, and it's what the ambulances and helicopters use to call in.  Usually when it goes off it means I'll be getting another idiot, er, I mean another patient.  I wearily ambled over to the box to listen in and see what I would be getting.

A gunshot victim?  A stabbing?  HA...no.

The ambulance driver came on the box, explaining that he was transporting a young man with a history of bipolar disorder.  His vital signs were all perfectly normal, and he was acting perfectly normal.  But earlier that evening when he was supposed to take half of his prescription pill, he had accidentally taken the whole pill, and he was coming in to get checked out.

Incredulous, I looked at the nurse taking the call.  She looked right back at me with a straight face.  "We get these all the time," she said.

REALLY?  I wasn't sure who I should be more angry at - the patient for having the audacity to call an ambulance for something so ridiculously frivolous, or the ambulance team for actually agreeing to bring the moron in.

Listen up, people - believe it or not, ER does NOT stand for "Everything wRong", "Every Rash", or "Exceptionally Ridiculous"!

Well, maybe it does.

Thank you

When I started this blog back in October, I didn't really think anyone would care enough to read it.  It seems I was wrong - somehow this blog has developed a fairly steady readership.  I'm not sure where all of the readers come from, and I suppose in the end it doesn't really matter.  Because as of today, "Stories from the trauma bay" has 500,000 pageviews.

If someone had told me back in October that in only 9 months I would have half a million pageviews, I would have had a good laugh.  But here we stand today at 500,286.


So to all my readers - a very gracious and heartfelt thanks.  And to all the people who have taken a few minutes of your valuable time to write me an email - questions, comments, stories, thank-yous, fanmail - I sincerely appreciate every single one.  Please keep the feedback coming, and please feel free to share the blog with your family, friends, and coworkers.  I hope we can reach 1,000,000 soon!

Tolerance

In my line of work, we have to be tolerant of a lot of things, stupidity being one of them.  There are so many stupid things I see, many of which I share here.  But there are a few things I just can not tolerate.

• Drunk drivers

This one is fairly self-explanatory.  There is no excuse for drunk driving.  Ever.  The only people who do this are the ones who put themselves in this situation, and there is always a way around it - call a cab, call a friend, walk home, sleep in the bar, whatever.

• Grown men crying 

Don't get me wrong, I have no problem with men crying when there is a reason - his wife has died, his leg is dangling off his body, his favourite team lost the World Cup or the Superbowl.  But I just saw a man in the trauma bay who had been in a car accident and had a sprained ankle and a sprained wrist.  No broken bones, no one in the accident was seriously hurt, nothing.  But he just sat there and cried.  And cried.  He spent over an hour in there, and he was sobbing the entire time.  Not even his wife could calm him down.

• Women who howl

I don't have a problem with women crying either.  It's a normal response to something very stressful.  But DO NOT sit in my trauma bay and howl like a wolf in heat.

• Pregnant women who use drugs

Also self-explanatory, but I see it way more often than I'd care to.  One woman who was 7 months pregnant explained that she didn't think the heroin she snorted would affect the baby because it was "just like Tylenol, right?"

• Patients who spit

This is just common decency.  Most of these people are drunk, but some of them just seem to think that spitting at people who are trying to help them is ok.

I'm sure there are more, but this is a good start.  If you happened to be one of the few who saw the repeated post that I deleted, I apologise.  I couldn't remember if I had told that story yet or not, so thanks to the two people who reminded me.

Friends

My wife is my best friend.  She has been since we met 15 years ago.  Whenever I have news, I want her to be the first to know, I care deeply for her, I trust her implicitly, and I tell her everything.  That's what friendship is all about - caring for other people - right?

I guess some people didn't get that memo.

"Oh great, another great bastion of humanity just washed up in trauma bay #2." 

This is what I said when this next patient rolled through the door.  He was a young healthy man, clearly heavily intoxicated, reeking of alcohol, and acting as obnoxious as humanly possible.  It would have been very easy to dismiss him as just another belligerent drunk guy, because at the time we had no idea what happened.  The guy was "found down" with bruising around his face, so he was either A) acting obnoxious while drunk and got beaten up, B) acting obnoxious while drunk and  fell flat on his face, or C) he was abducted by aliens, subjected to untold torture, and then went home and got drunk to try to forget the pain.  I had a feeling this guy was going to land solidly in category A.

Boy was I right...sort of.

The problem with severely inebriated patients is that we can not rely on their physical examination.  The term "feeling no pain" is not an exaggeration - people can have broken limbs, lacerations, and all sorts of injuries of which they are unaware because of their intoxication.  So after doing a complete physical exam (remember the A-B-Cs?), I had a suspicion that something else was going on, even mentioning to one of the nurses that I recently had had a drunk patient who also turned out to have bleeding on his brain.  So I decided to get a CT scan of his brain, spine, chest, abdomen, and pelvis just to make sure I didn't miss anything.  And I'm glad I did, because he also happened to have bleeding in his brain.

Now the fact that I caught this isn't the point of this post.  The reason I'm posting this is because unlike with most of these patients, I found out why he was "found down".  It turns out he was at a pickup basketball game at night and was drinking heavily with his buddies.  He made some stupid, obnoxious comment (I know, I know - shocking!), and one of the players suspended the game to beat the shit out of him.  After he crumpled into a puddle in the middle of the basketball court, his friends pushed him to the side of the court and continued playing until someone called for a medic.  

How's that for friendship?

Do as I say

Smoking is dumb.

I could end this post right there and there would be very little argument or discussion (except possibly from die-hard smokers who will only give up their cigarettes when they die).  I can't blame people for starting to smoke 50 years ago before the dangers were known and it was still considered "cool".  However, do any of these sound cool:

• Heart attack
• Stroke
• Lung cancer
• Emphysema
• Chronic bronchitis
• Smelling like shit
• Breath like Satan's ass

In fact, 4 of the top 10 causes of death in the civilised world can be at least partially (if not mostly) attributed to smoking - almost 34% of all deaths are from heart disease, stroke, lung cancer, and COPD.  Not to mention the fact that you just look like an idiot with a flaming stick of dried, poisonous weed hanging off your yellowing fingers.

Surprisingly, several of the surgeons who trained me have told me of them time when they were training, walking through the hospitals on morning rounds, leaving their cigarettes on the window ledge outside their patients' rooms.  One of the cardiac surgeons who trained me will still leave in the middle of a cardiac bypass to step outside for "a breath of fresh air".  Yes, he would scrub out of heart surgery to have a cigarette.

As I was walking out of my office towards my car a few days ago, I noticed not one, not two, but three staff members of other doctors' practices sitting outside smoking.  What kind of example are these people setting?  How could I reasonably lecture someone on the dangers of smoking if that patient saw my receptionist or medical assistant with a cigarette on her lips as she walked in?

Which brings me (finally!) to my point - "Do as I say, not as I do" is utter bullshit.  Practice what you preach.  

Semi

Whatever these things are called where you come from - tractor-trailer, semi, big rig, prime mover, Mack truck, lorry, artic - they are absolutely terrifying to be near on the road.  I will admit that most people who drive them are respectful of traffic laws and drive just fine, but every now and then I see one clearly being driven by a maniac that makes me wish I were on the other side of the planet, not just the other side of the road.

I was driving to the hospital yesterday morning and saw one pulled over to the side of the highway, two police cars (with their lights blazing) flanking it at either end.  The policemen were administering a roadside field sobriety test on the driver of the truck...at 9 in the morning.

Now let's all think about this for a minute.  One of two things was going on -
1) The driver was drunk, during rush hour, behind the wheel of a 45,000 kg (50 ton) weapon carrying up to 1000 liters (300 gallons) of explosive fuel and was putting everyone around him at grave risk, or
2) The guy was such a bad driver that it looked like he was drunk and was still putting everyone around him at risk.

Fortunately he was on the other side of the highway and hadn't killed anyone yet.  Yet.