Thursday, 29 March 2012

Blame Hollywood

Hollywood doesn't always get it right. In some movies like "Scarface" you're supposed to root for the bad guy. You know he's evil, but you still want him to win. I can't blame movies and TV for contributing to the downfall of society, but I can at least place some responsibility on them for brainwashing people on certain subjects.

Have you ever seen a movie where the bad guys elude the police, cause several dozen cops to crash, and then get away? Of course. Have you ever seen the bad guys shooting up the good guys and then getting away? They pull a gun, fire a few shots off, and get away clean while the bumbling cops are still trying to figure out what went wrong and how they can hide their mistakes from their chain-smoking captain. You've seen that movie, right? Of course you have. I'm sure it occasionally happens in real life too. But the problem is that the movies make it seem easy. Too easy.

A 19-year old kid was brought to me today having been shot multiple times. Innocent robbery victim? Wrong place at the wrong time? Caught in the crossfire? Not hardly. He allegedly pulled a gun on the police and fired, and they responded in kind.

Now the difference between this guy and the police is that one of them is a kid who has seen too many movies, and the other not only is trained extensively in marksmanship but also wears a bulletproof vest. See where this is leading?

You guessed it. Unlike in the movies, the good guys actually got the bad guy.

He was brought to me with no pulse and multiple gunshot wounds in his chest, abdomen, arm, and leg. I performed a resuscitative thoracotomy (I opened his chest), and unfortunately he had bled to death internally. He didn't stand a chance.

At least Hollywood had this part right today - the good guys usually win in the end.

Tuesday, 27 March 2012

Safety equipment

Seatbelts were invented with one thing in mind - protect the occupants of a vehicle from catastrophic injury.  Airbags were invented for the same reason.  But seatbelts only work when they are worn, and airbags can be disabled.  Why on earth would anyone do such a thing?  Ignore or disable something that is there to save my life?  Read on, fearless reader.  Read on.

Companies that produce power tools engineer tool-specific safety devices to protect the consumer.  A razor-sharp table saw blade spinning at over 3000 rpm seems quite dangerous, and it's very comforting having a blade guard protecting my fingers.  Unfortunately it's often very easy to remove these devices, though only the clinically insane would do so.  I suppose they may think the damned blade guard is annoying and just gets in the way.  So why am I telling you this?  Obviously there's a reason.  Don't get so antsy.

An otherwise-healthy 35 year old man was brought to my trauma bay having been shot in the abdomen.  I took a quick look and saw a tiny pinhole under his right rib cage.  "Now wait a second, Doc, this guy was shot.  So why the hell were you talking about power tools before?"  What, you haven't made the connection yet?

He shot himself in the abdomen with one of these:

For those who don't know, that's a pneumatic roofing nail gun.  See that tip?  That's the very well-designed safety mechanism that won't allow the gun to fire unless significant pressure is applied to the tip.  In his infinite wisdom, this guy had decided that the gun would fire much faster and he could therefore get his roofing job done that much quicker with that damned annoying safety tip removed.  Somehow he also decided it would be a really hilarious joke to pretend to his buddies to shoot himself in the abdomen, forgetting about the lack of the safety tip.


We had no idea what size nail he had been using, but he had enough pain to earn a trip to the OR where we found a single hole in his gall bladder.  Nothing else.  He did well and went home a few days later.  He went back to work a few weeks after that. 

I can cure a lot of things, but I have yet to find a cure for stupidity.

Sunday, 25 March 2012

Wakeup call

If you've read my blog, you no doubt have seen me talking about learning from mistakes. Some people understand quickly when life is trying to tell them something. Others need a little extra nudging. Some, however, are seemingly deaf when the universe is talking to them and need to be metaphorically slapped across the face with a chainsaw.

What's your favourite evening activity? Stay with me here, I'm going somewhere with this. Going out to a bar? Board game night with the family? Perhaps a movie and hot buttered popcorn? How about getting together with several friends to steal a car?

What, that's not your idea of a fun night? Well it was for two patients of mine this week. They (and a few other buddies) stole a car and took it for a joyride. Unfortunately the owner reported it stolen, and the police caught up to them. I guess these guys hadn't seen enough police chases on TV to know that running from the cops is stupid and almost always ends up with the car wrapped around a tree and/or them in handcuffs. It doesn't help that they're all teenagers.  Brash, indestructible, and stupid.

The car ended up wrapped around a tree. Two of the victims came to my trauma bay. All the others died in the crash.

One of these young men (who was not wearing his seatbelt) is now in critical condition in my Intensive Care Unit with a large portion of his skull removed due to massive bleeding in his brain. There's a good chance he won't survive. The other young man (I should call him a kid since he's still a minor) WAS wearing his seatbelt and had not a single scratch on him. I kept him overnight for observation for his mild concussion, and when I went to see him the following morning, the police had already informed him of the death of his friends. I told him this is his big chance. This is your chance to make a change and turn your life around, I said. I almost begged him not to end up back in my trauma bay, because the next time he may not be so lucky. I told him this was his wakeup call.

I just hope he hears it and doesn't hit the snooze button. The universe can only talk to you but so loudly.

Friday, 23 March 2012

Compare and contrast

No one likes those "Compare and contrast" essay questions in literature classes.  Fortunately that's not what this post is about.  This is about two very different patients with two very different outlooks on life.

The patient I just finished with is a 60 year old woman with chronic pelvic and back pain.  Instead of seeing a pain specialist, her brilliant plan was to commit suicide by slashing her wrists.  That technique just doesn't work, especially when all the lacerations are barely through the skin.  She still managed to lacerate both her forearms to the tune of about 60 cm.  She just wanted the pain to stop...but she never thought to try pain medicine.  She tried to take the easy way out.  She told me that she just didn't want to wake up tomorrow.  I told her that I was very sorry, but that she would most assuredly wake up tomorrow in our psychiatry ward.

Compare that to the patient I saw just prior, a 40-ish year old Middle East war veteran who stepped on a landmine a few years ago and lost his leg below the knee, his testicles, his penis, and half of his abdominal wall.  After going through over 40 operations (with several more still to go to reconstruct his penis) and years of rehabilitation, he was back on his feet and back on his motorcycle living life to the fullest until a car pulled out in front of him this afternoon.  Fortunately he only suffered a broken elbow.  He didn't blame anyone, and he wasn't angry at the world for his injuries.  He clearly has 9 lives, and he's used up at least two of them.

I do feel sorry for the first woman.  Obviously she has endured years of pain, but then again, so has the second guy.  The difference in how they view life is startling, though.  He's lost his manhood but not his positive outlook.  I just wish more people could be like him.  Maybe he should become her therapist.

Tuesday, 20 March 2012

Domestic violence

I've had several questions asking about this next picture.  In case you haven't seen it, here is the picture:

The story is not for the faint of heart, and it's enough to get your blood boiling.  A man was picking up his kids from their mother's house when they got into an argument.  His response to the disagreement was to go back inside, get his gun, and shoot her multiple times.  She was hit in the left arm, the abdomen, and the head.  I took her immediately to the operating theatre for a laparotomy where I found multiple perforations in her small intestine and colon, all of which I repaired successfully.  I then stayed to assist the neurosurgeon who performed a craniectomy - he removed a large piece of her skull, stopped the bleeding in her brain, and put the bone on ice to (hopefully) reimplant later.  This procedure allows the brain to expand outside the normal confines of the cranium, because there is very little room inside the cranial vault for the brain to go.  The picture above is her preoperative picture.  The bright white spot in the middle is the bullet sitting in the middle of her brain (no, we didn't remove it - see here to read why not).  And below is her postoperative picture.

You can see where the skull is missing.  That bright white spot in the middle guessed it, the bullet.

She survived, but unfortunately she has not woken up yet.  It's been just over a month and she remains completely unresponsive.  I discharged her to a nursing home a few days ago where she will likely live out the rest of her days like this.

They have not caught the shooter.  I can only pray for her and her children and hope that justice will be served someday.

Monday, 19 March 2012

Indescribable stupidity

Some people are so indescribably stupid that words fail to portray just how stupid they actually are.  However, I'm going to do my best to do exactly that.

At some point in your life, you have to learn from your experiences.  You just have to.  Otherwise, you're going to end up like this next guy who just hasn't seemed to understand that the world is trying to tell him something.

At the beginning of my last shift, the first patient of the day was reported to be a man who jumped out of a third story window.  Surely he was trying to escape a burning building, right?  Or maybe he fell off a balcony?  Perhaps he was just taking a stupid dare and jumped for the hell of it?  These thoughts were going through my head when the medics wheeled him in with several police officers following closely behind.

Uh oh.  That's never a good sign.

The first thing I saw when I look at him were two very mangled-looking wrists and a very abnormal elbow.  I did a quick once-over and saw a large vertical scar on his abdomen that looked just like the type of incision I make for people who get shot.  I asked him what the scar was from.  "That's from when I got shot 2 years ago."

Oh, great.  "So what happened to you today?" I asked him.

"I jumped out the window."

"And why in the world did you do that?" I asked, feeling like I knew the answer.

"I was trying to get away."

From what?  He wouldn't tell me.  Finally, after several tries, I said, "Perhaps from these guys over here with the guns and handcuffs?"


Uh huh.  It turns out that he and his buddy were robbing a house.  Unbeknownst to them, the homeowner was still at home and had hidden in a closet.  She called the police who confronted the two hoodlums, and this guy, in his great wisdom, chose to jump out of a third floor window rather than get caught.  After a full workup, in addition to his bilateral open wrist fractures and horribly fractured elbow, he also had a very nasty fractured hip.  He may never regain full use of either wrist.

After informing him of his injuries, I looked at him and said, "Next time this happens, just let them catch you."

NEXT TIME?? I hear you yelling.  Yes, next time.  He didn't learn his lesson and change his behaviour after getting shot and nearly dying, so what makes you think he'll learn anything from this experience?

So how did I do?  Did I describe him well enough?

Friday, 16 March 2012


This is a bit of a rarity, but I have an update on the young man who had a meat cleaver embedded in his face (read about it here).  If you are squeamish, you may want to skip this one.  Oh, stop retching you big baby.  It isn't THAT gory!

I saw him for follow-up in my office a few days later, and his wound had healed beautifully (if I do say so myself).  Unfortunately he had suffered some major nerve damage to 3 of the 5 branches of his facial nerve (which controls all movement of the face).  I sent him to a plastic surgeon for a consultation (since nerve repairs like this are very complex and very highly-specialised).  The plastic surgeon happily took on this difficult case, and he took him back to the operating room.

The scar went directly across three branches of the nerve (temporal, zygomatic, and buccal branches).  The three severed nerves were identified and repaired successfully.

It was a very elegant repair of the nerves, and I give full credit to my colleague for the procedure.  If only all of my patients could have such a nice outcome.

UPDATE 3/20/12: I have decided to take down these pictures because I did not take them myself.

Thursday, 15 March 2012


I have a bit of a love-hate relationship with my local police. On one hand I appreciate the fact that they protect me from all the psychotic assholes in the area. On the other hand, they sometimes bring these psychotic assholes into my trauma bay.

One of these rock stars was a 16 year old kid who stole a car and was caught. So he pulled over like a good citizen, right? OF COURSE NOT! Come on, I just told you he stole the car!! He just floored it. After about 30 minutes of running at 150 kph (95 mph), he finally lost control and hit a tree.

Now typically after a car accident, the medics very carefully extract the victim from the wreckage. This kid, on the other hand, they tazed, yanked out of the car, and handcuffed before slapping a cervical collar on him and depositing him in my trauma room and waiting around to see if they could haul him away to jail.

Fortunately once he got to the hospital he behaved himself like a perfect gentleman. Wait, were you not paying attention? He STOLE A CAR AND RAN! He acted like a complete jackass. This 16 year old punk was a wild man, trying to climb off the bed, yelling and screaming, kicking and spitting. It took 6 large police officers and security guards to hold him down.

During all this commotion, he was screaming that we have to let him go. We can't hold him down! He knows his rights!! Then he hit me with this:


After I (and all the cops) stopped laughing, I composed myself, looked him right in the eye, and said,

"Sir, they're already here."

Friday, 9 March 2012

Use your brain

The brain is a miraculous organ.  There are around 100 billion neurons all interconnected and firing various neurotransmitters.  This allows us to move.  It allows us to see, smell, feel, taste, and touch.  It allows us to have a full range of emotions.  The only problem is that the brain only works when it's used.  This seems to be a problem for many people who appear to forget that this brain exists inside their heads, and that using it makes them look and act smarter.

I was on trauma call this past Saturday night, and my phone rang at 2:30 AM.  My heart immediately started pumping - a gunshot?  Stabbing?  No.  A car accident?  Pedestrian struck by a car?  Nope, none of the above.  It was a patient that I saw in the hospital about 2 months ago for a skin infection who apparently had been readmitted a few days before.  Surely he was having a heart attack, right?  Or his intestines were hanging out of his body, right?  Actually, he was being discharged with a prescription for oral antibiotics, and he was just worried he wouldn't be able to afford the pills.

A...but...he...are y...wha...

I literally paused for several seconds to gather my thoughts and to wait until he told me the real reason he was calling.  This was the only way I could think of to avoid screaming "ARE YOU FUCKING KIDDING ME?!?"  Because that was the real reason he was calling.  The cost of his antibiotic.  At 2:30 in the morning.

During my pause, I realised that there were three possible responses I could give him: I could A) be nice and ask him politely to call back during regular business hours during the week, B) I could be a bit harsh and tell him that it's inappropriate to call a doctor at 2:30 in the morning for this issue, or C) I could simply hang up on him.  I chose to combine A and B - I harshly told him it was incredibly inappropriate to call for such a frivolous reason in the middle of the night, and to call back during regular business hours.

Shockingly, he hasn't called.

That brain sure is a fantastic organ, but only when used properly.

Sunday, 4 March 2012

Guns vs. Knives

Guns don't kill people. The little holes that the bullets make kill people. Knives, on the other hand, kill people. The interesting thing about your murder weapon of choice is how personal you want to get with your intended victim.

You can stand several yards away from someone and shoot him. It's very impersonal, and you can even shoot multiple times if you like. But to stab someone, you need to be within arm's reach, potentially looking this person directly in the eye as you plunge the knife into his body. THAT'S personal.

Why the morbid thoughts? A patient I took to the OR last night was stabbed 20 times. TWENTY TIMES. Think about that as you're looking over the list of what was stabbed:

Right shoulder
Right hip
Left cheek
Left ear
Left scalp
Chest 3 times
Abdomen twice
Back ten times

Fortunately, none of the injuries were life-threatening. I explored his abdomen and stopped the bleeding, put a tube in his left chest to re-expand his collapsed lung, and tediously repaired all 20 stab wounds (the one on his scalp alone was about 25 cm or 10 inches long).

Now I've been righteously pissed off before. But how much rage must you have inside you, and how much anger must you have towards this person to stab him this many times in all these places?