Friday, 27 July 2012


I've often said that surprises in my line of work are usually bad.  For example, I saw a 40-year old woman in my office some time back who was referred with a small painless breast lump.  She had no family history or other risk factors for breast cancer, so I reassured her that is was likely a benign mass, but I recommended a biopsy nevertheless.  SURPRISE!  It was breast cancer.  I did a mastectomy and she did very well.  Fortunately, not all of my surprises are bad, and I do get some happy endings.

You may recall a patient of mine who was stabbed 20 times a few months ago.  His girlfriend never left his side.  She was with him when he was admitted, every time I went to see him on rounds, and during his follow-up visits to my office as well.  Thankfully the young man did very well and I haven't had to see him since.  But about a month ago I was walking through the emergency department waiting room and SURPRISE I saw his girlfriend sitting there alone, looking quite ill.  She told me that she was the patient this time - she had been having flu-like symptoms for a week.  I wished her and her boyfriend well and continued on my way to the trauma bay.

That was the first surprise.

The second was when she walked into my office earlier this week to pay her boyfriend's bill in full.  SURPRISE!  As you can imagine, this is a very rare occurrence, but it's one that I accept happily.  I asked her if she had recovered from her recent illness, and she smiled sheepishly and said, "Not really."

"Oh?  Is everything ok?" I asked.

"It will be," she replied with a big grin, "in about 27 weeks."  SURPRISE!  She's 13 weeks pregnant with their first child.  The vomiting that brought her to the emergency department was morning sickness.

See?  A happy ending for her boyfriend's saga with an even happier ending for the two of them.

Wednesday, 25 July 2012


I've heard it said before that stereotypes are rooted in reality.  Sure, stereotypes are over-simplified generalisations that can be grossly inaccurate - the dumb blonde, the drunk Irishman, etc.  But my stereotype of ER doctors being morons is based on innumerable interactions with these people, and I'd say my conclusion is rather accurate, with a few exceptions.  I'm sure I've made my utter disdain for most emergency physicians clearly evident, but there's a damned good reason for it - they suck.  Seriously, they all suck.  I promise that I haven't developed this point of view for no reason.

I got a call from a frantic ER physician for a patient with an acute abdomen.  Just to give some background, saying the words "acute abdomen" to a surgeon is like a ship telegraphing "SOS" - it means someone needs surgery RIGHT NOW, and we come running.  I did exactly that - I happened to be in the hospital making rounds, so I ran down to the emergency department and looked for the patient on the registration board.  I got nervous when I couldn't find his name - Was I too late?  Had he died already?  It had only been a couple of minutes!  SHIT!

The ER doctor was nowhere to be found, so I asked several of the nurses if they knew where I could find Mr. X (not his real name), but they all assured me that they had no earthly idea whom I was talking about.  That's when I remembered I was dealing with an ER doc.

My suspicion began to take over.

After I assured myself that Mr. X (still not his real name) was not yet checked in, my panic subsided and I wandered over to the waiting room and asked for Mr. X.  A very comfortable-looking middle-aged man raised his hand, and he was happy to tell me that he had been having abdominal pain for about a month, but it was just a bit worse today.  He couldn't get an appointment with his doctor for a few weeks, so he came to the emergency department instead to get checked out.

When I asked the ER doc about it, he told me very matter-of-fact that he had overheard the patient telling the receptionist that he was having "a really bad stomach ache", so he assumed it was an acute abdomen and called me right away.  No blood work, no X-rays, no CT scan.  He hadn't even looked at the patient, let alone examined him.

So what do you think?  Think my opinion is justified?

Saturday, 21 July 2012


If you're over the age of 21, think back to that age.  Think about what you were doing and what your responsibilities were.  I would venture that many of my readers were perhaps starting their first job, getting their careers underway, maybe dating, though probably not seriously.  I was just finished college, about to start graduate school.  I was still a year away from meeting my wife, so I was blissfully (read: miserably) single.  

If you're under 21, think about where you are now and what you're doing.  Now keep that thought in your head for the next few minutes, because it's about to get blown away.

I was consulted by one of our obstetricians on a 21-year old woman due to abdominal pain which turned out to be from gallstones.  She was 19 weeks pregnant, and her pain from the gallstones wouldn't go away.  The second trimester is a good time to do surgery, so I discussed the risks of removing her gall bladder laparoscopically, including the remote risk of losing the fetus.  During the discussion, I asked if this was her first pregnancy.

"No, it's my fifth."

HOLY SHIT that's a lot of pregnancies for such a young woman, I thought.  Fortunately my mouth was smarter than my brain and said, "So how many children do you have?"

"Oh, I have four.  They're 5, 4, 2, and my baby is 1."

That's right - she's 21 and is pregnant with her fifth child.  Think about that for a moment.  When I was that age I could barely match a tie with a shirt and pants, and I was barely responsible enough to feed and clothe myself let alone 5 other tiny people who are completely dependent on me.

I'm not judging her parenting ability, because I didn't see that in action.  She may be the best mother in the world.  What I am judging, however, is bringing that many new people into this world which is already fucked up enough as it is.

Saturday, 14 July 2012


When people ask me to describe what a trauma surgeon does, I generally tell them that I fix holes. Holes in the spleen, colon, stomach, neck, liver, etc. That's a drastic over-simplification, but it's also only half of what I do. The other half is education.

I can generally put my patients into one of five categories: innocent, uninformed, ignorant, stupid, or terminally idiotic. If the uninformed, ignorant, or stupid ones survive and leave my hospital having learned nothing, either I haven't done my job properly or they don't have the brain power to learn anything. Fortunately the subject of this post fits into both "innocent" and "uninformed". At least he used to.

The subject isn't even a patient of mine - he's a teenaged reader of this blog. I get fan mail every so often (a huge thanks to all those who send it, by the way), but this one is the most powerful yet. I received this particular email from him a few days ago, and it perfectly illustrates the potential power of words. In case you're wondering, I have his approval to publish it.  I'm still keeping it anonymous for his protection:

I recently stumbled onto your blog, I think from FML or something, and I wanted to thank you. I never really wore seat belts before I read your blog. Incredibly stupid, yes? I just never thought about it. My parents always tell me to, but they don't enforce it and they don't wear a seat belt unless they're driving, and only sometimes at that. I highly respect you as a person and as a surgeon, and I felt the need to thank you for probably saving my life in the future. I put on a seat belt without even thinking about it, after a week or so of consciously putting it on. 

Again, thank you.

Sure I can save your life by putting your body back together, but sometimes saving lives is a passive thing made possible by prevention. So to this reader (and whomever else may have learned something):

You're very welcome.

Saturday, 7 July 2012


I may be going soft, because I just can't bring myself to call these next two boys stupid.  I think they're just too young and innocent to know that what they were doing was unbelievably stupid, reckless, and dangerous.

Last night while his parents were out of town, a 16-year old kid helped himself to the family car.  He picked up his 15-year old pal, and the two went joyriding.  Well, they went joyriding after helping themselves to some of their parents' liquor.

Dumb?  Yes.  But what's even dumber is not having enough driving experience to be able to handle the older car, losing control, and driving it off the road and into a tree.

Fortunately, neither of the kids was seriously hurt.  But if you've read this blog at all, you know I'm not done yet.  Of course it gets worse!  

After the crash, the boys got out and walked around, no doubt assessing the damage to the car to see how much damage there would be to their asses when their parents got home.  I can only assume the driver considered wearing shoes while walking on broken glass optional, because he told me he felt like he had broken glass in his foot when he tried to walk.  I took a look and indeed he had a tiny laceration on the sole of his foot.  I ordered an X-ray to confirm - you don't have to be a radiologist to see the problem here:

Those rectangular things sitting in the soft tissue of the sole of his foot are not one, not two, but three shards of glass measuring up to 1.7cm in length.  I injected his foot with numbing medication, lengthened the incision a few millimeters, and fished out all three pieces of glass.  Here's his X-ray afterwards:

Aah, much better.  It's a good thing teenagers are indestructible, right?

Monday, 2 July 2012

Bad to worse

Some of these stories just write themselves. I sometimes have to think about how to turn a patient encounter into a blog post. But sometimes, like last night, I get a vision as it's happening.

At 10PM, a call came in for a victim of an 8m (25 ft) fall. The call itself was nothing unusual. What was unusual, however, was everything else about this case.

The 48 year-old female patient arrived a few minutes later, and I asked her what happened today. "Nothing today."

Uh, what? "Then when did you fall, ma'am?"

"Oh, 2 days ago. But my back started hurting and I started peeing blood today. So I called for an ambulance." The red flags were already going up.

She refused to tell us her last name, asking us to call her Betty (not her real name). After her workup (including CT scans from head to toe) revealed absolutely nothing wrong with her (including crystal clear urine), she continued complaining of severe back pain, so bad that she couldn't move.

Riiiight. This didn't add up at all. "But you've been walking around for the past two days, right?" I asked her, not believing a word of it.

"Well, I'll be honest with you," she started. "I've been taking oxycodone and Valium, and that's the only thing that's allowed me to move around."

I glanced at her blood work - her blood alcohol level was 0.391, several times the legal limit.

"So you've been self-medicating with narcotics, benzos, and a hell of a lot of alcohol?"

She looked at me like I was crazy. "Well, I was supposed to be in court yesterday for my DWI from last year, but they couldn't proceed with the trial. But my back is killing me, so what prescription are you going to give me?"

THIS is her game? She got out of her DWI trial, so she got hammered on booze and narcotics? And now she's trying to score more from me?

"Not today, madam" is what I said to her, but "OH HELL FUCKING NO!" is what I was thinking. You were unlucky enough to get the doctor who doesn't give a fuck if you lodge a complaint against me. You will NOT get your fix from me.