Misinformation

As a father and a physician, my last post about Jahi McMath was the most difficult I have ever written.  I've been following her tragic story since it was first brought to my attention, and it still is not quite over.  As opposed to the last post, writing this one was one of the easiest.

One thing that pisses me off more than almost anything else is the willful propagation of misinformation.  The Internet is a wonderful treasure trove of information, and a wealth of information on any subject imaginable is only a few keystrokes away thanks to the magic of Google (fuck you, Bing).  But the downside is that false information is just as readily available, and people are just as liable to believe it.

The more I read about Jahi McMath, the more upset I become.   Not so much about how the family is handling the situation, though I believe they are handling it exceedingly poorly.  Not so much how their lawyer Christopher Dolan (aka Scummy McDouchebag) is making himself sound like a clueless jackass and attention-whore, though he obviously is ("It is our position that no doctor determination can end a life without parental consent", he stupidly said).  No, what bothers me the most is that in spite of the fact that six different doctors confirmed that little Jahi has died, the family wanted a 7th opinion.  And the seventh opinion they wanted was from Paul A. Byrne, MD.

If you haven't heard of Dr. Byrne, you're about to be educated on just how blinded by faith a supposed man of science can become.

Dr. Byrne is an American neonatologist and pediatrician from St. Louis, Missouri.  He is past-president of the Catholic Medical Association and an avid opponent of the entire concept of brain death, and he is vehemently opposed to organ transplantation.  Despite the stance of the vast majority of the medical community, Dr. Byrne does not believe brain death even exists - "it has become clear that 'brain death' is not true death" he wrote in August, 2011 [1].  In that story he makes several references, including quoting his own article from The Journal of the American Medical Association as if it were someone else's work.  That's red flag #1: quoting yourself.  Tsk tsk, Paul.  The second red flag, arguably much bigger, is that one of his other references is www.lifesitenews.com, a site which was started by anti-abortion zealots and which is anti-homosexual, anti-contraception, anti-stem cell research, and anti-anything-that-isn't-strictly-Catholic.  They state on their website, "LifeSiteNews gives priority to pro-life, pro-family commenters and reserves the right to edit or remove comments."

Riiiight.  Not exactly a respected scientific outfit there, Pauly.

The third (and biggest) red flag is that Dr. Byrne posts his commentary on www.renewamerica.com, an ultra-conservative website started as support for a radical whack-job.  His arguments against the concept of brain death are so ridiculous they could almost be considered comical.  The only reason it's not funny is that people actually believe him.

People have known for hundreds of years that the brain is where the person actually lives, not the heart.  The other organs (heart, lungs, intestines, spleen, liver, pancreas, etc) merely support the brain.  This is not subjective, conjecture, or opinion, this is fact.  People can live normally without a spleen.  People can live without kidneys (on dialysis).  People can live with a failed liver for months while waiting for a transplant (Yes Paul, a transplant).  People can even live without intestines (on IV nutrition).  And people can live without a heart - the first artificial heart was implanted in 1982, and people can now live for months with artificial pumps circulating their blood while waiting for a heart transplant.

But you can not live without a brain.  This is a very simple fact, one that is taught on Day 1 of medical school, and one that Dr. Byrne and his followers consistently and stubbornly and ridiculously fail to acknowledge.

Death is defined as either 1) the complete cessation of biologic function or 2) the irreversible loss of brain function.  Without the brain, there is no life.   Death by #1 is no less dead than death by #2.   But Dr. Byrne states that "Death is separation of the soul from the body."  That one line speaks volumes - this doctor, this purported man of science, defines death religiously rather than physiologically.   Dr. Byrne also likes to use misdirection to further his lies:

"Since there are two definitions of death (cardiac death and brain death), it is clear that either is enough to be called deceased.  If there are 2, Jahi must not be dead by the other method, or she would have been, or could have been declared dead by the other one." 

No, Dr. Byrne.   It doesn't work that way.  Brain dead is just as dead as cardiac dead.

Dr. Byrne also seems to have completely forgotten his basic physiology.  I'm sure he learned in medical school, just as I did, that the lungs and heart both function independently of the brain.  The heart can still beat and the lungs can still ventilate (move air in and out) and respirate (exchange oxygen for carbon dioxide) without input from the brain.  But Dr. Byrne incorrectly says, "After true death chest compressions or a ventilator can only move air; there cannot be respiration, because respiration is a function of a living human body."  This is patently false - respiration is a function of functional lungs, NOT of a living body.  Lungs simply do not require a brain to do their job.

Think that's bad?  Oh but wait, it only gets worse:

"So-called 'brain death' or 'cardiac/circulatory death' are terms concocted by transplant physicians and their allies who wanted to enlarge the donor pool by including patients who are really not dead in the traditional sense of the word."  

Another fabricated lie by the good doctor, a preposterous conspiracy theory that transplant surgeons, who wish only to give their patients a new chance at life, hover like vultures, waiting to rip organs out of unsuspecting victims, like grave robbers in the 1800's.  The concept of brain death as death was advanced by the Harvard Medical School in the 1960's to differentiate brain death from a persistent vegitative state as the possibility of organ transplantation was becoming a reality.  Brain death was not remotely a new concept, but at the time it had to be more strictly defined so ethical lines would not be crossed.  It was transformed into law in the United States in 1981 as the Uniform Determination of Death Act, which was supported by the American Medical Association and the American Bar Association (probably the only time in human history when doctors and lawyers have agreed on anything).  The Australian definition of brain death is identical.  "Brain stem death" in the UK is a similar concept.  In fact, when you look at the worldwide view, brain death is universally accepted, and there was universal agreement on the neurologic examination in diagnosing brain death, though the exact criteria vary from country to country [2].

I've spent the past week following this entire story and reading comments from other readers.  It is astounding just how many people are convinced Jahi is alive because her heart is pumping, and that she will miraculously wake up.  Several of them reference other people who have been diagnosed (obviously misdiagnosed) as brain dead who have woken up.  However, after an exhaustive search of the medical literature, I can find exactly zero documented cases of someone whose brain is actually devoid of blood flow and function coming back to life.  Brain dead is NOT THE SAME as a coma or a persistent vegitative state. 

Our job as doctors is to help patients get better, but part of our job is also to educate our patients and their families.  Spreading false information based on lies is dangerous and completely against the purpose and spirit of medicine.  Brain dead is dead, despite what Dr. Byrne and Jahi's family choose to believe.  

You may choose not to believe in science all you like.  It doesn't make it any less correct.

If you'd like to read Dr. Byrne's complete ridiculous column, make sure you're sitting down, and prepare to be completely exasperated.  Ready?  Go.

1. http://www.renewamerica.com/columns/byrne/110818 
2. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria.Neurology. 2002 Jan 8;58(1):20-5.

Jahi McMath

If you're looking for insults, you won't find them here.  Not this time.  This story is too sad, and I can't even bring myself to insult anyone involved, even if it's warranted.

My wife brought this story to my attention after a friend of hers told her about it.  It is incredibly tragic, and it makes me sad just thinking about it.  What makes it worse is how the family has handled (and is continuing to handle) their awful misfortune.  And what makes it worse still is how much misinformation is out there and how little the general public seems to understand the concept of death.

A 13-year old American girl named Jahi McMath went to a hospital in California for a routine adenotonsillectomy, uvulopalatopharyngoplasty, and resection of her inferior turbinates for treatment of her obstructive sleep apnea.  Shortly after surgery she began bleeding.  According to the family she continued to bleed so heavily that she eventually suffered cardiac arrest, and CPR was started.  Her heart eventually restarted, but her body apparently had been deprived of oxygen for too long for her brain tissue to survive.  An EEG done two days later confirmed everyone's worst fears - the little girl was brain dead.  Over the next 24 hours a total of five physicians, two associated with the hospital and three not, confirmed the diagnosis.

Doctors told the family the heartbreaking news, but the family, either choosing not to believe them or not understanding the concept of brain death (or both), did not allow the hospital to take her off life support.  Instead, they filed for a temporary restraining order from the court to continue life support.  A judge granted the restraining order, and the hospital was forced to continue providing care for the deceased girl.  She has been deceased now for 13 days, and yesterday the judge actually inexplicably extended the restraining order by another week while waiting for a sixth opinion.  Not surprisingly, the diagnosis of brain death was confirmed yet again today.

Brain death is defined as an irreversible absence of brain function.  Unlike all other tissue, the central nervous system (comprised of the brain, brainstem, and spinal cord) does not have the capacity to heal or regenerate.  Once it is dead, it stays dead.  As long as a brain dead patient is kept on a ventilator, the heart will still beat, the lungs will still function, the kidneys will still make urine, and muscle reflexes will still exist.  But without brain function, the person is gone.  Physiologically it is the same as cardiac death where the heart stops and all organs then fail.  "Brain dead" is physiologically (and legally) exactly the same as "dead".  And no court order can change that.

As a father, I can certainly understand how devastated the family is over the shocking, unexpected loss of an innocent little girl after what was supposed to be a routine surgery.  But after reading numerous articles about the story, it has become clear that the family does not understand the concept of brain death, nor does a large segment of the population.  "Despite what they say, she is alive. I can touch her, she is warm," her mother said.  "With air she lives, her heart beats, her kidneys produce urine, she is warm and soft."  The family staged a rally in front of the hospital, chanting "Keep Jahi alive!  Keep Jahi alive!"  There is a Facebook page (KeepJahiMcmathOnLifeSupport) with hundreds of comments by people who clearly don't understand that she is dead and are expecting her to wake up and walk out of the hospital.

No.  As unspeakably depressing as it is, she is not alive, and she has not been for almost two weeks.  She is warm and her kidneys function because her heart is pumping oxygenated blood through her.  Her blood is oxygenated because a machine is breathing for her.  But a beating heart does not equal life.   This is not the 15th century - we know that the heart is just a muscular pump, and it does not determine the person; the brain does.  And as sad as the situation is, the hospital obviously has no obligation to continue treating a deceased patient.  The family's lawyer said, "It is our position that no doctor determination can end a life without parental consent."  This is utter rubbish.  The doctors did not determine when her life ended - all they did is confirm her death using a battery of tests.

Reading comments on some of the articles is even more disheartening.  There are countless commenters who think the hospital is just trying to "pull the plug" and get rid of her.  Several have even suggested the hospital is trying to get rid of evidence of wrongdoing.  Many other commenters say that the girl should be kept on life support because "miracles" happen, and there are instances of people declared "brain dead" waking up.

I have been unable to find a single article in a reputable medical journal anywhere in the world that documents an actual brain-dead patient waking up.  I suspect that every instance, including those on organfacts.net and lifesitenews.com, involves confabulation and confusion about the diagnosis.  Many people equate brain death with a coma or a persistent vegetative state, but the three are not remotely the same.  People can wake up from a coma.  But brain death equals death.

Medical science has not advanced to where a deceased person can be brought back to life, no matter how many times we read "Frankenstein" and want it to be so.  The hospital has been more than accommodating to a distraught family, but "life support" is for the living.  As a father, I wish I could give this family a hug.  As a physician, I wish I could sit down with them and explain why Jahi will never wake up.  My heart goes out to them, but this grieving family needs to understand and let go, and their little girl needs to be laid to rest.

There is much more to this story, and it continues to evolve on a daily basis.  I will update this and continue posting as the situation changes.

Legal illegal drugs

Legal illegal . . . what?  What the hell does that even mean?  Based on the title, you might think I've been using some of these drugs that I seem to hate so much.  Don't worry though - I haven't, and it'll all make sense by the end.

My last post about marijuana stirred up some sentiment, as I fully expected it would.  It seems to be a hot-button issue for a lot of people.  One of the arguments I hear all the time is that more people have been hurt by the "War on Drugs" than by the drugs themselves.  That may or may not be true, and to be honest I'm not sure if that could ever be proven.  But even if it were true, does that mean that we should legalise marijuana just to prevent violence?  By that logic we should also legalise heroin, methamphetamine, cocaine, ecstasy, LSD, shrooms, and PCP because they all are implicated in drug violence.

The major argument for legalisation of marijuana seems to be that it has so many benefits and so few drawbacks that it should be legalised for recreational use.  The argument states that marijuana has beneficial medicinal effects, so that lends more support for legalisation.  Well now we've finally gotten to the point of this post.  Let's look into that, shall we?

I will be the first to admit (and I have said it many times in the past) that marijuana has numerous positive medicinal effects.  It is a very potent anti-emetic, it is highly effective in controlling pain, and it lowers intra-ocular pressure in patients with glaucoma.  So what's my problem with marijuana?  If it's such a great medicine, why am I so against it?  To answer that question, we only need to look at the list of other illegal drugs, starting with the health benefits of heroin.

"THE WHAT??!  Benefits of heroin?  Everyone knows how horrible heroin is!  Are you high, Doc?" I hear you ask.

Nope, I'm not high at all.  Heroin was initially marketed as a cough suppressant and a cure for morphine addiction (Bayer didn't know at the time that heroin is actually metabolised to morphine in the body).  And I'm sure most non-Brits reading this will be surprised to find out that heroin (IV, epidural, and oral) is widely used for the treatment of pain in the UK where it is known as diamorphine.  So because it has medicinal purposes just like marijuana, it should also be legalised for recreational use, right?

Moving on to good old cocaine, the rockstar drug of the 80's which devolved into its own degenerate brother, crack cocaine.  Indigenous populations in South America have been chewing coca leaves for thousands of years as a mild stimulant and appetite suppressant, but it has real medicinal effects as well.  It is a very potent vasoconstrictor and local anaesthetic, and ENT physicians in Australia commonly use it for mouth ulcers and nasal surgery.  Ever heard of lidocaine?  They both end in "-caine" for a reason.


 
So we should legalise recreational cocaine too, right?  Oh, but I'm not stopping there.  I'm just getting warmed up.

Ever heard of Sernyl?  Probably not, since it was only tested as a surgical anaesthetic for a few years in the 1950's and 60's before being banned when it was found to mimic schizophrenia and cause general fucking insanity in people.  Then some idiots caught on to how much fun they could have by smoking it, and the PCP boom was born.  That's right, PCP was almost used in medicine before smart people banned it.  But it has medicinal purposes, so it can't be all bad and people should be able to use it legally for recreational purposes! 

"Ok fine," you potheads may be thinking.  "Those are a few examples of illicit drugs which have some medicinal use.  But surely not meth!  Surely Walter White and Jesse Pinkman were cooking a purely bad drug, right?  Methamphetamine couldn't possibly have any medicinal purposes, right?"

WRONG.

No, you're not seeing things.  That's Desoxyn, also known as methamphetamine hydrochloride, approved in the United States for the treatment of ADHD, similar to Adderal and Ritalin.  Look, it's an actual medicine!  So we should definitely legalise recreational use of crystal meth!  Who cares that's it's highly addictive and will completely fuck up your life?

I won't even mention how MDMA (also known as Ecstasy) is being researched for use in treatment of Post Traumatic Stress Disorder and how 83% of study participants were essentially cured with a combination of MDMA and psychotherapy.  I also won't mention how LSD is being re-examined for its effects in psychiatric patients.  But I don't hear anyone (except idiot drug users and stupid drug advocates) screaming that Ecstasy and LSD should be legalised for recreational use.

My point here is that sure, marijuana has some benefits for certain patients, but that isn't nearly enough to justify its legalisation for recreational use.  I'm sure many of you are moaning and groaning that marijuana isn't the same as other "hard" drugs, marijuana is a plant, marijuana is harmless, blah blah blah.  You're just itching to tell me that no one has ever overdosed on marijuana, it isn't addictive, and alcohol is worse.  Save it, because it's the same bullshit I've heard over and over again.  I'm 100% positive you won't change my mind, just as I'm sure I won't change your mind.  That is not and never has been my intention, because those people are so firmly convinced that their weed is so completely harmless that they will never listen to any arguments to the contrary.  They continually tell me to ignore the "government propaganda" and do my own research.  The difference between them and me is that I clearly have done the research, and I have clearly come to the conclusion that the bad outweighs the good.  So you people can go piss off and smoke your herb to your heart's content, as long as you do it far away from me so I don't have to deal with you or the stupid things it makes you do.

Deadly marijuana

Yes, marijuana is deadly!  There, I said it, and all you pot advocates will soon find out not only that you're wrong, but just how wrong you've been.  One of the main arguments for legalising pot is that it isn't addictive, it's simply a harmless plant, no one has ever overdosed on it, and it can't kill you.

I have definitive proof that all of you idiots are dead wrong.  Pun intended. 

At 2 AM my pager awoke me from a dream about Scarlett Johansson (Scarlett, call me) to politely inform me (read: scream in my ear) that I would be getting two stabbing victims in 5 minutes.  By the way, why the hell is it always at 2 AM?  Can't you violent assholes get your stabbings done and over with during the day and let me sleep like normal people do?  Is there some reason your altercations have to happen in the middle of the night?  Don't you lunatics sleep?

Where was I?  Oh yeah, Scarlett Johansson.  Er, I mean stabbings.  Right.  My feet always feel 25 kg heavier at 2 AM, but somehow I managed to stumble my way into the trauma bay a few minutes before my victims arrived.  The first one was stabbed in the hand.  His wounds were clearly no big deal, so I turned my attention to the other guy.

"He's been fighting us the whole way," the medic informed me.  "He's not saying much, but he was stabbed all over.  Back, arm, leg."  I didn't hear them say "chest" or "abdomen", so I immediately relaxed somewhat.  As the medics moved him over from their stretcher to our gurney, I got the feeling I might get back to sleep soon.

And then he promptly died.  

Out of nowhere, his heart just stopped.  We immediately started CPR and got a breathing tube in, all while my team and I were looking to see where the holes were:

• 5 in the right arm
• 1 in the right hand
• 1 in the left thigh
• 1 in the left hand
• 3 on the back

None of his injuries looked as if they should be life-threatening.  My mind started racing as I ticked through each possibility - maybe he had bled to death?  Maybe the stab wounds in the back hit his lung or heart?  Maybe he was on some illegal drug and had overdosed?  I couldn't shoot an X-ray or a CT scan while CPR was ongoing, and I didn't have time to wait for the results of his blood work to confirm my suspicions.  My best bet was a punctured lung, so I quickly inserted chest tubes into both sides of his chest.  Nope, nothing.  No punctured lungs, no blood in his chest. 

Next I grabbed my ultrasound machine to make sure the knife hasn't plunged deep enough through his back to penetrate into his abdomen or heart.  Negative, zip, nada.  No blood in his abdomen, no blood around the heart.  A Foley catheter in his bladder showed no blood, so his kidneys were fine too. 

After about 15 minutes of CPR, his heart finally restarted.  As his blood pressure stabilised, we now had time to evaluate him fully with X-rays and CT scans.  His chest X-ray was clear, so I scanned him from head to toe.  Unfortunately (or fortunately, depending on how you look at it), his scans were all negative too.

So what the hell happened to this guy?  Healthy men in their 20's don't just die.  A few minutes later, his blood work and urine tox screen came back.  He had lost a good deal of blood, but not enough to bleed to death.  His alcohol level was 0.  His tox screen, however, was positive.

For marijuana.

He was so high that he vomited during the ambulance ride, and he aspirated that vomit back into his lungs, and that caused his heart to stop.  But the story doesn't end there.

Did you forget all his stab wounds?  Because we certainly did, once we verified that all of them were superficial.  After talking with the police, we found out that he and his two roommates were smoking pot in their flat, and a few guys broke in to steal it from them.  They were all too high to fight back, and all three of them were stabbed multiple times.

By my count that makes exactly two potentially fatal reasons not to smoke marijuana.

As you all surely know, I'm always up for a marijuana debate.  Any takers?

Excuses

Excuses are like Twilight movies - there are bad ones, and there are really bad ones, but there are just no good ones.  You may think one might be ok because it doesn't look so bad at first glance; in fact it may even seem like a good idea at the time.  But then you start it and you realise just how god awful it actually is and what a mistake it was to even think about it, and you know you should stop, but you just don't.  And the further you go, the deeper you go with it, the more you realise that this is the worst shit ever and I can't believe I did that to myself.  Some of the worst excuses that you may have heard include:

• My dog ate my homework
• I forgot
• This isn't what it looks like
• I thought you were coming home tomorrow!
• I didn't know

As bad as making excuses may be, sometimes a situation is just so bad that not even the best excuse will get you out, and you come out looking worse than the mayor of the largest city in his country who admits to smoking crack cocaine, but only because he was really really drunk.

I was called recently by the intensive care unit about a very unfortunate 51-year old woman who was critically sick and actively dying.  She had bounced from hospital to hospital for the past year without a diagnosis for her various vague complaints, finally landing at our hospital two weeks ago and being diagnosed with metastatic small-cell lung cancer.  If that sounds bad, it should.  Because it's bad.  Very VERY bad, as in less than 5% of people who have it are still alive five years after they are diagnosed, and median survival is only 2-4 months.  Nearly everyone who gets it is a smoker, just like this patient.  As the intensive care doctor was describing her 2-week hospital course, I looked through her bloodwork on the computer, and nearly every number I saw - electolytes, kidney function, liver function, heart function, lung function - was grossly abnormal.  Every organ system was shutting down, and her blood chemistry was more out of whack than seeing Bill Nye the Science Guy on Dancing With The Stars.  Obviously something was drastically wrong, and they wanted my help fixing it.

I did a complete (though rapid) assessment (since she was dying in front of my eyes), and it looked like her entire small intestine had lost its blood supply and died.  I told the intensivist that there was bad news and worse news.  The bad news: if I didn't operate on her that very minute, she would surely die that night, probably within a few hours.  The worse news - if I somehow managed to get her to the operating theatre, she would die even quicker, likely on the operating table.  She was too sick to bring back, and there was nothing I could do.

Her entire family gathered in the worst room in the hospital - the ICU family conference room (aka The "Your Family Member Is Dying" Room), and I broke the bad news as gently as I could.  Considering they had spent nearly a year searching for a diagnosis and had just started chemotherapy two days prior, they took it as well as I could have expected.

But that was where it went from sad to "I want to choke the shit out of you" frustrating.

Her husband asked, "Well should my children get checked for lung cancer?"

I didn't immediately understand his question, so I asked, "Why do you ask?" though as I was saying it I figured he thought lung cancer was hereditary like breast or colon cancer, and he wanted to make sure his children weren't at risk.  As I was about to address that, he hit me with this shocker:

"Because they both smoke."

Dead silence.

ARE YOU ACTUALLY TELLING ME THAT YOUR MOTHER IS DYING OF CIGARETTE-INDUCED LUNG CANCER, AND YOU BOTH STILL SMOKE?  ARE YOU FUCKING KIDDING ME??!  

Fortunately those were not the words that came out of my mouth.  "No," I said as calmly as I could, trying my hardest to resist the temptation to grab the two kids by the ears and ask what the ACTUAL FUCK they were thinking.  I looked them both right in the eye and said, "But you both need to QUIT.  RIGHT.  NOW.  You have no excuse any more to put even one more cigarette in your mouth.  None."


Her son started to protest, but I very firmly and finitely said, "NONE."  He stopped dead in his tracks.

Did he listen to me and quit smoking?  I don't know.  But what I do know is that he has no excuse to continue.

Optimists vs. pessimists

WARNING: EXTREMELY GRAPHIC PICTURE BELOW IS EXTREMELY GRAPHIC.   I WILL NOT BE HELD RESPONSIBLE FOR ANY KEYBOARDS AND/OR MONITORS RUINED BY VOMIT.

op·ti·mist (op-tuh-mist)
n.
1. One who usually expects a favorable outcome.
2. A believer in philosophical optimism.

I tend to see the worst in any situation, the worst in people, and the worst in the world in general (except when it comes to my children).  If you've read this blog at all, I think I've made that plainly obvious.  But I also think that good doctors, especially good surgeons, should be pessimists.  People who only expect good things to happen can easily overlook potential hazards, dangers, and pitfalls.  On the other hand, people who expect the worst are able to prepare for the worst and then hope for the best.  As much as any other profession, doctors need to be aware of not only what is happening, but what could possibly happen.  In other words, to hell with optimism; I'm a die-hard pessimist.  That isn't to say that I don't have a shred of optimism left.  No, I still have a tiny Inner Optimist that likes to whisper in my ear that everything will be ok if I just keep my chin up and stay positive.

I find my Inner Optimist annoying as hell.

The call at 3 AM was for a guy stabbed in the abdomen, and reportedly he was eviscerated.  In layman's terms this means his guts were supposedly protruding out of his stab wound.  The last time I had got a call for an "evisceration" a few months ago, the medics were frantically running around like starving hyenas as they dropped their patient at my door.  When I removed the gauze that they had placed to protect his supposed innards, what greeted me was not intestine but a small blood clot.  So when I got the evisceration call this time, my Inner Optimist said, "Meh, it's probably nothing.  I'm sure he's fine!  Stay positive!"

The young man smelled drunk and looked uncomfortable.  He smelled drunk because he was drunk.  He looked uncomfortable because, well, I think this picture will make the reason glaringly obvious:




My Inner Optimist took one look at him and passed out.

In case you can't tell what you're looking at (or if you are a big big baby and refuse to look), that's a long segment of his small intestine coming out through a 3 cm stab wound in his left upper abdomen (the stab wound itself is covered by his entrails).  I took him to the operating theatre where I found a total of 6 lacerations in his small intestine.  I repaired all of them, and despite his attacker's best efforts, he's now doing just fine.

My Inner Optimist regained consciousness two days later.  It's a bit weaker after that episode, but it's just as annoying.  "Hey, things could have been worse!" it keeps telling me.  "He could have died!  You should be happy he survived!  You should be more optimistic!"

Maybe, but pessimists get more happy surprises.

Brains

Which animal has more neurons, a lobster or an ant?  If you said "ant" then either A) you are an entomologist or B) you cheated, because any reasonable person would never guess that ants have 250,000 neurons while lobsters only have 100,000.  Granted those 100,000 neurons control a very delicious organism, especially when it's dipped in drawn butter.  Or baked in ravioli with marinara.  Or Thermador. Or...

Wait, what was I talking about?  Oh right, brain size.  In comparison, a cockroach has a million neurons in its brain, a mouse has 75 million, a cat has a billion, and humans have 85 billion. 

I think that roach has this next woman beaten. 

At 3 AM she drove her car into a ditch while drunk (of course).  This normally wouldn't have even make a blip on my radar since drunk drivers are so common, but there was something about her demeanor that was annoyingly familiar.  She was so thoroughly obnoxious, condescendingly calling me "sweetheart" (a very bad move), that it caused a synapse in my own brain to close.  

I know that condescension, I said to myself. 

After a quick search through our computer system, I found out why - I saw her almost exactly two years ago after she ran her car into a light pole.  She was just as obnoxious then, yelling at everyone that we needed to be extra careful "because I'm 7 fucking months pregnant!"  I guess she kisses her baby with that mouth.  Thankful as I was for the sage advice, I was just as thankful that she wasn't seriously injured.  That time.  Yes, I'm foreshadowing. 

Just as I was about to smugly confirm my suspicion, something else caught my eye - she was seen again 21 months later (that would be 3 months ago if your brain didn't do the math quickly enough) after, you guessed it, another car accident.  She had given birth to yet another baby 2 days prior to that accident, so I suppose she was out celebrating her new bundle of joy by drinking heavily, smoking PCP, and driving into a tree.  Again she had no serious injuries, but she did have another smashed up car. 

Now fast forward to last night.  Yet again she was drunk and high on PCP.  Except this time the Call Gods decided that this idiot needed to learn a lesson.  I wonder if her broken knee, broken back, and broken neck will teach her anything.

Then again, she would have to have more brain cells than a sponge to learn that. 

In case you hadn't guessed, sponges don't have brains. 

Call Gods

It seemed my last post spurred a rather interesting theological debate, so I thought I would expound on the subject just a bit.  If you've been wondering if I believe in god, yes I do - I firmly believe in the existence of the Call Gods.  The Call Gods watch over all doctors on call all over the world.  They decide what patients will come in, when, and for what reason.  You do not mess with the Call Gods.  If you ever decide you'd like to mess with the Call Gods, you DO NOT MESS WITH THE CALL GODS.  

So if any doctor on call is ever stupid enough to say, "Gee, it sure is quiet around here," the Call Gods take it upon themselves to ensure that a shitstorm of Gomorrah-like proportions will rain down on this foolish half-wit exactly 14 seconds later, only relenting when the call shift is over or the ignoramus quits his job to sell costume jewelry and counterfeit handbags on the street.  This is not the beneficent God you may think you know - the Call Gods are evil and vengeful, and they have a very twisted sense of humour.  Hmm, now that I think about it, they sound just like me.

The Call Gods do not reserve their torture for unsuspecting pinheaded nincompoops who disavow all knowledge of their existence.  No, they seem to enjoy paying particular attention to me whenever I am on call, though they are terribly uninspired when it comes to choosing patients to drop in my lap.  It seems whenever I'm on call they choose a theme for the day for me - Drunk Day, Broken Hip Day, Seizure Day, Tattooed-Nipple And Pierced-Clit Biker Day - and nearly every patient will fit this narrow profile.  For whatever reason, the Call Gods decided that one fine recent day would be Fall Day.  Everyone was falling - falling down stairs, falling off ladders, falling out of attics, falling after getting hit with a bat.  Ok, maybe that last one technically doesn't count.  Anyway, when I found out I was getting my sixth fall victim of the day already, my first thought was, "Bring it on, Call Gods!  Hit me with your best shot!"

Yes, I taunt the Call Gods.  YOU CAN'T HURT ME!  I AM INVINCIBLE!!

And hit me they did - the smell of alcohol hit me before the patient actually reached the door.  The medics told us the patient was found on the ground outside a movie theater, and it was unclear if he had fallen after being assaulted or had just fallen down from being piss drunk.  Regardless of the reason, he happily vomited on my shoes as we transferred him from their gurney to our stretcher.

Though he was too drunk to talk, I thought I would go through the motions and ask his name.  As I was opening my mouth the nurse said, "Wait . . . is that John {not his real name}?"

John?  Who the hell is John?  And did he really just say "not his real name"?

"Oh yeah I forgot," the medic said.  "He had this hospital ID on when we found him."

I looked at the ID card, and the nurse was absolutely right - John was one of our emergency nursing assistants.  "I just gave him an assignment last night," the nurse continued, looking from John to me and back again.  "He just got off at 8 this morning!  And he was supposed to be back at 3:30 today for another shift."

I looked at the clock - it was 3:25.

"He made it," I said dryly.  "Just in time."

Beliefs

WARNING: IF YOU ARE A DIE-HARD CREATIONIST, TURN BACK NOW.  THIS POST WILL PISS YOU OFF AND YOU WILL BE ANGRY AND WANT TO ARGUE WITH ME (you will lose) AND NEVER BELIEVE ANYTHING I SAY EVER AGAIN.  YOU HAVE BEEN WARNED.

In case you haven't guessed by now, I love to think.  Using my brain is very satisfying, and unlike most of the people about whom I write, I do it often.  The best part about my brain is that it doesn't take much to get it buzzing.  I overheard a discussion between two radiology technologists a few days ago that got my brain gears spinning.  I'm paraphrasing a bit here, but this is the gist of the conversation:

Tech #1: You know, I just read a theory that Eve wasn't created from Adam's rib.  No really, some people think he was actually created from her.
Tech #2: Nah man, Adam was created from dust, and she was made from his rib.  It says so in the Book.
Tech #1: I know exactly what it says, but that's what I just heard.

After a few seconds of this clearly sarcastic debate, I smiled and said, "I thought we evolved from monkeys", knowing full well that monkeys and humans evolved from a common ancestor and thinking I was making a mildly-amusing joke to go along with theirs.

They looked at me like I had two heads.  My smile faded.  They weren't kidding.

"You actually believe that crap?" tech #2 asked me.

"You don't?" I replied, my eyebrows raised so high that they were threatening to burst through the top of my forehead.

I won't bore you with the remainder of the conversation, because, well, there wasn't one.  They looked at each other, wordlessly deciding that I was a lunatic and not worth talking to, and promptly changed the subject to football or something else equally uninteresting.

Perhaps not coincidentally, I got an email from Aaron (not his real name) some time back that I've been holding on to.  It went a little something like this:

Hi DocBastard,

Love reading your blog and all the comments on FML. You definitely sound like a pretty interesting person!  In your last blog you mentioned evolution.  Now even though I know it isn't related to medicine a whole lot, I would love to hear you give us your opinions on evolution in general.  I've always been fascinated that people can dispute evolution despite all the evidence (and basic logic) pointing toward it and I bet you'd be able to write an awesome article on it.  If that's too tough a subject to write about maybe how the human body could have evolved over the last couple thousand years.  Or even if you could talk about how the field of medicine has changed too.  I'm sure you'd have a lot of insight on all those topics!  Keep the blog coming!
Thanks.

I will admit that I am no expert in the field of evolution, nor do I have an advanced degree in theology.  However, I have done a fair bit of reading on the subject of Young Earth Creationism, mainly because I find it fascinating that there are people (ie batshit-crazy crackpot nutcase fruitcakes) who believe in it.  Now if there are any creationists who failed to heed my initial warning and have actually read this far, I WARNED YOU, YOU IDIOT!  Now please don't misunderstand me.  I don't think you're stupid, just misguided.  And maybe a little bit stupid too.

There are creationists who think that evolution is stupid, and they go to great lengths to explain just how stupid they think it is.  Allow me to introduce Dr. Kent Hovind.  (He fancies himself a "doctor" because of his three degrees in Christian education, all from non-accredited institutions - his opening line in his most recent "doctoral" thesis was "Hello, my name is Kent Hovind."  Seriously.)

In case you aren't familiar with the difference, I am not referring to so-called theistic evolutionists who believe that evolution is real, but that it was started and subsequently guided by a Supreme Being.  Intelligent design is a similar concept.  I'm talking here about died-in-the-wool, real-world, actual Young Earth Creationists like Dr. Hovind who believe that the world was created by God some 6,000 years ago.  Some, Dr. Hovind included, even believe dinosaurs co-existed with man a few thousand years ago:

I'm not sure where they think all those dinosaurs went or why they vanished, but they have several absurd theories that explain everything.  For example, "The oldest tree is 4,300 years old and the oldest reef is 4,200 years old; therefore, everything on earth must be younger than that."  If you're in the mood for more laughs, here are some direct quotes from Dr. Hovind:

• Communism is a direct offshoot of evolution.
• The stars would have to evolve.  There's an awful lot of stars out there folks, but nobody's ever seen one form . . . I think it is scientifically impossible.
• Macroevolution . . . is when an animal changes into a different kind of animal.  Nobody has ever seen a dog produce a non-dog.  But the evolutionist believes that a dog came from a rock.

Uh . . . ok, Kent.  Whatever you say.  If you're still in the mood for a laugh and have two hours to spare, I'd strongly encourage you to watch this video of Kent's "100 Reasons Why Evolution Is Stupid".  Needless to say, all of his 100 reasons are . . . well, stupid.  The volume of evidence for evolution is massive and incontrovertible, so I see no reason to present it here.  There are thousands upon thousands of articles to read showing how animals, plants, continents, planets, solar systems, and galaxies form and evolve.  None of them, I'm quite certain, explain how a rock turns into a dog.  Sorry to disappoint you, Kent. 

While we're on the subject of human evolution, however, I did find something that some people may find interesting.  Dr. Alan Kwan, who has a PhD in computational genomics (whatever that is) predicted how humans will continue to evolve over the next 100,000 years, including developing larger heads, larger eyes, darker skin, and thicker eyelids:

Admittedly the end result is a bit freaky, but I'm sure Neanderthals 100,000 years ago would have thought the same if they saw a picture of a modern human, especially if that human was Dennis Rodman or Sandra Bernhard.

Regardless of my obvious disdain, I believe that everyone has the right to believe in whatever they want, regardless of how preposterous it is, as long as those beliefs aren't foisted on me.  In the words of W.C. Fields, "Everybody's got to believe in something.  I believe I'll have another beer."

Ruining the ending

We're going to go on a little detour today, away from the usual stupid patients, stupid doctors, and all the usual stupidity.  No, today I'm going to take you, my intrepid readers, on a trip.  Close your eyes.  Go ahead, close them and imagine with me.  Ok, now open them up and remember that you're reading a blog and can't read with your eyes closed, dummy.

Now imagine, if you will, that you're reading a great novel.  One with werewolves and sparkly vampires, perhaps.  Wait . . . forget that.  Imagine instead that you're watching a great movie with wonderful acting, a riveting plot line, great heroes, and a mysterious villain, and just as you're about to discover the identity of Kaiser Söze . . .

The movie shuts off.

NOOOOOOOOOOOOOOO!!!!  God damn it, now I'll never find out that Bruce Willis was riding Rosebud while eating Soylent Green with Norman Bates' mother and Tyler Durden, who is actually Luke Skywalker's father!

"Ugh, here we go again.  What's the damned point, Doc?"

Ah, the point, right.  I'll get there.  I just can't guarantee there won't be any plot twists in the meantime.

I was on my morning rounds recently ("Finally!  Something medical!"  Alright hush, you.), and I entered the room of my latest stabbing victim (who was stabbed in the liver and nearly bled to death), only to find her surrounded by a room full of visitors.  I introduced myself as her trauma surgeon, to which the patient announced, "He's the one who saved my life."  I was just about to say "Thank you" when one of her visitors said, "Hey, you also took out my appendix!"  I take out a lot of appendices, so he didn't look immediately familiar to me.  I asked his name, and as soon as he said it, I remembered him.

"Right, now I remember you," I said as I pointed an accusing finger at him.  "I also remember that you never showed up for your follow-up appointment."

"Yeah...you're right," he laughed as he pointed to his abdomen.  "But I'm doing fine.  Everything went really well, so I didn't think I needed to come back."

So how the hell does this relate to ruined endings, you may be wondering.  For a surgeon, the gratification is all in the follow-up - that is our happy ending, our satisfying outcome, our denouement as the hero rides off into the sunset.  I like to know how my patients do, especially the ones who go home immediately after surgery.  How long their pain lasted, if they had any complications, if they found my watch that mysteriously disappeared during their surgery and probably didn't fall into their abdomen.  You know, the usual.  If a patient never follows up, I don't know if he developed a wound infection, if his pain got better, how his experience was, or if he died.

This particular guy chose not to come back to see me because he figured a follow-up appointment would be a waste of his time.  But the purpose of even a simple two minute appointment is that I get to look at the wounds, poke on the belly, and make sure all questions are answered.  And look for my damned watch.

So on behalf of surgeons everywhere, please don't ruin our endings.  We want to know that Leonardo DiCaprio is not investigating Shutter Island, he's a patient.  We need to know that the Planet of the Apes is Earth.  We have to know what's in the box at the end of "Se7en".  But we don't give a shit what happens at the end of Twilight.  Not one little shit.

Fuck you, Twilight.

Getting personal

I'm a very private person.  Anyone who has read any significant portion of this blog knows that I rabidly defend my patients' and family's privacy.  But what I don't generally talk about is my own privacy (though despite my attempts to quash you, several of you continue to enjoy trying to unravel the mystery of where I live).  I also tend not to divulge specific details about myself, because MIND YOUR OWN DAMNED BUSINESS, NOSEY. 

But I've given it a lot of careful thought, and after my ruminations I've decided that I'm not completely opposed to revealing certain things about me.  So in the spirit of transparency, I will now truthfully and completely disclose all of my various tattoos, identifying birthmarks, distinguishing features, and piercings.  

I have none.  HA!  I WIN!

I got an email from some random jackass (seriously, that was his email address) who decided to get personal with me.  He was curious to know more about what I was like as a child.  Wait, you really want to know, jackass?  You really want to delve into this fucked up head?  You really want to know what makes me tick?  Fine, you asked for it.  Here goes: I was small and quiet and generally tried to stay invisible.  Happy?

No??  What, that's not good enough?  Well here's exactly what the jackass had to say in his email:

Hey Doc, you should post a story about your school life, as in like elementary, high school, middle school.  Such as were you popular, were you picked on, were you the bully, did you enjoy it?  Obviously you had really good grades, but what did your graduation feel like and such.  Thanks for reading, keep up the awesome posts. 

I try not to talk about my childhood because of how traumatising it was.  Summers in Rangoon, luge lessons.  In the spring we'd make meat helmets.  When I was insolent I was placed in a burlap bag and beaten with reeds, pretty standard really.

Ok there's a very small possibility that wasn't necessarily my childhood.  My shrink would say I'm deflecting.  I'm kidding, of course . . . I don't need a shrink, I'm fine, dammit.  What I said before was true: I was the small, quiet, shy kid.  I made up for my insecurities by being the funny one.  I learned very early that other kids tease the short kid less when they are amused.  So I became the class clown, sometimes getting in trouble for my antics.

As I got older, the kids started to give exactly zero fucks if I was funny.  They saw my height as a liability, a weakness, something they could exploit.  For a few years I took the abuse, hoping that the bullying would stop as the kids got older - they should grow more mature as they grew taller, right?  Mature they did, but all that meant was deeper voices taunting me and bigger muscles hitting and pushing me. 

It finally came to a head when I was 12.  One of the popular boys was doing his usual ritualistic teasing, and he pushed me and said something relatively insignificant that I can't specifically remember, but whatever it was, I thought to myself "ENOUGH IS ENOUGH".  I made a fist, spun around, and slugged him right in the gut.  HARD.  As he doubled over and slowly crumpled to the ground, the entire gymnasium went silent, all eyes on the short, quiet kid who they thought would always just take it, would always be a prime target, would never fight back.  I looked around silently from person to person, the look on my face clearly saying, "WHO. THE. FUCK. IS. NEXT."

Though I generally do not condone violence in any way, no one laid a hand on me or bullied me from that day through my graduation. 

Secondary school was not terribly challenging at all, academically or socially.  I had a small group of close friends, all of whom I still am in contact with today.  I was that guy that never really studied but aced all his classes anyway.  You know, the kind of kid that most other students hate.  But because of that one incident (and perhaps because my body finally decided to hit puberty at age 15), the bullying was over.  Eventually I graduated near the top of my class which helped me get into a good university, though the memories of being mercilessly bullied for years, and the constant fear that it would resume, never went away.  The support of my family and friends were the main things that got me through.   

Now I think that's enough pain for me today.  If you have any other personal questions for me, keep them to yourself.  Or if you really want to hurt me again, just give me a nice paper cut and pour lemon juice on it.  Now leave me the hell alone.  I have to go call my psychiatrist. 

WWDBD

I have a confession to make: the title of this post is utter plagiarism.  I admit it.  I blatantly stole it from a reader named Emily (not her real name) who sent me an email with that same cryptic subject line.  If you feel the need, you may turn me into the Blog Plagiarism Police, even though Emily gave me permission to reprint her email, so actually you can't.  Ha!  So there!  And now that we have that little legal matter out of the way, Emily brought up a very good question, one that I previously hadn't really thought much about.  And as everyone (except my patients) knows, thinking is good.

Subject: WWDBD (What Would DocBastard Do)
Hello! My name is Emily {still not her real name} and I would love your input on my sticky situation since it sounds like you love your job just as much as I love my job.  I am 20-ish years old {not her real age} and I am a surgical tech.  I LOVE LOVE LOVE my job, and couldn't imagine doing anything else.  Part of why I went into the medical field is because I have spent A LOT of time in the hospital and I wanted to give back.  I was born with a congenital heart disease called Tetralogy of Fallot.  No big deal.  I had an open heart surgery when I was 7.  Haven't had any big problems other than needing a pacemaker, which I got a couple of years ago.  But just in the past 10 months, the shit hit the fan.  I was put on the transplant list 4 months ago, which I always knew would happen sometime in my life.  However, I did a complete 180 and was delisted and am just being followed in transplant clinic medically.  My transplant surgeon was VERY adamant that I find a new career because of the risk of getting a dirty needle stick and contracting HIV or hepatitis C.  I will eventually need a transplant, and I know that if I were to get HIV or hepatitis I would either A) not be able to accept a heart or B) die from the disease when I'm immunosupressed.  When my transplant surgeon told me this, I simply asked him what the overall goal of a transplant patient is.  His response was to get the patient back to their original normal life.  I just smiled and said, "But scrubbing is my normal life."  As of right now I'm still scrubbing.  I double glove, I'm cautious, but I can't predict when those damn surgeons decide to throw something. {N.b. We do NOT do this.  Much.}  So Doc, what would you do?  Scrub or find a new career?
Emily 

Well isn't that an interesting question wrapped in a quandary surrounded by mystery engulfed in an enigma immersed in a puzzle deep fried in a predicament dipped in ranch dressing.  Yes, ranch dressing.  Everything is better dipped in ranch dressing. 

Anyway, after thinking carefully I gave her a long, well-thought out, elaborate (ie boring) reply.  I'll give you the short short version of what I told her: do what you love.  Unless you love robbing banks or smacking puppies.  No, "smacking puppies" is not a euphemism, you sick bastard.  

Finding a career you like is hard enough, but finding one you love is next to impossible. The theoretic risk of getting slashed in the jugular by a blood-soaked, scalpel-wielding surgeon is always there, but living in fear of that is useless, unless  of course you're working with Dr. Nick, Dr. Hannibal Lecter, or Dr. Evil.  And if you're working with one of those guys, you have much bigger problems than getting pierced with an HIV-infected needle.  Come on, folks . . . They're fictional.

But think about it this way: do you want to live your life in fear of what may happen, or would you rather just live your life?  Don't misunderstand me here.  I am NOT in any way advocating this YOLO lifestyle that seems to be all the rage nowadays.  But if you're going to slave away for 8-12 hours a day, you may as fucking well enjoy it if you can. 

And for any YOLO morons out there thinking "He's right!  I only live once!  I should jump off a bridge because hey, it's there!" . . . yes.  Go jump off that bridge.  But don't bother with that pesky parachute or the annoying bungee cord.  They tend to be unreliable anyway. 

Another stupid number

One million five hundred thousand is a large number.  A very large number.  How large?  If you were to take 1,500,000 standard light bulbs and put them end to end, it would make it from the Tower of London to Stonehenge with a few hundred light bulbs to spare.  Why light bulbs?  Because it's my damned blog and I'll use whatever random measurement I want to make the number look more impressive.  And why London?  Because the distance just happened to match.  I could have used the Eiffel Tower to Rouen, The Leaning Tower of Pisa to Bologna, or the Temple Mount in Jerusalem to Haifa, so don't read too much into it.  Seriously, stop it.

Not that the number needs any assistance to look better.  It's pretty impressive on its own.  To put it in perspective, here are some statistics:

• There are 1.5 million non-profit organisations in the United States.
• 1.5 million years ago, modern humans (Homo ergaster) were skilled tool-makers and hunters and had just learned to control fire.
• 1.5 million people are killed worldwide due to indoor pollution from cooking fires each year.
• There are 1.5 million new Android devices registered each day.

And one final statistic - As of today, this blog has been read 1.5 million times.

I've said it before, but it bears repeating: THANK YOU.  Without my loyal readers (and random people who I'm sure have accidentally stumbled across my crazy little nook and run away screaming), I would have quit writing years ago after the first post.  If anyone missed the million mark and wants to leave a comment letting me know where you're from, this is your last opportunity.

Until we hit two million.

Alcohol

I realise I often preach about alcohol now, but before I fully understood its dangers, I admit that I had my fair share in college.  Fortunately I got it all out of my system by the time I graduated, and my consumption now is limited to a drink every now and then with my wife or friends.  But according to my college friends, I talk a lot when I drink.  A lot.  As in, "For fuck's sake, SHUT UP YOU GARRULOUS BASTARD!"  (Yes, my friends use words like "garrulous" in everyday conversation.)  Where was I?  Oh, right.  Anyway, there are various reactions to alcohol - some people get quiet, some dance on tables, some get stupid, some get sexual, and some get obnoxious. 

This next guy falls firmly and concretely into the last category. 

He was brought to me at 2PM.  The medics told me that a bartender had found him in his parking lot, unconscious, face down on the pavement in a pool of blood.  As soon as he hit the door I leaned over his head to get an initial impression of the situation and two things immediately struck me: 1) he obviously had a laceration on the back of his head that was bleeding profusely, and 2) he smelled like he had bathed in tequila.  Possibly rum.  Despite his obvious drunkeness I did what I always do and introduced myself and asked his name (all names have been changed to protect the stupid). 

"It's Tom Johnson, and FUCK YOU!" he spat at me. 

"Well that's not a nice way to talk to your doctor," I told him, trying my best not to pass out from the fumes being emitted from his mouth. 

"Wait, lemme see you," he slurred.  "No, you're not my fucking doctor.  Fuck you.  I'll kill you, you asshole."

Now I've been cursed at many times before, but this guy was about to take the prize for Most Profane Asshole.  Even the nurses were trying to talk him down. 

"Why are you cursing at me, sir?"  His behaviour was so preposterous I was on the verge of breaking down and laughing hysterically.  

"Oh just fuck off!"

After trying unsuccessfully for several minutes to explain that we were trying to help him, we decided to just complete our workup and (hopefully) get rid of him.  

Fortunately he had no serious injuries (though his blood alcohol level was nearly 4 times the legal limit), so I fixed his laceration and gave him several liters of IV fluid, and once he was sober his wife drove him home. 

I figured he was just another drunk, something we see every day.  But I found out later that he's a highly-respected lawyer.  Another busted assumption. 

If this is how he treats people who are trying to help him, I hate to think how he treats his enemies in court.  I hope I never end up on his bad side. 

Priorities

I've been married for over a decade and a half, but I remember my wedding day like it was yesterday.  We invited about 200 people, but only 95 actually came.  There were some really good reasons that some people couldn't come ("My baby is due that day") and some...not so good excuses for other people not showing up ("Oh shit, it was yesterday?  No way!")  And there were a few people who were determined to come despite overwhelming obstacles, like my grandmother who had trouble walking down the aisle but did it anyway.

Of all the people we invited, my grandmother most definitely had her priorities straight.  She realised that she only has a limited number of grandchildren and a limited number of years on this planet.   Besides, she loves me and my wife, and a typhoon, a massive swarm of killer bees, and a sharknado wouldn't have kept her away, god damn it.

On the other hand, other people's priorities are...hm, how shall I put this?  Ah I got it - fucked.

When my pager told me at 2AM that I had a trauma victim in the trauma bay "NOW", that told me one of two things:  either the patient was driven to the emergency room in a private vehicle, or the triage nurse determined that a patient who just arrived needed to be seen more acutely by me rather than waiting to be seen by the emergency room staff, and that the patient was "upgraded" to a trauma.  While those "NOW" traumas are usually a big heaping, steaming pile of bovine feces, my pager also said "gunshot wound", so my heart started beating a little faster, and I rushed down to see what was going on.

What greeted me was a man who looked less traumatised than I did after I stubbed my toe earlier that day.  He was standing up, taking off his clothes, and laughing with the staff.  I, on the other hand, was not amused.

A big steaming pile of...

I looked around for the medics, but finding none, I asked the nurse what had happened.  Apparently the patient had driven himself to the hospital (well that explains that), because he had gotten shot in the back.  Yesterday.

Yes, you read that right.  Yesterday.

He had no symptoms except for mild stinging at the gunshot site just to the right of the middle of his back.  He had no neurological symptoms, no abdominal pain, no shortness of breath, no chest pain, no bloody urine, nothing at all that signified that he was remotely injured except for the tiny hole in his back which wasn't even bleeding.  I've had hangnails which looked worse.

I looked at him and the nurses incredulously, looking for some reason why some super-smart rocket scientist thought this patient needed to be upgraded to a trauma, especially at 2AM when I'd much rather have been either sleeping or dealing with a real trauma.  But then I had another thought - why in the name of Phineas Gage had he not sought medical attention, oh I don't know, right when he was shot?  So I did the only logical thing - I asked him.

"Well, I didn't think much of it yesterday," he replied calmly.  "But I had a wedding to go to today, so I thought I should get checked out."

I was speechless.  He could have said he was afraid of questions by the police.  He could have said he felt fine.  He could have used any number of 1000 decent (though bullshit) excuses.  But of all the bullshit excuses he could have given me, he chose that one?

I turned around and walked out.  Halfway up the stairs, my pager went off again.  This time it was a forklift accident - real trauma.

Sigh.  I turned around and headed back in.  My bed would have to wait.

Being responsible

I'm fairly certain that most people, at least those with more than 17 brain cells, know that drinking and driving is stupid.  Lining up an alternative way home, be it a designated driver, public transportation, a taxi, a horse, or good old-fashioned walking, is the smart thing to do before you venture out for your night on the town.  If you are a regular reader of my humble blog, I'm also fairly certain that I've bludgeoned you over the head with this fact repeatedly.  But if you're new here and just joining us, welcome to the party.  Leave your keys in the bowl by the door, because you won't be using them.  We'll have a responsible designated driver take you home. 

Hopefully just not the same designated driver this next guy had, however. 

He was in his 30's, handsome, well-dressed, and with that short beard that makes women swoon and that I just can't seem to grow because my facial hair just hates me.  Um...ahem...Anyway, he was out at a bar (no doubt picking up chicks with that damned sexy beard), and he realised he had too much to drink.  He was far outside the city, and waiting for a taxi would take too long, so he asked one of his new buddies (that he had just met) to drive him home.  

He got in the car and was just telling the guy where he lived when I suppose his new friend saw his fancy suit and shiny watch and figured, "This guy must have some money!"  So he pulled a gun on him and tried to rob him.  The wise (but drunk) man quickly jumped right back out of the car, but unfortunately the alcohol blunted his reaction time and his reflexes.  

So he got shot, right?

No.  The asshole apparently decided, "If I can't rob him, no one can!"  Or something.  I still have trouble figuring out how these idiots think. Anyway, he did the next most logical thing: he hit him with the car.  

And then he ran him over.  

When the guy got to me, he could barely breathe because his chest was so badly crushed.  He ended up having 14 broken ribs (you only have 24 total), a punctured lung, a cardiac contusion (bruise of the heart muscle), a fractured scapula (shoulder blade), a broken neck, and lacerations all over his face.  

He was lucky to be alive, something of which I reminded him when I saw him in my office a month later for his follow-up appointment.  He had stayed in hospital for about 2 weeks before going home, and though he was improving, he was still very sore from all his injuries and was not back to work yet.  It would take several more weeks, I told him, but I expected him to make a full recovery. 

I also expected him to choose his designated drivers more carefully in the future. 

More medical myths

A comment someone made a few days ago inspired me.  She said, "It's possible to drown in a teaspoon of water", and it inspired me to think she's an idiot for believing something so patently obviously wrong.  It also inspired me to write another post on medical myths.  I am shocked that so many of these exist, but even more shocked that people continue to believe and propagate them. 

Take a deep breath, folks. We'll be going deep here. 

Myth: Pulling a grey hair will cause two to grow back in its place. 

Reality: Ha!  Only one hair grows in each follicle, so how exactly would that work?  In fact, pulling hairs can damage the follicle so the hair doesn't grow back at all.  Which is better: one white hair or no hair, baldy?  Yeah, I thought so. 

Myth: A base tan will protect me from sunburn, so I'm going to the tanning salon before I go to the beach.  I'm so smart!

Reality: No you aren't so smart.  Tanning equals skin damage whether it's from the sun or a tanning booth, and it won't protect you from getting burnt.  It also increases your risk of skin cancer by almost 70%.  Want a tan?  Spray it on.  And tell the Oompa Loompas hi for me. 

Myth: Don't wake a sleepwalker. 

Corollary: Sleepwalkers walk like zombies with their arms in front of them. 

Reality: No and no.  It isn't dangerous to wake someone while they are sleepwalking.  The proper thing to do is try to guide them back to bed.  And they walk normally just like any other person, unless they are having a midnight craving for braaaaiiiinssss. 

Myth: Do not, under any circumstances, let people with a concussion fall asleep or else they will die.  

Reality: I see this all the time on TV and in movies, and it drives me a little bit crazier each time.  "Stay with me!  No no, don't fall asleep!"  People who are concussed will NOT die if they fall asleep.  Excessive sleepiness is actually quite normal after a concussion, and the proper thing to do is let them sleep.  

Myth: I'm staying up all night partying on Friday night because I can make up for it by sleeping more over the weekend!  Woohoo paaaarty!!

Reality: Actually, this one is true.  If you lose a few hours over the week, you can make up for it by sleeping more during the weekend.  But if you routinely sleep until 2PM, that just makes you a lazy bum so get your ass out of bed. 

Myth: Im so drunk but I need to drive, so I'll have some strong black coffee and I'll be good to go!

Reality: NOOOOOOOOO!  Especially if you live near me, stay the hell off the road if you've been drinking.  I don't care what you put in your stomach, it will NOT magically decrease your blood alcohol level any faster.  The alcohol in your blood needs to be metabolised.  Full stop.  The caffeine may help wake you up a bit, but it will not sober you up.  So put the keys down.  Now. 

Myth: Blood in veins is blue and blood in arteries is red.  It must be true because it says so on the Internet.

Reality: There may be truth in advertising, but the Internet has led countless people astray, and this time it's you.  Blood is red.  Deep red.  You know, like blood red.  Have you ever heard of blood blue? No, of course not.  And the show Blue Bloods does NOT count.  

That's it for part 2.  There are lots more out there, and I welcome any comments and/or emails with more myths for me to bust.  I think Jamie Hyneman and Adam Savage would approve.