Friday 26 April 2013

Random pictures

After 18 months of posting stupid stories and over 1 million page views, I've gotten a few dozen emails from readers (I hesitate to be so arrogant as to call you "fans").  Some people ask questions, some write to say thanks, some have sent stories of their own, and some have sent pictures.  But now that I think of it, I haven't gotten any hate mail.  Yet.

Anyway, I've used (and will continue to use) some of the stories that people have sent in my posts, but sometimes the interesting pictures that are sent are just that - interesting pictures with interesting stories.  So I thought I would share some of them.  All of the people who have sent these have given me permission to use them, so for all the American folks out there, HIPAA can go fuck itself.

Maddie is a very brave 16 year old girl who has had scoliosis since she was 8.  Scoliosis is an abnormal curvature of the spine, and it can be crippling.  She tried a brace at first, but after three years that was ineffective and she had her first corrective surgery to fuse her spine when she was 14.  Her second was when she was 15.  After a few weeks at home, she started going back to school full time.  What impressed me the most about Maddie is that this brave girl didn't let her chronic pain stop her from playing lacrosse and softball and riding her horse.  How is it that children often endure serious medical problems better than adults?

Anyway, here is Maddie.  Before her surgery is above, after is below.  Good for you, Maddie.

Next is Van.  Van is one of the good guys - he wears his seatbelt and he gives his drunk buddies a ride home when needed.  On one such night, Van was run off the road by a large truck.  He went into a ditch, rolled his truck, and finally hit a tree.  Because he was wearing his seatbelt, he literally walked away from this horrific accident:

This one is from RK who was driving a friend home when a drunk driver crossed the median and hit them head on, causing them to roll over 6 or 7 times.  RK suffered a broken pelvis, patella (kneecap), and wrist, while his friend walked away with a few scratches.  A huge congratulations to Chrysler for creating an SUV that can protect its occupants so well (notice all the airbags which deployed):

This was sent by DS who suffered a dislocated pinky finger while playing football.  The injury ultimately required surgery, but it also caused him to miss his entire senior year of football.  However missing sports allowed him to focus on his studies and improve his grades which then allowed him to get into a good university.  There's a silver lining right there!

And finally we have Mary (not her real name) who stepped on a knife one fine Australian morning.  I'm not exactly sure why she allowed herself to bleed all over her clean kitchen floor before putting some pressure on the wound or why she decided to take this picture.  Probably something to do with Facebook, Instagram, or Twitter.  Ugh.

So that's the end of Part 1. I'll be happy to make Part II when I have more pictures. HINT HINT


Pills and prescriptions are a funny thing.  Think about it: I give you a piece of paper with some indecipherable chicken-scratch on it, you present this paper to a pharmacist, and this poor pharmacist tries to decode my illegible handwriting.  Fifteen minutes later you are magically presented with a bottle full of some possibly-toxic chemical in pill, tablet, powder, capsule, caplet, or liquid form that will cure your ailment, whatever it may be, hopefully without causing diarrhoea, constipation, nausea, headache, insomnia, drowsiness, bleeding from the eyes, bubonic plague, cat scratch fever, malaria, insanity, or outright killing you.

Ok, so maybe "funny" wasn't exactly the right term.  "Incredibly dangerous" seems much more appropriate.  Most people, I'm sure, don't understand just how dangerous some of these medicines can be.

Consider, if you will, this silly little fairy tale.  Many years ago chemists were looking for a way to combat a very nasty rodent problem.  No, they didn't hire the Pied Piper.  Instead, they formulate a new kind of pesticide to kill rats and mice.  The idea is that the rodents eat so much of the poison, which turns out to be a very potent blood thinner, that they bleed to death internally.  Now since it was so effective at killing rodents, some genius later evidently thought, "Hey, this poison could also be used as a blood thinner in humans as a medicine!  BRILLIANT!"

Sounds like some ridiculous horror story, right?

That's the very real rat poison on top and the just-as-real human medicine on the bottom.  Same stuff.  It's the EXACT SAME STUFF.  Still sound ridiculous?  Warfarin, one of the most commonly prescribed blood thinners in the world, is used to treat blood clots in humans.  And I've seen some people bleed to death from an accidental overdose.  In fact, the Federal Drug Administration in the US estimates that 15% of all major adverse effects are caused by warfarin alone.  Think about that for a second - if  you collect all the major side effects of all drugs on the market worldwide, 1 in 6 is due to this one drug.

Fortunately most other medicines (other than chemotherapy agents) weren't designed to be poisonous, but they still can have bad side effects.  People don't seem to think about that, though.  Did your doctor talk to you about the potential side effects of that medicine he just illegibly wrote for you?  Did your pharmacist talk to you about them as he handed the medicine bottle to you?  Shouldn't they have?

Did you bother to look up the drug online before you took the first one?  Shouldn't you?

Smoking kill faster...update

If you read this recent post about a woman who continued to smoke despite having been diagnosed with several respiratory diseases, you may remember my last line:

If this woman does eventually succumb to her many pulmonary ailments, I think Dr. K should submit her for consideration of a Darwin Award.

After reading the post, Dr. K emailed me to tell me that about a month after her previous visit, she came back to the ER in cardiac arrest.  Unfortunately Dr. K was not able to restart her heart, and she died.

One could make the argument that if you have a terminal illness, why not enjoy your last few weeks or months and do whatever you want?  Smoke however much you want!  Right?

Sorry, but I can't find any logic to that argument.  Would she have lived any longer had she not been smoking?  Who can say.  But I would argue that the smoking certainly did nothing to help her, and it may indeed have shaved a few days off her already-drastically shortened life.

It's awfully sad either way.

Tuesday 23 April 2013

Dumbest doctor?

I was asked a few days ago by Adrian to share a story of the dumbest doctor with whom I've had the displeasure of working.  So I searched the deepest recesses of my brain, trying to unmask some of the horrid memories I've stashed away and tried valiantly to forget.  These are the most frustratingly ridiculously maddeningly stupefyingly stupidly stupid...stupid...oh hell, I lost my stupid train of thought because of all the stupid memories of stupidity that just came flooding back.

Thanks, Adrian.  I'll be in therapy for years because of this.  I hope you're proud of yourself.

Unfortunately I couldn't think of one specific story that stood out from the rest, so I'll have to give you some of the, lowlights.

1) An ER doc frantically called me for a patient with a "cold leg". This is a surgical emergency because it means blood supply to the limb has been cut off, so we have only hours until the muscle starts to die.  I rushed to see the man and quickly examined his leg, only to find a normal pulse in his very warm foot (meaning his blood supply was just fine).  After calming myself (to prevent myself from punching the ER doc in the face and demanding to know why he was such an idiot), I asked the patient a few questions, and within 30 seconds I had diagnosed him with shingles.  SHINGLES!  Why the hell does it take a surgeon to diagnose a simple viral infection?  Oh right, because the ER doc never actually touched his leg.  He just heard the patient say "My leg hurts", so he called me.

2) A different ER doc asked me to consult on a drunk patient who fell down and bonked his face (yes, "bonked" is the technical term). He had already had a full workup, including multiple unnecessary X-rays and CT scans (more than I would have done), and everything was normal.  So...why the consult request if everything was normal?  "I just wanted to know what to do with him," the ER doc said.  Really?  What exactly do you expect me to do with him?  Is this DocBastard's Babysitting Service?

3) I was asked to see a patient in the ER who had fallen and had a pneumothorax (a "punctured lung"), for which the treatment is inserting a tube into the chest to allow the lung to reinflate.  I entered the patient's room, only to find the ER doc preparing to insert the tube into his abdomen just over his liver, a full 15 cm (6 inches) lower than she should have been in the chest.  I quickly stopped her and saved the patient from being stabbed in the liver and becoming a real trauma patient.

4) An ER doc asked me to see a patient with excruciating abdominal pain from a bowel obstruction, but the doc just couldn't figure out where it was coming from.  It took me about 0.4 seconds to notice that the patient's scrotum was the size of a large grapefruit because a good portion of his intestine was in it due to his enormous hernia.  I guess the ER doc just forgot to look there.  Oops.

5) An ICU doc asked me to see a patient who was actively dying from a heart attack.  Apparently the genius had ordered a CT scan of the chest and abdomen and had noticed gallstones, so he expected me to do something about them.  While she was dying of a heart attack.

So which is your favourite?  You know, after dealing with all this nonsense I think it's a minor miracle that I haven't bashed my head against the wall.  Adrian, I'll be sure to send you the bill for my therapy sessions and antidepressants.

Thursday 18 April 2013

Smoking kills faster

Ok, I'll resist my usual temptation to rant and rave about how stupid smoking is and how it kills people in approximately 8,472 different ways.  Everyone knows that it smells horrible, it's expensive, it looks stupid, oh and did I mention it KILLS YOU?  Sorry, sorry, sorry.  I'm done, I promise.  So now you must be left wondering, "What the hell does he mean that smoking kills faster?"

Don't I always explain myself eventually?

Dr. K (not her real name), an emergency physician in the United States, wrote to me to about a woman who was brought to her ER complaining of shortness of breath and chest pain.  Now I know what you're thinking -

"BOOORING!  I'm going to go find some cat videos on YouTube."

Whoa, hold on there cowboy, stay with me here.  It gets more interesting, I promise.  I admit this is a very common pair of complaints, and any doctor (or anyone else, for that matter) who knows anything about medicine would immediately think of a heart attack.  But what made it less common (and therefore more interesting - see, I told you!) is that she was only 29 years old.  This beautiful young woman had a long history of multiple bouts of pneumonia spanning back several years, and she had undergone a mini-biopsy of her lungs a few years ago which showed something called bronchiolitis obliterans with organising pneumonia, otherwise known as BOOP.  This is a relatively rare condition where the lung becomes chronically inflamed and the air sacs fill with connective tissue, inhibiting their ability to exchange carbon dioxide for oxygen.  She had undergone a further workup a short while later (including a formal lung biopsy) and was also diagnosed with respiratory bronchiolitis-associated interstitial lung disease (which is also bad) and idiopathic pulmonary fibrosis, which is extremely bad and has a median survival after diagnosis of 3-4 years.

Sounds pretty damned serious, right?  And anyone in their right mind who carries these diagnoses wouldn't dare go near a cigarette because that only makes lungs worse, right?

Come on now!  Didn't you read the title?

Dr. K (still not her real name) noticed the characteristic yellow staining on her fingernails (no, she was not a yellow clay sculptor or a turmeric harvester), not to mention the unmistakable stench of cigarette smoke all over her clothes.  Despite the overwhelming evidence, the woman denied smoking (of course).  But her husband spilled the beans and told Dr. K that she was indeed still smoking.  The worst part about all this is that this is not an uneducated woman who just doesn't know the damage cigarettes can do (then again, these days who doesn't know how stupid smoking is?) - she has a PhD in biology and is a university professor.

"People are not educated.  Ok, it's all over the place that smoking kills, but I'll give most people the benefit of the doubt and say that they just don't know better.  NOT THIS GIRL.  Do you ever feel like sometimes we set nature back?  Survival of the fittest...what happened to that?"   - Dr. K

I'm not sure what Darwin would say about survival of the fittest when it comes to human behaviour.  I've seen some damned stupid people survive some damned stupid injuries.  But now you know what I mean by "smoking kills faster".  If this woman does eventually succumb to her many pulmonary ailments, I think Dr. K should submit her for consideration of a Darwin Award.

Wednesday 17 April 2013


I don't care where in the world you live, if you haven't seen what happened yesterday at the Boston Marathon, you must be living under a rock.  I've been following it as much as possible on the news, and it's incredibly tragic.  That someone would do such a vile thing during an event that is supposed to bring people from all over the world together makes me disgusted, angry, and saddened.

We do mass casualty drills several times a year, but I haven't actually had to deal with one myself.  Having watched some of the news reports carefully, it looks like the first responders (police, fire and rescue) did a fantastic job managing the situation.  Triaging scores of patients at one time is a nightmarish proposition - sometimes you have to make the decision to pass over someone who is gravely injured (but still barely alive) in order to try to save others who have a better chance at surviving their wounds.

My thoughts are with the injured and their families.  I hope the perpetrators of this heinous crime are found quickly and brought to justice even more quickly.

Tuesday 16 April 2013

Almost a patient

So far I've written about stupid doctors, stupid lawyers (oh, I thoroughly enjoyed that), stupid questions, and of course stupid patients.  But I haven't written about someone stupid who wasn't my patient.


Some people I can just tell will end up either in my trauma bay or on a cold steel slab soon, some sooner than others.  For example, when motorcyclists pass me on the highway like I'm standing still, I usually yell after them "See you soon, idiot."  Not that they can hear me, of course.  But screaming at them somehow makes me feel better.

I got a call from the ER at midnight about a patient who was actively dying and needed immediate surgery (I'll leave out the details because they aren't relevant).  I apologised to my wife for waking her (as per Bastard household protocol), jumped in my car, and raced towards the hospital.  Fortunately in the middle of the night there's usually no pedestrian traffic to worry about.


Got that sense of foreboding yet?

Halfway to the hospital I nearly ran over a woman who I can only describe as leisurely strolling across 3 lanes of traffic.  Bad enough?  Of course not, but I'm sure you knew it got worse.  She was also wearing all black in the middle of the night.  What, still not stupid enough?  Ok then, she was also looking down at her cell phone, not paying any attention at all to the world around her.

I have no idea (nor do I give a flying fuck) if she was updating her Facebook status, tweeting about what she was doing in the middle of the road at midnight, or flinging pissed-off birds at pigs.  Regardless, she didn't even bother to trouble herself to look up as I slammed on my brakes and swerved, barely missing her.  She did, however, pause long enough to yell "ASSHOLE!" and give me a nasty gesture.

I shrugged off this idiotic encounter and got to the hospital in time to take my patient to surgery, which she survived.  It was speed, not dumb luck, that allowed my patient to survive that night and make it out of the hospital in one piece.  It was the exact opposite that kept this imbecile OUT of the hospital and out of the morgue.

I imagine her latest tweet was "OMG just almost got run over lolol #yolo"

Monday 8 April 2013

DocBastard FAQ

I always try to encourage questions from readers either by email or in the comments, but it seems people are very hesitant to post comments.  So most of the questions I get are via email.  But I've noticed that I continue to get variations of the same questions, so I've decided to create a one-stop answer repository for you.  This is not because I want everyone to know everything about me; rather, it's much more selfish than that - I just want a link where I can point people from now on instead of answering the same damned questions over and over and over.

DISCLAIMER: Not all answers herein will be truthful, useful, helpful, or any combination thereof.  Some answers may or may not be completely or partially fabricated, invented, or otherwise fictional.  Batteries not included.  Please allow 6-8 weeks for delivery.

Now that that's out of the way, let's begin, shall we?

1) Where are you from?
HA!  You really thought you'd try that first, eh?  Nice try, but I'm not falling for that one!  Did you really think I was going to answer that?

2) Fine, asshole.  Why won't you tell us where you're from?
Well that's a much simpler question to answer, so I'll answer it in as complex a fashion as possible.  My family is my first priority, and my patients come next.  Part of taking care of my patients is protecting their privacy.  All of the stories I tell are true (with certain details admittedly altered or embellished), so if you knew I was in London or Montreal or Sydney or Beijing or Moscow or Johannesburg, it might be easier to figure out who these people are.  I simply can not let that happen.

3) So I guess you won't tell me your name?
You guessed right.

4) Are you actually a doctor?
Seriously, I get this one all the time.  Yes, I am.

5) If you're actually a doctor, how do you have so much time to comment on FML and to update your blog?
What, are you some kind of time management expert now?  Trust me, I find the time.  I happen to be very efficient with my time, so when I can save a few seconds here and there, they add up.

6) Are you an ER doctor?
No.  NO.  NO!  Why don't you just slap me in the face, because that would hurt less.  In case you didn't catch that, no I'm not.  I'm a trauma surgeon.

7) Well excuuuuse me.  So what's the difference anyway? 
An emergency physician sees anyone who walks into the emergency department with a sniffle, a sprained ankle, pinkeye, chest pain, a hangnail, abdominal pain, anything.  A trauma surgeon sees only those people who are brought in having suffered a traumatic injury - falls, car accidents, stabbings, gunshot wounds, my-lawnmower-ran-over-my-foot wounds, etc.  We evaluate them and then perform surgery to repair any damage done, from simple things like lacerations to more complex things like shattered spleens.

8) Why do you call yourself "Doc Bastard"?
Easy, because I'm a doctor and a bastard.  NEXT QUESTION!  What, not good enough?  Ok, well the "Doc" part should be easy enough to figure out if you read question 4.  As for the "Bastard", when I decided to start commenting on, I thought I would act like the biggest asshole in the history of assholes to the posters and the other commenters.  "DocAsshole" just didn't look right, so "DocBastard" was born.  I quickly abandoned that idea, but I'm just not creative enough to think of a new username, so it stuck.

9) When did you decide to become a doctor?
When I was five years old, I visited my grandfather's medical office.  I saw his ophthalmoscope, otoscope, and stethoscope and thought, "Cool, I want to use these toys someday!" and I never looked back.

10) What about surgery?
I didn't decide that until I was well into medical school.  Believe it or not, I entered medical school thinking I'd go into pediatrics or psychiatry.  Surgery was barely a consideration then.  But on the first day of my surgery clerkship, I scrubbed into surgery for the first time (it was a groin hernia repair), and the scrub technician dressed me in my sterile gown and gloves.  The moment I put my hands on the patient, I knew I belonged there.

11) What does it take to be a trauma surgeon?
Hard work, determination, and a bit of luck.  You have to be willing to spend considerable amounts of time away from home, and you have to have a family that is supportive.  It's nearly impossible to spend 24 hours at a time in the hospital and survive without someone who loves you unconditionally to come home to.

12) Have you ever considered publishing these stories?
Ha!  No.  Writing is merely a hobby for me, and to be honest I never thought anyone would read this crap.  Now if anyone happens to know an editor or publisher and wanted to point him or her in my direction, I certainly wouldn't object.  HINT HINT

13) Who is your biggest influence?
That would be my father, DadBastard.  He was a surgeon as well, and a damned good one at that.  I'm told my personality is very similar to his, even down to his mannerisms.  He has always been my role model, and I can't think of anyone to whom I'd rather be compared, except maybe his father, GrandpaBastard (who unfortunately passed away several years ago).  They both tried repeatedly to talk me out of going into medicine (and surgery), since they knew first-hand the sacrifices I'd have to make.  But I think they just wanted to make sure my heart was really in it.

14) What's this lump on my ass?
I have no idea, but it's hideous.

15) Can I ask you other questions?
Yes.  See the disclaimer above.

Wednesday 3 April 2013


People can be inspired by the strangest things.  Artists can be inspired by a beautiful woman, a screenwriter may be inspired by war, a musician may be inspired by a particularly nice ass.  I know of many people in the medical profession who were inspired to go into the field because of something that happened in their own lives.  People with diabetes pursuing diabetes research or becoming an endocrinologist, people with severe allergies doing immunology research, people who had surgery at a young age going into surgery.  I was inspired to go into surgery by my father who was also a surgeon.

Little did I know that *I* could be an inspiration, even from afar.

Mr. R (not his real name) wrote me a few days ago, and after reading his letter, I asked if I could share it.  Fortunately he agreed.

Hi DocBastard.  I have been debating writing this post for quite some time. Let me start by introducing myself.  My name is [name redacted] and I'm 20 years old from [location also redacted] but born in raised in [damn it, stop making me redact things].  I have been beset by health care problems my whole life.  It started at 3 months old with tracheomalacia [a congenital weakness of the windpipe] and lived with a tracheostomy until the age of three.  In addition to this I suffered heart failure until roughly the age of six.  From approximately the age of 7 to 14 I broke eight bones and had at that point fourteen surgeries.  For a brief three years I had no issues to speak of.  Then on February 22, 2011 my world was turned upside down.  I had just finished working out and wasn't feeling too good, and I noticed that my arm had gone numb and I couldn't speak. Five hours later I was informed that, even though I was only 18 years old, I had suffered a transient ischemic attack [basically a mini-stroke] due to an atrial septal defect [a hole in the heart].  The news turned my world around - I had to turn down over $100,000 in scholarships.  I went through depression...and then I found your blog.  (Now I know what you're going to say - "Thank god, he's finally getting to the point!")   
I want to thank you for providing me a source of relief when I was stopping myself to pieces.  Thank you for reminding me that even though I've had it rough, it could always be worse.  Thank you DocBastard, for even though you didn't know it you convinced me to apply to medical school so I can help others like the wonderful doctors in my life have helped me.
I am profoundly honoured that my writing could inspire someone to pursue medicine, though I don't think I can claim full credit.  I have a distinct feeling that Mr. R's experiences had a lot to do with it too.

There are many great reasons to go into medicine - doctors are generally very well respected, we are among the most highly-educated people, and we get to cure diseases and help people get better.  There are even better reasons to go into surgery - mainly, I get to fix things instantly with no waiting, and I get to save lives, often in dramatic fashion.  So it always worries me that young people would look at a potential career in surgery and see only the bad things.  Sure it's a difficult lifestyle with long hours, a lot of time away from home and family, long and difficult operations, we are often underpaid...wait, why do I still do this to myself?