Thursday 31 October 2013


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. 

Wednesday 30 October 2013


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, 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.

Friday 25 October 2013

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. 

Monday 21 October 2013

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. 

Friday 18 October 2013

More motorcycle madness


In case you missed my recent post on motorcycle safetywhat the hell is wrong with you?  I put the link right there!  Go read it! 

Ok fine, you lazy ass.  My point in that post was that motorcycles are incredibly dangerous.  And shortly after writing it, I found more pictures I had taken of several other patients who utterly and completely proved my point beyond any reasonable doubt. 

A man in full protective gear crashed his motorcycle after taking a turn too fast.  Not only did he still end up with road rash (despite his complete full-body "protection"), it didn't help his femur at all:

Ow.  Leather and kevlar DO NOT PROTECT BONES.  Got that?

A few days later a woman was riding her death trap, also in full protective gear, when she hit some gravel, lost control, and crashed.  Did all that leather save her?  See for yourself:

That metal rod running up and down is the temporary splint.  And the bone underneath the rod is what used to be her knee.  The end of her femur is completely shattered, and you can see several shards of bone protruding through her skin.  The medics brought me a chunk of bone the size of a plum that they found on the road.

And yet another idiot was riding his murdercycle when he was hit by a car.  Had HE been in a car, he would have been fine.  But his leg took the brunt of the impact, and it was far from fine:

So what's my point?  Yeah, you get it.  Motorcycles are dangerous. Blah blah blah.  I'm not sure if I'm beating a dead horse or driving my point home here.  Maybe both.  Either way, it's my damned blog and besides, I just needed an excuse to post these pictures.

Monday 14 October 2013

Are you high?

Just based on the title I can already hear the stoners complaining.  "Oh great, here goes Doc preaching about pot again!  We get it!  You hate weed!  Get over it, you sanctimonious prat!"

Congratulations, you can read.  Yes, it's another post about pot.  No, I haven't changed my mind.  I still think recreational marijuana is stupid and dangerous. 

"No it's not!  It's safe when used correctly!"

Maybe, but who the hell uses it "safely"? Certainly not the people I see. 

I heard over the box (the citywide emergency services communication system) that we were getting three car accident victims at the same time.  It seems a car veered into oncoming traffic and hit a van head on.  They brought me a passenger from the van and two people who were in the car.  

The first woman (from the van) had a concussion and some broken glass in her foot.  The driver of the car that hit the van had several lacerations around her eye.  The passenger in the car (her boyfriend) had a broken leg and a lacerated spleen.  

So what's the point?  Well I'm glad you asked.  If you were paying attention (and are not high), you've probably already guessed that the driver of the car was high on marijuana, something she failed to tell me even when asked directly about drug and alcohol use.  

And if it wasn't bad enough that she caused her boyfriend's broken leg (and the other woman's injuries), apparently she was so high that she didn't bother to put her 4-year old daughter in her car seat.   The little girl suffered a depressed skull fracture, and I'm not sure if she will survive. 

Recreational marijuana use is stupid.  IT IS STUPID, and I see this kind of thing on a regular basis.  Is anyone really surprised that I feel this way about pot?  Anyone?  After everything I've seen, how could I possibly think anything different?  I freely welcome any marijuana advocate to tell me why I should change my stance on pot.  If you can convince me, I solemnly swear I'll buy you a big bag of weed. 

(Though it'll probably be dandelions and ragweed.)

Thursday 10 October 2013


TMI means different things to different people.  I did some research (AKA a 0.2728 second Google search) on the definition of TMI:

- Thinking Machines Inc., manufacturers of super computers
- TMI Associates, a Japanese law firm
- Three Mile Island, a nuclear power plant that had a partial meltdown in 1979

To most people, however, TMI stands for Too Much Information, ie when someone tells you something that makes you wish you had ear bleach.  I will be focusing on that definition for reasons that will (hopefully) become clear soon.  When is too much information too much?  More information is usually better than less in my line of work, right.  Well, sometimes too much is just too damned much.

One of my recent patients was a 50-ish year old man who was found lying face down in the street next to his bicycle.  I have no idea if he crashed or if he was hit by a car, and I quickly determined that it didn't matter one bit.  He reeked of alcohol and his face looked like he had gotten into a nasty bar fight (and lost).  Our extensive workup showed multiple facial fractures and a blood alcohol level over 3 times the legal limit. 

I went to see him the next day as he was waiting for the maxillofacial surgeon to repair his face.  I passed by his girlfriend in the hall as she was leaving - she was worried, in tears, and obviously cared for him a great deal since she had been at his side all night.  As soon as I got to his room he launched into his entire life story, including several excuses for why he drank heavily every night.  I tried to use body language (slowly inching towards the door) to let him know subtly that I didn't give a fuck, but he kept on going until I thought my ear would fall off.

Too much information!  Please stop talking! I said to myself. 

"Things are bad at work.  I'm probably going to lose my job.  And my home life is really hard with Sally (not her real name) right now, Doc."

I don't care. Please stop, I thought.

Then he leaned in close...  

Oh god, no, I silently begged him.  Please stop...for fuck's sake don't say anything more...

"And there's another woman that Sally doesn't know about..."

Fuck.  FUCK. 

I politely told him that the facial surgeon would be in to see him soon, and I finally extracted myself from his room, wishing the antiseptic hand gel worked on brains, too.  And for the cherry on top of this shit sundae, as I was walking away, he yelled after me,

"Oh yeah, Doc!  Don't tell Sally know!  You know..."

I'm pretty sure doctor-patient confidentiality doesn't cover infidelity.  I'm pretty sure Sally already knows.  And I'm pretty sure I should keep my big mouth shut and keep my nose out of his personal business.  But I'm absolutely positive that was too much information. 

Sunday 6 October 2013

More things I don't understand

I consider myself a pretty smart guy, but there are certain aspects of the world that continue to baffle me despite heavy rumination on the subject.  Yes, rumination.  Look it up.  I shall now expose even more of my fallibility by admitting to yet more things I will never understand:

- women
- where the fuck that lost sock went
- why that moron in front of me won't get out of my way
- how anyone eats pickled herring
- why some idiot patients feel the overwhelming need to lie to me
- why these idiots think I'll actually believe their ridiculous stories

To wit, a fine young gentleman (read: idiot) was brought to my fine trauma bay after he was allegedly assaulted.  Assaults are often amusing because of the preposterous stories they tell.  Fortunately this guy was no different (and no smarter) than the rest.  His story was just slightly different than the one the police told.  Let's see which one is more believable: 

Patient's version: So I found this set of keys on the ground outside my apartment, right?  And I thought I would be a good citizen and return them to the rightful owner, you know?  So I did what any Good Samaritan would do - I tried the keys in a bunch of doors until I found the one it would fit in so I could give them back.  I should get the Nobel Peace Prize and stuff because I'm such a good guy.  But a group of thugs thought I was trying to break in, so they beat the shit out of me with a hammer. 

Police's version: He stole a set of keys and was trying to break in to a house when the neighbours saw him and beat the shit out of him with a hammer.'s hard to decide whom to believe.  

Tuesday 1 October 2013

Giving up

Not everyone makes it.  Not everyone who gets to me makes it back out alive.  A few people come to me in the midst of dying, and they finish their journey shortly after arrival.  One of the most difficult things in medicine is determining who is lost, who has traveled too far down the path to eternity to bring back.  I don't like giving up, but sometimes I have to give in.

I had just such a patient recently.  I'll call her Bertha.  She looked every bit of her 80+ years, and those years had not been kind to her.  Decades of smoking cigarettes had ravaged her lungs to the point where she required oxygen at home. There were numerous other medical problems as well, but that didn't stop her from driving.

I wish it had, and so did the tree she hit.

It seems Bertha passed out while she was driving, probably because her oxygen level had dropped too low.  She woke up as the medics were extracting her from her car (the tree was fine), and she immediately started complaining of difficulty breathing.  Her breathing was so difficult that she didn't even feel the broken bones of her lower leg poking through her skin.  When she got to me, it was clear that she was in very bad shape, and I got that sinking feeling that never seems to end well.  She had severe pain in her chest (I suspected rib fractures), and she had a very nasty open fracture/dislocation of her ankle.  For her own protection she needed to be placed on a ventilator immediately, because she looked like she was going to go into respiratory arrest any second.

Unfortunately Bertha wasn't my typical car accident patient (young and healthy).  When older people suffer massive chest trauma, a contusion to their heart can be life-threatening (or even life ending).  When that older person also has lungs that have been destroyed by cigarettes, it's usually game over.  Bertha got her breathing tube, and just a few minutes later, my worst fears came true: her heart stopped.  We started CPR and gave her medications to try to restart her heart.  After a few minutes, it restarted, but I was afraid the damage to her heart and brain was too much for her system to bear.  I was also afraid that when those medications wore off, her heart would stop again.

And just 5 minutes later, it did.  We did CPR again and got it restarted, but then it stopped once more.  As my team continued doing CPR for the third time, I ran to talk to Bertha's daughter.  I told her exactly what was going on, and that it was probably time to give in.  I didn't think Bertha was going to make it.  Her trauma was too severe, and she had no physiologic reserve to tolerate it. 

"Please don't give up, Doc," she said.  "Please."

I decided to respect her wishes and keep going despite my grave doubts. 

I ran back to the trauma bay, and we got Bertha's heart restarted for the third time.   I waited for it to stop again...and waited...and waited... but this time, it didn't stop.  She required two medications to keep her blood pressure elevated, but her heart kept on going.  The next day the orthopaedic surgeon fixed her ankle and she no longer required those medications to keep her heart pumping.  The next day she woke up.  Two days later her breathing tube was removed and she started breathing on her own.

Bertha's daughter hugged me a few days later as I told her that her mother tried really hard to die.  And I admitted that I had been ready to give in.  Bertha just smiled, coughed weakly, and said, "But I wasn't ready."

Not dead

I'll start this post by answering a few questions that may or may not be burning in your mind: No, I'm not dead.  No, I didn't g...