Tuesday 31 December 2013


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.

Wednesday 25 December 2013

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.

Sunday 22 December 2013

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?"

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.

Wednesday 18 December 2013

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?

Saturday 14 December 2013


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.


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.

Monday 9 December 2013

Optimists vs. pessimists


op·ti·mist (op-tuh-mist)
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.

Wednesday 4 December 2013


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. 

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...