Sunday, 28 July 2013

Not his time

I've been on this planet for quite a while, and thinking about things is one of my favourite pastimes.  Unlike most of my patients, I actually like to use my brain.  And after all those years of thinking about stuff, I've managed to come to a few concrete conclusions:

1) I'm fairly certain that I don't believe in fate or destiny. 
2) I'm pretty sure that everything doesn't happen for a reason. 
3) I'm kind of convinced that luck (good or bad) doesn't exist. 
4) I'm nearly 100% positive that coincidences are merely coincidences.

What, not concrete enough?  If none of those statements sound like I'm totally convinced, there's a damned good reason.  And that reason is exemplified by this next guy I'm going to tell you about. 

A young man in his early 20's was brought to me having been shot twice in the abdomen.  A gunshot to the abdomen is bad, because bullets tend to tumble around, break apart, and change direction as they encounter soft, wet, squishy things like livers and spleens and guts and stuff.  One gunshot to the abdomen is bad, but two gunshots is more than twice as bad.  As he rolled through the door, he was pale as a sheet and sweating profusely, even though it was frigid outside.

Uh oh.  Bad sign. 

We tore his clothes off, and he did indeed have two gunshot wounds on his abdomen, one near the middle and the other about 6 cm (2.5 inches) away to the right.  His initial vital signs showed that his heart was racing and his blood pressure was low.  He was bleeding to death - actively dying - and needed immediate surgery.  I had no time to do a CT scan or any other diagnostic test to try to find out what was injured.  The only way to get any additional information was to stick a long cotton-tipped swab into the wounds to see which direction the bullet went - up, down, left, right, or straight in.  It's not a lot of help (and not necessary), but at least it's something.  And in that situation, the more information I have, the better. 

As the nurses were frantically preparing to bring him down to the operating theatre, I grabbed a swab and gently inserted it into the wound on his right side, looking for the bullet tract.  It didn't go up, not down, not straight in...ah, there it was - it went left, towards his belly button.  I followed the tract along his abdominal wall looking for the site where it penetrated into his abdomen...

...and the swab came out the other hole.  Wait, what?  I checked again, this time inserting the swab into the other hole.  And it came right out the first hole.  I double and triple checked, and finally came to the conclusion that the bullet had gone into his abdominal wall at a sharp angle, tracked through the soft tissue, and had come right back out without doing any major damage. 

So why was he so sweaty with a rapid heart rate?  He had simply fainted from seeing his own blood.  That was it.  He was absolutely fine. 

After he woke up a few minutes later, his vital signs stabilised, and a CT scan confirmed that the bullet never penetrated into his abdomen.  I cleaned up his wounds and sent him home, AFTER making sure that he was perfectly aware that he is one of the luckiest people I've ever met. 

Fate?  Destiny?  Coincidence?  Good luck?  Ha!  Hell if I know.  Mrs. Bastard would simply say it just wasn't his time to go.

Thursday, 25 July 2013

Not your place

Imagine you have a job to do.  A very difficult and important job, one that took you years of education and training to get good at doing.  And now imagine someone comes along and says something that completely undermines your authority and prevents you from being able to do that job.  You would be pretty upset, right?

Now imagine that person has no business saying anything at all.  Now how upset would you be?

Probably as angry as I was.

I was asked to see a patient in the emergency room who had an acute gall bladder infection.  He had already had a special gall bladder scan that confirmed the diagnosis.  It's is a very common problem, one that has a very simple solution - give some antibiotics and do surgery to take the damned infected thing out.  Even before I saw the guy, I was planning on booking him for surgery that evening.  Even though you have to have eaten nothing for 6 hours prior to surgery, this usually isn't a problem for gall bladder patients because their pain gets worse when they eat, so nearly all of them have fasted for hours by the time I see them.  That way I can whisk them straight into the operating theatre.

So what's the problem?  Well, as I was about to walk into his room, the nurse informed me that he had just eaten dinner.

"WHAT?" I asked in utter disbelief.  "WHY?"

"The tech who was doing the scan told the patient, 'Yup, your scan is positive, but if you're hungry, you can eat from my standpoint," the nurse said.

I was literally speechless (this, as you can imagine, is a rare occurrence for me).  It is one thing for a tech to tell a patient what they think the result of their test is (although many of them are very good, they are not doctors and do not have formal training in reading the scans they perform).  But it is quite another thing (not to mention entirely unethical) for them to give any clinical advice of any kind.

Unfortunately, by the time I picked up my jaw off the floor the tech had already left the hospital, so I didn't even get to tear her a new asshole (which I CAN fix, by the way).  But I did have to tell the patient that his surgery would have to wait until tomorrow.

My job is hard enough with all the idiot patients I have doing stupid things.  The last thing I need is MORE idiots like this one getting in the way.

Monday, 15 July 2013

Protocols

Nearly every profession has some kind of protocol.  It may be a checklist that workers go through once a day (turn on the lights, set the temperature, turn on the machines, unlock the doors, etc), or it may be a list of rules they have to follow.  Protocols are designed to prevent us from forgetting things and making sure that everything that needs to get done actually gets done.  But the downside is that they also prevent us from having to think.  Some people may believe that not needing to use their brains helps to take pressure off and is therefore a good thing.

I don't.

I was walking through the intensive care unit today after seeing my patients there, and I happened to notice a man who looked to be in very bad shape a few beds down.  In the 0.4 seconds it took me to glance at him, I was able to see that he was comatose, intubated on a ventilator, had a cervical immobilisation collar on, and had an intracranial pressure monitor in his brain.  As you can imagine, one must be severely injured to require such equipment.

I also happened to notice that he had three armed police officers in his room.  Three.  When someone is under protective custody (ie someone who has been attacked), there are generally one or two officers guarding the room from outside.  Only people who are under arrest (READ: bad guys) have the officers in the room with them.  And only REALLY bad guys need three of them.

After surveying the scene, I approached the nurse and asked the obvious question - is this guy who is in a coma, unable to breath on his own, probably close to death, really a flight risk?  The nurse started laughing, and I heard his laughing continue and intensify as I walked out of the unit shaking my head.

I imagine that this particular police department has a protocol that "ALL REALLY BAD GUYS MUST BE GUARDED BY THREE ARMED OFFICERS TO PREVENT FLIGHT".  And I imagine that in most cases, this is a good thing.  But here it makes no sense whatsoever.

I would welcome any police officers' or other public servants' comments.  Please tell me I'm wrong.

Wednesday, 10 July 2013

Non-trauma

The great thing about being a trauma surgeon is knowing that all of my patients are potentially critically injured and that I have the opportunity to save them.  You can't beat that thrill, you can't deny that rush of adrenaline, you can't help the excitement of the unknown, the anticipation of...

...the plop of the bullshit that some idiot medics drop on my doorstep. 

So when is a trauma not a trauma?  When it isn't a trauma.  That seems obvious enough, right?  While I can't expect medics to diagnose injuries in the field, I would think that it's easy enough to at least tell if someone has suffered a traumatic mechanism of injury. 

Based on the crap they have been bringing me lately, however, I have to assume it's significantly harder than it looks.  

A middle-aged woman was brought to me, purportedly because she fell.  When she arrived without a scratch or any complaint of pain, my suspicions started to rise.  The medics said they were worried she had fallen.

Wait, worried she had fallen?  Had she fallen or not?   I asked the patient, and she said she had been feeling dizzy and weak, so she went to sleep under a tree.  When she woke up she couldn't remember going to sleep, so she called emergency services.  And because she couldn't rememer, the medics thought she might possibly have perhaps fallen.  Maybe.  It turns out I had suffered more trauma than she had when I shaved that morning.  I guess these medics took the "fall" in "fall asleep" literally. 

If that wasn't bad enough, a different crew brought me my worst non-trauma of all time a bit later.  A woman who had undergone a hip replacement operation a week prior was lying in bed at home doing therapy with her physical therapist when she heard a "pop" and felt a pain in her hip. The therapist called emergency services, and instead of bringing her to the hospital where her orthopaedic surgeon works, they brought her to me. As a trauma. What kind of trauma, you might ask?

I have no goddamned idea.  If you're wondering, her X-rays were normal.  Please, try to control your surprise.

Did you just hear that plop?  Yeah, me too. 

Sunday, 7 July 2013

Necromancy

There are many things I will never be no matter how hard I try: a professional athlete, a movie star, and a hand model to name a few. And to name another, a necromancer. I've tried my hand at necromancy dozens of times.  I've read all the books, practiced the incantations, mixed the potions, and collected the necessary talismans (talismen?).  Unfortunately my Frankenstein skills suck - I still have no ability to raise the dead.  But despite my protests to the contrary, the medics in my area refuse to believe this. 

These rocket scientists brought me another corpse recently so I could try my hand at resurrection again.  During a domestic dispute a young man in his 20s was stabbed with a kitchen knife by his girlfriend just above the left nipple - a perfect kill shot.  After 30 minutes of struggling, she realised she would never be able to get his lifeless body up the basement stairs, so she finally called emergency services.  They arrived a few minutes later to find him dead, so they did the only logical thing - they declared him dead and brought him to the morgue.  Story over. 

What, have you forgotten the subject of the post already?  No, these geniuses started CPR on this stone-dead man, bundled him up, threw him in their ambulance, and deposited him, CPR still ongoing, in my trauma bay 20 minutes later.  At this point he remained firmly deceased despite my fervent hand-waving and spell-casting.  Maybe I mekalekaed when I should have makalakaed.  I did what they refused to do - I allowed him his eternal rest and declared him dead. 

Perhaps these guys had just watched Miracle Max bring the mostly-dead Westley back to life in "The Princess Bride".  Who knows.  Unfortunately, that's fiction.  Until the medics finally grasp the concept of death being absolute, I will have to continue practicing (and failing) at the art of necromancy.  

Tuesday, 2 July 2013

Hard to believe

You'd think that after seeing and hearing so many ridiculous things that I would stop disbelieving what I hear.  You might think that eventually I would just give in and stop questioning it.

Nope.  Despite my best efforts, it just hasn't happened yet.  Because it seems that somehow people keep getting dumber. 

A 25-year old man was brought to me in the middle of the afternoon having wrapped his car around a tree.  The first thing the medics told us through the patient's howls of pain was that the guy had been clean from drugs for a while, but he just shot up some heroin that day.  The second thing was slightly less surprising - 

He had also been drinking. A lot.  On a weekday afternoon. 

Shocking. 

"Fucking hell, doc!  My knee!  God damn it, my knee!"

I told him we'd give him morphine while we did our evaluation, but he told me he had a preference for hydromorphone (a synthetic narcotic about 10 times stronger than morphine).  It's never good when they have a narcotic preference.  I gave him the morphine anyway (because I'm not about to let some drunken heroin-addicted idiot dictate his own care), but of course it didn't touch his pain.  His tolerance to narcotics was approximately that of an obese heroin-addicted hippopotamus. 

It turned out he had a very good reason for screaming so much - a badly-broken knee and a fractured sternum (breast bone).  So what caused the accident, I wondered. 

"Duh, it was the alcohol, Doc!"

Well, yes and no.  At 120 kph (75 mph) he reached down for his cigarettes which had fallen onto the passenger-side floor, and the tree must have jumped out in front of him while he was looking down. 

I already knew that smoking was dangerous and stupid, but drinking, shooting heroin, speeding, and reckless driving is taking it to the next level of stupidity.  This is ├╝berstupid.