Tuesday 11 February 2014

Therapy and coffee

A brief note to my patients (not that I expect any of them to read this): I am NOT a therapist.  Let me repeat that in case you missed it: I AM NOT A THERAPIST, and I am most assuredly not YOUR therapist.  I have no interest in hearing about your personal problems.  I am a trauma surgeon, and if you have a punctured lung, a hole in your colon, or a tear in your liver, I very much care about that.  However, I do not care that your dog died when you were 7 and you never got over it.  I do not care how your brother teased you about your curly hair when you were kids.  I am not interested in how your Daddy was always working and missed your piano recital when you were 10. 

Despite my disinterest in such matters, many patients feel the overwhelming need to dump all their dirty laundry (along with their blood and/or vomit) all over my lap.  It's almost like they see the white coat and immediately think "I have 33 years of issues to get through, and YOU are going to help me cope with ALL of it.  RIGHT NOW."

Now don't misunderstand me - I have the utmost sympathy for patients who are injured, and I will do everything I can to help them get through their ordeal.  But I do NOT care that Mr. Smith only gave you a B- on your Wuthering Heights essay when goddammit you KNOW you deserved an A.

However, despite the many times when patients have felt the need to get things off their chests, I've found very few of them to be either amusing, educational, or both.  It's an even rarer circumstances when I've felt authorised to give them advice on such personal matters.  As you may have surmised, one such situation arose recently.

After a long 24-hour trauma shift, all I want to do is have a coffee, go home, have a coffee, take a shower, have a coffee, and spend some time with my family.  With a coffee.  I had already managed to take care of 18 trauma patients during one particularly busy shift (including two who had tragically arrived dead and stayed dead), and with only 15 minutes left to go and a large cup of coffee on my mind, I thought I was home free.

The Call Gods had other ideas. 

As I was daydreaming about my first coffee at home (the hospital coffee is pure, unadulterated crap) my pager went off, telling me that I would be getting a pedestrian struck in 10 minutes.

DAMN YOU, CALL GODS!  The coffee would have to wait, unless the medics were late.  Please be late...please be late...please be late...

Exactly 10 minutes later (DAMN IT!) the medics brought me 20-year old Ellie (not her real name).  "This one is a real piece of work!" one of them chuckled as he dropped her off.  Chuckles the Medic couldn't really tell me what had happened to her since she wouldn't talk to them.  "She says she got beaten up.  She doesn't really seem badly injured, but she's complaining about pain everywhere.  She's a real winner!" Chuckles gleefully continued as he and his cronies laughed themselves out the door.


I did my initial survey from head to toe and saw just a few scrapes on her knees and hands and a bloody swollen nose.  And then I made my first error - I asked her what happened.

Much like any argument I've ever had with Mrs. Bastard, as soon as my mouth was open I regretted ever opening it.  She launched into her story that didn't end for at least 30 minutes.  We were able to do our entire workup, X-rays and CT scans included, before she was even close to finished. 

Ellie told us that she and her boyfriend had gotten into an argument over another girl (I don't care) which had escalated into a fight (I don't care).  Not just a fight - a fistfight (I DON'T CARE).  That might explain the abrasions and contusions on her knuckles.  But Ellie was perhaps 150cm (just under 5 feet) tall and might weigh 45kg (100 lb) soaking wet.  I've met very few men smaller than that, so I'm assuming he won based on her broken nose.  I'm also assuming he wasn't satisfied with just winning, because he apparently decided to run Ellie down with his car.  Fortunately she was just knocked onto her hands and knees (explaining the knee abrasions) with no real damage done.

But as I was looking over her scans (and finding nothing else broken), she continued telling me about her history with her boyfriend (I DON'T CARE).  He had stabbed her last year, she said.  And he had cheated on her with at least 2 other girls.

"Oh but Doc," she finally concluded.  "Can you tell me how I can avoid getting another STD from him?  He already gave me something last year, and I think he got something else from one of those other whores, and I don't want to catch anything from him again."

Wait wait wait, let me get this straight - he cheats on you, stabs you, beats you up, and tries to run you over with his car, and you want to know how not to catch an STD from him because . . . you're . . . staying . . . with . . . him?

"Yeah Doc, I love him."

I closed my eyes for a moment and went to my happy place.  When I opened my eyes, she was looking at me expectantly, like I was going to give her some sage wisdom.  I took a deep breath.  "The best way," I said slowly and deliberately, "to avoid catching an STD is to NOT sleep with someone who cheats on you, stabs you, beats you up, and runs you over."  I then splinted her nose and sent her home. 

My coffee was waiting.


  1. 24 hr shifts? Damn. I don't know if I would be comfortable with a guy performing life saving surgery on me when he has been up for 23 and a half hours. I wonder if they would get upset if I asked them how many hours they had been working if I ever needed surgery.

    1. That's the sad truth about many people working on the frontline in A&E/ER departments. In the UK and other European countries, we have a policy that prevents us from being able to work more than 48 hours per week, however it's impossible to stick to it as a healthcare professional. If someone needs your help you can't say "well, it's hometime now, so toodles!" you have to stay. And if you do work more than 48 per week, you can't say that you have, so you don't even get paid for it. Sad times :/

  2. I think this post highlights the differences between medics and surgeons - not saying that as a doctor I would consider myself a therapist either, but speaking to patients and building rapport is something I really enjoy doing. You might not always relate, or even care but I find it's really important to listen :p

  3. So I take it that you're not much good at aura fluffing? One day we'll be able to bill that as a procedure.

  4. Doc this is possibly one of the most hilarious posts I have ever read.... One day I will personally buy you a coffee!

  5. I had to laugh. In my current field (compliance and medical documentation) I have to beard physicians in their den (offices) and speak to them about their charting. Almost invariably I'm treated to a solid 15 minutes of "woe is me" before we can get down to business. I tell the new folks that a good 25% of the job is therapy. I listen and commiserate about how medicine has changed and what a tough hand they've been dealt. Once that's out of the way and I've been appropriately therapeutic and validated their feelings of angst, we can accomplish a lot in a short time ha!

    See, everyone needs a good session of talk therapy on occasion!

  6. At least you had your coffee doc. Lol

  7. As much as I hate it when I end up on the receiving end of someone's soul (did you know this is a frequent event on public transit?), I can understand why these patients are unloading on you. If they're seeing you, they've obviously been through something traumatic, and you're one of the first people they see. However, this one was just really sad. Ugh.

  8. Loved this article.

    It's funny you write about how you don't care about those things, because where I live I've had this problem with doctors trying to give me irrelevant advice I don't want to listen to (and have not asked for), and I've heard this complaint by MANY people here. I've always dreaded going to the hospital because the doctors have generally been nosy and rude. Ranging from what colour of clothes to wear to what type of make up to use and even when I should marry or get pregnant, these are the sort of "side-comments" that many doctors here feel their patients want to hear. I don't care what you think about my clothes, or when you think I should get pregnant, please just treat this fucking burn on my hand.

    Makes me wish professionals were not only taught "skills" but also how to behave like polite human beings. But you can't teach that sort of thing anyway, can you?

  9. This story reminds me of a fight I once had with a drug-addict! Doesn't sound too relevant I know but bear with me...

    It was the day my father died. Already not a good day. I'd left the hospital and was on my way home by train when a couple got into the nearly empty carriage I was in. They were quite loud but in an amicable way initially. However, this quickly descended into a tiff, which became a row, which turned into a full-on shouting match. Then I heard a smack; the unmistakable sound of flesh on flesh. I was facing away but stood up and looked around. They were both standing and saw me. I thought at least that me being there would stop the physical fighting, but not a bit of it. As I watched the bloke hit the girl hard enough to knock her back into her seat.

    Then something broke inside me. If you asked me what I would do in that situation would say that I'd be torn with indecision - I would want to say something, or stop him, but would be too aware of the chance that I would get stabbed or that they would both turn on me. That day, however, I have no idea what happened. Something just snapped and the next thing I knew I was shouting into the guy's face from a distance of about 3 inches. Luckily we were pulling into a station and he jumped out before one of us did something I'd regret or come to my senses!

    Speaking to the girl on the remainder of the journey, it turns out that he was an addict and she was a recovering one. I only got her side of it of course but apparently he would hit her and cheat on her and wanted her to get back on whatever he was on and threatened to lie to her rehab if she refused so her recovery support would be withdrawn. All round, a pretty shitty guy.

    I gave her my card and said that if she wanted someone to testify about the incident then she should call me but she never did. I'm pretty sure that she was so besotted with this guy that no matter how selfish and brutal he was she was just going to keep on going back to him. She had several kids too - not that she really looked old enough to. I just worry that if he would hit her in public, what would he do to her, or indeed the kids, when nobody was looking?

    I told her as I left the train to look after herself. I really hope she did.

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