Weight problem

I have a weight problem.  No, I'm not overweight.  I'm not underweight either.  In fact my BMI is a very healthy 22.4.  So what's the problem then?  Nothing . . . for me.  The problem is for everyone else - my weight has been stable for the past 20 years, and that pisses people off.

"Fuck you, Doc!  I've been trying to lose weight all my life!"

Yeah, that's exactly what I'm talking about.  My body just doesn't hold calories.  Oh, I may possibly put on a kg or two on holiday by, for example, eating 6 lobster tails at the seafood buffet one night (yes, really), but all I have to do to drop that weight is switch from sugary drinks to water when I get home, and I'm back to my usual svelteness within a few days.

Hmm, I can hear several readers' teeth grinding and . . . is that screaming?  Maybe I should stop.

No dammit, I know I'm torturing some of the more gravitationally-challenged here, but bear with me for a moment, because this subject is too important.  It turns out I'm not the only one with this sort of weight problem.  One of my readers named Lauren (not her real name) emailed me a link to a very interesting story written by a student at Yale University named Frances Chan (her real name.  No really, it is.  Seriously.).  Frances, studying at Yale University, recently documented her difficulty not with her low weight, but with her school's medical professionals' perception of her low weight.  She's been 90 lbs since high school, and she shares a slight frame with her entire family.   But after a trip to student health for a breast lump, she received a letter about a "concern resulting from your recent visit."  There is no better way to scare the shit out of a woman than telling her something like that.  Frances was appropriately concerned - was the lump cancer?  She was too young to have breast cancer!  What could they possibly want?

Fear not, the lump was indeed benign.  She was called back due to concern that she was too skinny.  The clinician then dropped a bomb directly on her head:

I would {be forced to} meet with her for weekly weigh-ins. These appointments were not optional. The clinician threatened to put me on medical leave if I did not comply: "If it were up to the administration, school would already be out for you. I'm just trying to help."

Not optional?  What??   Frances had been healthy her entire life - thin, but healthy.  But because this clinician thought she was too underweight, she was forced to meet weekly to get weighed like a boxer or a beauty queen.  Ok, bad examples.  But wait, it gets worse: in addition to her mandatory weekly weigh-ins, she was also made to see a nutritionist and a mental health counselor, have urine and blood tests done, and even get an EKG to test her heart.  Shockingly, all her tests were normal.  You know, because she was, and always had been, completely healthy.

Frances was told she had to gain 2 pounds or else risk getting expelled from one of the most prestigious universities in the world.  So what did she do?  She dutifully abandoned her normal, healthy diet in favour of the exact thing that every nutritionist in the world tells us to avoid - a high-carbohydrate diet, supplementing meals with ice cream and worthless empty calorie snacks.  She even resorted to taking the lift rather than stairs to burn fewer calories.

Her unhealthy efforts were rewarded with exactly the two pounds she desired.  Believing she had succeeded in fulfilling her quest and thinking her ordeal was at an end, she was told that she had to gain three more pounds. 

More ice cream?  Cake?  Doughnuts?  Oreos?

No.  Frances had had enough.  She abandoned her pursuit and decided to skip all future mandatory appointments.  Instead, she did what she should have done from the beginning - focus her attention on her studies rather than some bullshit witch hunt which tried to make a healthy person sick.

I understand and appreciate what Yale was trying to do.  Eating disorders are very prevalent among college-aged women, and they can be just as dangerous as obesity, if not more so.  But the way they went about it in Frances' case is all wrong.  Threatening expulsion for non-compliance was reprehensible.  And trying to force the girl to gain weight was simply ridiculous.

Frances' story angered me on several levels.  A well-timed phone call to her family verifying her usual weight could have prevented this debacle from the start.  Short of that, Yale should have minded their own goddamned business.  Forcing treatment on someone who doesn't want it 1) is unethical and 2) ostracises the patient, especially when that treatment is unnecessary. 

At the risk of sounding condescending (which is not my intention, I assure you), I'm proud of Frances for finally standing up for herself and refusing further compliance.  I do wonder how things turned out for her. 

Frances, if you are reading this, I sincerely hope the good-intentioned folks at Yale came to their senses and that you were able to resolve the issue.  If you were not, then yes I would like fries with that.

I kid, I kid.

Thanks to Lauren (still not her real name) for bringing this to my attention.  And thanks to Frances (still her real name) for speaking out.  To read Frances' original post, click here.

The Stupids

I've been asked several times what I think is the hardest thing in medicine to treat.  Cancer can be quite challenging, as it often involves multi-modal treatment via several different specialists, and every cancer is just a little bit different.  Brain injuries can also be a test of one's abilities, as everyone's brain seems to react differently to similar injuries - one person with a subdural haematoma may be awake and talking to me while another with the same injury may be completely comatose.  Pain disorders such as fibromyalgia and chronic pain syndrome are just as difficult to diagnose as they are to treat.

But none of these things is the most problematic medical conundrum we see.  Nay dear friends, the title of this post should have tipped you off: The Stupids is far and away the most onerous disorder on the planet.  Unlike many medical disorders, The Stupids is very easy to diagnose.  Unfortunately, as easy as it is to spot, it is equally as impossible to cure.

Allow me to introduce you to 65-year old William (not his real name), if you please.  Before you start getting aggravated at William, he did nothing wrong, save standing on a relatively short wall, losing his footing, falling off said wall, and landing on a tree stump.  As he fell he realised he would hit the ground hard, so instead of falling onto his back, he twisted around to try to fall on his front.  Well William isn't quite as limber as he used to be, so things didn't exactly work exactly as he planned.  Instead, he landed on a tree stump next to the wall.  Fortunately for William, his ribs broke his fall.

Ok, as I read that back I have to admit that was perhaps a pretty stupid thing to do, especially at his age.

William was brought to the famed "Outside Hospital" (also known as "any hospital other than where I work") where he was diagnosed with 4 broken ribs and a very tiny pneumothorax (his right lung had collapsed about 2%).  He spent the next 3 days in hospital, requiring no treatment for his rib fractures or pneumothorax (other than pain medicine) before going home.  And that's when I met him.

"Wait just one damned second, Doc!  You just said he went to an outside hospital and went home after three days!  Where the hell do you come into the picture?"

Dammit, haven't I told you to stop interrupting me!  You're messing up the story just when it was about to get good!

As I was saying, the night he got home William went to sleep, but he was awakened around midnight by a sudden shooting pain in his right chest.  Keep in mind here that he had just broken several ribs a few days prior, and that rib fractures hurt like hell for several weeks.  So the logical thing for William to do would be take a pain pill and wait, right?

No, William's wife called for an ambulance.

Ok, sounds reasonable enough.  So once the medics arrived the the logical thing for them to do now (after examining him and finding his vital signs perfectly stable, of course) would be to give him his pain pills and wait, right? 

No.  They decided to drive him to the hospital.

Ok . . . so NOW the logical thing to do would be to take him back to Outside Hospital where he had just been discharged and which was a few minutes from his house, right?  Right??

I think you see where this is going.  NO.  They decided to drive nearly 75km (over 45 miles) to my hospital for a trauma evaluation.

If you're banging your head against your desk (or facepalming if you're reading this on a smartphone, which everyone seems to be doing these days), then you are experiencing the exact same reaction I had.  I incredulously asked the ambulance crew why they had driven over an hour out of their way when William had just been discharged from his local hospital earlier that day.  Their rationale was that he had a traumatic mechanism, so he needed to go to a trauma hospital.  I tried explaining to them, slowly and using small words, that his trauma had been 3 days prior, he had no new trauma, his vital signs were perfectly stable, and his lung exam (which took me approximately 12 seconds to perform) was also perfectly normal.  All I got back was a vacant stare which told me that none of this was actually getting from his ears to his brain, which I'm not entirely certain was even there in the first place.  I do wonder how some of these people manage to remember to breathe.

Just in case someone wasn't telling me the entire story, I went through William's initial CT scan from Outside Hospital (which he was kind enough to bring with him) and then rescanned his chest.  All I found was that his tiny pneumothorax had already completely healed, he had no new injuries, and he in fact had five rib fractures initially, not four (nicely done, Outside Hospital).  The ambulance had driven him all the way across town because of a simple muscle spasm.

One of these days I'm going to give myself a subdural haematoma from hitting my head on a desk.  I really try not to do it, but it somehow makes me feel better when I encounter something like this.  Hm . . . perhaps that means I have a mild case of The Stupids too.

Shit.

Casanova

Some men just seem to have it.  No, I don't mean herpes.  I'm talking about "IT".  You know, that special something that very few men have, that ability to make women want them and men want to be them.  Casanova had it.  Ryan Gosling has it.  George Clooney has it.  I have it . . . ha, um not really.

Anyway, some guys just have that personality.  Women swoon and bat their eyelids and dream of white picket fences and puppies in the yard (and possibly slightly naughtier things) the second they see these guys.

So there's Jude Law and Ryan Reynolds . . . and then there's Mikey.  Mikey didn't exactly have "it".  I'm not sure what the opposite of "it" is, but whatever that is, Mikey had that.

Nothing good happens at 3 AM, and that's when I met Mikey.  He was laughing and giggling and slurring like a schoolgirl as the medics wheeled him in.  Ok, maybe schoolgirls don't exactly slur, but you get the idea.  Regardless, as we were all staring at the besotted mess that was Mikey, he sat up, looked around the trauma bay, and slobbered, "Hey, at least you guys brought me to a hospital with cute nurses!" with a very creepy leer that exposed his 5 remaining teeth.

Every single woman in the room (nurses, physician assistant, students, techs) rolled her eyes and gagged in unison.  You know how women who live together often end up syncronising their menstrual cycles?  Yeah, it was kinda like that, even with the moaning and groaning and complaining.  I kid, ladies.  I kid.  Actually I groaned right along with them at his sheer brashness, and that only made him smile and laugh.  Creepily.

I introduced myself, and he looked immediately disappointed that I didn't have boobs.  I made sure not to apologise for my testicles.  "What happened, sir?" I asked him, bracing myself for more misogynistic, drunken ramblings.  As expected, I was rewarded with exactly that.

"Well there I was at the bar {shocking revelation} minding my own business {sure you were} and all of a sudden these three guys were all up in my shit!  So they start a fight with me, and then outta nowhere all three of these guys started punching me in the face!  Three of them!  So I finally got sick of different dudes punching me {you finally got sick of it?  Why did it take three of them for you to get sick of it?}, so I was chasing after this one guy, 'cause I was gonna beat his ass, and then I noticed I was bleeding because one of them stabbed me, I guess.  Hell I didn't even know I got stabbed, Doc!"

On the right side of his neck was a 3 cm superficial stab wound, nothing a few sutures wouldn't cure.  It was clear this guy would live to brawl and womanise another day.  As I was wondering what had gone so wrong that had made not one, not two, but THREE different people want to assault him (though based on his behaviour I had a strong feeling I knew the answer already), I asked my assistant to grab a few suturing supplies to fix him up.

"And while you're getting stuff," he said with another creepy look, "how about you get me your phone number so I can call you later!"

"How about not!" she replied with a shudder.

"Why not?  I don't see a ring on your finger!"

She turned around and silently held up her wedding ring while staring him full in the face.

"Well NOW I see it.  Damn."

I turned around and looked him dead in the eye.  "You will be respectful with my staff.  NOW."

That shut him up . . . for about 5 seconds.

After this little episode, there was not a doubt in my mind why those men had tried to knock him out.  Whether he had been hitting on their girlfriends or just acting like a general nuisance, he had obviously fully deserved it.

Ladies, on behalf of men everywhere, I apologise for the existence of men like Mikey.  Men like Orlando Bloom make women drop their panties at the sight of them.  Women drop their panties at the sight of men like Mikey too . . . but only because they've soiled them.

2,000,000

WHO ARE YOU PEOPLE?  SERIOUSLY, WHO THE HELL ARE YOU??

I don't understand this at all.  There are only 229 subscribers to SftTB (that's my stupid nickname for this stupid blog), but as I write this, my tiny little worthless, meaningless, good-for-nothing blog has surpassed 2,000,000 page views.  That either means that A) each of my fabulous subscribers has checked in 8733 times, B) there are a lot of people out there who visit here often but aren't subscribers, or C) I personally have clicked on my own blog approximately 1,998,472 times.

Regardless of the reason, I am absolutely amazed that there have been 2 million page views since I started writing this about 2 1/2 years ago.  In addition to being astounded, I am also deeply honoured that so many people have taken time out of their busy day and devoted a few minutes to spend time with me.

So once again, in lieu of my usual sarcasm and snarkiness, I would like to say with all honesty and sincerity, thank you.  I've had many people email me to tell me they've told their husbands, wives, siblings, friends, classmates, pets, and prison cell-mates about SftTB.  If you enjoy what you read here, please feel free to share this blog with others (as long as you don't find it as insipid and vapid as I do).

Now that that's out of the way, for the love of god stop lurking and subscribe already!  You know you want to!  You apparently can't subscribe from the mobile site, so go find a damned computer and sign up.  And follow me on Twitter or something.  And get off my lawn.  Oh, and if you haven't done so already (or even if you have), please leave a comment telling me where you're from and how you found me.

In case I haven't gotten my message across yet: thank you.  I love you all.

Not really.

Best,
Doc

Family love

My mobile phone is important to me.  I don't carry a personal pager (Just as an aside, why do so many doctors still have these ancient artifacts?  It's 2014, people!  They are obsolete, so why does my hospital make me carry one for trauma call?), I don't have an answering service (see above), so anyone at the hospital can reach me 24 hours a day no matter where I am.  I take very good care of my phone because I need it (Flappy Bird), and though I can't really call it essential (Angry Birds), it damn near comes close (Twitter).  My car is also important to me.  It gets me where I need to go safely, reliably, and quickly.  I take very good care of it, because that's what I do to things that are important to me. 

But cars, mobile phones, and pagers are replaceable.  People . . . not so much.

So if I feel that strongly about replaceable things, imagine how I feel about something as irreplaceable as my family.  NOTHING is more important to me than my family, and I would go to the ends of the Earth for them to ensure their happiness, safety, and health.  If my daughter wants an ice cream, then goddammit I will find a farm, milk a cow, separate the cream, harvest some sugar cane . . . or perhaps just go the store and buy some damned ice cream.  Well, as long as she's eaten her dinner, asks me politely, and hasn't already gobbled a full carton of ice cream that day, which (knowing my daughter) she probably has.

Anyway, you get the point.  I love my family.  Unfortunately it often feels like I'm alone in that sentiment.

There is very little more frustrating than my trauma pager going off as I'm walking into the hospital (except perhaps the pager going off 10 minutes before my shift ends).  On this fateful day it literally went off as I was entering the building.

Ok, Call Gods.  It's going to be THAT kind of day, eh?  Fine, then bring it, you evil fucks.

My pager told me that it was a fall (which are usually not terribly exciting), so I moseyed my way up to the trauma bay.  A few minutes later Melvin (not his real name) rolled in, completely unconscious. 

"We think he's about 25, Doc," the medics started.  "No medical history.  His mom found him at the bottom of the stairs.  He hasn't moved at all since we found him."

Uh oh.  That's bad news for Melvin.

"Yeah, his mom said she heard him fall about midnight last night, but she didn't call anyone," the medic said with a chuckle.  He must have seen the blank look of confusion on my face, because he continued, "I guess she said she was sick of his shit, using PCP all the time, so she just left him there."

She left him on the floor all night?  Wha . . . What??  My blank look of confusion did not change at all.  The medic stared right back at me, so I realised that was the end of the story and the rest was up to me.

On examination, his heart was beating and he was breathing on his own, but those were the only signs that he was alive.  His limbs were flaccid and his eyes were closed, but when I opened them his pupils were different sizes, a sign known as anisocoria.  Uh oh.  There was a bit of swelling on his face, but other than that there was nary a mark to be found on him. 

"It's just the PCP, right Doc?" the medic laughed.  "Right?  Doc?"  His smile faded.

"No", I said without a hint of humour.  No, PCP doesn't put you in a coma like this.  A combination of a head injury and anisocoria told me that something very bad was going on in this young man's head, and whatever badness it was had been going on for over 8 hours.  A CT scan confirmed a huge 6cm epidural haematoma which had been compressing his brain all night, and which no one, not his family, not the medics, had taken seriously.  My neurosurgery colleague and I brought him immediately to the operating theatre to drain the blood clot and relieve the pressure, but the damage had already been done. 

After the surgery was over we went to speak to his grandparents (his mother didn't show up, presumably because she was still 'sick of his shit').  We told them the grim news, and they didn't look the least bit surprised, nor did they look worried.  "You know," his grandmother said, "the only reason we called the paramedics was to get him out of the way.  We just couldn't pick him up off the floor."

I was disgusted how this family treated Melvin.  Unless you're a murderer, a rapist, a child abuser, or a politician, no one deserves to be treated like a bag of garbage, left to rot on the floor.  This young man deserved a chance, despite his sordid past.  His family denied him that chance, and Melvin paid the ultimate price.

If you've managed to read this far, please find someone you love, give him a big hug, and tell him you love him more than anything.  Please.  I'm hugging both of my children right now.