Saturday 28 June 2014

Is this thing on?

After nearly 3 years and over 2 million pageviews, I'm finally getting the idea that there are more than a few people who read this blog.  Ow . . . wait, I think I strained my shoulder patting myself on the back there.  Maybe I should take some homeopathy for the pain.  Anyway, several dozen young people (students in high school or university) have emailed to tell me that I've inspired them to pursue a career in medicine, and a couple have even told me they are interested in trauma surgery.  Every email like that makes me feel as warm and fuzzy inside as if I'd eaten a stuffed bear.

But is that it?  As great as it feels being someone's inspiration to go into medicine, can't I do more?  I'm not sure I succeeded changing any minds with my rants on homeopathy, the antivax insanity, and marijuana (though I do try).  So am I a lousy writer like Stephenie Meyer (incidentally, why "Stephenie"?  Can no one spell a name properly anymore?) with no ability to sway opinion and convince anyone about anything?  Or can I actually educate and change people's minds regarding subjects I am passionate about?

After getting this email from Taylor (not her real name), I'm ready to do away with my personal Amanda McKittrick Ros comparison and say "yes I can".

Though you've undoubtedly heard this hundreds of times by now, I found your blog through FML, and I really do love reading. It's rare, at least where I come from, to find a doctor who seems to be as well grounded and sincere as you come across, so, good on you! Cliché comment aside, I'll get to my point.  

Ever since I was a child, it had been my dream to ride a motorbike. My father owned several, and rode them daily until an accident left him pretty traumatized. I was too young to know of the details, but as I understand it, he was thrown from his bike when hit by a car from the back. He had some pretty heavy duty injuries, and even thirteen years later, he says his shoulder and knee have never been the same. 

Despite this, I was still utterly obsessed with motorbikes. Perhaps it was because I was too young to fully understand the accident, but it hadn't discouraged me in the slightest. Now, I know what you're thinking. She's an idiot. But here's the good news! From your many, many posts surrounding the issue of motorbikes, I have been entirely converted. It's serious stuff. I don't want to get myself killed. I don't want to find myself in a situation similar to those on your blog.

I'd really like to thank you for putting your stories out there. They've made a difference to me. I'm aware of the dangers, and I've come to the realization that it's just not worth running the risk. Thanks for taking the time out to read this. Keep it up, Doc!
Huzzah!  It works!  Taylor, you're listening to your brain (and to me, perhaps) rather than to your heart.  Well done!  Your heart is stupid anyway.  Seriously though, why does everyone say "Listen to your heart"?  It just sits there and beats repeatedly.  Faster, slower, faster, slower.  But your brain is what does all the thinking.  Listen to your brain, damn it.

Regardless, it's gratifying to know that there will now be one fewer motorcyclist on the roads, so I have one fewer person to worry about.  And one fewer prospective patient . . . the patients who pay my salary and allow me to buy food for my family . . .

Hm, maybe I'm looking at this all wrong.

UPDATE: Just after posting this, I got this email from Angela (not her real name):
I emailed you several months (I think) ago about me deciding to quit smoking after reading one of your stories.  I just wanted to tell you I have successfully quit smoking, and my mother has too. I told the story (for lack of a better word at the moment) that motivated me to quit smoking to my mother, and that is what helped her quit.  I'm much happier that my mother quit smoking, as she has enough medical problems.  Thank you very much for sharing your stories, because thanks to just one of them, I was able to motivate myself (and stop making excuses) to quit. 

Thank you again, ~Angela
Double huzzah!  Congratulations Angela, to you and your mother.

Wednesday 25 June 2014

Mrs. Bastard Update

If anyone heard a huge sigh sigh of relief coming from this direction yesterday, that was me after I heard that my wife was being released from the hospital.  I may have yelped and jumped for joy just a little too, but that's just a rumour.

This was no ordinary pneumonia.  This was . . . well, just look for yourself.  Here is what a normal chest X-ray looks like (unceremoniously stolen from Wikipedia):
Notice the nice clear lung fields.  Notice how there is no vicious, nasty plague abiding in there.  Now, compare that to this:

That is my wife's actual chest X-ray last week when she was first admitted.  Almost the entire right upper lung (that's on the left of the picture, by the way) is involved with some kind of evil nastiness.  What you can't see (that the CT scan showed) is that in addition to a very dense consolidation of her entire right upper lobe, she had areas of pneumonia in the left upper lobe, lower lobe, and lingula as well.  That explains why she was having fevers, chills, and a nearly-constant cough.  And THAT is what she was living with while still going to work, making dinner, doing laundry, and taking care of her family.  

After three days of intravenous antibiotics, her X-ray had already improved to this:
It's still markedly abnormal, but by this point she was breathing much more easily, her white blood cell count had nearly normalised, and she was ready to come back home to me.  It takes nearly a month to recover fully from pneumonia - in the meantime it feels like you've been run over by a very large truck.

But she's still trying to make dinner and do laundry despite my protests.

Friday 20 June 2014


There is very little that fazes me.  I've seen the worst of the worst - gunshot wounds to the head with brain oozing onto the gurney, blood spurting to the ceiling (literally), stabbings to the abdomen with loops of bleeding bowel sitting outside the abdomen, dead ruptured colons with bellies full of stool . . .

So now that I have you all thoroughly disgusted, you're probably wondering what the hell my point is.  No, it isn't to see how many keyboards/iPads/tablets/phones I can ruin by getting as many readers as possible to vomit on them.

I've been asked several times what scares me.  If all of those vile things I mentioned before don't bother me (I'll defer from describing the really disgusting stuff I've dealt with), what does?  What really gets my blood pressure up?  If a necrotic scrotum doesn't make me feel nervous (sorry, that just slipped out), what does make my anal sphincter tighten?  What does scare the hell out of me?

Well I found out the answer to that question tonight: my wife in the hospital.

Mrs. Bastard has been sick with a cold for over a week.  Coughing, body aches, congestion, the usual viral stuff.  Nothing to do, just rest and hydrate.  Well Mrs. Bastard doesn't believe in rest.  She believes in powering through whatever is ailing her, and she's continued working through this plague.  Even when her temperature was approaching 39 degrees Celcius (that's around 102 degrees Fahrenheit in case you still cling to that antiquated scale), she went to work, made dinner, did laundry, and took care of our kids while I was out on call.  She persevered, refusing to give in to whatever was trying to take her down.

But this afternoon it got acutely worse.  She started having difficulty breathing, her chest felt tight, and she was having difficulty moving air.  When I heard her say "I think I need to go to the hospital", I knew something was seriously wrong.  This woman doesn't believe in seeing doctors.  She practically needs to have a limb missing to request medical treatment, and even then she'd probably finish cooking just because she doesn't have time for missing legs.

When we got to the hospital, her heart rate was elevated, her oxygen levels were low, and she was sweating profusely even though it wasn't warm.  Blood tests showed her white blood cell count was elevated (a sign of infection), and her chest X-ray scared the bejeezus out of me.  It was so obvious that it could have been read by the woman mopping the floor - pneumonia.  Not just in one lung, but in both.  The radiologist actually said to me, "She's been walking around with this big pneumonia?  She must be really tough!  This should have knocked her sideways!"

That's right - my wife has been walking and driving around, going to work, and taking care of her family with bilateral pneumonia for the past 3 days.

I'm used to being the captain of my ship - I'm supposed to be the one in control.  I tell people what to do, and they do it.  But seeing my wife in a hospital gown, being on the opposite side of the patient-doctor relationship, having to sit idly by while some other doctor examines my wife . . . it's a feeling of utter helplessness that is difficult to explain.  I see patients with pneumonia all the time - most make it, some don't.  But when it's your own partner, the person you swore to love and cherish and take care of for the rest of her life . . . it's a completely different story.

That is what scares me.

Mrs. Bastard, if you're reading this (and there's a good change you are), please get well soon.  Please come back to me.  Please come back home.

Tuesday 17 June 2014

Vomit and zebras

There is little in this world more disgusting than vomit.  I'm not talking about your own baby spitting up - somehow when you feel a bottle's worth of milk oozing warmly down your back, it isn't so bad.  But when a grown adult empties his stomach onto the floor - the sound, the smell . . . it makes others want to follow suit.  The big problem with vomiting (other than the smell and sound, of course) is trying to figure out why

There are approximately 2,957 causes for vomiting.  Common reasons include a stomach bug (aka viral gastroenteritis or stomach flu, which isn't actually the flu but a different virus), medication side effects, pregnancy, eating "bad food", inflammation, and the ever-present "other".  Trying to figure out why a certain patient can't keep anything down can be maddening, though tests (like blood tests, X-rays, abdominal CT scans, and stool tests) can be helpful.  In viral gastroenteritis, all these tests are typically normal, however, making it a diagnosis of exclusion.

But what happens when vomiting is due to one of those "others"?  

When you hear hoofbeats, the first thing you think of is horses.  Obviously.  But zebras have hooves too, so how can you be sure it's a not a zebra coming?  Because common things are common and because zebras don't live here, that's why.  

Oh really?

Karen (not her real name) had just such an experience with her daughter Zebra, er, Ella (not her real name).
Hi Doc Bastard,

I am writing to you about a medical story that I hope you will agree has ridiculous parts to it.
In 2011 we had one child, a 26 month old named Ella (not her real name) {Karen wrote that, not me!}.  One morning, Ella threw up right after she woke up.  No big deal, kids get the flu all the time.  I took off work and stayed home with her.  She got better throughout the day and was even eating by the end of the day, so I decided this was a 24 hour thing and didn't even take her to the doctor.  Then the next morning, again she threw up. I decided I should take her in.  My pediatrician (Dr. K) looked her over and decided she had the flu, just like I had thought.  Give her fluids and rest, she will get better.  And Ella did, for the most part.  She was fine for the next few days, went to daycare, and was gaining her appetite back.  But by the weekend she had begun throwing up again and had a new symptom: she was lethargic.  Normally I could never get her to take a nap, she would fight it and then finally she would go down.  Now she would sleep for 3-4 hours and I had trouble waking her.  Since it was the weekend, Dr. K advised us to go to the ER. 

We saw a very young-looking, very tired-looking ER doctor who wanted to do a CT of Ella's abdomen to see what was going on.  The CT only showed constipation, and the doctor said the reason Ella was vomiting was because she was constipated.  She kindly assured me that this is more common than I would think, given the diets of Americans today and that she sees about 100 cases a year.  

After some enemas, they did another CT. She was clean as a whistle.  And then Ella promptly threw up again.  I asked the doctor what was causing her to throw up now that the constipation was gone.  She told me Ella must have contracted the flu during all this, so wait a few days and it would clear up.  Okay. 

For the next several days, Ella got worse.  Throwing up all day, not eating anything, and lethargic, not playing.  I brought her back to Dr. K, who was concerned Ella was dehydrated.  She sent us back to the hospital for IV  fluids, and we went home.  The next day, Ella threw up again. This has been going on for two weeks now and Dr. K was very concerned.  She sent us for labs, but they came back NEGATIVE.  No virus, no bacteria, nothing.  So, Dr. K made us an appointment for the next day to go back to the hospital for another CT, this time it was of Ella's head to "rule anything out" {looking for zebras!}.  The following day we got the CT results, and the doctor looked shocked, perplexed and upset.  "I looked at her scan," the doctor said.  "She has a mass in her brain.  She has hydrocephalus so badly that I am afraid to give her any more fluids. You will be transported immediately to the Children's Hospital downtown".  That is what he said, but the look on his face told me "Your two year old has an inoperable tumor and she is going to die".  What happened after that is pretty much a blur. 

We waited in triage for hours, and eventually her neurosurgeon (Dr. F) showed up.  He was the calmest person in a room full of hysterical people.  His calmness helped me.  "She has a brain tumor.  We get these all the time.  I have seen this before.  We will give her steroids to bring down the swelling, and then I will do my best to remove the entire thing".  He then explained to me that tumors do not kill people, hydrocephalus kills people. 

Ella had an 8 hour surgery to remove the tumor.  She came out of the surgery slowly, with Dr. F standing over her the entire time.  She stayed in the hospital for a few days, and then we took her home.  Little by little, she got better and much happier.
You said that surgeons, since you can't see the results, are judged on their bedside manner.  That is true, but in this case, if he had left any of the tumor in, the results would likely have been fatal.  I know you say that people tell you thanks and appreciate what you do.  I don't know if this is normal, but to me the amount of gratitude and admiration I have for this man seems equivalent to love.  It's a weird feeling, loving someone you don't really know.  I don't know if other people love their surgeons, but I do.  He unequivocally saved Ella's life, and because of him, she has the best chance at survival that she can have.  She still sees him every 6 months, after her MRI.
Thanks for letting me share my story with you.
Thanks to Karen for sharing her (and Ella's) zebra story.  I'm happy to report that it's now been three years since Ella had her surgery, and she remains happy, healthy, and best of all, tumour-free.  I hope she remains that way for many decades to come.

With all the stupid, ugly, and awful stories I share, stories like this are, unlike the smell of vomit, a breath of fresh air.

Saturday 14 June 2014

DocBastard's Fantastical Homeopathy Journey, Part 3

This is the final installment of my journey through the wild world of homeopathy.  If you haven't read Part 1 and Part 2, please go back and read them, because this won't mean a whole lot if you don't.  Unless you're just here for the punch line, of course.  But what kind of fun is that?  You're skipping the appetizer and entrée and going straight to the dessert!

Fine.  For you meal skippers (and those of you who already forgot what happened in Parts 1 and 2), here is a quick recap:
  1. Homeopathy is a joke
  2. I'm trying it anyway
  3. Dr. Homeopath sold me Rhus tablets for my back pain
  4. I took the first dose and am waiting to see if it works
And now . . . the exciting (read: stupid) conclusion of DocBastard's Fantastical Homeopathy Journey!  Strap yourselves in!  Or just continue siting there in your underwear while you lie in bed wasting time before going to sleep.  That's right, I know all about you.

Anyway, while I waited for my miracle potion to work, I looked up the price of Rhus tablets online.  I was not surprised to find out I paid Dr. Homeopath almost double what I could have paid on Amazon.


Still I waited.

While I was still waiting (and killing time on Amazon), I decided to see what other people had to say about the magical healing powers of Rhus via their comments on the site.  Here are a few excerpts:
  • This one, however, DOES work as well as ibuprofen {Hell, that sounds good}. 
  • Really helps my osteoarthritis. Starts to work right away and after a few doses I can move quite easily.{Well these first two reviews sure sound promising!  Maybe this stuff really works!}
  • Works for poison ivy. Takes a few days to clear up symptoms completely {But . . . poison ivy clears up in a week or so anyway . . .}
  • it was helpful (especially with the itching and weeping) and the worst was over in a week {uh . . . see above.}
  • I've had poisen (sic) ivy, oak...numerous times. This did not work for me. {Damn it.}
  • I usually give a product like this at least 90 days to take effect. It's been only 30 days, but so far can't report a noticeable difference in pain levels, jury is still out. {Wait, you've waited 90 days for it to work and you're still taking it??  Are you insane?  My back hurts NOW!  I'm not waiting 90 fucking days!}
  • So far it hasn't helped my husband or myself. We are on our 4th bottle. We will continue taking what we have as maybe it takes longer. {Each bottle lasts about 982 years, and you've taken *4 bottles*?  And you're STILL giving it a chance??)
That was exactly the bullshit I was expecting.  So I waited more.

And waited.

Much to the surprise of no one with an IQ higher than a newt's, I felt no difference in my back by the time I went to bed that night.  While staring longingly at my bottle of ibuprofen, I took another teaspoon of the stuff, hoping (but not expecting) that I would wake up feeling like a nimble, lithe teenager again.  My bottle of ibuprofen seemed stunned and saddened that I was rebuking it.  Unlike homeopathy though, I was pretty sure that it would forgive me and still work when I went crawling back to it.  It did seem odd that I was supposed to take just a teaspoon of the magic stuff at a time, but according to Dr. Homeopath, more dilute is more effective.  BULL. SHIT.  Before bed, I wrote this in my journal:
"Ow.  Still fucking hurts.  God damn it, want ibuprofen.  I think it misses me."
Day 2
"Had to crawl out of bed.  Need actual medicine."
I woke up, took another teaspoon of bullshit Rhus, and thought that at this rate, the bottle of Rhus should last me until scientists have invented nanorobots which can heal anything instantly (come on you smart scientists!  Nanorobots!  Get on it!).  I looked again at the bottle of ibuprofen, and I realised that when I take ibuprofen (which is a few times a month), it usually is starting to work by the time I'm done with my morning coffee.

My morning coffee . . .

Coffee . . .

NO.  NO morning coffee.  Dr. Homeopath had told me very specifically that any caffeinated beverage, especially coffee, was off limits.  But . . . but . . .


So instead of my morning coffee and a couple of ibuprofen, I had to rely on a single teaspoon of magic water.  Eight hours later I took another dose, and eight hours after that I took another.
"No change.  This sucks."
I went to bed that night feeling like a samurai sword had been lodged in my back for 100 centuries.  But I was still hopeful I would wake up feeling like . . . oh, fucking forget it.  I had no hope at all.  My magical medicine wasn't so magical, much to the surprise of NO ONE.  But I was resolved to continue taking my stupid goddamned water three times a goddamned day.

Day 3
No change.
Day 4
Day 5
Day 6 
Whatever.  Fuck this.  You already fucking know.

Day 7
I had a follow-up appointment with my homeopath, and I almost gleefully told her it wasn't working.  At all.  It took every bit of restraint not to yell in her face at the top of my lungs "I KNEW THIS STUFF WAS COMPLETE BOLLOCKS!!"  With a smile, she calmly advised me to stick with the Rhus, as it often takes weeks to start working.

FUCK THAT.  If I'm having pain, I'm not waiting weeks for something to work, especially when that something has no plausible mechanism and flies in the face of biology, biochemistry, anatomy, physics, physiology, and pharmacology.  As soon as I got home, I took two ibuprofen tablets, and what do you know - exactly 34 minutes later (yes, I timed it), my back pain started easing up.  And exactly 12 minutes after that (YES, I TIMED IT) I was able to bend over and touch my toes for the first time in a week.

I absolutely, unreservedly, categorically refuse to believe in a system of medicine that requires you to believe in it for it to work.  I don't have to believe that removing an appendix will cure appendicitis - it does.  I don't have to believe that ibuprofen will help with pain and inflammation - it does.  Unlike Samuel Hahnemann and his followers in the 1800's, we understand pharmacology, pharmacokinetics, physiology, pathology, and the dose-response.  Unlike homeopathy, not only do we know that modern medicine works, we know how it works.

Of course I realise that any case study like this has an N of 1, so I shouldn't extrapolate this personalised treatment failure to mean that homeopathy in general is a failure.  But fuck it, I will anyway: Homeopathy is, was, and always will be utter, complete, downright, 100% twaddle.  Its very premise, that like cures like, is based on a flawed, incorrect hypothesis from the 1700's (when no one knew jack shit about anatomy and physiology) that has never been shown to be true for any condition ever.  Like, quite simply, DOES NOT CURE LIKE.  That alone should be enough to blow homeopathy out of the water, but there's plenty more.  The concept of "provings" is so ridiculous as to be laughable.  Moreover, thinking that higher dilutions makes a more potent remedy is preposterous and flies in the face of everything that we know about how medicine works (ie the dose-response relationship).  Transferring the memory of a substance into water by striking it vigorously on a surface (succussion) is nothing more than magical thinking.  And two hundred years of research on homeopathy, mostly low-quality, shoddy, and non-reproduced (or non-reproducible), has elucidated exactly jack shit.

So to make a long story short (TOO LATE!), those that peddle homeopathy are scam artists, and those that believe in it may as well get a tattoo across their foreheads that says

Wednesday 11 June 2014

DocBastard's Fantastical Homeopathy Journey, Part 2

In case you missed Part 1 of my fantastical journey through homeopathy, what the hell are you doing here?  Go back and read it!  This post won't mean a whole lot unless you've read it, so go read it.  Now.  Seriously, go away and read it.

If you're still here that means you either completely ignored what I just said and like to fly by the seat of your pants, or that you've read Part 1.  In either case, I'll do a quick recap in case you've forgotten:

  1. I have chronic back pain
  2. It sucks, but ibuprofen works pretty well
  3. Homeopathy is bullshit
  4. I'm sick and fucking tired of homeopathy zealots claiming that because I've never used it, my science-backed opinion that it is bullshit is invalid
  5. I am trying homeopathy because I'm an idiot
  6. I filled out an approximately 4,492 page questionnaire by Dr. Homeopath (not her real name)
  7. I was just called back to her consultation room

Right.  Now with that stupid and probably unnecessary summary out of the way, let's move on to . . .

Day 1 (continued)
The homeopath came in and said, "Hello Mr. Bastard (not your real name), I'm Dr. Homeopath (not my real name)" with a big smile on her face.  I resisted the urge to scream "WHAT IS THIS BULLSHIT!" at her and shook her hand, which she returned warmly.  She then sat down and quietly reviewed my intake questionnaire with a determined and knowing smile on her face, nodding every now and then and saying, "Mmm hmm" as if experiencing an epiphany from the fact that on a scale of 1-10, my fear of animals is a 1, my sensitivity to criticism is also a 1, but my irritability is a 6 (yes, those were also actual questions).

She then did what I think was the smartest thing she could have done - before asking anything else, she asked what I knew about homeopathy and if I had any preconceived notions about it.  I told her that I was familiar with the concept of "like cures like" and with the dilution of remedies, but I didn't tell her I was a doctor and I didn't tell her about my disbelief in her entire profession and everything she does.

"That's good," she said.  "The fact that you're here means you believe in what we do.  There are a lot of sceptics out there."

Really?  I hadn't noticed. 

After pretending to do a physical examination (I didn't have the heart to tell her that she did the lung exam all wrong and that my heart is actually in the middle of my chest, not directly under my nipple), she seemed to have a conversation with herself about the different remedies we could try - Rhus toxicodendron, Kali carbonicum, Ledum, Hypericum, Bryonia alba, Nux vomica, Gnaphalium.  I was not impressed that all the names were in Latin - it seems a way to make ordinary things look extraordinary.  Natrum muriaticum, for example, is plain old ordinary table salt, but gosh, natrum muriaticum sure sounds more sciency and mediciny!  She then hemmed and hawed, apparently having another internal debate about which would be best, finally deciding on Rhus.  Apparently (according to her) Rhus works best on back pain that is violent and relieved by motion or bending backwards.

Ok, that makes sense.  Sort of.

"It also works best on patients who have a dry mouth but are often thirsty," she continued.

Ummmm . . . what?  What does that have to do with anything?

She then told me is that it is derived from poison ivy that is harvested at night, because the toxic oil in the plant is supposed to be at its most potent at night. 

Wha . . . wh . . . what are you . . . I don't even . . .

I asked her how, according to the "law of similars", poison ivy would be effective for back pain.  She looked at me like I was the dumbest man on the planet.  "Because, you cretin, the provings showed that when the toxic oils are applied to the skin of healthy individuals, it causes ulcers and excruciating pain.  So of course it will treat pain!  Imbecile!"  Ok, I admit those may not have been her exact words, but that was definitely the gist.  It's entirely possible that she may have been very polite and gracious while spouting her complete rubbish.

What she didn't tell me (that I found out during my post-experiment research) is that Rhus purportedly causes over 11,000 symptoms in healthy individuals, so it can supposedly cure all those symptoms in sick people and is therefore one of the "biggest" homeopathic remedies.  Wow, one medicine that can cure 11,000 things!  Amazing!  Not only that, poison ivy is supposedly a restless plant (because it grows so rapidly), so it is also supposedly a great remedy for restless patients.  Uh, yeah.

Ok then, Rhus it shall be, 30C globules (pellets, pills, tablets, sugar pills . . . whatever).  It just so happened that Dr. Homeopath (still not her real name) had some Rhus for sale, and it was only {price redacted}.  Such a deal!  I paid the fee for the initial consultation and for the bottle of 250 Rhus tablets, and as I handed over the money the only thing I could think of was this:
The dosing was as follows: I was to take two placebos globules and dissolve them in a cup of water.  Then I was to take 5 ml (one tsp) of that "solution" up to three times a day and start to taper once my pain improved.  This seemed entirely ridiculous to me - diluting an already-ridiculously diluted "medicine" even more?  Seriously?  Taken this way, the 250 tablets would last me approximately 982 years.

Now before I hear anyone say, "But you already admit that you think this stuff doesn't work!  You aren't giving it a fair chance!"

Well, I don't have to believe that ibuprofen works.  I just put it in my mouth, and whether I want it to work or not, 30-40 minutes later my pain (whether it's a headache, back pain, joint pain, champagne, or propane) starts to improve.  Any real medicine shouldn't need me to believe in it.  I don't want to have to worry about hurting my medicine's feeling by not believing it works.

I wanted to take the first dose right there in my car, but Dr. Homeopath told me I was not to eat or drink 15 minutes before or after taking it.  I'm not sure why that should make a difference to magic water and magic sugar pills, but I dutifully complied nonetheless.  I figured that after my 65 minute appointment, it would take me at least 15 minutes to drive home and regain my sanity anyway.

As soon as I got home, I wrote down in my handy dandy Homeopathy Journal exactly how my back felt:
"Hot poker in left lower back . . . like always"
Now that I had established my baseline, I took the first dose.  I tried to figure out the strength of the "solution" as I dissolved two of the little pills in a cup of water.  As I swirled the water vigorously to get them to dissolve, I wondered if I was somehow deleting the water memory.  Was I somehow "un-succussing?"  Was that even possible?  Whatever, I thought.  Fuck it.  I then took one teaspoon while thinking, "This is such bullshit" and sat and waited for it to work.  So I sat.  And I waited.

And I waited.

That is the end of Part 2.  I do apologise for splitting this into three parts, but whatever - Peter Jackson did it with "Lord of the Rings", so I'm doing it too.  The final chapter will be posted in a few days.

Wednesday 4 June 2014


There aren't many things that make me angry.

HAHAHAHAHAHA ok sorry, that's a total lie.  There are SHITLOADS of things that piss me off enough to make me want to punch a mime, and anyone who's read this blog knows that.  But there are only a few things that truly make me irate enough to raise my blood pressure.  Unfortunately several of those things seemed to stack up at the same time a few nights ago.

A 17-year old girl was allegedly assaulted and brought to me emergently for evaluation.  She had a bit of a bloody nose, but no real complaints.  She was crying profusely and wouldn't talk, which tipped me off that there was something strange going on.  After we managed to calm her slightly, the truth came out - her cousin, with whom she lives, had a friend over.  In the middle of the night, that friend crept into the girl's room, hit her in the face, and raped her.  The girl was smart and fought back, and when her attacker tried to put his penis in her mouth, she bit down.  HARD.  As he bled and presumably screamed his head off (pun intended), she ran away and called emergency services.

She was physically uninjured though obviously emotionally traumatised, and I called the sexual assault team to assist.  As I was finishing her paperwork and wondering how some people can be so evil, I was thinking to myself that, speaking of evil people, I hadn't gotten a multiple gunshot wound victim in a while.  The thought was interrupted by the overhead speaker announcing that we would be getting a high-level trauma in 5 minutes.  In true Call God fashion, my pager confirmed the trauma was a gunshot victim.  The assistants bustled around getting everything ready, and a nurse ran in to tell me that the patient had lost his pulse in the ambulance and CPR was in progress.

Oh, just fucking great.

I had just finished putting the impermeable paper boots over my shoes and the nurses were just finishing putting the body bag on the gurney (yes, really) when the medics burst through the door with an obviously dead young man who looked young enough to be my son.  Like most dead people, his pupils were fixed and dilated, his skin was grey, and his hands were cuffed behind his back.  I immediately started my initial survey and . . .

Wait, wait, wait . . . handcuffs?  What the hell?

It was then that I learned exactly how difficult it is to do an initial evaluation when the patient's hands are cuffed in front of him.  After I asked him nicely ("WILL YOU GET THESE GODDAMNED THINGS OFF HIM!"), the officer removed the handcuffs.  I saw two holes in his right arm, one large hole in his left chest, and another large hole in his right groin.  The big problem was that none of the holes was bleeding, most notably the one in his groin.

Wait Doc, why is that a problem?  It's good when people don't bleed, right?

In this case, not so much.  The wound was directly over his femoral artery, which just happens to be the largest artery in the body (next to the aorta), and with such a large hole in it, it should have been bleeding enough for me to hear it.  No bleeding from the femoral artery means one thing and one thing only - there was no blood left to bleed.  As we continued our resuscitation efforts I got the story from the police: he had apparently been in an altercation with the police, and when he pointed his gun at them and opened fire, they shot back.  He managed to bleed nearly to death as the police handcuffed him, and he had finished bleeding to death in the ambulance.  Exhaustive measures were, as usual, insufficient to bring the dead back to life.

A few hours later in the wee hours of the morning as I lay wide awake, I had more than enough time to think about the events that had transpired that night and why they had pissed me off so thoroughly.  What angered me the most about what happened to the young girl was, well, everything.  I was (and continue to be) incensed that some men seem to think they are within their rights to take what they want.  If something like this ever happened to my daughter, I am completely unconvinced that I would be able to restrain myself from surgically removing his requisite male anatomy with an old rusty shovel (anaesthesia not required).

As if that weren't enough to exasperate me, I was confronted with the second situation immediately afterwards.  The police took the time to handcuff the man who was bleeding to death, but they didn't take the time to hold direct pressure on his leg, which would have easily saved his life.  I realise that this was a bad guy who shot at the police, but even he deserved a chance to stand trial.

Sometimes things go right, sometimes they go wrong.  When everything seems to go wrong at the same time, it all adds up to a very bad day.  For me, and for them.

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...