Monday 24 November 2014


I'd like to start this post by stating in no uncertain terms that I don't advocate people hurting themselves intentionally in any way.  That being said, IF one ever decided one really wanted to hurt oneself, here are a few reasonable options one could consider:
  • Boisterously proclaim your hatred of the home team in any football arena in Ireland
  • Go 150kph on a motorcycle through rush-hour traffic with your eyes closed
  • Attend a New York Yankees game wearing a Boston Red Sox hat and jersey
  • Jump out of the Eiffel Tower without a parachute
  • Walk barefoot on Legos
Or you could simply do what Sammy (not his real name©) did.

It had been a rather boring day for me.  So far I had gotten only 1) an 80-year old woman who had mistaken her accelerator for the brake pedal, crashed into a wall, and fractured her ankle, knee, and wrist, and 2) a 20-year old who had gotten hit by a bus and had a broken ankle.  Since I don't do bones, I called the orthpaedic surgeon so he could work his magic on both of them, and I waited until something truly epic arrived.

My wait would be long and tragically fruitless.

Around 10 PM I got a call that my next patient would be a 15-year old boy who had been hit by a car while riding his bicycle.  Fifteen years old.  Ten o'clock at night.  On a bicycle.  I'll give that a second to sink in.  

Ok, ready?

Hopefully you're all thinking the same thing I was at the time - What the hell is a 15-year old boy doing riding his bicycle at night?  If you were thinking anything else, I'd like to invite you to leave now, since we're clearly not on the same page.  Anyway, for those few of you still remaining, as I waited without bated breath, I had already started mentally reviewing the lecture I would surely be giving him about not being stupid.  Sammy arrived a few minutes later looking entirely uninjured.  It took me all of  about 18.2 seconds (I timed it) to discover that his only outward sign of trauma was a small abrasion on his right ankle.  About 5 minutes later I was looking at his completely normal X-ray, so I gave him the good news that all he had was a sprained ankle and opened my mouth to start the diatribe.

And then Mom got to to the hospital.

She had a look of sheer panic on her face, and I immediately realised that she had no idea what had happened and was imagining her son dead in a ditch.  I put my harangue on hold and quickly ushered her in to reassure her that Sammy was fine, but that I needed to talk to them both.

Ready.  Steady.  GO.

"My first question for you," I asked Sammy, "is what the hell you were doing riding your bicycle at night."  It wasn't so much a question as an opening statement.

Sammy looked a bit stunned, hung his head, and sheepishly turned away, clearly choosing not to respond rather than giving an answer that he too knew would be stupid.  I looked at Mom who was staring intently at her son with the painfully-obvious "WHAT THE HELL DID YOU JUST DO?  ANSWER THE MAN'S QUESTION!" look (Note to MomBastard: yes, I remember that look well).

But I wasn't nearly finished with him yet.  Not remotely.  I waited a moment until he looked back at me, and then I fixed him with a stare dead in his eye.

"I see a lot of injured patients in this trauma bay, and most of them have done something really stupid that landed them here.  You just did something REALLY stupid."  He looked away again.

I glanced up at Mom, expecting her to look shocked at my words, but she only nodded, silently giving her consent for me to continue.  I obliged.

"Were you wearing a helmet?"  He shook his head no.  "THAT was stupid.  Riding your bike at night?  THAT was stupid.  Riding your bike A) at night, B) without a helmet, and C) while wearing black sweatpants and a black shirt?  THAT was REALLY stupid."

He couldn't even bring himself to look me in the eye.

"You got lucky, Sammy.  This time, you got lucky.  Next time you do something stupid you might not be so lucky.  I do NOT want to see you back here in my trauma bay.  Understood?"

He nodded, almost imperceptibly.

I turned to go and caught Mom's eye.  She mouthed "Thank you" to me and started crying as I walked out without another word.

Sammy is still a young, impressionable teenager, one who still has the capacity to learn from a mistake that was indeed very stupid, though fortunately not costly.  This time.  Perhaps next time he won't be so lucky.  But with a little reinforcement from Mom after my little tirade, maybe there won't be a next time.  Maybe, just maybe, I gave Sammy something he can take with him forever.


  1. on a related note, the visibility coefficient of blonde hair in contrast with black clothing at night is about half a block. fortunately the stopping distance of a 22 ton fire tender is just less than half a block.

    about twice a year we respond to pick up a pedestrian or group of pedestrians who did not feel it was necessary to be sure all the traffic
    A) saw them
    B) felt it necessary to stop

    most of them survive.

  2. I never understood why you wear helmets while riding a bike. Yes, I understand it's actually a pretty safe thing for kids learning to ride one, but teenagers and adults?
    But that only my opinion because I am from the Netherlands.

    1. And he was obviously stupid, no lights and wearing black clothes. We get fined for that. Do you guys have that, in other countries?

    2. The safety level of wearing a helmet doesn't change when you magically hit adulthood

    3. We don't wear helmets because we use them everyday.

      You could argue it could be like having to put the seatbelt, but one thing about riding a bike in the NL is that it is much, much safer than in most other countries. How many of them have a dedicated bike lane for example? How many other countries severely punish accidents against bikes to the point you become paranoid of them when you're behind the steering wheel?

      In the end, it's still smart to carry a helmet. It doesn't prevent accidents, but it can save you from serious brain damage IF it happens.

    4. well, I can't speak for the rest of America, but I started wearing mine after learning how uncomfortable it is to have road debris picked out of a face and ear. - and how long it took the road rash to heal.

      I think a discussion on a different forum came to the realization that the netherlands has much slower normal speeds on bicycles than the US.

    5. What I also don't get is why riding your bike at 10pm is such an outraging thing to do apparently? Unless if Sammy didn't have his lights on I don't understand the problem.
      If he was indeed riding his bike without proper lights, then that was in fact incredibly stupid of him, but also Doc maybe should have mentioned that in the post ;)

    6. Doc wouldn't have mentioned him wearing black clothes, or been angry at him in the first place, if he thought to put on lights or something.

    7. You wear a helmet because when my son was five he hit a patch of sand and fell and his head hit the curb. There was a 1" depreression in the forehead area of the helmet with foam hanging out.

      Had he not not had the helmet, surely would have been a depressed skull fracture. As it was, other than a little chin rash he was fine.

    8. When I was 8 I hit a bump and flew over my handlebars and hit a rock while I was biking with my dad and brothers. I was wearing a helmet and still got 26 stitches in 3 different layers and a mild concussion. My helmet was cracked about 2.5 inches up my head. Imagine if I hadn't been wearing it.

  3. I have a bike helmet from a particularly bad wipe out as a kid that has small stones embedded in it. I take it out to show the neighborhood kids why wearings a helmet is indeed "cool". I leave out the part where I was racing my friend down a dirt road going as fast as I could, instead of slowly circling the cul-de-sac like they are.

    Helmets are good.

    Worry not, if his mother was anything like mine it would very much be "If you're not dead, you're GOING to be".

  4. Oddly the evidence for the benefits of cycle helmets is surprisingly thin. There is quite a good review here:

    In summary, academic analysis suggests that they should be effective but the best real-life examples (where helmets were made a legal requirement in Australia and New Zealand) just showed a big decrease in the number of cyclists with little significant decrease in injuries (and thus an increase in the number of injuries per mile cycled).

    I would always advocate children and those learning or otherwise prone to a fall wearing a helmet but in others it may not indicate stupidity - they may simply have read-up on the literature in the area!

    1. PS - In contrast, cycling at night without lights (especially on the road) is always a sign of stupidity!

    2. and by "literature" you mean anti-helmet propaganda.

      helmet story number two: the mother of one of my childhood friends drifted into traffic and got clipped by a car. there were three separate circles painted on the ground labeled "helmet" - but none labeled "corpse"

      the failure rate of helmets is directly related to the rate of people not wearing them properly, either because of stupidity, or to try to make a point - which, come to think of it, also classifies as stupidity. - and it is not just learners who have a chance of falling - it is anyone who shares a road with anyone else, or goes fast enough to suffer an injury if they should run into something.

    3. It is difficult to see what anyone has to gain by propaganda against helmets. Obviously there is plenty to gain by selling more.

      My description of that site as "literature" was obviously a little exaggerated but the results in Australia are also quite surprising. What is important is that things are not always as "obvious" as they seem and there are often unintended or unexpected consequences - people in safer cars are more dangerous to pedestrians, for example, because they feel safer and so drive more recklessly. It's anecdotal evidence that leads to things like the MMR scandal in the UK.

    4. they don't want to wear helmets. what's so hard to see about that? they also aren't helmet manufacturers, so they have nothing to gain by selling more.

      I am no more dangerous to pedestrians in my 2012 quick response truck than in my 1941 fire engine ( both district owned) because I am a good enough driver to keep both of them in my lane of travel.

      now if a pedestrian should walk into my lane - say, because he was assuming that cars magically stop for pedestrians - then his risk would be greater facing the 1941 engine, because the brakes are much older technology, and don't perform as well.

      I wear a helmet, because I remember how much not wearing a helmet hurt. I want other people to wear helmets because I don't want to get left supporting a brain damaged vegetable just because they wanted to enjoy hearing the wind whistling through the holes in their head.

  5. I just got my vintage Fuji back on the road this year, and had never worn a helmet in my life and had no plans to start. Hearing me talk about how nice it was to careen around town on my bike, Mr. McThornbody decided he should get his road worthy and join me. Fortunately, his maiden voyage was a leisurely pedal up the street we live on. Have you ever heard a pinch flat explode? Seriously, it sounded like someone had fired off a 12-gauge. He also had almost no control getting stopped. If he'd been flying down some hill at 25 mph there would have been nothing left but a smear on the pavement. I bought a helmet the next day. Road rash is one thing; a closed head injury is a whole different animal.

  6. Doc, you're getting lax! There are two location (country) giveaways in this post. :)

    1. Are there? I thought there were three.

    2. I saw two - you're not in the Netherlands, or - judging from other response - you would not have been concerned about his lack of a helmet.
      you're not in Brooklyn, or the mother would not have thanked you for lecturing her son instead of letting her do it.

    3. and I saw two subtle giveaways that are directly opposed to each other. well played, doc.

  7. Helmets help when you have an accident. Lights at night help you avoid an accident. You emphasized the *least* important error he made and didn't mention the most important one.

    1. What do you consider his most and least important errors? In my opinion, the fact that he was out on his bicycle so late was his first (and most important) mistake. Everything else is secondary.

    2. Rightly or wrongly, I'm pretty sure that most European countries wouldn't consider it anything unusual for a fifteen years old to be riding a bicycle at ten o'clock at night.

  8. Now if only MORE mothers allowed (and thanked) physicians for their tirades, maybe some stupidity down the line would be prevented!!!

  9. or maybe he wanted to die and if you had not yelled at him in front of his mom you would have learned something.

    1. You're right, I should have patted his knee and reassured him that he would be JUST fine, and then I should have sat next to him and told him in nice, soothing tones that he was ok.

      I'm not sure what universe you live in, but in mine that would have been the same as saying nothing at all. And no, he didn't want to die, he was riding to a friend's house.

  10. Bravo, Doc. That's how you educate the young'uns. I'm sure that's at least one life you've saved right there, and hopefully his kids' lives too. If you don't make an impression on them while they're still young, it's much harder afterwards, as - unfortunately - you know full well.

  11. As late as I am, I'd like to add to the chorus: bicycles aren't motorbikes. If someone is pedaling at 15-20 kph (10-15 mph), they have about as much energy as if they were running. Falling at that speed is uncomfortable, but is it dangerous enough to warrant a helmet while you go running? Not particularly.

    Now, if someone is going faster than 20 kph, it's probably a good idea to put on a helmet. My rule of thumb is: street clothes and no sweat, no helmet. Lycra and sweat, strap it on. (By the way, this is the same pattern as you can see in the Netherlands or Denmark.)

    The important consideration is whether the helmet protects from the usual sources of injury. To the extent cyclists' injuries come from collisions with cars/trucks, helmets do next to nothing, because the energies are just too large, and victims mostly die from trauma to other parts of the body anyway. (There are some studies showing that wearing a helmet makes drivers pass more closely, thus *increasing* the danger.) On the other hand, to the extent injuries come from falling or riding your bike into an obstacle, i.e. from your own energy, helmets may be able to cope with the energy, and the chances of fatal wounds to other parts of the body are low.


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