Monday, 31 March 2014

Drunk driver

I suspect most people know someone who has been affected by a drunk driver.  I also suspect that everyone who has more than 18 brain cells knows that every other driver on the road has the capacity to be one of those dangerous idiots.  Every time I get into my car, I do it with the firm belief that I'm the only good driver out there, and every single other car around me is being driven by a besotted moron on his way back from a night of liquor-soaked debauchery.  You can call it pessimism, you can call it defensive driving, or you can call it paranoid and delusional.  Whatever gets me and my family safely from point A to point B is what matters.

But what happens when you encounter a drunk driver when you're not behind the wheel?  Sound impossible?  This story I got from Mariel (not her real name) proves otherwise:

Hello, Doc. I've been reading your blog for a while now and I thought I could share my story. I'll try to make this as easy to understand as possible. I'm not sure I will succeed.

My parents and I were leaving my grandparent's house. The house is downhill, just after a turn. My mom and I were waiting by the porch and my dad and my grandpa were talking in front of the garage. That's when a car turned the corner and, instead of slowing down, it went faster, lost control, and hit my dad and grandpa.

My dad hit the car's windshield and managed to fall on his feet, but due a fractured sacrum and pubic tubercle, he couldn't stand up. My grandpa was thrown against the garage and hit his head.  The impact was so strong he was turned around so his head was facing the car. He was in cardiac arrest by the time the ambulance got there.

My father is mostly fine, but my grandpa died due the head trauma. The driver of the car that hit them was drunk. 

My grandma is alone now because a stupid 45-year old man thought he could drive after wasting himself in booze.

I don't really think I have a whole lot more to say about that.  Drunk drivers are menaces not only to other drivers, but to pedestrians and everyone around them as well.

Mariel, my sincerest condolences to you and your family.

Thursday, 27 March 2014

Mass casualty

Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me.

The above poem, "The New Colossus", was written by Emma Lazarus in 1883, and it became one of the world's most famous verses after being inscribed on a plaque in the Statue of Liberty outside New York City.  Thousands of immigrants were greeted by this poem upon entry to the United States, but the words could just as easily be inscribed above the door to my trauma bay.  I seem to have a knack for attracting the huddled masses, but my forte is definitely attracting the wretched refuse, and they all appear to enjoy coming to meet me on the same night.

A trauma surgeon's worst nightmare is a mass-casualty event - a train derailment, a plane crash, a collapsed apartment building, a Justin Bieber concert.  Fortunately in most places around the world, these events are fleetingly rare, but we run training simulations on such possibilities nevertheless.  One of the most difficult things to do in a mass casualty event is triage - rapidly assessing which patients are the most severely injured but who are also salvageable.  Taking too much time 1) doing CPR on the guy with the open head wound and brain matter leaking onto the gurney, or 2) suturing a knee laceration on the lady who is otherwise mildly injured, decreases the survival chance of the guy with a metal pole sticking out of his abdomen.  The first patient has essentially no chance of survival no matter what I do, and the second patient clearly will be fine.  But the third patient also has a decent shot of living, but only if he receives immediate attention.  That is the art of the triage - not only who needs fixing, but who needs it first.

So naturally the burning question in everyone's mind at this point is (or should be), "Have you ever been in such a situation, Doc?"

Well, no.  Not exactly.  Actually, sort of yes.  Not really.  Kind of.  Ok, a bit.

After a boring first twelve hours of a 24-hour shift, it seemed nothing exciting would happen that day.  Fortunately I knew better than to taunt the Call Gods by mentioning that little tidbit.  The Call Gods, in all their malevolent glory, didn't need any such taunting, however.  At 8:30 in the evening my pager interrupted my viewing of the latest episode of "Sherlock", telling me I would be getting a level 2 (not as serious as level 1) gunshot victim in 5 minutes.  My pulse quickened slightly as I made my way to the trauma bay, but it quickened even further a minute later when my pager informed me of a second gunshot victim, this one a level 1, also in 5 minutes.  As I walked into the trauma bay, my pulse reached very near Full Blown Panic Mode when they wheeled in a third gunshot victim, also a level 1, who had been dropped off at the hospital by his buddy.


I started looking at the first victim, and the second guy (the level 2) was wheeled in less than a minute later.  I started my silent internal triage as I examined the first one - he had been shot in the abdomen, but it was a seeming glancing blow from near his flank through to his back.  His abdomen was soft and essentially pain-free when I pushed on it, a sign that he was probably not seriously injured, and I triaged him to the back of the line for now.  As I was running to see the second guy (who was now vomiting blood on the floor), the third one was wheeled in, a medic straddling his pelvis while performing CPR.


A 2-second glance at the second victim revealed two gunshot wounds in his abdomen, one near the umbilicus (belly button) and a second (presumably an exit wound) in his left flank.  But as opposed to the first victim, this guy's abdomen was rigid and he screamed when I touched him there, a sure sign of peritonitis.  My silent triage continued - this guy was salvageable, but something extraordinarily bad was happening inside his belly, and I clearly needed to be in there RIGHT NOW.  But I also needed to see what was going on with the third victim RIGHT NOW.


I instructed the nurse to wheel victim #2 directly down to the operating theatre, and I yelled to one of my assistants to call the operating room and tell them the patient was coming.  I then ran to the third victim who had been shot in the left chest.  He had no pulse, but I had no idea how long he had been down.  What I DID know was 1) I had around 10 minutes while victim #2 was wheeled to the operating theatre, put to sleep, and readied for surgery, 2) this guy statistically had a 99% chance of dying, and 3) his chance of death increased to 100% if I didn't do anything.  My only option was to do a resuscitative thoracotomy (ie "crack his chest") to expose his heart and lungs and try to do something . . . anything to bring him back to life.

It took me about 30 seconds to put on my gown, gloves, and mask, another 60 seconds to get into his chest, and then an additional 2.17 seconds (I counted) for his entire blood volume to pour out of his chest onto my feet (which were mercifully covered with shoe covers).  I did a quick survey of his chest, and the bullet had ripped through his left lung, tearing a major branch of the pulmonary artery and causing him to bleed to death internally.

One minute later I was halfway to the operating theatre, having declared victim #3 dead as I removed my shoe covers, then re-examined victim #1 to make sure my initial assessment was correct (it was), and finally barking various orders to the nurses and assistants.  I got into the operating theatre just as the nurses were finishing applying the sterilising solution to his abdomen.  I took a deep breath, realigned my chi and chakras, and slashed his abdomen open with the ferocity of a 1000 lions.

An hour later I had successfully repaired several holes in his stomach and colon, so I started congratulating myself on a job well done.  Then my Internal Pessimist reminded me that I had just pronounced a man dead (and still needed to inform his family), I still had a gunshot victim in my trauma bay who may or may not need surgery (he didn't), and there were still 10 hours to go in my shift.

I fucking hate my Internal Pessimist.  But the little shit was right - I had two more gunshot victims later that night.  One of them was shot in the leg, the other in the head.  One of them survived.

This was a night I won't soon forget.  It's the closest I've come to a mass casualty event, and hopefully the closest I'll ever come.  

. . . Until my daughter asks to go to her first One Direction concert.  Maybe I can get my Internal Pessimist to take her, and I can stay home and watch "Sherlock".

Sunday, 23 March 2014

Death of a patient

During my training one of the surgeons I worked with told me that every surgeon has his own personal graveyard that he visits every night where he tours all his failures in his dreams.  It seemed like an overly dramatic bit of histrionics, and I have to admit I chuckled softly to myself at the time.  A few years later after I had finished my training, my graveyard started slowly filling, and I stopped laughing.  Fortunately DocBastard Memorial Gardens is small and new gravestones are rarely added, but it is definitely there, and I visit often.  Every tombstone I see is an opportunity to learn, to avoid making the same mistake twice.

Sadly, I added a new tombstone last night.

As certain people get older they may look like they are aging well, but underneath the surface there is skin that isn't as smooth and taut as it used to be, organs that aren't functioning as well.  My patient was no different - she was not too old, but she was definitely starting to show her age.  Sure she looked pretty good on the outside, but she had been getting slower and slower over the past few months.  She had been in her usual good state of health until last night, when she suddenly got sick.  It seemed that everything inside her had suddenly stopped working all at once.  I took one look at her and knew immediately that something was seriously wrong, and she needed immediate surgery.

A few minutes later I opened her up, and what greeted me was confusing at best, and horrifying at worst.  I've been inside many patients just like her, but somehow she was just different.  Nothing was where it should have been, but I still couldn't immediately identify what was making her shut down.  I started dissecting carefully, moving things around, taking things apart where I had to, removing other things that also obviously needed removing, trying to identify the problem.  It was very delicate work, and I knew that one false move could spell the end.

And then it happened.  One tiny movement that should have been more delicate than it was, wasn't.  One slight misstep was all it took, and just like that it was all over.  I suppose I could have tried to repair the damage, but it was obvious that even though the injury was tiny, it was also unfixable.  I dropped my head, cursed silently under my breath, and closed up without another word.  Nothing anyone could have said would have changed a damned thing.

I know I don't ever release patients' names, and I risk raising a few eyebrows doing this, but I'm going to make an exception in this case.  I hope this can serve as a cautionary tale to any other surgeons (or anyone else, for that matter) who decide to be less careful than they should be.

RIP, iPhone 5.  You will be forever in my personal graveyard.

Monday, 17 March 2014

Surgery must be stopped!

A reader alerted me to this article in the newspaper The Times a few days ago, and I thought I would share it:
LONDON (Reuters): In a shocking announcement, the United States Department of Health and Human Services, the UK Department of Health, and the Canadian Ministry of Health have all agreed to suspend recommendations for laparoscopic cholecystectomy, a minimally-invasive removal of the gallbladder that is among the most common procedures performed worldwide.  US Secretary of Health and Human Services Kathleen Sebelius quoted the enormous number of patients seriously injured and killed by this procedure each year as the reason for withdrawing their recommendation, and she demanded more research into why so many people have this operation performed.

"In the United States alone," Ms. Sebelius reported to a joint session of congress last week, "there are approximately twenty million people living with gallstones.  There is only about a 20% chance of these patients developing gallstone pain over a 20 year period, yet 500-600,000 people still have their gallbladders surgically removed each year in the US.  Every one of those patients is at risk of hemorrhage, infection, bile duct injuries, blood clots, and even death."

Indeed, statistics show that up to 15% of patients undergoing laparoscopic cholecystectomy, which was only first done in 1985, are converted to the "open" technique, which is the old-fashioned procedure and involves a much larger incision, slicing across the abdominal muscles and causing much more pain and an increased risk of bleeding and wound problems.

In addition to bleeding and infection, up to 3 in 1000 patients undergoing this incredibly dangerous surgery will accidentally have their main bile duct accidentally torn, cut, or clipped, and these injuries are often not identified until days after the surgery.  Almost 1 in 500 have a hole punctured in their stomach, colon, or small intestine, and unbelievably the overall complication rate is as high as 1 in 20.  As many as 1 in 250 undergoing the procedure die due to complications, and if you happen to be lucky enough to survive, you have a 40% chance of developing bloating, abdominal pain, and indigestion, possibly permanently, after surgery.

"These injuries and deaths could all be prevented if people would just opt to live with their gallstone pain," Canadian Minister of Health Rona Ambrose told Reuters yesterday.  "Surgery just shouldn't be necessary.  I've heard a few anecdotes of people who read a story on Natural News and bought some kind of magic potion on Amazon or something which promises to flush the body of toxins and gallstones and other evil humours.  Surely this is a better option than letting sadistic surgeons cut you open and remove an organ.  These people were trained by barbers as recently as last century!  It's truly barbaric." 

UK Secretary of State for Health Jeremy Hunt went even further, stating "More investigation into the dangerous and lethal practice of surgery is needed.  We cannot in good conscience recommend anyone have this surgery, and possibly any surgery, until we can be sure that no one will ever again suffer a complication of any kind.  To my knowledge there has never been a double-blinded study done on gallstones, and until that is done we feel the practice should be stopped.
Sibelius, Ambrose, and Hunt all suggested trusting a random website which touts the healing power of cilantro and turmeric than some doctor who spent 20 years getting educated in the cutting-edge science of healing people.

Now for those of you whom have never read A Modest Proposal by Jonathan Swift, I suggest you click on the link and read it before you go any further.  I'll wait.  No seriously, go read it and I'll wait here.

All done?  Good.  The above Times article I just quoted is satire and entirely fabricated.  It never appeared in any newspaper, because I just wrote it.  However, the statistics I quoted are actually 100% true, and I presented them in a way to make the procedure seem as terrifying as possible.   

So why am I making it sound like my colleagues and I are butchers who routinely maim and kill innocent people?  Because I want to put myself out of business?  No, it's simply to illustrate a point.  People undergo surgery knowing that it is relatively safe, though not 100%.  The risks of surgery are small, but patients undergo it anyway, because the benefits far outweigh the risks.

"So what's the point, Doc?  What does this have to do with anything?"

My point is that many people these days are opting not to immunise themselves and their children against preventable diseases, even though vaccines are orders of magnitude safer than surgery.  There is a large (and growing) faction of anti-vaccinators who forgo vaccines against measles, hepatitis B, tetanus, the flu, and others, many of them potentially-fatal diseases, because there are infinitesimally small risks.

What these people fail to realise is that there are risks with everything.  There is a risk that your car will explode when you start it.  There's a risk a meteorite will fall on your head and kill you.  There's a risk that a sinkhole will swallow your house.  There's a risk a squirrel will maul your face in your sleep.  But that doesn't stop us from living our lives.  It does make me close my windows at night, though...fucking evil squirrels.

But this is just how absurd anti-vaccination zealots and their arguments against routine vaccinations are.  Vaccines are very safe, and this has been studied and documented over many decades.  But vaccines are also not 100% safe, and this has also been well documented over the same period.  Just like with surgery, a few people are injured, and a few people die.  But vaccines are far safer than surgery.  Of the millions upon millions of doses of vaccinations given per year, a handful of people are seriously adversely affected.  By far the most adverse reaction is pain at the site of injection, but headaches, malaise, and flu-like symptoms are also very common.  The serious reactions (including death) are fleetingly rare.

The anti-vax faction wants people to believe that these serious reactions are much more common than they are, making their stories sound as alarming and as terrifying as possible just as I did with my story about gallbladder surgery.  They are also desperate to link vaccines to everything from autism to diabetes to other auto-immune disorders.  But there is no conclusive evidence linking vaccines to any of these.  Stories and anecdotes abound ("I got the flu vaccine, and the next day a train crashed into my house!  It must have been the flu vaccine!"), and everyone seems to know someone who knows someone whose child developed autism 2.4 seconds after getting a vaccine.

The most telling aspect of anti-vax lunacy is how they claim that vaccines don't work.  They have graphs that show how the death rate of various diseases was already dropping before vaccines were introduced, so obviously vaccination is a hoax!  I mean, just look at these graphs and see for yourself!
"Oh my god!  Vaccines really haven't saved us!  It's all been a lie!"

Now wait a second and think.  Look at the dates on the graphs.  The advancement of medicine and antisepsis and supportive care were exploding in the early-to-mid 1900's, so of course the mortality rate would improve independent of vaccines.  What the anti-vax people don't want you to see is the trend of the actual incidence of the diseases:
As they say, a picture says a thousand words.  You can clearly see the normal annual fluctuations in incidence, but you can also clearly see how the rate dropped to near ZERO after the vaccines were introduced.  There is just no doubt that vaccines do exactly what they are supposed to do, and they have successfully eliminated (or nearly eliminated) many potentially-deadly illnesses, including polio and smallpox, which killed between 300 and 500 million people in the 20th century alone.

Despite this seemingly-overwhelming evidence, these groups of people, medical professionals included, continue to denounce vaccination programs, believing the minimal risks outweigh the concrete benefits.  These nurses and doctors are advising their patients not to immunise themselves and their children, recommending instead various foods, potions, herbs, and other hocus-pocus voodoo magic, which may all be perfectly healthful, but will protect you from polio exactly as much as a boot to the head will.  As the movement grows, outbreaks of these entirely preventable diseases are becoming more and more common

I would never be so duplicitous as to say that vaccines are 100% safe, because they are not.  But they are pretty damned close.  They are probably the second-most safe and effective preventative measure (next to soap) medicine has ever known.  Parents need to understand that there are risks, no matter how minuscule, before they come to a decision about immunising themselves and their children.  But they also need to understand how the benefits far outweigh those risks.

Now who is ready to have their gallbladder removed?  I have an opening next week.

Wednesday, 12 March 2014


'Dr. Evil'!  I didn't spend six years in Evil Medical School to be called 'mister', thank you very much." - Dr. Evil

The rigor of spending years in medical school, followed by several more years in medical or surgical training, then followed by several decades of helping people seems (in the past, at least) to have earned doctors a respected standing in the community, and rightfully so (if I do say so myself).  "Yes, doctor" used to be the usual refrain in hospitals and doctors' offices, with most people following "doctors' orders" to the letter.  Admittedly that wasn't always a good thing, since doctors are human and therefore fallible, and we do make mistakes on occasion.

Regardless, that sense of esteem seems to have degraded significantly over the past few decades.  I have some difficulty pinpointing the exact cause, but I at least partially blame Google (fuck you, Bing).  All you need to do is input your symptoms into the search engine, and in 0.325 seconds you can find out that you either have tularemia, Wilson's disease, a heart attack, or (most likely) just a simple cold.  Now that the entire content of centuries of knowledge and research is available with just a few keystrokes, doctors just don't seem to have that mystique of the all-knowing healer.  

But I had no idea just how much that respect had withered until I met Isabella.

You might say I heard Isabella (not her real name) before I met her.  Her voice preceded her by at least 10 seconds as the medics wheeled her down the hall into my trauma bay.  I can't even remember what she was yammering on about (INDOOR VOICE, PLEASE), but whatever it was held great importance to her and only her. 

After the medics described how this 20-year old girl had been bumped in the hip by a car reversing out of a parking spot at the approximate velocity of an intoxicated snail, I introduced myself as her trauma surgeon and asked if she had any medical problems. 

"No I don't, dear."

The tone of this "dear" wasn't polite or affectionate like your grandmother would use.  No, it was more like a guy calling another guy "pal" when saying, "Yeah, let's take this fight outside, pal."  

Trying to stay polite, I continued.  "Do you take any medicine at home?" 

"No nothing, hon."

I again heard a distinct sneer in her voice.  The insincerity hit me in the face like a fart in a taxi with the windows up, but I pressed on, suppressing my growing annoyance.  I asked her what hurt.

"Just my hip a little.  Dear."

Without another word (but while grinding my teeth enough to wear off the enamel) I completed my workup.  I looked at all her X-rays (which were all shockingly normal) and went to tell her that all she had were bumps and bruises.  I then made one last mistake - I asked her if she had any questions.

"No, sweetie."

And that was the last straw.  I don't know what problems she had had with doctors in the past, but I refused to allow her to take out her frustration on me.  I looked her dead in the eye and in my best Clint Eastwood voice said, "My name is not dear, hon, sweetie, sweatheart, or babe.  My name is Doctor {redacted}."

The room went dead silent, and I saw the nurses all look at each other with wide eyes as if to say, "Did he actually just say that?"  All of them grinned, and two of them actually started applauding (apparently this young lady had been just as condescending to them as well).  The girl was clearly taken aback, stunned that someone had the audacity to stand up to her.  My bet is that she had been treated like a little princess her entire life and was used to people bowing down to her.  I was frankly surprised she wasn't wearing a tiara.  But I wasn't done with her, or her attitude, just yet.

"Now, do you have any questions for me?" I repeated slowly and grimly, refusing to break eye contact.

"No, doctor," she replied meekly.

That was the most respect she had shown anybody all night. 

Friday, 7 March 2014


I'd like to take a break from storytelling for a bit and instead take a little trip, with your indulgence of course.  Naturally you're more than welcome to come along if you'd like.  If not, then move aside and let the good people get by.  I assure you it isn't a long trip regardless of your current location.

Yes, come with me to a place where stupidity is nonexistent.  Where everyone actually uses his brain inside his head before speaking.  Where every action is premeditated.  Where sentence fragments are acceptable due to creative license.  Where crime is non-existent because it's dumb and only dumb people commit crimes.  And where everyone knows that indefinite pronouns like "everyone" are singular nouns and thus require singular verbs.

This amazing location may sound like some imaginary place like Narnia, Neverland, Willy Wonka's Chocolate Factory, Atlantis, or Walmart (seriously, can you really buy flat-screen TVs, clothes, tyres, and pineapples there?!), but I assure you it's quite real. 

So what's the name of this wonderful, fantastical place where only good, intelligent people exist?  Where stupidity isn't just frowned upon, it's against the law?  Where bacon is a main course and not simply relegated to a breakfast side dish?  Where dessert is always eaten first because why the hell not?  Why, it's Bastardia.

And the location of this magnificent place?  Sadly, it's only in my head.

For now.

The Bastardia of my imagination is a kind, civil country.  There is no need for police or armed forces, because no one argues.  Oh, there may be an odd squabble over whether you prefer 2% milk or fat-free, a tiff over whether football is better than football (it is), or a minor row over whether you like cats or dogs (cats obviously).  But major confrontation is joyously absent because everyone communicates with each other and uses words rather than fists (or other more dangerous weapons) to solve problems.  Everyone cares what other people think and respects their opinions.  Everyone living here is intelligent, sensible, logical, respectful, and reasonable.

Now that I think about it, it sounds a bit like Vulcan.  Minus the pointy ears, of course.  Hm.

Obviously I've thought long and hard about what Bastardia will be.  Other than stupidity, there will be a few other things that will be gloriously illegal in Bastardia: 

  • Tobacco
  • Ke$ha
  • Using a jackhammer at 6AM
  • The recorder (the worst musical "instrument" ever invented)
  • Celebrities being famous for no reason (I'm looking at you, Kim Kardashian and Paris Hilton)
  • Country music (Red Solo Cup, Toby Keith?  Really?)
  • Reality television
  • Politics
  • Bigotry

I apologise - those last two entries seem to be repetitious.  Anyway, Bastardia will be the Utopia of the 21st century, and it will come to fruition someday.  I've determined that there are just 4 easy steps I'll need to fulfill:

  1. Find enough money to buy or build an uninhabited island large enough to accommodate my whims (I figure one the size of Iceland should suffice)
  2. Terraform the island
  3. Build the necessary infrastructure (roads, libraries, schools, hospitals, Starbucks, etc)
That's the easy part.  Yes indeed, finding several trillion pounds/dollars/euros/rupees/rubles is the easy part.  So then what's the hard part?  Well if you were paying attention, you'd notice I only mentioned three of the four steps.  So the hardest step would be step 4...

Finding enough people who would qualify to live there.  The line forms to the left, right behind Neil deGrasse Tyson and Natalie Portman.  But no pushing!

Donations are being accepted now.

Monday, 3 March 2014


I have two children whom I love dearly.  They are the most precious things in the world to me.  I will love them with all my heart until the day I die, and nothing will ever change that.

But they are disgusting creatures.  That's right, I said it - small children are vile, nasty, repulsive little monsters who think nothing of pooping in their pants and running around in it, leaving little trails of foul wretchedness behind them.  The smell doesn't seem to bother them, nor does sitting in it for any length of time.  My daughter even fell asleep in her own vomit when she was a toddler.  But somehow parents get through it all, because in some strange inexplicable way it isn't all that bad when it's your own child.  As long as it is your child's faeces or vomitus that you're wiping off the wall or floor or sink or ceiling (don't ask), it's all still perfectly reasonable.

When it's an adult, however...

Charles was found down in the street between two parked cars.  The medics weren't sure how he got there, though somehow they were convinced that he had stolen a motorcycle and crashed it even though there was no motorcycle at the scene.  I've never seen a drunk skunk, but Charles was obviously as drunk as one, and he just as obviously needed a trauma surgeon (apparently).  In addition to being grossly intoxicated, Charles was also morbidly obese to the tune of 160 kg or so (350 lbs).  And he was so drunk he decided that he would treat the ambulance as his own mobile restroom.  As the medics wheeled him in, the mellifluous aroma of vomit and shit overwhelmed the entire place, driving several of my staff members out of the department.  It also drove several other members in, just so they could see the glorious spectacle that was Charles.

Now I can handle my 2-year old's poopy tush perfectly well without even batting an eyelid, but I do not have the fortitude to deal with the veritable mountain of crap that Charles laid down.  Everyone donned masks, but that was about as effective as trying to stay dry in the ocean by wearing a mesh bikini.  Despite the stench we fulfilled our duty (pun intended) of doing a comprehensive workup, and other than a nice scalp haematoma, he was fine.

After we concluded our survey, the nurses and techs went to work cleaning up his self-induced mess.  As the nurses removed his stool-encrusted clothes, in his drunken stupor Charles kept murmuring "Pull my finger" and laughing to himself.  Fortunately no one was stupid enough to fall for THAT old trick.  The clothes were mercifully discarded (and then incinerated, I hope), and then came the task of wiping his, ah, shall we say generous posterior.  When the nurses finally got his ass cheeks pried apart, they found out just how lucky they were not to have pulled his finger when several small plastic bags containing a white powder fell out.

Everyone froze.  The room was dead silent (except for the odd gag from one of the security guards).  Charles stopped laughing, apparently having figured out that we had found his stash, and he said the only logical thing anyone could have possibly said in that situation:

"Uh, that's not mine."

One of the nurses took the bait and piped up, "How is it not yours?  It just fell out of your ass!"

Charles paused for just a moment, but he stayed right on course: "Uh, I must've sat on it or something."

Several of the nurses nearly started crying from laughter, though it could have just been their eyes still watering from the fetor.

I don't have any idea what that white powder was - cocaine, heroin, crack, amphetamine (which isn't blue, by the way) - but I have a sneaking suspicion it wasn't talcum powder or baking soda.  The bags were handed to the police, who seemed less than convinced that they didn't belong to Charles.  He got himself a lovely pair of bracelets and an all-expenses paid trip to jail.

As ridiculous as his excuse was, I give him full credit for sticking to it.  But it taught me a whole new meaning of the term "ass crack".