Monday, 22 June 2015

Indefensible

WARNING: HORRIBLY DISGUSTING PICTURE OF GORE AND DISFIGUREMENT AND BLAH BLAH BLAH BELOW.  TURN AROUND NOW IF YOU ARE A BIG WEENY ETC ETC.  No but seriously, it isn't that bad. 

I've mentioned my much larger older brother before, but I've never written about my also-much larger younger brother.  Until now.  He and I didn't always get along when we were kids.  In fact, we fought like, well, like brothers.  Well, more like Tasmanian devils, only louder and more vicious.

Ah damn it, a story about Doc when he was a child?  Who the hell cares?  Where's the stupid patient story, Doc?

Hey hey hey, pipe down!  There's a stupid patient story later, so just be patient and indulge me for one goddamned second while I reminisce wistfully over here.  Now can it.

As I was saying, when I was about 13 years old, I witnessed LittleBroBastard getting picked on by a bully three years older and a full head taller than he.  The older boy was teasing him, shoving him, and taunting him mercilessly.  Now wait just one damned minute, that is not ok, asshole, I thought as I watched it happen.  He's my little brother!  Only I am allowed to pick on him!  Though I wasn't the fighting or confrontational type, but I walked right up to the boy anyway and slugged him in the gut.  Down he went in a heap of unbridled testosterone and over-aggressive obnoxiousness.

And I promptly got called to the principle/headmaster's office.  Of course.

I trudged slowly to the office, expecting to get suspended or beaten or defenestrated or something.  Rather than punishing me, however, the headmaster leaned in close with a wry smile and almost whispered, "I would have done the same exact thing if that had been my little brother.  Go back to class."

My point (finally!) is that while some actions may have good intentions and the act itself remains wrong, it is still somehow defensible.  Some actions, on the other hand, may not have bad intentions but are completely indefensible.

Still following me?  No?  Well then skip the rest and go check out some cat videos on YouTube.  For the three of you who are still interested in how this will all play out, please do stay with me.  Because Evan (not his real name©) illustrated my point beautifully recently.

The only good thing I can say about Evan as he was wheeled in to my trauma bay was that at least it wasn't 3 AM.  His style of screaming is almost tolerable at 5 o'clock in the evening when he rolled in.  Almost.  Evan, a healthy 24-year old guy, had been riding his motorcycle without a helmet (naturally) when he lost control and crashed into a car.  The medics reported that he flipped over the car and landed awkwardly (is there any other way to land after hitting a car?) on his left side.  There was a large pad covering his left thigh, and the medics told me that he had an open femur fracture (though this is only accurate about 25% of the time).  Well, if he has an open fracture at least he has a good reason to be screaming, I thought somewhat grimly.  I removed the pad carefully, and what I saw can best be described as a velociraptor attack wound:
Evan's left thigh
His thigh seemed stable, however, so I would have been surprised to have found an underlying femur fracture (an X-ray would later confirm that my lack of suspicion was completely warranted).  A thorough head-to-toe examination failed to identify any other major injuries, though I was completely unsurprised that his breath reeked of alcohol. 

Alcohol + motorcycle + no helmet + nighttime + idiot = ?

That's a bad mathematical equation right there.  Anyway, over the next 45 minutes, all the king's horses and all the king's men (read: I) managed to put Humpty Dumpty back together again.  I placed about 80 sutures in his leg and had to remind him at least that many times to stop fucking squirming goddammit and shut the fuck up.

There's a very slight chance that what I actually said was "Please lie quietly so I don't injure one or both of us, sir".  But what I was thinking was much more colourful and contained words and phrases more suitable for a Westerosi tavern.

After I was finished, I looked over his labs and was still unsurprised to find his urine drug screen positive for both marijuana and cocaine.  Surprisingly, he had no serious injuries other than the dinosaur mauling.  By that time his mother had arrived to pick him up, so I took her aside to tell her what I found, as well as that her son had been drunk and high on multiple drugs and was lucky that the only person he injured was himself.

She was shaking her head and frowning while I was telling her the bad news, so I assumed she was on my side.  That's when I rediscovered (yet again) how stupid it is to assume.

"But it wasn't his fault," she said.  "The car hit him!"

I guess she saw my look of sheer incredulity and was uncomfortable with the silence that ensued, because she filled that awkward silence with even more stupidity.

"He was just in a car accident a few months ago and he broke his elbow and five ribs.  He was high then too."

As I stared at her in awed silence she then continued defending his behaviour for some inexplicable reason, explaining that he was just going to the store to pick up a few things, it wasn't a long trip, he wasn't that drunk.  You know, all the usual bullshit.  I'm sure my eyes conveyed quite clearly what was going through my head, most notably "What the fuck are you talking about, you lunatic?"  I finally got tired of listening to her defending his indefensible behaviour, so I told her the same thing I tell the family of every drunk driver - "My wife drives my children on these same roads, and if he had injured or killed one or all of them, I would NOT be ok with that.  AND NEITHER SHOULD YOU."

I can't say that either of them understood the gravity of the situation, but neither of them looked particularly abashed as they left a few minutes later.  I felt like slapping the shit out of both of them as they walked out just to try to make sure they got the message.

I think that would have been completely defensible.

51 comments:

  1. HE hit the CAR and it was the fault of the person in the car???

    that is some serious entitlement logic, there.

    add in the fact that he was very recently in a car accdent while drunk and high, and I would posit that he is fully justified in not wearing a helmet, as there is nothing there which needs to be protected.

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  2. Usually you have a warning with graphic photos like this.

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    1. I think the graphic, naughty bits have been blacked out, on the left up near his crotchal region. Fortunately, it didn't take too many pixels to spare us the view.

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    2. Dang, that would have been my excitement for the whole week. 8-)

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  3. Wait, apart from actual velociraptors, how would one get a wound like that in a motorcycle accident? It looks as though he tried to remove a tattoo with a spoon. Can someone please explain the physics of that injury to me?

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    1. My best guess (despite not knowing much medically), it looks like a severe case of road rash combined with maybe having been dragged over some debris.

      Could also have been caused by part of the bike or car disintegrating and flying around at who-knows-how-fast as he went crashing to the ground.

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    2. I suspect he hit something resembling a spoon, rather than road rash. possibly even his mirror or handlebar.

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    3. That does look kind of like a handle bar imprint. But wouldn't that leave a bruise, not a tear like that?

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    4. not if you hit it hard enough.

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    5. I honestly have no idea. Maybe there was actually a velociraptor ranging around out there.

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  4. Is it just me or does it look kinda like a unicorn? The top is its head, the bottom are it's front arms trying to give a terrifying hug.

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  5. The behavior of the mother and son reminds me of the saying that goes something like, "Don't try and teach a pig to sing, it will only frustrate you and irritate the pig."

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  6. For as nasty as that wound is, he's lucky all things considered. My guess that would be handle bar/mirror/windscreen trauma. Who knows, not the brightest crayon in the box.

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    1. not the sharpest spoon in the shed.

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  7. Doc Bastard: "I managed to put Humpty Dumpty back together again. I placed about 80 sutures in his leg".

    It looks like skin and tissue were removed by the accident, not merely a slicing wound. How does one repair this with sutures? Wouldn't this require skin grafts? (I am not a doctor.)

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    1. It looks like tissue was lost, I agree. But Believe it or not, there was no tissue loss. The wound edges all came together much like a jigsaw puzzle.

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    2. that's a pretty impressive amount of elasticity to that skin, then. from my side of things, I wouldn't expect that much.
      (I think the most I've seen has been maybe a quarter to a half inch, but not rounded on the ends like that.)

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    3. It always stretches more than you expect. Think about how babies come out versus the "normal" unstretched size of the vagina.

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    4. true, but it is not considered normal to give birth through your thigh.

      but again, my side is scooping them up and sending them your way, not examining the details.

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  8. Doc, I've just slapped the shit out of both of them for you.

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  9. It's a shame that where drink/drugs account for an injury, you can refuse to treat them. Kinda behave and I'll treat you. Act like a tit and there goes your entitlement to treatment. Hopefully it'd get (some) people to stop being idiots.

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    1. unfortunately, that is something of an ethical lapse. we take care of patients, not because they are stellar people, but because WE are stellar people.

      of course, if we made them personally responsible for all costs incurred by their stupidity, that would be acceptable. and there are various sedatives available to emergency responders for some of the more obnoxious cases. - and yes, that is ethically appropriate, because the sedative allows a better quality of care for the patient.

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  10. Sorry about being off topic but Doc, you have to read this story. A guy in Virginia was getting a colonoscopy and set his phone to record before his procedure. Some jokes were told and he sued for mental anguish, defamation, embarrassment, loss of sleep and medical malpractice. I agree with what one of the defendants said in the recording: this guy is definitely a wimp.

    http://www.washingtonpost.com/local/anesthesiologist-trashes-sedated-patient-jury-orders-her-to-pay-500000/2015/06/23/cae05c00-18f3-11e5-ab92-c75ae6ab94b5_story.html?tid=pm_pop_b

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    1. none of which would have happened if he hadn't secretly recorded the procedure. of course the anesthesiologist WAS unprofessional in her conduct, but here we have a guy who is clearly looking for a payout.

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    2. We are all here because we enjoy reading Doc's irreverent humor in the course of his days in the ER. We find it amusing to hear what he's actually thinking when interacting with patients who can be trying. If he made a few rude comments while the person was unconscious in the OR I wouldn't be offended or accuse him of being unprofessional. From reading other online forums devoted to nurses and other medical professionals I gather that what this guy sued over is a fairly common occurrence in the OR, minus the false diagnosis of course. I included the link because I really wanted to know what he thought about the story. Personally, I'd rather not know what was said about me while I was under anesthesia, especially while someone was spelunking my intestinal tract. I'd be more concerned with what I might say or do coming out of anesthesia. Someday maybe Doc could write a column regarding funny and/or inappropriate things patients do in those circumstances. I've read that certain drugs, such as propofol, can have an aphrodisiac-like effect on the patient. It's commonly used during colonoscopies too.

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    3. common or not, it is something my end of emergency services considers to be poor customer service. that is what break rooms are for.

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    4. You said earlier, "none of which would have happened if he hadn't secretly recorded the procedure." Without the recording there would be no lawsuit because the guy never would have known. I kind of don't get the difference between this and what people say in the break room. I'm not trying to be confrontational, I'm just curious what you think about the merits of the suit. The guy lucked out because Virginia has such a lax rule regarding which secret recordings are admissible in court. They require the consent of just one party and that could be the one making the recording. The jury also bent the rules by letting the defamation charge stand when the law clearly states that the comments must be made as if stating a fact that would convince reasonable people. Judging by the comments on the tape I get the impression the guy was being somewhat of a tool beforehand. Thanks to this guy's recording and lawsuit the story is all over the news and the tapes are available for anyone to hear on multiple news sites. He was allowed to remain anonymous when the suit was publicized while the names of the defendants are splashed all over the web. How was he defamed if no one knows his identity? It's not the doctors who made the tapes public. This just gives people another example of how to game the legal system and scam the medical profession: Secretly record everything and hope someone cracks an inappropriate joke!

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    5. Please try to keep the comments on topic. There's a very strong possibility that this story will be addressed in a Daily Beast article in the very near future.

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    6. He taped it and he could. It is a one party state. The doctor defamed him. It was actually defamation per se. He won. She was asked to leave. The statements were wrong you take your plaintiff as you find him/her.

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  11. Just another FYI DocB, you know who is still trolling your Jahi post from May 25th.

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  12. The last post he left was on June 12th. Doc must be deleting them as they appear because someone said he was back on the 17th too yet there were no new comments then either. Just curious, how are you seeing them?

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    1. He's posting as anonymous. His style and turn of phrase(aka troll bait) are easy to spot.

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    2. It's kind of a bizarre thing to for him to form an unrelenting obsession over.

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    3. it is pretty common for people with defective brains to form unrelenting obsessions over bizarre things.

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    4. The last post anyone left on the May 25 entry was June 12 as well so how is it that JB/anonymous is still trolling when this is June 25? Are you seeing posts dated after the 12th?

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    5. there is a very discreet link to see more posts at the bottom of the thread.

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  13. have to ask - besides not wearing his helmet, was he also not wearing other protective gear?

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    1. He was wearing pants, a shirt, and dirty socks.

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    2. hence the ease the velociraptor had snacking on him.

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    3. Ken, that made me giggle like a little kid.

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  14. We all have to die one day if it was your day to die it wouldn't have mattered if you got on that bike and decided to stay home all day, you could have slipped down the steps and broke your neck if it's your time it's your time. I ride all the time and love it.

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    1. So if I'm understanding you correctly, you believe the movie Final Destination was nonfiction?

      That said, I'm not at all surprised that you ride.

      And by the way, congratulations on posting on a non-Jahi-related post. I'm very proud of you for branching out and trying new things.

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    2. Doc- I've found that scare tactics like this usually come from someone who is jealous or insecure. Kind of like, "I can't do that, so I'm going to go out of my way to make it so that you can't either." People can be paranoid and they have the right to stay indoors instead of going out there and riding on two. But I've found, most other times, people are just ignorant.Though I do watch motorcycle accidents on youtube, but my main reason is to learn from others' mistakes. Seeing how people went wrong so that you don't have to.

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    3. That sound you didn't hear was me laughing my ass off at your implication that I am either jealous of your motorcycle riding or insecure in any way.

      And calling me ignorant on the dangers of motorcycle riding is so utterly ludicrous that I have to believe that you're either drunk or a troll or both. I'm going with both.

      Congratulations on getting permanently banned. Idiot.

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    4. Let's all stand up and have a big round of applause for Doc.

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    5. Thank you, Doc B. You rock!!

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    6. Did you really ban him? This is great.

      You've done a terrific job of making him look like an idiot. Of course he helped you out quite a bit.

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  15. The photo gave me a flashback to an ER patient many moons ago while I was still working as an RN. Woman brought in from water skiing accident by a military helicopter (lake 50 miles from hospital and military installation very close to the lake).

    The story went like this: she was in the process of getting back into the boat via a "step" at the rear of the boat, and the driver of he boat thought she was in the boat and hit the throttle. The prop took a 10-lb. roast beef-sized piece of her lateral buttocks and thighs. She came in with a clumsy bandage keeping it all in one piece. When the ER doc took the bandage off, the respiratory tech and phlebotomist had to excuse themselves from the room.

    I, of course, thought it was the coolest thing ever.

    Then we had to deal with transferring her asap to the nearest Kaiser facility, on a Sunday, and the nearest facility was 2 hours away. But I digress...

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  16. Isn't drunk driving a crime where you live doc? Shouldn't the police put him in cuffs once he's ready to be discharged, slap him with a few hundreds of dollars fine and take his permit, especially if he's a repeating offender.. What's indefensible Ia that the law let's asshats like this roam free..

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    1. Of course it's a crime. However, the police are too lenient too often, especially when no one else is hurt.

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