Monday, 13 July 2015

Timing

Probably the most difficult aspect of being a trauma surgeon is not being able to control my schedule.  I don't necessarily mean my call schedule itself, though that is often outside my control as well.  What I mean is that other specialties have the ability to see patients on the days that they choose and at the hours that they choose.  I, on the other hand, get whatever patients I get whenever they decide to come in.  I can't choose to get a guy who falls off his bar stool and bonks his head at 1 PM, because those idiots don't fall off their bar stools at 1 PM, they do it at 2 AM.  What I've discovered over the course of my career is that surgery and trauma patients usually have terrible timing.  No one seems interested in letting me sleep, so instead they get appendicitis at 11 PM or stabbed at 3 AM.

Such was the case with Michael (not his real name©) and his series of friends.

My pager woke me from a dream about Scarlett Johansson (at least I wish it had been about Scarlett Johansson.  Seriously Scarlett, call me) to tell me that I would be getting a high-level stabbing victim in five minutes.  I looked at the clock and was completely unsurprised by what I saw.  

Of course.

As I was walking briskly downstairs, my pager went off again, telling me I would be getting another high-level stabbing victim in four minutes. 

My walking pace quickened.

Over the next few minutes my pager would go off three more times, all stabbing victims who, I learned later, had all been at a house party when two cars full of lunatics arrived with various sharp stabby things and a thirst for random violence.  

At least that's what Michael, who turned out to be victim number four out of five, asked me to believe.

I ran from room to room to room trying to determine who was the worst injured.  Two of them appeared to be completely fine, and two looked to be slightly less fine though still seriously injured.  And there was one whose wound looked like it should have been actively killing him, though in reality he looked as though he could have walked home. 

That, of course, was Michael.

His rather scary-looking injury was a single stab wound just to the left of his sternum.  Though it was a potentially dangerous (ie lethal) area, his heart rate was 70, his blood pressure was 120/65, and he looked calmer than I (though the fact that I kept running back and forth among four other victims may have riled me slightly).  He kept asking when I was going to patch him up and send him home.  I did a quick ultrasound which showed a bit of fluid around his heart, and a CT scan done a few minutes later (as I was putting a chest tube into Victim #3) confirmed a hemopericardium (blood around his heart).

Uh oh. 

There's only one place that blood could be coming from, so he went straight to the operating theatre where we found a small injury to his heart muscle, but no active bleeding.  His myocardium was repaired, and he was closed up.  Success!

Except that I still had 4 other victims to tend to.  Fortunately #1 and #2 just needed a few stitches and #3 and #4 both needed only chest tubes.  Nothing else life threatening.

When I went to see Michael the following morning in the intensive care unit, his very pregnant wife was sitting next to him.  When I say "very pregnant", I mean she looked like she could have popped at any second.  They asked all the usual question, including how long I expected Michael to be in hospital.  I told them probably three or four days, and his shoulders slumped.

Michael started to speak, but his wife finished the sentence for him:

"But I'm having the baby in three days!"

I asked if it was their first child, and of course it was.  I told them that I would do the best I could to get Michael to see his first child's birth, but I also told them I would make no guarantees.  I promised I would send Michael home as soon as he was ready, but not a minute before.  They were both visibly disappointed, but they also understood.

Fortunately Michael's hospital course was completely uneventful.  Over the next two days he recovered rapidly and smoothly.   By day three his chest tube was out, and he was ready to go home. I thought I would have to physically restrain him from running out the door.

I found out sometime later that I had discharged him just in time for him to make it to the other hospital to see his son being born.

Well, at least one of us has good timing.

13 comments:

  1. I typically find starting to cook dinner, and going to bed are especially good triggers for the Call Gods.

    ReplyDelete
    Replies
    1. Indeed. Also any attempt to use the restroom will often trigger their ire.

      Delete
    2. that happened yesterday.

      Delete
    3. Any attempt to use the restroom will also alert any and all children and pets in the area to either do something dangerous and need you immediately or just throw open the door and be annoyed at your presence.

      The call gods win for inconvenience but kids win for frequency.

      Delete
  2. Wow, this guy has more luck than judgement. Had the knife struck a couple millimetres off, he could have been dead by the time he got to you. He not only got to live, but even made it to his wife in time. I'm impressed.

    ReplyDelete
  3. I'm glad that he was able to see his son's birth.

    ReplyDelete
  4. Well, there's one lucky guy! Survives a very f'ing nearly deadly stabbing and just makes it to see his child born. I just hope that if it was not all as innocent as he makes out then he stays clear of this type of thing in future, if only for the sake of his son - you don't get many chances for warnings like that.

    ReplyDelete
  5. I feel positively virtuous for showing up at the ER with my appendicitis at 11 in the morning!

    ReplyDelete
  6. Nice to read a story with a happy ending! Let's hope "Michael" stays away from wild parties in the future...which may indeed happen, if he's recruited to help out with the feeding that little ones often demand between 2 AM and 3 AM! Like the Call Gods, babies tend to mercilessly disregard our "normal" adult sleeping schedules. :)

    ReplyDelete
  7. yep, just woke up at 3:30 in the morning for a patient who will never make it to the operating theatre - because we could take care of ALL the patient's "needs" out of a first responder kit.

    ReplyDelete
  8. Well, I hope that was "Michael's" last wild party with unwelcome participants with sharp stabby things. I don't suppose his son was named Bastard in your honor, do you?

    ReplyDelete
    Replies
    1. Now....THAT would be the start to an interesting life!

      Starting with the cell phone photos shared with family and friends, taken as soon as the little guy was delivered and cleaned up...

      "First pics of our little Bastard!"

      Fast forward, to ordering the cake for his first birthday party....

      "Yes, I'm SURE. I DO want the message to say, 'Happy Birthday, Bastard!'"

      School days...not so much fun...

      Delete
    2. Of course, I'm betting that Doc Bastard isn't really named L'il Bastard. Or Major Major.

      Wednesday

      Delete

If you post spam or advertisements, I will hunt you down and eliminate you.

Comments may be moderated. Trolls will be deleted, and off-topic comments will not be approved.

Web-hosted images may be included thusly: [im]image url here[/im]. Maybe. I'm testing it.

COVID-19 Mythbusting (clean)

Due to popular demand (well, two polite requests, actually), I have decided to create a clean version of my post about COVID-19 myths . If...