Tuesday, 8 September 2015

Rehab

If you've never heard of Amy Winehouse, take a moment to look her up (or just click on her name).  Go ahead - I'll wait here.  I promise not to leave without you.

Ok, she's gone!  Quick, let's ditch her!

Kidding, kidding.  But seriously, Ms. Winehouse was a ridiculously talented young lady (with a ridiculously ironic name) who, like many other musicians before her, ended herself way too young due to the effects of drugs and alcohol.  Arguably (and again ironically) her best-known song was "Rehab", an autobiographical song (which won numerous awards) protesting her father's wishes for her to undergo drug and alcohol rehabilitation.

That's a very garrulous and needlessly-stupid way for me to introduce rehab, especially considering that's not even the type of rehab I'm talking about in this story.  I'm talking about physical rehab here.  Hm, I guess I've never been very good at segues, so maybe I shouldn't even bother to try.  Though now that I think about it, I think Natalia (not her real name ™) could have used Amy Winehouse's type of rehab too.

There you go, a segue.

Natalia came in as a high-level trauma, having been shot in the left axilla (armpit).  That's always a tricky area, because I never know which way the bullet went - up into the axillary vessels, sideways into the chest, down into the abdomen, etc).  On her initial exam she had no breath sounds on the left side (uh oh), her abdomen was markedly tender (UH OH), and we found the exit wound on her right flank (UH FUCKING OH).  It's almost never good when a bullet goes in one side of the body and out the other.

Oh, and one other thing we found on her were track marks on her right arm.

Shit.

Though some shootings appear on first glance to be drug-related, I usually don't like to assume they are, because I tend to be wrong.  Sometimes, however, it is exactly what it looks like.  According to the police officer who came with her, this was a drug deal gone bad, and Natalia ended up on the wrong end of the gun.

When I placed a chest tube in her left thorax, about 600ml of blood came out.  Fearing something very bad going on in her abdomen, I took her directly to the operating theatre where I found that the bullet had ripped two holes in her stomach, tore through her liver, and then went through her right kidney before exiting into the outside world.  After repairing everything (except the kidney, which I left alone), I admitted her to intensive care where she spent the next several days detoxing from heroin.  I guess if you really have to go through heroin withdrawal, doing it intubated and heavily sedated in the ICU is the way to go.

It took her nearly three weeks to get off the ventilator, and by the time her lungs were functioning well enough to get her off the ventilator, she was so debilitated and weak that she couldn't stand without three people helping her.  She clearly needed rehab (finally, the point!), the physical rehab type, not the drug rehab type.  But unfortunately Natalia wasn't having anything of it.  Even though she couldn't walk and barely had the strength to stand, feed herself, or wipe her own ass, she just wanted to go home.  And she kept threatening to leave against medical advice.

I had a sneaking suspicion there was a sizable bag of heroin back at home that was calling her name.

It took several more days (and several people) to convince Natalia that rehab was where she belonged.  I think that nearly falling and cracking her skull open while trying (and failing) to walk to the restroom finally convinced her.

Finally after two months in hospital, the transfer arrangements were completed, and Natalia finally left.  The following day I saw that her name was off my patient list, and I was thrilled for two reasons: 1) for getting her out alive, and 2) for preventing her from leaving against medical advice.  Success, right?

Right?

Around 10AM that morning my phone rang.  I recognised the caller as the social worker who had arranged everything for Natalia.

Well this can't be good.

Social worker: Hi Doc, good morning.  Did you hear about Natalia?
Me: Uh, oh.  Uh, no.
SW: Well she got to the rehab facility just fine, and she just . . . well, she just left!
Me: Wait, she did what?
SW: Yeah, I made all the arrangements, the ambulance took her there, they checked her in, and then she just . . . left!  She went home!
Me: . . .
SW: Can you believe it?

And I said no, no. no.

61 comments:

  1. That's so sad. Isn't there a way you can make someone stay in there if they're a danger to themselves?
    Also I love Amy Winehouse. Valerie is my favorite song.

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    Replies
    1. Unfortunately, this isn't a case of a patient doing implicit physical harm to themselves. We have to respect their right to choose and refuse care, even when you want to slap sense into them instead. Can't live their life for them.

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  2. Amy Winehouse! You know I'm no good.

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  3. I actually miss Amy. So talented

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  4. If the addict doesn't want to get clean rehab doesn't have a chance of working so what would be the point of forcing it on someone? Besides, I don't think you can force someone into rehab in the way that a mentally unstable person who is a danger to themselves or others can be committed against their will. A judge can order someone into rehab if the person has committed a crime. In that case, they could go to jail if they refuse or try to leave because they would be in contempt of court.

    I used to know someone whose adult stepson was addicted to heroin. He was ordered into rehab by a judge. It had absolutely no effect on him. He went right back on drugs and would sell things he took from his own family to support his habit knowing that his father wouldn't prosecute. The guy didn't even live at home but he had a key and would just go in when no one was home and help himself. The father would go to the local pawnshop and buy back the things his son had stolen. It was one step removed from just giving his son the money to buy drugs.

    It's amazing how many families enable their loved ones in such ways.

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  5. Can I believe it? absolutely. I also agree that you can't force a person to stop doing drugs except by force. (though I believe this rehab facility was physical rehab, not drug rehab, was it not?)

    but now the question: was the kidney left alone because there was nothing that could be done, or because it would fix itself just fine without intervention?

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    Replies
    1. 3rd option re: the kidney, maybe something *could* have been done, but it wasn't necessary because of the second one.

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    2. Yes, but leaving a wound untreated can cause an infection if it won't heal on it's own naturally. I'm not a doctor, but I would assume that having an open wound in your kidney isn't really the same thing as having a non-functioning one.

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    3. Like a few other organs, kidneys can stop bleeding and heal as long as they aren't actively bleeding, which hers was not.

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    4. good to know. (& @anon: that was option 2)

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  6. As Anonymous@16:10 said rehab is useless if they don't want to get clean.

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  7. This just boggles my mind. Wouldn't Natalia (not her real name ™) have actually been over the withdrawal symptoms after two months in the hospital? I seriously don't know, because I don't do street drugs, but man, to be clean would seem like such a gift you wouldn't think she'd eff that up. But, yeah, I suppose there are underlying emotional and psych reasons for any addiction that really aren't addressed just by getting someone sober/clean.

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    1. There's physical and mental addiction to drugs. The worst part is this hit was probably more potent since she was detoxed (kinda like having an espreso after drinking decaff for a while), which will make it even harder to motivate herself to quit.

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    2. There's the emotional/psychological attachment to the lifestyle and the people who go with it, too. Moving forward with recovery from addiction often requires giving up certain *relationships* that were associated with the substance abuse too.

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  8. This comment has been removed by a blog administrator.

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    1. Hello John. You're not fooling anyone by posting as "John Bennton" on the Keep FB page. Aside from that, you're beating a dead horse and this is the wrong place to post about Jahi.

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    2. This comment has been removed by a blog administrator.

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    3. Darn it, Doc. What did "Bennton" say?

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    4. Nothing relevant, interesting, or otherwise worthwhile.

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    5. That's not what he said.

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    6. not verbatim, but it is an accurate representation.

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    7. Darn it Cleopatra you made me go look at the Keep page.

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    8. Did you see the error?

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  9. Well that actually ended better than I thought. I was sure she went home pulled as much heroin as she was doing before her "accident" and ODed. So all and all a happy tale for me.

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  10. Rehab is a money grubbing sham so I don't blame her.

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    Replies
    1. You're thinking of the wrong type of rehab. The kind she went to (and left) is the physical kind, where people learn how to walk and breathe after injury or debility. That is most certainly NOT a "money grubbing sham".

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    2. HA! Care to tell the rest of your followers that?

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    3. What in the world are you talking about? You have one chance to make some sense. Use it wisely.

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    4. Your followers were thinking 'drug' rehab sir.

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    5. I thought I made that clear in the story. Evidently not enough. I'll edit it.

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    6. if you will look above, you will see that not all the readers did.

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    7. Anon 02:56, Doc made it clear, don't blame him for your lack of reading comprehension. You're the only one who thought otherwise. The comments regarding drug rehab were all in response to Nicole's post.

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    8. Cut my throat then.

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  11. Curious: Why would you leave the kidney alone if the bullet went through it?

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    Replies
    1. see above - it is because the injury was not so severe that the kidney could not heal on its own.

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    2. *could heal*

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    3. if the damage was not so severe that the kidney could heal on its own, then Doc WOULD need to have dome something about it. maybe hit it with a hammer or something to trigger the self-healing.

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  12. This is when the phrase "You can't help someone who won't help themselves" comes into play sadly.

    I just hope she didn't OD on that first hit she took. As long as she's still alive there's hope that someday she'll see the light.

    (Yes, I am an annoyingly optimistic person, why do you ask?)

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  13. Doc, what did you do for the lung/chest injury? Just close the entry wound and leave the chest tube in place for a couple days?

    ReplyDelete
    Replies
    1. Everyone is six feet tall, slender with super long limbs and tiny heads.

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    2. Yes. The vast majority of pneumothoraces and haemothoraces will heal on their own with just a chest tube.

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  14. I just want to know what angle she was at relative to the shooter to get shot in the armpit and have it come out where it did.

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    1. Doc, if this is getting too detail specific for your comfort, please delete the following comment.

      That said, I hope we get an answer to this because I want to guess and see how close I am.

      All I can picture, from the description given in the post, is that she was either crouched or was pushed down so that she was at least on her knees with the shooter standing almost directly over her on her left side. She put up her left arm in a defensive posture to protect herself and was shot in the armpit. My guess is that it must have been almost a straight shot downward, pretty much through the center of her body.

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    2. No. That's not how you figure out the azimuth angle and bullet trajectory.

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    3. Well, I'm no forensics expert, but I watch one on TV ;)

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    4. I have no idea. It's a strange angle to be sure.

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  15. If it's "almost never good when a bullet goes in one side of the body and out the other", what I struggle to visulise are the occasions when it is good!

    PS I was asked to prove I'm not a robot by selecting all images containing cabbage - and was then presented with several images featuring lettuce! Do we conclude that robots know the difference but humans don't?

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    1. Bullets that pass through tissues without tumbling or deformation have lower velocity and less kinetic energy. They are more than likely to exit the body which means that a low caliber handgun was used in this case.

      The higher the velocity of the bullet, the more kinetic energy, the more shearing forces that produce tissue contusion termed temporary cavity. Rifles.

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    2. Ugi - sometimes the bullet can travel subcutaneously from one side to the other. I've seen several VERY lucky patients like that. That's the only situation.

      As for the verification, Google asks some strange things apparently.

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  16. So quiet in here. Yooooohoooo!

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  17. My real name is Natalia so I did a double take on this post for sure, bless your heart for saving this woman's life. Some people just refuse to listen in this world no matter what you do or tell them, who knows what happened to her after that hopefully she is still on this earth. Doc, is it hard to find a bullet within a human body? I've worked with cadavers in human anatomy in college but with all the fluids we have leaking about when we are still alive what is the trick to doing so?

    ReplyDelete
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    1. It can be nigh on impossible to find a bullet, depending on what body cavity it's in.

      As for the bodily fluids, you'd be surprised how little bleeding there is once the incision clots. It only takes a few minutes.

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  18. Lt. Charles Gliniewicz, the 30-year police veteran from Illinois who was reportedly shot by 3 men he was chasing had gunshot residue on his hand and finger.

    Suicide? Why?

    He was 1 month away from retirement. Why?

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    Replies
    1. more likely he had tried to return fire.

      a bigger question is why a 30 year old is one month from retirement.

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    2. No. The bullet went on a downward motion through his chest so I'm not buying that story. He was 52 yrs old and a U.S. Army Vet.

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    3. I'm beginning to like Trump. I don't agree with his mexican comment but I like his Tax Plan.

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    4. I don't agree with his make Trump rich no matter who it hurts Plan.

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    5. They're all the same but the Dems don't have anyone for 2016. Clinton is just another wealthy figure and both Warren and Sanders won't get the party's nomination because of her. Between Clinton and Trump, I'll go with Trump.

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    6. I can't afford a republican administration. They will gut the ACA and I will be driven the rest of the way into bankruptcy.

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  19. Not so relevant but Amy Winehouse went to my former school. Trivia of the day.

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    1. Goldie Hawn attended my junior high school. We had the same gym teacher (decades apart). I'm glad Goldie is still around being herself and I'm sad that Amy Winehouse is dead.

      Wednesday

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