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.
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?
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.