Monday, 5 October 2015

Sense. This story makes none.

If you've been here for a while, you know by now that some of my stories make little sense until the big reveal at the end (at least that's how it seems in my ego-inflated head).  You know, something like an M. Night Shyamalan movie . . . before they started to suck.  Now don't misunderstand me, I don't mean to say I think my stories are as good as the Sixth Sense in any way.  I'd never be that arrogant.  Maybe as good as Unbreakable, though.  Yeah.  But not The Happening.  God no.  And definitely not The Village or Lady in the Water.  Those two steaming piles of horse shit represent several hours of my life I'll never get back.  Those 4 hours would have been better spent waxing my back or learning to juggle chain saws. 

Anyway, this isn't one of those stories.  Like all of M. Night's recent movies, this one makes no sense at the beginning, fails to improve by the middle, and by the end there is just no good resolution at all.

Make sense?  No?  Good.  Kind of makes you want to stick around to read it, just to watch the impending train wreck, right?  Hello?  Are you still there?

Damn it.

For the two or three die-hard masochists who still remain (likely just my parents . . . they'll read anything I write no matter how bad it is), I'll do my best not to bore you.  Much.

Just as I was sitting down to eat my very appealing-looking Frozen Vending Machine Hamburger© (I swear I saw something similarly appetising in Shaun Of The Dead), my pager alerted me that an assault had just arrived in the trauma bay.  Wait no, not an assault, but two assaults.  

My "meal" would have to wait.

Walk-ins are not terribly uncommon, but two arriving simultaneously is, and it usually indicates a pub brawl.  The patients are usually two of the lesser entrants who couldn't hold their own against their larger (and drunker) opponents.  Occasionally it's domestic violence or something similar where the two patients beat each other up.

Nope.  Not this time.  Not exactly.

When I got to the trauma bay a minute or so later, the first victim was obvious - a young woman sitting on a stretcher with a black eye, holding a toddler in her arms.  Since she looked reasonably ok, I immediately started searching for the second victim who I thought might need closer attention.  But the trauma nurse saw me looking around, smiled that "I-know-something-you-don't-know-but-will-definitely-upset-you" smile, and pointed to . . . the baby.  The same baby who was sitting happily in mum's arms, smiling, drinking a bottle.

Really?  Really?  The baby was the second trauma victim?  What the . . .

I went back to Lisa (not her real name™) to assess the damage.  No instability in her face, no bleeding, normal eyesight.  Her 6-month old baby was happy as can be with no ill-effects whatsoever.  After speaking with Lisa for a few minutes, I got her story.  Apparently she had been arguing with the baby's father when he had punched her in the face (because that's apparently what people do when they argue).  Unfortunately the argument was taking place on the top of the stairs (because apparently that's where people argue), and Lisa had been holding the baby at the time (because apparently screaming at your mate while holding your child is normal behaviour).  She tumbled backwards down the stairs, baby and all.  She lost consciousness, but the baby was shielded by Lisa and wasn't even scratched.

I evaluated the baby, and he seemed completely fine, bright-eyed, not crying, uninjured.  I did a quick head-to-toe examination, and finding not a single mark on him or anything remotely resembling a traumatic injury, I sent him to the main department to be evaluated by the emergency physician. 

Other than the black eye Lisa was also uninjured.  A CT scan confirmed no brain injury and no facial fractures.  As I was looking at her scan, a nurse brought in the baby.  To be scanned.

Yes, the emergency physician had bewilderingly ordered CT scans of the brain, spine, and face for the baby.  FOR THE BABY.  They were all negative.  Please try to contain your surprise.

What did not come back negative was Lisa's urine drug screen, which was positive for cocaine.

After the baby was cleared by the emergency doc, I sent them both home, still shaking my head in bafflement at the sheer absurdity of it all.

Did any of that make sense to any of you brave souls who stuck around?  Because none of it did to me.  Still doesn't.  I've read this back half a dozen times, and it's all completely ridiculous.

The only thing that makes less sense is that after it was all over, I went back and still ate that damned hamburger. 

EDIT:
Several people have already pointed out the obvious that the emergency doc was just covering his ass by over-ordering tests.  While I understand that perspective, there was absolutely no indication to expose this child to any amount of radiation, let alone 3 CT scans' worth.  

54 comments:

  1. Agreed, none of this "makes sense" if we base our assessment of the situation on what we think that normal, reasonable people would be doing. But, sadly, there IS a reason to err on the side of caution, sometimes almost to the point of absurdity, when there's a small child involved in a situation in which there are also the dynamics of domestic strife and/or substance abuse. Looks like you had both here.

    The ER doctor surely saw the same thing you did...the baby appeared OK, in terms of not having suffered injuries from the reported "fall." The extra screening is meant to check for *other* injuries, perhaps internal and already healed to a degree, that might have resulted from previous abuse or neglect.

    Does this hospital have a policy in place, or a requirement established by local ordinance, that requires this extensive examination when a young child who has suffered an injury while in the care of the parents is brought in? Sadly, it's now routine in my little corner of the world. :(

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    1. We see so few babies that I have no idea.

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    2. see any assaults by babies? I know a person who got a broken nose from a baby.

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    3. theoretically a baby should not be big enough to do enough damage to need your services, but it sounds like that is no guarantee you won't be seeing the victim, anyway.

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  2. Oh, I stick around and read the posts all the way through. I find it a bit like reading a mystery novel, or watching one of those not-quite-got-it-right crime shows on TV: I'm always trying to play "Guess what the result is" before I get to the big reveal.

    This time? Completely got me. Was not expecting mother and child, at least, not mother and baby. Mother with a black eye, my first thought was, "Maybe a toddler threw a toy." and that the second trauma would have been unrelated.

    As for the burger, well, I can actually understand that, at least. While vending machine burgers are rarely appealing to look at, and sometimes less appealing to eat, hunger, as they say, really is the best spice of all.

    Regarding fighting at the top of the stairs while holding a child... I highly doubt situational awareness was either of the parents' strong suits on that one. Punching someone at the top of the stairs could have been a heck of a lot worse than just a black eye and some bruises. While they're holding a kid could really have ended up being worse. Not that I advocate punching people, as there are far more effective ways to settle a disagreement without resorting to violence.

    As for the extensive examination of the baby, I can actually somewhat understand that: Basic Cover-Your-Ass along with making sure someone who can't say that they hurt or where it hurts is physically okay. Last thing anyone wants to deal with is the idiot father wandering in screaming "You killed my baby!" Because we both know some idiot stupid enough to punch his mate and child down the stairs would be the type to show up and blame it on anyone else but himself if any harm actually came to them.

    Anyway, I've rambled on long enough. I need to learn not to make replies to things at 4:30 in the morning. I get long-winded (well, I would if I were talking. What would you call it here exactly?) when I'm tired.

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  3. Eh, my mom actually fell down the stairs holding me as a toddler, she drove me to the ER,and waited for the next day to get her severely sprained ankle checked. She was worried that her memory of the fall was inaccurate (having been an RN with a background in psych, knew memory was not always accurate), and I may have had injuries.

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  4. The thing that amazes me is that she didn't try to blag some opioids from you "for the pain"!

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  5. If her tox screen was positive, I am surprised the CPS was not called.

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    Replies
    1. Yeah why wasn't child services called? How was she able to take her child home after something like that?

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    2. There was no evidence of either 1) abuse or 2) neglect. There is no ethical or legal reason to call just "because mum did something stupid".

      Read this for more information: http://journalofethics.ama-assn.org/2009/02/cprl1-0902.html

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    3. Whether or not child protective services, police, or any other agency gets involved is usually a function of what procedures the hospital has to follow, as determined by local ordinances. That's an administrative policy, not necessarily something a doctor in the ER trauma bay is left to figure out on his or her own.

      As we've speculated previously, that may have been the reason the ER doc ordered the CT scans for the baby (to rule out healed fractures or other previous trauma that might have indicated prior abuse). Once the baby was found to be in good health, the hospital had done its due diligence as required in that jurisdiction.

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  6. Doc: If Lisa had no insurance then that would mean that she lives in a country that doesn't have a uniform health system. Correct?

    The word 'mate' is also slang for 'friend' or 'partner' used in New Zealand, Britain, Australia, and Tasmania.

    So doc, are you from the land down under or NZ?

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    1. John - I have no idea where you got any information regarding insurance. Please point out where you saw that, or everyone will (likely correctly) assume that you invented it in yet another failed attempt to make me look bad.

      Mate: (noun) 1. each of a pair of birds or other animals. That's straight out of a dictionary, definition #1, not slang.

      Any other questions? I do so enjoy our little chats.

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    2. "Other than the black eye Lisa was also uninsured."

      Doc: You edited the word 'uninsured' to 'uninjured.'

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    3. I guess at that point we realize that everybody else saw that in context and automatically read it as "uninjured" because it matched the context of the story.

      so that leaves the question of whether you read it as uninsured because your brain is defective, or if you sought it out because your obsession with DocB indicates your brain is defective.

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    4. It's not that had to edit blogs my friend.

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    5. Apparently, at least for you, reading comprehension is that hard. The word "uninsured" does not make sense in that sentence. The word "uninjured" is obviously the intended word.

      Oh, and you used the word "had" incorrectly in your post.

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    6. Yes it does.

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    7. it is actually very difficult to proofread your own writing because you know what it should say - and I'm NOT your friend.

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    8. No, I did not edit anything except for the "EDIT" paragraph at the end, John. "Uninsured" doesn't make any contextual sense anyway, so you're accusing me of lying to make you look stupid.

      I think everyone else will agree that you don't need my help to look stupid.

      Although I truly enjoy watching you make a buffoon of yourself on every post, your antics have run their course. Goodbye, John.

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    9. Is John just now "realising" Doc used the word mate and is trying to pin point where he is and who he is? In all the articles Doc has written and with John's futile attempts to "terrorise" him by nit picking every single word, he never picked up on reading his British way of spelling words? Piss off you muppet!

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    10. doc has mentioned he makes a point of using Oxford spellings as the medical industry commonly prefers them.
      not that this reduces the sincerity with which we invite him to bugger off.

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  7. once I got to the part about her testing positive for cocaine, it all made sense.

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    Replies
    1. If you drink alcohol you do drugs. hypocrite.

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    2. and what drug is driving your thought process?

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    3. Anon 05:49 - The major difference is that cocaine is illegal. Now keep the conversation civil or you will be deleted. That will be your only warning.

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    4. If you are anti drug because you think drugs have a negative affect on the body, or because you think someone should not be doing it just for the fun of tripping out, then you are being hypocritical because the majority of people on this page have done alcohol. Tell me I'm wrong bubba.

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    5. okay, you're wrong bubba.

      to be precise you are making assumptions with absolutely no basis.

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    6. Anon - that's not the way the hypocrisy works. Here, I'll spell it out for you so hopefully even you can understand: An example of hypocrisy would be saying "Doing cocaine is wrong" when you are an active cocaine user. But what you're saying is "Well, you've used a drug (alcohol), so if you aren't in favour of ALL drugs then you're a hypocrit". That isn't hypocrisy, it's just stupid.

      I'm glad I could clear that up for you.

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    7. and then, of course, there's the assumption that I'm drunk.

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  8. Awesome post as always Doc. For some reason before reading it I had a question pop up that I'm not sure if you have answered before...has Mrs. Bastard ever thought of doing a post about Intreasting stories that come up being married to a trauma surgeon?

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    Replies
    1. Thank you, Matthew. That's an excellent question, one I've never thought to bring up to her. She isn't much for writing, so I doubt she would be interested. But I will definitely ask her. It would be my first guest post!

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    2. I'd be interested too. :)

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  9. You know, it was enough that the story was absurd. The turn the comments took was equally so.

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    Replies
    1. you say that like it's a bad thing.

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    2. One point for Lisa. Two points for Ken.

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

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    1. I am so confused by this comment...

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

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    3. Thank you for that information... Almost as confusing about the relevance as the above comment.

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    4. Alzheimer's and other dementias would do that.

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  11. Replies
    1. Eventually he'll get the message.

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    2. I wouldn't hold my breath.

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    3. We can only hope Ken. We can only hope.
      Connor

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  12. Note this ismt john!
    I thought ct scans had so low amount of radiation that its negligable and needs not b worried about? Im asking becuz i dont know i know i dont know better than u do doc. Is it not negligable for babies? Or is 4 ct scans (which i KNOW is excessive!) To much radiation at that point? At least for a baby? Again this is Not john. Im asking to find out for myself. Im not so arrogant to think i know better than an actual doctor
    Connor

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    1. Also sorry for shorthand and typos typing on my phone.
      Connor

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  13. Hey doc! Love your stories. But wouldn't you have had to call social services if the mother tested positive for cocaine?

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    Replies
    1. We can only hope he/someone did.

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  14. This is just nitpicking but a 6 month isn't a toddler yet.

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