Holiday request

I'm venturing a bit outside my comfort zone on this post, but it's for a very good reason: to honour a request by Mrs. Bastard.  Now I'm by no means a "Yes, dear" kind of husband, but I do everything I can to make her happy, especially when her request makes my life just a bit easier in the process. 

Last night Mrs. Bastard had an interesting proposal for me.  Unfortunately it did not involve any adult fun-time activities, but it piqued my curiosity nonetheless:

"As a holiday present for your readers, why don't you ask them to ask me questions.  Sort of an 'Ask Mrs. Bastard' kind of interview."

Hmm . . .

I had to admit I was intrigued by the idea.  I seem to recall someone emailing me just such an idea some time ago, but I never mentioned it to her since I didn't think she would ever agree in a million years.  But, as it seems to happen so often with her, I was wrong.  Again. 

Sigh. 

Anyway, she's obviously up for it, so this is your chance, folks.  Put your questions for Mrs. Bastard in the comment section before she changes her mind.  They can be any question you like - questions about her, questions about me, how the hell she puts up with me, what makes her tick, what she sees in me, why she hasn't traded me in yet for a better model, etc.  I solemnly swear (really) I will ask her each and every one.  I do not guarantee, however, that I will post every response, and I can definitely guarantee that any questions she (or I) deems too personal will be ignored and/or deleted with alacrity and extreme prejudice.

Ready?

Go.

Perspective

I have a pretty damned good life, and I'm not a bit ashamed to admit it.  I am healthy, I managed to find the most wonderful woman in the world before anyone else nabbed her, I have two beautiful, healthy children, and I happen to be in a profession that allows me to live a very comfortable lifestyle.  I seem to have no reason or right to complain about anything.  Ever.

But, I still do.  Yes sometimes events around me stack up so that it seems the world is conspiring against me, and at times like these I begin to feel sorry for myself like a big baby.  I whine and complain and moan and groan with no legitimate reason to do so.  Fortunately these times are rare, so my family and colleagues don't have to suffer my maudlin, melancholy, moody self very often (huzzah for synonymous alliteration!).  Plus, it seems that every time I find myself in such a mood, something eventually happens that metaphorically grabs me by the ears and screams in my face, "SNAP THE HELL OUT OF IT, YOU FUCKING IDIOT!"

Just such a thing happened again a few days ago.

As I was on call for general surgery, I went through my entire day seeing patients without a single call from the emergency department/A&E.  Not a gall bladder, not a bowel obstruction, not even a perirectal abscess.  Nothing.  But the Call Gods evidently wanted to have some nasty fun with me, because just as I was about to sit down to read my son a bedtime story, the call came.  

Appendicitis.  Of course.  Goddammit, why?  Why couldn't they call me at noon?  Why must I miss ANOTHER bedtime?  My blood was boiling, my blood pressure was rising, and I started bitching to myself, thinking of an alternative career I could pick up.  I could be a car salesman or a window washer or a chef or anything else god damn it!

Then I took a deep breath.  Calm down, stupid.  It could be worse.  Much worse. 

I went to the hospital to see the patient, who had a relatively simple and early case of appendicitis.  Her operation should take me no more than 15 minutes, so I immediately called the operating theatre.  I was perfunctorily told that there were several scheduled cases from the daytime still pending, and that one of the orthopaedic surgeons had an emergency open fracture to do.  I would have to wait until he was done, which meant waiting another 5 to 6 hours.  At least. 

SHIT.  Moan, moan, moan.  Well, at least I would get to read that story to my son.

I went home, read my son his story (Charlotte's Web, if you were curious) put him and my daughter to bed, and waited.  And whined.  And waited.  And then I whined and waited some more.  Four hours later I was still waiting, so Mrs. Bastard decided to go to bed while I waited and whined to myself.  

Finally just before midnight the operating theatre called me to let me know that they had called in a second team, and my patient was ready.  She was fortunately much more patient and understanding than I.  Regardless, I brought her into the room, helped the anaesthesiologist put her to sleep, and walked back out of the room to scrub.

While I was scrubbing I looked down the hall and saw the aforementioned orthopaedic surgery also scrubbing.  I waved to him and went into my room.  As I was putting on my gown and gloves, I asked the nurse what the orthopaedic surgeon was doing, since he should have been done with the open fracture by then.

"Oh, he's doing a total hip replacement.  On a 94-year old."

He's doing what?  To a what?  At midnight?!

"Yup, he had to bump himself to do the open fracture, so he is just starting it now."

Wooooooow.

As expected, the appendectomy was very simple (it actually only took me about 14 minutes).  I finished my surgery, scrubbed out, spoke to the patient's son, changed, and went home, all before the orthopaedic surgeon had really gotten into the meat of his case.  

And just like that, I realised I could be that guy.  Even worse, I could be that guy's patient.  Suddenly I didn't feel sorry for myself anymore.  My minimal misery was severely put in its place.  

I got home around 1AM, snuck into my children's bedrooms, gave them both a kiss, tucked them in, crawled into bed, kissed my wife, and promptly fell asleep. 

Life was good again. 

Ha freaking ha

It's time for another post about the Call Gods.  Yes indeed, yet another goddamned post about the goddamned Call Gods.  I can hear several of you groaning, "Not another Call Gods post!  We're sick of hearing Doc's paranoia about them, especially since they don't exist."

And that's where you're wrong, nonbeliever.  They exist.  Oh, do they ever exist. 

What, you don't believe me?  Still?  How is that even possible?  Are you even listening??  After everything I've told you, you still don't believe me? 

Juuuuuust wait.  You will.  And by the end of this post if you still haven't converted to my weird little religion, then you obviously haven't been paying attention this whole time, and you should probably head off to YouTube to search for some fail videos or something.  Or maybe go check out fmylife.com.  Either one will make you feel just that much better about your own life.

Where was I?  Oh right, I was talking about myself as usual.  Anyway, in addition to the fucking Call Gods (Ha ha!  Just kidding, Call Gods!  Please have mercy!) I also talk about appendicitis a lot, because I see it a lot.  It seems to me sometimes that I'm curing the world of appendiceal disease one person at a time.  But lately I've been in a bit of an appendix lull.  I haven't taken out an appendix in about a month, whereas I usually do at least one or two a week, if not more.

Hear that foreboding music yet?

This morning as I showered (stop picturing me nude, you perverts) I was thinking "Wow, I haven't done an appy in a while.  How long has it been?"  It had been at least three weeks, and I couldn't remember ever going so long between appys.  So I tried to remember the last one I did. 

Dun dun duuuun . . .

The call from the emergency doc predictably and inevitably came at 4 PM (at least it wasn't midnight, right): a healthy 62-year old guy with, you guessed it, acute appendicitis.  I went to the hospital to do the surgery, which turned out to be uncomplicated and relatively easy.  But just as I was finishing up, my mobile in my pocket rang.  "There is my next appendix," I joked with the staff.  I finished up and took the man to recovery.

Much to my relief, the call had been from a friend, not from the emergency doc again.  WHEW.  I changed clothes and got in my car, happy I would be home in time for dinner and my kids' bedtime.  

Dun dun duuuuun . . .

I hadn't even pulled out of my parking space when my mobile rang again.  I recognised the caller ID immediately - the ER/A&E.  And as you've probably surmised by now, it was indeed yet another appendicitis patient.  As I write this, I'm sitting in the operating theatre waiting for him to come up from emergency.  I've now missed dinner, and my kids will be fast asleep by the time I get home.  Mrs. Bastard too, most likely.

Fuck you for ruining yet another evening with my family, Call Gods.  Fuck you.

Jahi McMath update

In lieu of a stupid patient story this week, I have an update on the Jahi McMath saga.  That's right, the story that just won't go away still hasn't gone away - Jahi McMath's family has filed an amended complaint (thank you Professor Thaddeus Pope for uploading it) stating that they have evidence that she is, in fact, alive.

A board-certified pediatric neurologist claims to have examined her and has determined that she does not meet brain death criteria.  As Prof. Pope explains, the focus will be on paragraphs 30-36.  I'll present some excerpts from the complaint followed immediately by my thoughts on each.

30.  Since the Certificate of Death was issued, Jahi has been examined by a physician duly licensed to practice in the State of California who is an experienced pediatric neurologist with triple Board Certifications in Pediatrics,  Neurology (with special competence in Child Neurology), and Electroencephalography. The physician has a sub-specialty in brain death and has published and lectured extensively on the topic, both nationally and internationally.  This physician has personally examined Jahi and has reviewed a number of her medical records and studies performed, including an MRI/MRA done at Rutgers University Medical Center on September 26, 2014. This doctor has also examined 22 videotapes of Jahi responding to specific requests to respond and move.

This is specifically different than their prior claims in that this time a board-certified physician, a pediatric neurologist, in fact, has actually personally examined her.  According to the complaint he has also watched 22 videos of Jahi responding to verbal stimuli.  This paragraph gives me great pause for two reasons.  First, why is the physician not named?  There is much speculation that the doctor is Alan Shewmon, who is a vocal opponent of brain death, but why not reveal his name?  Second, why should he have to watch videos of Jahi supposedly responding to voice commands if he has personally examined her?  Did she not respond to commands when he was with her?  And are these the same lousy quality videos that have been posted and scrutinised already?  This strikes me as very odd.

31.  The MRI scan of September 26, 2014, is not consistent with chronic brain death MRI scans. Instead, Jahi's MRI demonstrates vast areas of structurally and relatively preserved brain, particularly in the cerebral cortex, basal ganglia and cerebellum.

32.  The MRA or MR angiogram performed on September 26, 2014, nearly 10 months after Jahi's anoxic-ischemic event, demonstrates intracranial blood flow, which is consistent with the integrity of the MRI and inconsistent with brain death.

Cerebral blood flow and MRI scans do not factor into clinical brain death.  And why are they referencing an MRI/MRA from over a year ago?  Don't they have a more recent study?  If not, why not?  If so, why don't they present it?

33.  Jahi's medical records also document that approximately eight months after the anoxic-ischemic event, Jahi underwent menarche (her first ovulation cycle) with her first menstrual period beginning August 6, 2014. Jahi also began breast development after the diagnosis of brain death. There is no report in Jahi's medical records from CHO that Jahi had began pubertal development.  Over the course of the subsequent year since her anoxic-ischemic event at CHO, Jahi has gradually developed breasts and as of early December 2014, the physician found her to have a Tanner Stage 3 breast development.

34.  The female menstrual cycle involves hormonal interaction between the hypothalamus (part of the brain), the pituitary gland, and the ovaries. Other aspects of pubertal development also require hypothalamic function. Corpses do not menstruate. Neither do corpses undergo sexual maturation. There is no precedent in the medical literature of a brain dead body developing the onset of menarche and thelarche.

I find it very hard to believe that Jahi, who was 13 at the time of her operation, had not started menstruating already.  According to a recent study of American girls, the average age of thelarche (breast development) is 9.7 years and menarche (onset of menses) is 12.8 years (12.2 for black girls).  It is highly probable that she had started menstruating already, and besides she would also not be the first brain dead child to undergo puberty, so these paragraphs are essentially irrelevant.  What bothers me most about this paragraph is that she had already started to develop breasts before her surgery as this picture proves:

This is a blatant lie in the complaint - she had undergone thelarche without question, likely years before (statistically speaking).  If they are so willing to make such an obvious lie in a legal document, what else are they willing to lie about?

35.  Based upon the pediatric neurologist's evaluation of Jahi, Jahi no longer fulfills standard brain death criteria on account of her ability to specifically respond to stimuli. The distinction between random cord-originating movements and true responses to command is extremely important for the diagnosis of brain death. Jahi is capable of intermittently responding intentionally to a verbal command.

This is the key paragraph.  The anonymous neurologist claims that she responds to stimuli . . . intermittently.  If this is actually true, then she is not brain dead.  However, that is a very big "IF", and it hearkens back to the question of whether or not she was able to respond when examined by the neurologist or only on video.  If she was only responding to voice on the videos, that is worthless as evidence in my opinion.  If I were the presiding judge, not in a million years would I accept those vague and unreliable videos as evidence of anything.  What this paragraph does not say is that the doctor performed (and that Jahi passed) a bedside brain death exam.  Perhaps I'm reading too much into it, but perhaps not.

36. In the opinion of the pediatric neurologist who has examined Jahi, having spent hours with her and reviewed numerous videotapes of her, that time has proven that Jahi has not followed the trajectory of imminent total body deterioration and collapsed that was predicted back in December of 2013, based on the diagnosis of brain death. Her brain is alive in the neuropathological sense and it is not necrotic. At this time, Jahi does not fulfill California's statutory definition of death, which requires the irreversible absence of all brain function, because she exhibits hypothalamic function and intermittent responsiveness to verbal commands. 

There are numerous reports of brain dead patients being kept on somatic support for years without their bodies deteriorating, so the fact that this has not happened to Jahi is also irrelevant.

In all, the evidence supplied by Jahi McMath's lawyer is suspect at best, worthless at worst.  I am incredibly curious why the neurologist was not named - this seems a very strange way to run a high-profile legal case.  Perhaps the anonymity was maintained because it is so high profile, but perhaps one of the lawyers here could shed some light on whether or not this is typical.  Regardless, I will wager these claims will be enough for the judge to allow the case to continue.

My one takeaway from this update is that if paragraph 35 is true, if she is truly able to respond to verbal stimuli, even intermittently, then she IS NOT DEAD.  Full stop.  Keep in mind that any claims of responsiveness made by the family will need to be verified by an outside neurologist.

And with that, I will open the comments to whatever wild speculation your brains can come up with, except for one particular individual who remains banned and whose comments will be deleted immediately (you know who you are).

Trauma drama

There's a very good reason "trauma" and "drama" rhyme.  I'm convinced that whoever was responsible for those two words' etymology could see the future and just knew that trauma patients would cause the second-most drama in the hospital.  The most is caused by psychiatric patients of course, unless you watch Grey's Anatomy, in which case you believe the drama is a result of the nurses and doctors all sleeping with each other in every bathroom, janitor's closet, and stairwell in the hospital.

As usual, I digress. 

Since I don't deal with psychiatric patients (much) (thank god) (there's a reason for that), I have to be satisfied with the Trauma Drama.  Fortunately, I'm seldom disappointed. 

Maurice (not his real name™) was brought to me one gloriously dramatic day having been shot in the back.  That doesn't usually happen if you're the victim of an attempted robbery (most armed robbers give up when their victims run away), nor does it happen often by accident.  Ordinarily you'd have to do something pretty awful to deserve being shot in the back.  

Maurice certainly fit the bill.

The trajectory of the bullet was admittedly strange to me - it entered his flank on one side and exited the mid-back on the other side.  That's an awfully odd track, so I instantly suspected something weird.  Maurice, like most every gunshot victim, wasn't offering up any details about what happened.  It's quite amazing how people instantly clam up the moment you ask how and why they got shot.

Regardless, Maurice's vital signs were surprisingly stable, though I strongly suspected something awful was going on inside his abdomen.  I pushed lightly on his belly, and he made a noise somewhere between a grunt and a squeal.  No need for a CT scan here - Maurice had peritonitis, and I called the operating theatre immediately.

I rushed downstairs and managed to beat him by several minutes.  I was waiting there with the police officers (who apparently had a few questions to ask Maurice), and they seemed to be chuckling to themselves.  When they saw me, they asked if I expected Maurice to live.  I told them I had no idea, and that it depended on what kind of catastrophe I found. 

"Did you hear what happened, Doc?" one of them asked me.

Oh, do tell.

"Maurice here was sleeping with his best friend's girl.  His friend found out about them, but he didn't say anything to Maurice, and they just got in his car together.  I guess he was planning on driving him to some remote location and then shooting him, but they didn't get that far, so the guy just turned and shot him while they were still in the car."

During surgery I found a series of holes in his small intestine and two in his colon.  It took me a bit less than two hours to remove two segments of his small intestine, put the ends back together, and repair his colon.  I left the operating theatre and told the officers that I expected him to live.

But the drama didn't end there - Maurice's wife showed up to the hospital later that evening.  I spoke to her briefly to tell her what I found and what I did to her husband, and she barely responded at all.  Based on the look on her face (which strangely reminded me of the look on MomBastard's face when I was a child and she knew I had done something wrong, I just didn't know which evil deed of mine she had discovered), someone had already told her why Maurice had been shot.  I (wisely) decided to leave it alone and not poke that particular snake.  I decided simply to be satisfied that Maurice didn't die from his wounds. 

Somehow his wife didn't kill him either.