Monday, 14 December 2015

Better than I

Yes, the title is "Better than I", because I'm an obnoxiously pedantic stickler for grammar, and "better than me" is grammatically incorrect.  So there.  And yes, "So there" is a sentence fragment, because I also have artistic licence.  Huzzah!

Anyway . . .

I've never really considered myself much of a wordsmith (though MomBastard and DadBastard might disagree with me), especially when it comes to speaking aloud.  When I write words on the page, however, I somehow (usually) manage to get relatively coherent thoughts from the deepest bowels of my brain onto the paper (virtually speaking), and it occasionally even comes out with some modicum of eloquence (though not in this post, apparently).  But sometimes, believe it or not, I find myself at a loss for words.  It doesn't happen often, and it always involves something surprising, shocking, or wholly unexpected.  When I find myself in this situation, I find it difficult (and sometimes impossible) to express myself.  The words which do tumble effortlessly out of my mouth in times like these resemble something a bridge troll might say.

Fortunately Glen (not his real name™) had no such tongue-tying problem.

Most of my patients bring themselves to me.  Not literally, of course.  What I mean is that most of them have done something that have caused their injury, either directly or indirectly.  A select few, however, are actually innocent victims, and through no fault of their own find themselves with a hole in something that needs fixing.  Glen fell squarely into that category.  He was on his way to his car after finishing his night shift at a store when he was carjacked.  He had undergone training at work and was taught to comply with the bad guy, so Glen did everything the bad guy screamed at him to do - get out of the car, hands in the air, give me the keys.  But as the bad guy got into his car, he turned around and shot him anyway.

This makes me believe that "mankind" is one of the English language's great oxymorons.

Glen was brought to me shortly after midnight as a "Level 1 gunshot wound to the chest".   These patients are usually either A) dead, B) alive but actively dying, or C) completing the act of dying when they roll through my door, but not Glen.  Unlike the usual pale, sweaty, and/or unconscious gunshot wound victim, Glen was sitting up on the stretcher, making jokes with the medics.  With a blood stain on his shirt. 

Um . . . what?

"Hey there Doc, this is Glen," the medic started.  "He was carjacked and shot this evening.  He has two gunshot wounds, one to the left shoulder, and one to the right chest.  No active bleeding.  He's been stable the whole time, blood pressure is 125/60, heart rate is 65, oxygen saturation is 100% on room air."  

A quick glance at Glen's wounds revealed that the medics had described him exactly right.  It appeared as though the bullet had gone into the back of his left shoulder, through both sides of his thorax, and out through his right chest.  I immediately started ticking off all the vitally important structures between those two holes:
Approximate location of Glen's wounds
  • Heart
  • Lungs
I initially stopped there, because just those two organs (ok three, technically) are enough to make any trauma surgeon incredibly nervous.  But unfortunately there is much more: aorta, pulmonary arteries, pulmonary veins, superior vena cava, left innominate/subclavian artery...

You get the idea. 

As I was looking at him quizzically, wondering how he was still alive let alone looking healthier and in a better mood than I (other than the several holes he had in his body that I did not), he flashed me a huge smile and said, "Hey Doc, how long do you think this will this take?  I have to be at work at 10."

Wait, wait, wait.  You just got carjacked and shot, and the thing you're most worried about is being on time for work?  The same work where you just got shot?  What kind of person does that?

I liked him instantly. 

I explained to him that he may have serious, life-threatening injuries, and he may need a huge life-saving operation depending on what those injuries were.  Since he was so stable, I sent him for a CT scan to see where this magic bullet had gone and what it had hit (or not).  As the pictures flashed on the screen, the look on my face must have gone from incredulity to amazement and back again.  The bullet had gone into the back of his left shoulder (missing his scapula), through his left trapezius muscle, between two ribs (fracturing neither of them), grazed the left lung (which was not collapsed), into the left pectoralis muscle (missing the subclavian artery and vein), through his sternum, through his right pectoralis muscle, and back out into the outside world.  Of all the major structures between the two holes, the bullet had hit exactly ZERO of them.  All he had was a fractured sternum.

As soon as I finished looking at the scans (and picking my jaw up off the floor), I went to give Glen the news.

"Well Glen, I have some good news and bad news.  The good news is that the bullet did no major damage to anything."
"That's great!  What's the bad news, Doc?" he said.
"The bad news is that I need to keep you here in the hospital overnight, and you're going to be late for work."   I tried to tell him how lucky he was, but my brain locked up.  I couldn't think of anything witty or even remotely interesting to say.

Glen had no such issues.  He flashed me another huge smile, gave me a high five, and summarised the situation better than I ever could:

"Well ain't that some shit."

Yes, Glen.  Yes it is some shit.  Those probably aren't exactly the words I would have used, but hell, who needs eloquence anyway.

55 comments:

  1. Surely "than" takes a subject only in conjunctional use "better than I am at expressing myself" and takes an object in prepositional use "better than me".

    I hope Glen cashed in his luck on the lottery that day!

    Ugi

    ReplyDelete
    Replies
    1. It depends if you see "than" as a preposition or a conjunction. I was taught that it is a conjunction, so "than I" would be correct always. But there are those who believe it to be a preposition, so "than me" would be correct. Both are considered standard usage, but I believe "than I" is correcter, simply because I enjoy being pedantic that way for some strange reason. https://motivatedgrammar.wordpress.com/2012/06/13/than-i-and-than-me/

      Delete
    2. Being a fellow grammar pedant, I see that title can go two ways.

      For example:
      She likes carrots better than I (like carrots).
      She likes carrots better than (she likes) me.

      Delete
    3. Those sentences have different meanings though, which is the reason I versus me is correct. Your argument is more that there are correct usages for than me that mean something else entirely than than I.

      Also, please forgive my lazy lack of quotation marks, I'm on my phone. And lazy.

      Delete
    4. Side note: I've been following this blog since day one, and it took a discussion on grammar for me to post a comment. 😂

      Delete
    5. Sarah - I obviously agree with you, but there is a substantial call which does not. I'm not a linguist, so all I can do is continue as I was taught.

      And thanks for finally commenting. I'm glad you decided to join us.

      Delete
    6. I agree with Sarah and DocB regarding the two usages having entirely different meanings which means Doc's usage was correct for what he meant.

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    7. I have been taught that the best gauge is to finish the phrase.

      "better than me am" is most definitely not right.

      Delete
    8. I am not only an English teacher but was taught grammar by nuns during the 50s and 60s, and would go with "I".

      Delete
    9. Well I think that should just about settle it. Thanks, Paula.

      Delete
  2. Doc, do you perform FAST exam/trauma ultrasound in your facility?

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  3. Replies
    1. Lucky doesn't even begin to describe it. I don't know WHAT went right that night and how many bad endings it will take to even out the statistics, but this is incredible! I bet this is a once-in-a-whole-career thing for DocB too! (Though of course I hope more good people end up lucky. Sadly I'm a realist though.)

      Delete
  4. In gunshot wounds, if the heart is beating, they have 95% chance of surviving.

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    Replies
    1. I would guess that nearly 100% of the time, when someone is shot, their heart is beating.

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    2. Anon 23:33 - I assume you mean that the survival rate is 95% if the heart is beating when they arrive? That may be true (I don't know the statistics offhand), but I don't know what point you're trying to make.

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    3. I was just wondering. Can you describe the characteristics of the gunshot wound on the left shoulder vs the right chest.

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    4. Only if you can describe how that information would be relevant. If you're trying to figure out which is the entry wound and which is the exit, forget it.

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    5. It's the assumption that the exit wound is always larger than the exit wound. That is not the case at all. Physicians without forensic training should refrain from making statements regarding entrance and exit wounds without actually measuring the wound, photographing them, and sending sample tissues for microscopic analysis. That's one way of interpreting gunshot wounds.

      Delete
    6. I meant to say the assumption that 'exit wounds is always larger than the entrance wound.'

      Delete
    7. He was facing away from the attacker and therefore was shot in the back. That's called listening to the patient, not making an assumption.

      Anything else, John? Your pathetic attempts at discrediting me are getting more and more desperate.

      Delete
    8. John has been googling again and believes he can trick DocB into messing up. Better luck next time Benton.

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    9. and, as always, basing his premise on wild assumptions.

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  5. Wow. With that kind of luck, I wouldn't be surprised if his car was eventually returned to him.

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  6. Glen sounds like he'd be a fun drinking buddy.

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  7. I like Glen too. I hope he went out and bought a winning lottery ticket and invited DocBastard out for a drink where they could both spend some time swapping stories.

    Everyone has an outrageous story to share. Some of us have too many.

    Wednesday

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  8. It isn't of that caliber, but last week I used a fire engine to transport the medics to a patient through floodwater - today, I recovered the wheel chocks that the water flushed out of the brackets, AND a representative of the patient told me to pass the word that the patient is recovering.

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  9. Dr. B:
    On the subject of the path of bullets- any thoughts on the most famous bullet in history - the one that struck John Kennedy and then John Connally?
    One bullet, seven wounds?
    Just curious.

    ReplyDelete
    Replies
    1. I honestly have never sat down to investigate it, so I don't know enough about it to formulate an opinion. I may have to look into it in more detail.

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    2. essentially, once a bullet hits something more solid than air, there is no telling what it will do. my vet told me of a dog he had seen. in a hunting accident, the dog was hit in the back of the head with a .22 caliber slug. the slug came to rest at the base of the dog's tail. the dog had no long term injury.

      Delete
    3. Because they haven't proven it. It will forever remain a 'theory.'

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    4. They haven't proven it doesn't sound very convincing to me.

      If you look at Connally's wounds and when he received them according to the Zapruder film, there doesn't seem to be any bullet trajectory other than thru Kennedy. Where else could the bullet or bullets could have come from?
      But I defer to an expert on wound ballistics and trauma.

      Delete
    5. Anon - Comments like the ones you just made about the Kennedy assassination conspiracy will absolutely not be tolerated. You can take that shit elsewhere, but you will NOT post it here. Do you understand?

      This thread is closed. DO NOT make any further comments on this topic.

      FULL STOP.

      Delete
    6. This comment has been removed by a blog administrator.

      Delete
    7. What part of "This thread is closed" did you not understand?

      Fuck off, troll.

      Delete
  10. As far as expressions go, I've always been partial to this line.

    "You're a better man than I am, Gunga Din!"

    Seems timeless.

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  11. Doc, your grammar is usually always correct, though your punctuation is not always spot on. Generally I stop reading whatever I'm reading if I see any kind of error, but since I'm such a fan, I let it slide. Although commas cannot literally save lives, you do on a daily basis and I respect and admire you for that. Also, I'm glad Glen was fine.

    (In case anyone was wondering... I'm an editor/publisher; it's my area of expertise. I don't need to justify myself to you. If I'm not getting paid to edit, I won't waste my time reading amateur work. Though, I would happily edit Doc's writing.)

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    Replies
    1. "Doc, your grammar is usually always correct"
      "usually always"

      Oh, the irony.

      Delete
    2. Muphry's law: any attempt to correct spelling or grammar online will contain a spelling or grammar error.

      Delete
    3. Anon 10:11 - If I ever misuse grammar or punctuation, please point it out. I'm not asking for a formal editor (I have one of those over at The Daily Beast already), just a friendly email telling me that I'm an idiot for abusing the Oxford comma or something. I'm always up for learning to correct old mistakes.

      Delete
  12. How do you explain this? A 50 yr old male found unconscious by girlfriend in bed. Brought to ER, intubated and found to be stable hemodynamically. Girlfriend said she heard 1 shot at 2 AM.

    Physical exam - No evidence of gunshot wound anywhere in the body. Negative thoracic wall injuries.

    Total Body CT scan showed a retained bullet in the R lung.

    Question: Where was the bullet fired from?

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    Replies
    1. Hi Anon - Though I enjoy a good mystery as much as anyone else, I must admit I don't appreciate your recent attempts at hijacking the comments. If you'd like to start your own medical mysteries blog, feel free.

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    2. It came from ABEM review questions. Happy?

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    3. So you're just copying questions from a book? Why on earth do you think that would make me happy? The fact that they aren't even your stories makes it worse.

      No more. I trust I won't have to ask you again.

      Delete
    4. What happened?

      Delete
    5. Someone decided to post some offensive comments and wouldn't stop despite several warnings, so I set the comments to "moderated" until he goes away.

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    6. I saw what he posted. I don't believe they were offensive at all.

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    7. Then you either A) are just as bigoted as he or B) didn't see the actual comments that I deleted. Considering my usual content, if *I* find something offensive, then it probably is.

      I will not speak about this any further, and any future comments on this topic will be deleted. I have no idea why that needs to be said, but clearly a few of you are incapable of getting the message through your thick skulls.

      Delete
    8. The bullet was fired from a gun. As to how it got into the victim's lung, I have no idea.

      Delete
  13. More than one "Anonymous" is too many. I really don't care if my comment makes it past moderation, however, if you have the power, would you limit the user names to unique ones only? Thanks.

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    Replies
    1. I've thought about it, but I haven't done that yet. If this continues, I will. But then folks like Wednesday would have to spend 12 seconds creating a google account.

      Ahem.

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    2. While I appreciate how irritating John can be, I don't believe that limiting comments to registeres users only is ideal. I cannot speak for Wednesday, but I do find it liberating to be able to comment anonymously once in a while; sometimes my opinions on similar issues can vary wildly and I wouldn't appreciate some stranger calling me out on my inconsistency, as I'm aware of it. Plus, it's one more password to remember and God knows I've way too many of those.

      I digress; your blog, your rules. Great read as always, Doc :)

      Delete
    3. Myrtilus didn't get his wish?

      Delete
  14. I already have a Disqus profile but that's not an option here :o(

    ReplyDelete

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