Monday, 27 April 2015

Foreign body

NOW I've seen everything.  No, I'm really seriously serious this time.

I know I've said this before, but this time I really really mean it.  I just don't see how the Call Gods can make up anything new.  Surely they are reaching into the very depths of their imaginations now, scraping the absolute bottom of their creative barrels, and they must be completely out of ideas.

But wait, I'm getting ahead of myself.  My apologies.  I'll start from the beginning.

I get some bizarre phone calls at 1 AM.  Nothing good ever happens in the middle of the night, and surely the emergency physicians know this.  In an attempt to soften the blow, they almost always start out the conversation with "Hey Doc (not your real name©), I'm sorry to bother you, but . . ."  Sometimes with difficult cases they know the blow can't be softened, so they begin with something more like "Hey, sorry but I got a complicated case for you."  That's never a good sign either.  But when they lead off with this:
So, uh, I have a weird question for you. . .
That is Guaranteed Not Good©.  Very very not good.  Whatever it is will be so not good that I am tempted to retire on the spot, just so I don't have to hear the end of that sentence and then deal with whatever catastrophe they're about to drop in my lap.

As I'm sure you've guessed already, I got just such a call recently.  And you've probably also surmised that I didn't give into early retirement.  There's no good way to summarise the conversation, so I'll simply present it exactly as it happened with as little paraphrasing as possible.

Emergency physician: "So, uh, I have a weird question for you."
Me (under my breath): Oh, fuck.
EP: What was that?
Me: I said 'What can I do for you?'
EP: Right. Must be a bad connection.  So anyway, I have this young lady here who, uh . . . she, uh . . . I don't know exactly how to say this.
Me: . . .
EP: She, well, uh . . . she swallowed her glasses.
Me: . . .
EP: Hello?
Me: . . .
EP: You there?
Me: Yeah.  I'm sorry, I thought you said she swallowed her glasses, but that must have just been the peppers I had for dinner, right?  Right?
EP (laughs): No, that's exactly what I said.
Me: Ok, she swallowed . . . did you say her glasses?
EP: Well not the whole pair of glasses.
Me: Of course not.
EP: Just the arm.
Me: Well of course.

If I wasn't awake before, I certainly was then.  I paused and thought about it for a few seconds, trying to figure out A) how the fuck that was even possible, and B) what the hell I was going to do about it.  Once something is in the stomach, there are only three ways to get it out: 1) Make an incision in the stomach and remove it directly, 2) get it out the way it went in, or 3) wait until it comes out the other end.

I told the emergency doc that if I had swallowed some glasses, I would want a gastroenterologist to try to remove it non-surgically (with an endoscope) before a surgeon cut me open.  If I had swallowed glasses.  If I had . . .

I couldn't believe I had actually just said those words in that particular order.

First thing the next morning after I woke up and had my cappuccino (yes, I spent 4 minutes making and enjoying a cappuccino.  I do love my morning cappuccino), I went straight to her room to check on her.  Her nurse informed me that she was already in the endoscopy suite with the gastroenterologist.  PERFECT!  I walked down one floor to endoscopy and ran right into my friend and colleague Dr. Ken (not his real name©) just as he was leaving the procedure room.

"Hey Ken, did you get it out?" I asked him.

Without a word (and with a big grin) he held a specimen bag right up to my face.  I expected to see one of those glasses arm covers in it:
HAHAHA no.  Instead, I saw one of these:

Yes indeed, an entire glasses arm.  As is usually the case with these foreign body patients, I was rendered nearly speechless.  I did manage to stammer out one nearly-coherent phrase:

"But . . . but . . . how?"

Ken affixed me with a look that clearly said, "Don't ask questions to which you don't want to know the answers."

And so I didn't.  I shook his hand, turned around, and left without another word.  But as I walked away, thankful that I wouldn't have to operate on this young lady, I realised I did have one more question:

Ok Call Gods, what the fuck is next?

Monday, 20 April 2015


"I'm so tired." - Lili von Shtupp, Blazing Saddles
I'm fucking tired.  Not sick and tired, just tired.  Sometimes it feels like I haven't had a good night's sleep in years, though that's probably a gross exaggeration - it's more like decades.  The day after I'm on call (especially a rough one where the Call Gods have their deranged fun at my expense), I'm less than useless.  My eyes constantly feel like they're being dragged down to the floor harder than Yoko Ono dragged down the Beatles.

I don't sleep enough, and even when I do it usually isn't good quality sleep.  I constantly worry about my patients, and I constantly worry about my children.  I don't worry about myself much at all - Mrs. Bastard takes care of that for me.  Of course, that doesn't leave anybody to worry about her, but don't feel too bad for her - she's a very tough lady, as her bout with pneumonia last year clearly demonstrated.

Anyway, my brain always runs at full speed, and that isn't conducive to anything even remotely resembling real rest (alliteration is cool).  Naps are out of the question - I invariably wake up more tired than when I went to sleep, completely defeating the purpose.  So I don't even bother trying.  I think the last time I took a nap, bell-bottoms were in style.  The first time.

Oftentimes when I'm not-as-tired-as-usual, I find my awake-self talking to my nearly-asleep-self, since at least I know I'll be good conversation.  Some time back I started keeping a log of things that Awake Doc says to Sleepy Doc (with apologies to Disney for hijacking two of their dwarves' names).  What follows are the things I wish I could say to myself as I find myself slipping into a sleep deprivation coma.

"The light is green. Go, idiot."
I haven't fallen asleep at the wheel in over 10 years (and fortunately that was at a red light), but the prospect of doing so again scares the shit out of me.  The last thing I want to do is end up a trauma patient in my own hospital.  Or any other hospital for that matter.  Drowsy driving is just as dangerous as drunk driving, so I try not to do it.  If I find myself falling asleep, I pull over for a few minutes.  And I always try to have a coffee before I leave.  Speaking of which . . .

"No, don't pour that into your coffee.  What do you mean 'Why not?'  Because it's orange juice, dumbass."
I've done this.  Believe me, it isn't pleasant.

"Stop mixing up your children's names."
One is a girl, the other is a boy.  Neither name is androgynous, they don't start with the same letter, and they sound nothing alike.  There's no excuse.

"Milk does not belong in the cupboard."
More than once I've woken up in the morning to find a nice, cold empty plate in the refrigerator exactly where the milk belongs, and room-temperature milk in the cupboard.

"Don't forget to set your alarm, stupid."
I have enough trouble remembering to do this when I'm not dead tired.

"Brushing your teeth with shaving cream won't get them very clean."
Speaking of which . . . 

"Don't shave while you're half asleep."
Gentleman, do you enjoy intact skin on your face? I apparently don't, because I still try to do this.  Speaking of which . . .

"You really want to shave now?  Fine.  Wondering why your razor isn't working, dummy?  Maybe you should stop shaving with the back side of the razor."
Doing this is surprisingly ineffective, as I've learned the hard way.  Multiple times.

"Hey, you forgot your belt."
No this isn't a huge deal, unless I'm wearing that one pair of pants I own that are just slightly too big.  Speaking of which . . .

"Hey, you forgot your pants.  Again."
Yes . . . again.  Seriously.

"Eat something."
I can also hear my mother (MomBastard) telling me that I'm wasting away, I'm only skin and bones, I need to eat something, what do I have in the refrigerator.  But sometimes I get so tired I either forget to eat or am just too damned tired to make myself chew.  It's a very effective diet plan, but not one that I would recommend to anyone.

"Put the seat back down."
Fine, I will admit I sometimes forget to do this even when I'm not tired. 

"Get some sleep.  Because you have to do this all over again tomorrow."
No matter how much I get done, there's always more to do, and some things get put off until the next day.  Fortunately Mrs. Bastard has a way of getting me to pack it in for the night and go to sleep.

Monday, 13 April 2015

10 Commandments of Trauma

Being a trauma surgeon is hard.  I am constantly dealing with idiots who have usually done something very stupid that put them in my trauma bay.  But I also multitask, performing life-saving surgery, talking to families and telling them their loved one has died, and babysitting drunk idiots, all while trying to keep Mrs. Bastard happy and trying to find time to see my little Mini Bastards (not their real names©) before they're fully grown.  Mrs. Bastard may argue with me that her life is even more difficult, since she also works full time and is the one mainly responsible for trying to tame my little monsters, and to be honest, she has a fair point.  

Before you think I'm just boo-hooing and being all melodramatic about the difficult life that I chose for myself, no this isn't a "Feel Sorry For Doc and Mrs. Bastard" post, so don't even think about dumping any unwarranted and unwanted pity on us.  Besides, this post isn't really about me (or her) anyway. 

After giving it much thought, though being a trauma surgeon and a trauma surgeon's wife may both be difficult, I've decided that being a trauma patient is the hardest job of all.

I understand that my trauma patients have it rough.  They are whisked from their car or home or McDonald's (yes, really) in an ambulance at breakneck speed, sirens blaring, weaving through traffic, often with no recollection of what has transpired.  They may regain consciousness en route without any clue how they got there.  One minute they're enjoying a Big Mac and Coke (mmmm . . . Big Mac and Coke . . .), the next moment they wake up with a hard collar around their necks and a haematoma on their forehead, strapped to a hard backboard which prevents them from moving, and they're screaming down the road towards the hospital.  Then once they get to me, all their clothes are cut off as they are stripped completely naked, IV's are shoved unceremoniously into their arms, and strangers start asking them questions while poking and prodding every square inch of their bodies.

Holy.  Shit.  This is what many people consider to be their ultimate nightmare, and rightfully so.

Yet, despite how difficult a time I know these people are having, I still expect a certain level of consideration and tact from my patients.  However, many (ok, most) of my patients fail to live up to even these admittedly low standards.

So with that in mind, I'd like to propose a list, a 10 Commandments of Trauma if you will, of how you should (and shouldn't) act with your trauma surgeon. 

Thou shalt not lie       
This goes without saying.  Or at least it should.  Don't tell me you weren't driving when you were.  Don't tell me you didn't smoke marijuana when I smell it on you.  Just tell me the damned truth.  I am not the police, I'm just trying to take care of you, so lying to me will avail you nothing.

Thou shalt not omit
If I ask you what medical problems you have, don't leave anything out.  Do you have diabetes?  Tell me.  Are you on blood thinners?  Tell me.  Do you have untreated HIV or hepatitis C?  Then FUCKING TELL ME before I am exposed to your infectious blood. 

Thou shalt admit to alcohol consumption
This ties in to commandment #1, but somehow everyone who is wheeled in smelling like The Pub at 2AM claims to have only had two beers.  I'm going to check your blood alcohol level anyway, so you may as well be honest.

Thou shalt not curse at me
I don't care how drunk you are, you will not swear like a sailor in my trauma bay.  My nurses and assistants and I will speak to you respectfully, but we damn well demand that you do the same, asshole.  I mean sir.

Thou shalt not argue with me about seatbelts and helmets
No, you are not safer by not wearing your seatbelt.  This is a ridiculous argument with absolutely no veracity whatsoever, and the fact that anyone actually believes this horseshit boggles the mind.  And helmets save lives and brains (just in case anyone making this argument actually has one), though if you actually are thinking about arguing this with me, then obviously the very existence of your brain is up for debate.  Not wearing a helmet or seatbelt is stupid and indefensible.  Full fucking stop. 

Thou shalt not say 'no'
Don't misunderstand me - I'm not saying that you should blindly follow anything your trauma surgeons says.  HOWEVER, if you find yourself in the care of a trauma surgeon and he (or she) tells you that you need immediate surgery, there is a very high likelihood that you will be dead soon.  Listen carefully, then say 'yes'.

Thou shalt not say 'I don't know'
What medicines do you take?  What do you mean 'I don't know'?  What's that scar on your abdomen? Oh, it's from the last time you got shot'?  Great, what did they do when they were in there?  What do you mean 'I don't know'?  It's your body - fucking KNOW IT.  If you don't care, don't expect anyone else to.

Thou shalt not whine about needles
Unless you actually are a child, don't act like one.  Yes, you're getting an IV.  Yes, it will hurt for 2.13 seconds.  Yes, I will give you morphine through that IV if you need it.  No, I will not put you to sleep to suture that tiny laceration on your arm.  And if you are covered with tattoos and tell me you're scared of needles, I will fucking slap you.  Not really, but in my head I will fucking slap you.

Thou shalt learn something
Ok, you made a mistake and did something stupid.  Fine, you're human just like the rest of us.  But if this is the third time your horse has kicked you, maybe you need to learn more about horses (or get a new horse that isn't an asshole).  And if this is your fifth time crashing your motorcycle, maybe you shouldn't be riding. 

Thou shalt be appreciative
We work long hours and spend the night in the hospital in a tiny call room away from our spouses and children just so we can be available 24 hours a day, seven days a week, 365 days a year (366 next year) to save you and your drunk ass.  Fucking say 'Thank you', at least once.

I plan on printing these out in a very large font and posting them on the door of my trauma bay, though I don't expect them to last long.  I have a feeling the administration wouldn't approve.   To hell with it, I'm going to do it anyway.

Monday, 6 April 2015

Bad drivers

I'm a good driver.  I don't drive too fast, I signal before I change lanes, I follow at a safe distance, and I don't distract myself by fiddling with my phone.  That said, I think I'm the only person in my entire area (other than Mrs. Bastard) who follows these very simple rules.  It seems that no one else within a 100km radius of me can drive for shit.  Some drivers are so bad or so reckless that there are two things I wish I had: 1) the power to revoke a driving licence on site, and 2) a giant roof-mounted laser to blast the most egregious offenders into oblivion.  Mostly I would probably end up using these on BMW drivers.  Assholes.

Under normal circumstances everyone around me can't seem to drive safely, but some of these idiots actually do various things to erode their already piss-poor driving skills even further.  A few ordinary idiots drink and drive.  Some slightly more creative idiots text and drive.  Every now and then some really special idiots do their makeup and read the newspaper while driving.

And then you have the rare mind-numbing, slap-yourself-in-the-face, what-the-fuck-are-you-thinking idiots like Nina (not her real name©).

Nina was brought to me one fine morning after she ran her car into a ditch.  As she was wheeled in, she was screaming, "OH MY FOOT!  OH MY GOD, MY FOOT!  OOOOOH MY FOOT MY FOOT MY FOOT!!"

Hm, it seemed her foot was hurting.  Ok, so she has a broken foot, I suppose.  Simple, I have an orthopaedic surgeon on call who can fix that.

We transferred her from the gurney to our stretcher, and the first thing I noticed was the surgical shoe she was wearing on her left foot.

Hm.  That was unexpected.

I asked her which foot hurt.  "THE LEFT!"

Well that solves that mystery.  But she wasn't done.


Well that explains that.  The next question was perhaps the most obvious - was it hurting more compared to before the accident.


If that doesn't make much sense to you, you're not alone.  It didn't make sense to me or anyone else in the room at the time either.  While shaking my head, I completed my workup which revealed no other injuries.  X-rays of her foot were entirely negative, of course.

Several minutes (and several nurses encouraging her to breathe) later, she calmed down enough to explain what the hell was going on, since none of us had been able to figure it out.  You see, she had run out of her prescription pain medicine after her surgery, and she was on her way back to the pharmacy to get more.

Ooh, that makes sen. . . wait . . .

But, I thought, it's only been 3 days since the surgery.  So how had she run out of her pills so soon?  Had she misplaced them?  Had her surgeon just not given her enough of them?  Did her dog flush them down the toilet?

Hahahahaha no, how embarrassingly nve of me to even consider a normal explanation.  No, apparently it was because she had been taking 2-3 times the normal dose, including SIX of them that morning just before getting in the car and driving.

And just when I thought the stupidity had ended, she had one more surprise in store for me in her urine tox screen: she was also high on PCP.

Maybe she thought the PCP would let her fly to the pharmacy instead of having to walk on her recently-operated-on foot. Who knows.  I didn't ask her before I perfunctorily discharged her.

If you're wondering, no I did not give her a new prescription for pain medicine.  I only give those to people who A) need them, and B) I am reasonably convinced will not abuse the shit out of them.