Anyway, even though I'm a surgeon, I still believe in promoting healthy habits. I know, I know, I'm supposed to be a stupid automaton with a scalpel and no brain, and public health is supposed to be the domain of general practitioners and blah blah blah. Fuck that. I see obese patients, I treat obese patients, and I operate on obese patients, and they happen to be much harder to take care of. Their surgeries are much harder than those of thin patients, there is a much thicker layer of fat to get through, it's more difficult to visualise the structures I need to see (read: not accidentally poke a hole in), and there is a much higher risk of wound problems. So though you may consider this to be a tad self-serving, I'm very interested in keeping people a healthy weight. When it comes to trauma surgery, being obese just isn't helpful.
Or so I thought.
If you believe TV and movies (*cough* Game of Thrones *cough*), any penetrating knife wound to the torso is immediately fatal, unless you're the hero, in which case you have at least 18 seconds to either A) breathe the name of the attacker so you may be avenged, or B) tell the nearest bystander to tell your wife you love her; only then will you exhale your last breath so that the aforementioned bystander may run his hand down your face and close your eyelids which I'm pretty sure wouldn't really work at all in real life.
In reality, stabbings are bad (obviously), but not usually fatal. I've written about this subject before, but for a really quick recap, most stabbing victims have entirely treatable injuries. Though the various injuries may be life threatening, most of these folks not only make it to the hospital alive, but due to the intervention of hard-working trauma surgeons, they leave it alive too. Like Liam (not his real name™).
Only not for the reason you may think.
I don't know if people keep their knives locked up during the day or what, but stabbings only seem to happen at night, usually around 3 AM. Sometimes people surprise me and come in at 2:45 or 3:15, but it's pretty consistent. Liam was no different - he got stabbed just before 3 and came in right after 3. I was having a dream about bacon when my pager woke me (god damn it), so off to the trauma bay I went.
I got there a few minutes before Liam arrived, and a nurse filled me in on the details she had gotten from the crew en route - youngish male, multiple stab wounds to the chest and flank, tachycardic (fast heart rate), but a normal blood pressure. In the ensuing 6 minutes before Liam arrived, I continually ran through my mind all the possible injured organs, which included . . . well, all of them. Literally.
The medics didn't seem too concerned as they moseyed down the hall a few minutes later. Liam, on the other hand, looked near death. He was sweaty, his eyes were glazed over, and he was thrashing all over the bed. In the trauma bay this is almost always a sign of shock - real haemorrhagic shock, not the "Oh my, I just saw a dead animal on the side of the road and now I'm in shock!" bullshit. So I again ran through my internal list of potential Very Bad Things that could be causing his impending death.
"Hey Doc, this is Liam," the medics started. "Thirty years old. Stab wound to the left upper abdomen and left flank. He's been tachy the whole time, last blood pressure was 155/90. Diminished breath sounds on the left, but his sats have been fine."
I absorbed this information quickly as they moved Liam from their stretcher to ours.
- Tachy - fast heart rate, could be bleeding. If not bleeding, it's probably bleeding. If it isn't bleeding, it's still probably bleeding.
- Normal blood pressure - if he's in hypovolemic shock, it's stage 1 or 2. Good.
- Diminished breath sounds on the left - he probably has a pneumothorax or haemothorax.
- Oxygen saturation is fine - he's young and has healthy lungs, so he's compensating for his injury.
- A 2-cm wound in the left lower chest (not the upper abdomen . . . maybe)
- A 2-cm wound in the left lower flank/back
- A 2-cm wound in the left lower abdomen
My Inner Pessimist began yelling at me. "The medics are wrong, stupid!"
I actually agreed with my Inner Pessimist for a change, though Liam still looked near death. Something didn't add up.
Sadly digital wound probings are notoriously unreliable, and any trauma surgeon that relies solely on that modality is making a grave (and possibly fatal) mistake. So off to the CT scanner we went. By this time Liam had calmed down significantly, his vital signs had completely normalised, and he was no longer sweating.
Ten minutes later my Inner Pessimist started laughing his ass off. The scan showed that the knife had penetrated only Liam's rather copious subcutaneous fat in all three locations. There were no serious injuries, no injured organs, nothing. Just a guy freaking out over a few tiny lacerations. He wasn't in shock he was just shocked.
Liam's wounds were irrigated, anaesthetised, and repaired within the half hour, and he was walking out of the trauma bay with a huge smile on his face a few minutes later. It must be awfully satisfying to go from thinking you're going to die to walking home in the span of an hour.
Had Liam been thinner, the knife could have easily done some major damage, and he could have been facing a major surgery (or two or three) or even death instead of leaving the trauma bay in an hour.
Don't misunderstand me, I am in no way advocating major weight gain here. But if you do plan on getting stabbed in the future (which I wouldn't recommend), you may as well stock up on ice cream, Oreos, and Coke and get started now. After all, you have a life to save - yours.