Tuesday 16 August 2016


I love to learn.  When I was a child I had to read books or *gasp* listen to my teachers.  But nowadays the entirety of human knowledge is contained on a tiny device I keep in my pocket, and any information I could possibly want is simply a finger tap away (Hmm, why did Nicolas Cage change his name from Nicolas Coppola?).  My mantra in life is "Any day you learn something new is not a wasted day."

Well, that's only partly true.  My real mantra is "Don't be fucking stupid", but that doesn't look quite as nice on a picture:

Actually I take that back.  I think it looks pretty damned spiffy.

Anyway, learning is one of the few true joys in life.  There are so many things to learn about, so many topics, so many funny cat videos on YouTube.  One of the best things about medicine (and surgery in particular) is that there are always new things to learn.  New drugs are discovered, new surgical techniques are perfected, new diseases are described, and new treatments are devised to conquer it.

And people discover new ways to act fucking stupid.

When I was a child I thought Russian Roulette was a "game" played only in movies like The Deer Hunter.  But no, it turns out that there are some people stupid enough to have played (and lost) in real life.  And I found out recently that despite the horrendous stupidity that must by definition be inherent in the game, there are still people fucking stupid enough to play it.

Like Tracy (not her real name™).

This should not be a difficult concept to grasp for anyone with more than two brain cells to rub together, but pulling the trigger of a loaded revolver may result in a projectile coming out of the business end very fast.  Even if the gun only has one bullet in it, there is still at 16.67% chance that dangerous things will happen.  That's a phenomenon that is generally regarded as bad, especially when the gun is being pointed at something important, like, for example, a person's head.  Apparently Tracy and her friends weren't aware of the concept, because they all decided to play while "partying". 

Nevertheless, somehow nobody lost.  Perhaps the gun wasn't actually loaded, or perhaps they all got very lucky.  Regardless, the game ended, and no one ended up with a bullet-sized hole in his or her cranium.  But the luck would run out a short while later when the game changed from Russian Roulette to Russian Poker.

I had never heard of Russian Poker before, but apparently instead of pointing the gun at your own head, you point it at someone else.  In other words, stupid goes to stupider.

If you can't hear that foreboding foreshadowing music, then you aren't paying close enough attention.

Tracy was clearly sick when she rolled through the trauma bay doors just before noon.  Not sick like *cough cough* but sick as in I'm About To Die, Please Help Me.  

"Hey there Doc, this here is Tracy.  She's 16, shot once in the lower abdomen.  I can't see any other wounds.  Her heart rate is around 120, blood pressure is about 90."

My Inner Pessimist started yelling at me, "Move faster, dummy!"  I already was moving fast, goddammit.  My Inner Pessimist can be a bit of a dick sometimes.

She was sweaty and had that glazed Don't let me die look in her eyes.  We stripped her clothes off quickly, and the medics were right - a single gunshot wound to the left lower abdomen near the pelvis.  We turned her on her side to examine her back, which superficially looked normal.  I then parted her buttocks (while the medics gaped) and found the other gunshot wound on the left butt cheek.  (Note to all future trauma surgeons out there - ALWAYS LOOK BETWEEN THE BUTT CHEEKS.)

My Inner Pessimist started yelling louder.

Take two fingers and put one on your left lower abdomen beside and below your hip bone and one on your left butt cheek.  Don't worry, go ahead - no one is watching.  Good.  Now imagine a line between those two fingers.  There are a lot of very important structures there - small intestine, colon, iliac artery, iliac vein, ureter, possibly even the bladder.  A hole in any of them could be bad, but an injury to the iliac artery can easily cause fatal bleeding.

She needed to be in the operating theatre - NOW.

Ten minutes later we had her in the theatre where we first put in a bladder catheter, and her urine was clear yellow - good, the chance of a ureter or bladder injury was fairly low (though still not zero).  Five minutes after that I had my hands inside her abdomen.  There was a fair amount of blood, but no catastrophic bleeding.  Inner Pessimist quieted down somewhat as I breathed a brief sigh of relief and quickly examined her colon and found it to be normal (another happy surprise).  My Inner Pessimist finally stopped yelling as I ran her small bowel and found one small bullet hole, which I stitched closed.  I found the entry and exit wounds in the left lower abdomen/pelvis, and the bullet had missed the iliac vessels by less than 1 cm.  It had also missed the sigmoid colon by 1 cm, the bladder by 2 cm, and the ureter by 1 cm.

Now that is lucky.

A few days later as she was recovering she told me the story of how she got shot, including the game of Russian Poker that she had evidently lost.  "I didn't even know they had guns when I went to the party," she told me.  Yet that apparently didn't stop her from participating.  Any reasonable person would, oh I don't know, LEAVE.  

But fortunately being a surgeon means constantly learning, and if there is one thing this episode taught me, it was to update my mantra:


  1. Send everyone at the party to jail--you clearly have a conspiracy to shoot someone, they're all guilty of shooting her. (Yes, Tracy is guilty of a conspiracy to shoot Tracy.)

  2. Russian Poker goes like this: You're dealt 13 cards and you arrange them to 1. Good 2. Better. 3. Best. The one with the best hand gets to shoot. I've never heard of that one.

  3. How drunk was Tracy(tm) before she arrived to not turn the hell around and leave this party when the guns WERE pulled out? Particularly when they involved pointing them at other players?

    So far neither of my kids have demonstrated themselves to be this foolish. Please, let them never participate in anything this stupid. Ever.

    1. Hi, Wednesday! As parents, we can see there are several other "fails" in this story, besides the obvious physical harm done to Tracy due to her gunshot wound.

      Tracy, age 16, *went to a party* and "didn't know" there would be guns involved. She ended up in the ER shortly before *noon.*

      Typical teenage "parties" don't start in the morning. Either she'd skipped school (if this was a weekday) and was hanging out with friends getting drunk or high, or she'd been out since the previous evening, and *everyone* in the group was totally wasted.

      In either case, something is seriously lacking in Tracy's life, in terms of parental communication and supervision.

    2. Wednesday, "SO FAR, neither of my kids have demonstrated themselves to be this foolish," sounds like you feel you need to pray that your children will use the common sense they were born with and that you instilled in them, that some adults assume we are predisposed not to use. Scarab, it is not only "as parents, [that] we can see several *fails*.." I have just barely left my teenage years behind and I recognize the all-around stupidity here. Please, don't let Doc's stories of irresponsible teenagers ruin the reputation of an entire generation.

    3. @ Hippodamia - Sorry if my tone implied that teens somehow have some innate tendencies to be irresponsible...I know that's *not* the case at all. There are plenty of people who are, chronologically, "adults," and even "seniors," who do dumber stuff than teens!

      The point I was *trying* to make was that the timeline in Doc's story about Tracy suggested that, for whatever reason, her parents apparently weren't aware of what was going on with her "partying." We don't know why, but something is definitely lacking in the communications area when a teen is hanging around with those who get involved in these kinds of situations.

    4. @ Scarab - Sorry I misunderstood your first message.
      Of course, there is a clear lack of parental/guardian supervision here. As others have pointed out, if this happened in the States (or anywhere else for that matter) making a case for stricter gun laws is futile as these minors clearly circumvented any laws already in place. Your point in this case, lack of guidance in the teen's life, is a bigger failure than the lack of gun control.
      (Might I add that as a Canadian, I cannot fathom the U.S' s obession with firearms; I was raised to be highly judgmental of it)

    5. My kids are both old enough to vote & join the military. That doesn't mean that adult (children) aren't capable of doing foolish things. Not only is the evidence here, it's on The Darwin Awards!

  4. My slogan is "you learn something new every day. so once you've learned it you can take the rest of the day off."

    that said, legend has it there has been at least one person stupid enough to play russian roulette with a semiautomatic pistol.

  5. Not to put too fine a point on it, but Russian Roulette & Russian Poker only happen in places where every mouth-breathing half-wit can buy a gun as easily as buying a six pack. We can't legislate stupidity but we can definitely place greater controls on guns.

    1. Unfortunately it can happen anywhere where guns and stupid people coexist.

    2. If a person cant buy a gun legally, and they are intent on buying and using a gun there is nothing you can do to stop them from doing so.

    3. Very true. I live in a city that has the toughest "gun control" laws in the USA, and also has had, in recent years, more shootings (both lethal and non-lethal) than anywhere else in the country.

    4. @Anon: well, not in the US. the NRA will stop at nothing to ensure that the black market for firearms is unimpeded.

    5. The NRA doesnt want a black market they want the legal market to stay more open for those who are There is a difference

    6. I accidentally backspaced I guess. For those who are less inclined towards illegal activities. Ergo for self defense and recreation IE hunting and target practice at shooting ranges

    7. which is why they resist any effort at making sellers accountable for who they sell to?

  6. Well done! Nice post! This really helps me to find the answers to my question. somerville vasundharaHoping, that you will continue posting articles having lots of useful information. Thanks a lot!


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