Monday, 19 September 2016

Parents

I'm a goddamned good father, and I'm not too proud to admit it.  Of course as I write that my 9-year-old daughter is sitting right next to me, but it's ok - I made her go to the other room before she saw it.  I don't know exactly how it happened, but Mrs. Bastard and I seem to have stumbled into an series of good parenting decisions and techniques (not that we are perfect), such that we have the best kids in the world.  I don't mean to demean any other parents out there, but it's a simple fact that someone on the planet must have the best kids in the world, and I just so happen to be that guy.  No, they aren't perfect either, but as Albert Einstein once said, no one is perfect.

It may not actually have been Einstein that said that.  Maybe it was Nikola Tesla.

Anyway, our parenting equation is rather simple - 1) Mrs. Bastard and I are always there for our kids, or if we can't be, we make damned sure to have a responsible backup, 2) every decision we make is for the benefit of our children, 3) we do everything we can to keep our children safe.  Very very simple.  Take those three things and add them up and you get two very strict (and very effective) parents with two very sweet, very well-behaved, and very well-adjusted children.  They're both also totally freaking adorable, but I can't really take credit for that - that's good luck more than anything else.  Plus, they obviously get their looks from their mother.

We didn't read any parenting books and we essentially ignored much of the advice that we got from our parents (sorry MomBastard, DadBastard, and Bastards-in-law), and yet we are somehow doing a damned good job.  I know this may seem like another Extol Doc's Virtues post, but it really isn't.  Well, I guess up until now it is.  But from now on it isn't.  I swear.  We aren't perfect parents - I yell a bit too much, Mrs. Bastard yells a bit too little - but we're good.

If only Aiden (not his real name™) had been so lucky.

I've said it many times before, but nothing good happens at 2 AM.  This is true for adults, but even truer for teenagers.  (As an aside, how can something be truer?  If it is true, can something else be more true?)  The only reason a 16-year old should be out at 2 AM is if he is working to support himself and/or his family.  Otherwise they should all be in bed asleep, which is exactly where I was when my pager woke me to tell me I would be getting a Level 1 gunshot victim in 5 minutes.

Sigh.

When Aiden rolled through the door, my first impression was "Why the fuck isn't this kid in bed asleep on a school night?  What the hell was he doing?  Why the hell was he shot?  Who did he piss off?"  Fortunately my ever-so-slight drowsy haze had worn off, so I had the self-restraint to ask him none of those questions.

"Hey Doc," the medics began.  "This is Aiden.  He's 16, through-and-through gee ess double-you to the right thigh."

Indeed Aiden had two small holes in his leg - one just above the knee and one on the back of his mid thigh.  But unlike in movies, it doesn't take a big hole to cause major problems.  My first priority in cases like this is to see what was hit.  There are lots of Very Important Things in the thigh (including 1) artery, 2) bone, 3) nerve, and 4) vein), so my job was to rule in (or out) injuries to all of them.  Sure there's plenty of muscle in there too, but who the hell cares about that.

I was able to lift his leg without him screaming in pain, so I tentatively scratched bone off the list of Potentially Injured Things.  I then placed my finger on the top of his foot to feel his pulse.

Wait, wait . . . his pulse?  On his foot?  Isn't the pulse on the wrist?

Yes, his pulse on his foot.  I didn't know this before medical school either, but on the top of your foot there's a little bone protruding slightly (the first cuneiform, if you were wondering), and just towards the outside of this is the dorsalis pedis artery, which is one of two arteries that supplies blood to the foot.  I put my finger there and felt . . . nothing.  I then went to his posterior tibialis artery (the other aforementioned blood supply to the foot) which is just behind the bone on the inside of the ankle.

Also nothing.

The pulses were strong in his other leg, so I knew we had a Big Problem.  How big a problem was still up in the air since I hadn't yet addressed question 3, the nerve (much like the muscles, the vein isn't really a big issue).  I touched his foot and asked him if he could feel it.

No.

I asked him to move his toes.

Nothing.

SHIT.  This had just gone from a Big Problem to a Really Big Problem.

Aiden was rushed down to the operating room where the vascular surgeon found exactly what we were all expecting to find - a lacerated superficial femoral artery and femoral nerve.  My colleague was able to re-establish blood flow by doing a bypass graft, and we tried to piece the nerve back together as best we could.

While you may be thinking "Hey, at least you got blood flow back!", a well-perfused leg with no sensation and no movement is not a leg at all, and an amputation and prosthesis is usually more functional.  Think of it as a bank with a top-of-the-line safe, a beautiful atrium, plenty of safety deposit boxes, and a vault full of money to lend . . . but no customers and no staff.  It may look like a bank, but it is not a bank, just an empty, useless building.  That is probably a terrible analogy, but it seems to have legs, so I'm running with it.

Har dee fucking har.

Horrible analogy and worse joke aside, Aiden's leg seemed like it would end up a useless appendage.  Maybe.  Time would tell if the nerve would heal.

When I went to see him the next morning and re-examine him, several female party goers were there.  At least, that was my first impression.  The two reeked of alcohol, marijuana and god-knows-what else, had on ridiculously long fake eyelashes and enough makeup to cover a clown car full of clowns, and were wearing mini-skirts that, if they were any shorter, would qualify as belts.

I figured they were Aiden's friends, though if I ever caught my daughter dressing like that I would immediately tell her to GO GET DRESSED.  Neither of them had shown up overnight when, you know, their loved one was shot, because they were too busy "at the club", they told me.

I was somewhat stunned to find out that one of the girls was Aiden's teenage sister.

I was even more stunned to discover that the other one was his mother.


Aiden had been shot while he was out partying on a school night.  His mother did not know this (and I had to inform her of it) because she had been out partying (at a different party, of course) with his sister.  Now do not misunderstand me - I am not saying that that 16-year-olds should be confined to their bedrooms and not allowed to go out.  What I am saying is that Aiden's mother had no fucking clue where he was, what he was doing, and who he was doing it with, and the reason for that was because she was too busy dressing up like a prostitute and getting drunk.

Actually I take that back - I've seen prostitutes better dressed than these two.

Am I being overly judgmental here?  Perhaps.  But keep in mind I'm not judging his mother based on how she was dressed, but rather on her actions: 1) not knowing what her young son was doing, and 2) getting high and drunk while not knowing what her young son was doing.  And to be fair, Aiden was the one who put himself in the situation that got him shot.  That was his doing, not his mother's.  But overall it was a glaring circumstance of irresponsibility at its very worst by everyone involved, and Aiden almost lost his leg because of it.

Yes, almost.  Fortunately Aiden's nerve decided to start healing, and by the time he left the hospital he was starting to move his toes and had some sensation back.

Perhaps my perspective will change when my children get older, but my actions will not.  I will continue to be there for them, and whether they like it or not I will know where they are and who they are with at all times.  I have friends and neighbours who have older children, so I know this is not only possible, but eminently doable.  There will be times when they screw up, I know that.  There will continue to be times when I am too strict and yell too much.  But there will not be times when I screw up and ignore being a parent.

They are far too important for that.

Monday, 12 September 2016

Fool me once

I don't know if Albert Einstein actually said that or not, but goddammit it's a good fucking quote.  And because Einstein is one of the most universally praised people in the history of mankind, I'm going to run with it, because maybe that will make me look better and smarter by association.

Probably not.

Just in case that first quote isn't clich├ęd enough, here's another:
That one is attributed to Anthony Weldon in The Court and Character of King James all the way back in 1650, though some people seem to think it was coined by anti-abortion activist Randall Terry (who was only born in 1959).  Really, people?  The adage is centuries old!

Anyway, I can't really decide which one is more pertinent for this story, so I'll go with both of them.  

I'm a cat guy.  Yes, I love cats.  I like dogs too, but I don't own one and never have.  I don't have a cat either because . . .

"Whoa whoa, wait just one goddamned second.  What the fuck are you smoking?  You're going from Einstein to Anthony Weldon to your preference of pets?  Do you not understand segues??"

SIT DOWN AND SHUT UP.  It will make sense in a moment if you'd give me a chance, for fuck's sake.

As I was saying, I would have at least one cat (probably two) if Mrs. Bastard weren't horribly allergic.  And while I do like cats, I like Mrs. Bastard a hell of a lot more.  After all, unlike Mrs. Bastard, cats can't make lasagna (much to Garfield's dismay).

Lasagna aside, as much as I like cats I understand that they bite sometimes.  When they get scared or startled or just decide to act like an asshole, they can release their inner lion and pounce.  I wouldn't get rid of a cat just because it bit me once, but if it was a constant problem, the cat would go.  Fool me twice, etc etc.  Sorry Hypothetical Cat, but I like my intact epidermis more than any tiny adorable feline.

House cats are quite small, and while their bites hurt, I've never heard of anyone getting seriously mauled by a cat.  Dogs are another story altogether.  Dogs can do real damage with their teeth, as several of my patients (and their various savaged body parts) can attest.  If a pet dog bit me unprovoked, the dog would be evicted.  End of story.

Terrence's Wife (not her real name™) obviously had no such policy.

Terrence was in his late 60s and had suffered a series of strokes over the past decade, leaving him paralysed with no sensation on the right side of his body and essentially bed-bound.  He lived with his wife (who took care of him and cooked for him), and his Jack Russell terrier, who ate him.

Before I go on, read that last sentence back.  No, that was not a typo.

I'll explain.

A few weeks back Terrence was brought to our hospital after his dog ate his toe.  Once again, in case you missed that little nugget, I'm going to say it again: The dog ate his toe.  When he was brought in, the great toe on his right foot was missing.  It was gone.  Just . . . gone.  The podiatrist tried his best to piece what remained back together, but dogs' mouths aren't known for being clean, and as expected the wound got infected.  After a lengthy stay in hospital, he was sent home on antibiotics.

And that's where we pick up Terrence's saga.

His wife woke up on this fateful morning and noticed something . . . odd.  She saw . . . wait wait wait, I can't say it any better than she did.  She said, and this is a direct quote without any paraphrasing whatsoever, "Well, he had toes when we went to bed last night!"

We looked at his foot, and the toes were gone.  All of them.  Gone.  GONE.  In case you don't believe me, here are Terrence's X-rays:

Notice anything missing?  On the off chance you aren't a radiologist, here is a normal foot. 
See those little toe-shaped things on the end where toes should be that look just like toes?  Those are toes.  

Terrence didn't have any.

When the medics first arrived on the scene, they had no idea what had happened to Terrence, nor did Terrence or his wife.  Somehow.  They were throwing around the idea that he had been attacked by an intruder.  Why they would believe that an intruder would break in, not steal anything, and then gnaw off his toes, I have no idea.  I wish I could have heard the conversation, but in my mind it went something like this:

Wife: Where are his toes?
Medic 1: Oh em gee your right! {yes, in my mind he misused "your"}  Where are his toes?
Medic 2: Maybe someone broke in and cut them off?
Medic 1: If they did, they used an old dull butter knife.
Wife: But they didn't steal anything!
Medic 2: Oh wait, there are his toes.

That was the point in the conversation when the dog bounded into the room and vomited up the toes onto the floor.  Lest you think my creativity is getting the better of me, unlike the fabricated conversation above, I am not making this part up: the dog actually truly and veritably vomited Terrence's toes.

The same dog that had eaten his toe a few weeks before . . . spent the night eating the rest of them.  And then vomited them onto the floor.

I can only imagine the stunned silence in the room.

I called the same podiatrist back, and he once again tried to piece what was left of Terrence's foot back together.  All the king's horses and all the king's men, you know.  

I'm sure the burning question in everyone's mind is: How quickly did they kill the cursed man-eating dog and get rid of its body?  Well, as of the last time I spoke to Terrence's wife, the dog was still alive and well and living at Terrence's house.  And eagerly awaiting his return, no doubt.  I mean, the poor dog must be hungry.  Am I right?  Hello?  Is this on?

So that leaves me with one final lingering question: What the hell do people say about "Fool me thrice"?

Monday, 5 September 2016

Prayer

"Keep praying."
"I'll pray for you."
"It's in God's hands now." 
"Have faith."
These words are probably uttered millions of times a day in hospitals all around the world.  I've overheard them countless times from family members, friends, nurses, techs, and my fellow doctors.  On first glance they certainly seem innocuous enough - they appear to be uplifting, caring, and supportive, right?

I, on the other hand, tend not to put much faith in faith, so I don't use such language.  To me prayer accomplishes the exact same thing in medicine as putting a banana in your ear - absolutely nothing.

I'm sure there are some religious folks out there reading this with steam coming out of their ears, and to you I merely say "Have faith".  I'll guarantee I will explain my position in due time.  I will not, however, guarantee that you will agree with me.

Now that I think about it, I've changed my mind.  I'll let Adriana (not her real name™) explain.  After reading one of my recent blog posts, her aggravation at the recent shoddy treatment of doctors in the media was reignited.  Because of recent events in her family, she was keenly aware that sometimes when doctors tell family members that their loved one is dead or dying, we are seen as heartless cretins with no soul, no compassion, no empathy.  We are seen as insensitive and unkind. . . for telling the truth.

This reminded me of a cartoon I've seen several times:
Cartoon by Clay Bennett
People in difficult situations don't want to hear the difficult truth - they want to hear something that makes them feel better, even if it isn't completely true.  So friends and family members tell them things to try to make them feel better - to have faith and pray.

But what does that really mean?  Does it help?  No, I'm not asking if prayer helps the patient get better (it doesn't), I'm asking if it helps the grieving family.

Adriana certainly doesn't seem to think so.
Please forgive the writing format and any spelling errors.  I am on autopilot right now.  My husband's grandmother has been in the hospital for a month now, and her husband has finally reached the point of admitting she is not going to get better.  She is unable to communicate and has a trach {a surgical breathing tube}, breathing machine and all the rest of the equipment that is keeping her alive.  We have learned about palliative and hospice care.  I have watched my almost 12-year-old cry and ask why bad things happen to her great grandparents around her even numbered birthdays.  Our 8-year-old just clams up and screams once in a while how much she hates what is happening and when is her Nanny coming home.  They can't see her anymore because it is too traumatic now.  My husband has just started college and he is trying to focus on his classes in the middle of trying to keep our kids and his mom (she is an only child) together during this hellish time.  It looks like this is the last weekend of being in limbo because her husband has finally decided to let her go peacefully and stop holding on to his unicorns and rainbows about the situation. 
The one thing that I can't seem to act properly about is when people keep telling us to pray for a miracle and that God always listens to His people.  We have faith.  We also understand that it is up to God on if we get that miracle.  I guess we didn't fill out the proper request chit because that miracle isn't going to happen and I really want to throat punch the next well-meaning person who tells us to keep praying and have faith.   
Share this if you want to and feel free to fix this up to make it look like it was written by someone who has their act together with the name removed please.  People need to stop telling us and anyone else to keep praying and having faith for a miracle.  They are just making it worse on all of us.  We keep a straight face, but we really want to slap the ignorant out of you guys when we hear that and have to tell you we are losing her and it seems to be God's plan.  We are not mad at God, but this hurts like hell already and making us feel like we just don't have enough faith to override what is happening dumps more crap on us.
I think that sums it up.  Telling someone to keep praying will never help, for several reasons:
  1. Prayer will not help someone get better.
  2. Telling someone who is not religious to pray will not make them feel better.
  3. Telling someone who is religious to pray will not make them feel better, because they already know that they are supposed to pray, and it implies that they are just not praying hard enough.
Will this change any minds?  I seriously doubt it.  By definition those with faith take everything, well, on faith,  But perhaps you'll at least think twice next time you tell someone to pray.

I have faith that you will.