Friday, 6 January 2017


Few inventions in human history have revolutionised communication more than the mobile telephone.  Actually, very few inventions have revolutionised anything the way the mobile has.  Ok, computers of course.  The internet, of course (I mean, how else would we be able to waste hours of our lives watching funny cat videos?).  Even as recently as 15-20 years ago, if someone wanted to get in touch with a doctor, it would mean sending a phone number to either an answering service or a pager and waiting to get a call back.  And waiting.  And waiting.  In 2017 however, nearly everyone has a mobile phone and is easily and immediately accessible from all over the world.  Myself included, unfortunately.

Since I am always so easily reachable, why the FUCK was I called multiple times by multiple different people at midnight about some stupidly ridiculously bullshitty bullshit that could (and should) have been easily cleared up well beforehand with one simple phone call NOT placed to me?

Deep breath.  Deep cleansing breath.

.  I'll explain.  Just as soon as I finish washing this radiologist's blood off my shirt.

Leonard (not his real name™) was an extremely pleasant though unfortunate 75ish year old man who had multiple medical problems, including a stroke several years ago which left him permanently confused.  His wife, who was equally pleasant and was able to answer all my questions for him, brought him to the hospital after he started vomiting uncontrollably.  Despite the fact that the janitor probably could have diagnosed his massive inguinal hernia from two rooms over, the emergency physician decided to forgo an actual physical examination and ordered a CT scan instead (or so I must assume).  Not surprisingly (read: entirely predictably), the CT showed a huge right inguinal hernia (SURPRISE!) which contained multiple loops of small intestine in his scrotum (SURPRISE!) which was causing a bowel obstruction (SURPRISE!). 

Not really.
credit: CHOP
When I saw Leonard about 30 minutes later, he looked uncomfortable and nauseated but in surprisingly very little pain.  Severe pain can be a sign that the hernia is either incarcerated (i.e. cannot be reduced back into the abdomen) or worse, perforated.  Fortunately I was fairly easily able to push the entire segment of small intestine back into his abdomen where it belonged, leaving his scrotum looking like a big floppy deflated balloon.  If you've never done this, and I suspect the vast majority of you have not, I strongly encourage you to try it sometime.  It's very satisfying.  Really.

Anyway, I watched the hernia for a few minutes for any recurrence, and his intestine stayed put.  Ha!  Victory is mine!  Take that, Call Gods!  Leonard would still likely need surgery for his huge hernia someday, but not today.  I explained the situation to Leonard's wife, who was very appreciative and thankful, and I strutted away feeling very smug and self-satisfied.

I was called first thing the next morning that the hernia was back, as was Leonard's nausea and vomiting.

Damn you, Call Gods.

When I went to see him, his hernia had indeed recurred, and though I was able to reduce it again easily, it came right back out immediately.  Damn.  Damn damn. 

Despite the fact that he was not exactly an ideal surgical candidate, Leonard would need an urgent (though not emergency) operation after all.  The cardiologists saw him that day and optimised him for surgery as best they could, and Leonard's hernia repair the following day went very smoothly, surprisingly so.  His postoperative course over the next 2 days was not unexpected as his nausea persisted.  It would pass, though.

Or so I thought.

Unbeknownst to me, his internist ordered another CT scan of his abdomen and pelvis that night due to his persistent nausea.  And just after midnight, the calls started pouring in.

"Uh, hi Doctor Bastard (not your real name™).  I'm the intern on the medical service taking care of Mr. Leonard.  I just got a call from the radiologist that his hernia has perforated."

He . . . wait, his what did what?  He doesn't have a hernia anymore because I just fixed it.  I tried to extract some more information from the intern (like what the patient's exam and vitals were), but she was flustered . . . and hadn't actually examined him.  Naturally.  As I was trying to get this information, the internist called me with the same note of panic in his voice.

Since I happened to be in the hospital for trauma call, I immediately logged on the computer and looked at the CT report.  Sure enough, the radiologist (henceforth to be known as Dr. Dumbass) had read a perforation of bowel in the hernia sac with fluid and air in the scrotum, and he recommended an immediate surgical evaluation.

For the non-surgeons out there (which, presumably, is all of you), air and fluid is normal in an area on which I just operated.  In fact it would be abnormal not to have air and fluid in the scrotum at this point.  Regardless, my Inner Pessimist started yelling and cursing profusely at me.

"Your hernia repair failed already, dummy!  It came back, and now it's perforated!  You suck!  Go see him!  NOW!"

For once I obeyed my Inner Pessimist and went to see Leonard.  He was lying very comfortably in bed, his vital signs were all rock stable, his abdomen was benign, and his scrotum, though definitely swollen, had no sign of bowel in it.  Hmmm.  I then ran (as fast as my legs decided to go at midnight) to the radiology department to look at the CT scan, and what greeted me didn't surprise me one bit.

The scan looked absolutely fine for someone who had just had a huge inguinoscrotal hernia repair 48 hours prior.  The oral contrast he had drunk had made its way through the entire small intestine, the dilation of his intestine from the obstruction had resolved, and he had exactly ZERO intestine in his groin or scrotum.

My Inner Pessimist was suddenly and noticeably silent.  I like to imagine he went off to a corner somewhere to sulk and find something I actually had screwed up.

I called back the internist first followed by his intern to reassure them that Leonard and his scrotum were both fine, and I told both of them that that was an extraordinarily irresponsible read by the radiologist.  All Dr. Dumbass (surprisingly not his real name™) had to do was make one simple phone call to the nurse, the intern, his GP, or to me (or he could have taken one look at the notes in the medical chart) to find out that Leonard had just had hernia surgery 2 days prior, and this fiasco would never have happened.  The intern assured me she would let the radiologist know, and I went back to bed, visions of plotting the radiologist's torture dancing in my head.

The rest of the night was gloriously quiet (except for a drunk assault victim at 4:00 AM), and I awoke to find a little gift in Leonard's chart: an addendum by Dr. Dumbass stating that there was in fact no bowel in his scrotum (shocking), and the air and fluid was compatible with his recent surgery (shocking).

I decided to take the sharp pincers off the torture instrument set I had assembled in my mind for Dr. Dumbass.  Everything else remained.

Leonard went home later that day feeling much better.  I told his wife about how Dr. Dumbass scared the shit out of everyone and given me a minor heart attack.  She had been equally frightened, but she made sure to tell me how thankful she was for everything I had done.  In fact she was so nice, I decided not to tell her about the torture I had planned for Dr. Dumbass, most of it with a rusty spoon.

Though now that I think about it, maybe I'll call her and tell her about it.


  1. my calls of that nature usually conclude with me saying "I think I forgot to turn it back on after I repaired it. look for the switch ______ "

  2. The CT scan makes doctors smarter.
    But it can also make doctors dumber.
    Case in point.

  3. I can speak from personal experience that reducing an inguinal hernia is the best feeling in the world, but also the weirdest feeling in the world. When it slides back into place, it makes for a very strange sensation, but the relief from fixing it is so incredibly satisfying that I would usually have to sit there and enjoy the relief for a moment.

    So, DocBastard is right, but I definitely do not recommend getting a hernia to have the pleasure of reducing it. Find someone else instead.

    Just don't go around asking random people if they have a hernia... That might get a little weird.

    1. "pardon me, sir, but do you have a hernia I can reduce?

    2. Not a doctor, can I still do this?

    3. we're now in a post fact world. credentials and competence are now optional.

  4. took me a minute to understand what i was seeing in that pic, at which point if i had a scrotum it would have ascended into my abdomen. good god the human body does horrible things to itself

  5. As satisfying as pushing a completely prolapsed uterus back into the vagina?


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