Superhero

There is a very slight chance that my decision to write this post as well as its content were strongly influenced by the fact that I finally sat down to watch "Dr. Strange" a few days ago.  A friend of mine told me it was his favourite Marvel movie and that I had to see it, but it somehow slipped by me.  Now having seen it, I agree it was pretty damned good (but then again, I'd probably see anything that Benedict Cumberbatch does).  But as with every superhero movie I've ever seen, it made me think about superheroes and their superpowers: how they get them, how they use them, why Batman is considered a superhero even though he doesn't have any superpowers and is just a rich guy with a bunch of fancy expensive gadgets, etc.

That being said, I'm fairly certain that Uri (not his real name™) is not a superhero, but I can't say I'm 100% convinced.

Uri was admittedly a bit of an anomaly in my trauma bay, in that he was shot in the late evening rather than in the middle of the night.  I don't think his attackers were thinking of me personally when they shot him in the chest, head, and neck so early (relatively) in the day, but I appreciated it nonetheless.  No one likes to be in the operating theatre at 2 AM.  NO ONE.

When the call first came in from the first responders, it sounded pretty grim (from what we could hear).  Multiple gunshot wounds to the head, multiple gunshot wounds to the torso.  That's the sort of call that prompts the nurses to put the body bag under the sheets on the gurney before the patient even arrives.  When he got to me 15 minutes later just before 9 PM, I was expecting to see them doing chest compressions.  Instead, what greeted me was a pretty awake young Uri.

"Hey Doc, this is Uri.  Multiple gunshot wounds, two to the back of the head, two to the chest.  He was pretty altered when we first got there, but he's started to come around.  His vitals have been ok though his pulse has been in the 140s the whole time."

Wait wait wait, how in the hell does someone who has been shot in the head start to come around?  This didn't make sense.  At all.  I started to try to convince myself that this would end up being nothing and I started thinking of going to bed soon, but my Inner Pessimist wouldn't let me.  "At least disrobe the patient and look at the holes first, dummy!" it wisely told me.

It took all of 2 seconds for me to realise how wrong I was.  I hate when my Inner Pessimist is right.  He had a gunshot wound to the right upper chest, one to the left lower chest, two on the back of his head, two on the left side of his neck, an exit wound on his right upper back, and another on his right lower back.

Those of you who know your anatomy can see already how bad this looked.  Those of you who don't know anatomy, well you probably got it quickly too.  An entrance on one side of the chest and an exit on the other is a Very Bad Thing.

I palpated the back of his scalp where the wounds were, and I could feel broken bits of bone underneath.  But Uri was looking at me and talking, so I figured the bullet probably went in, bounced off the skull, and came right back out.  "Don't be so sure!" my Inner Pessimist told me.  Sigh.  I next moved down to his chest.  He had decreased breath sounds on the left (that's bad), and no breath sounds on the right (that's worse), but his heart was beating.  Fast, but beating.  I then pushed on his abdomen and he groaned and tried to grab my hands.

Damn.  One thing I hadn't seen Uri do yet is move his legs.  I asked him to move them, and they didn't budge.  Maybe he didn't hear me through all the hustle and bustle going on around him.  I asked him again (louder) to move his legs.  "I'm trying, Doc.  I can't."

Shit.  SHIT. SHITSHITSHITSHIT

I now had potential injuries to the head, chest, abdomen, and spine, all at the same time.  I had no need for a chest X-ray to make the diagnosis of either pneumothorax or hemothorax (it didn't matter which) on both sides, because he needed bilateral chest tubes regardless.  But I needed a quick look into the abdomen to make sure he needed immediate surgery, because I wasn't sure the bullet had gone from the chest into the abdomen ("IT DID!  HE DOES!" yelled Inner Pessimist).  I did a quick ultrasound which showed obviously fluid around his spleen, liver, and bladder.  Blood.

Well, damn it.

We quickly put in the chest tubes and then wheeled him down to the operating theatre (2 AM is no fun, but 9 PM is reasonably ok).  In his abdomen I found holes in his left diaphragm, liver, and stomach, all of which I repaired.  After surgery we left him on the ventilator, but he still woke up and was opening his eyes and trying to talk.  Whew, at least his brain isn't injured I thought to myself.

We went straight from the operating theatre to the CT scanner to get a better look at where the bullets went.  Starting with the brain, Uri surprised the hell out of me.

Not Uri

The bullet had in fact bounced off the skull, but it had caused a significant amount of bleeding in his occipital lobe and left 3rd ventricle.  I was shocked that Uri was still awake, let alone trying to talk.  (Note this is not Uri's brain - his also had a skull fracture.)

Moving down to the chest, the bullet on the left side had indeed gone through the chest, into the abdomen, and through the spine at T11.  As I suspected, Uri was paralysed.  God damn it.  The bullet in the right chest had gone straight through his right lung, fracturing a couple of ribs on the way in and out.  No huge deal there, the chest tube should suffice.  But then I looked at the abdomen . . .

Not Uri

I almost couldn't believe my eyes when I saw that the bullet had also lacerated his aorta.  If you look at the white structure circled in red (that's the aorta), it looks like it's split in two.  Because it is.  (Note this is not Uri's abdomen - his looked much worse.)  You can probably imagine that having a laceration in the largest blood vessel in the body should result in death, and in the vast majority of cases it does.

Uri, however, had survived not one, not two, not three, not four, but five different injuries (brain, liver, lung, stomach, aorta) that could (and possibly should) have killed him.

But none of them did.

Is Uri a superhero?  That depends - is living a super power?  Well, maybe "living" isn't the right term.  Is surviving multiple horrific injuries that should have been fatal considered a super power?  And if so, what would his superhero name be?  We can't use The Boy Who Lived, because some silly wizard already took that one (yes, I'm a huge Harry Potter nerd.  Sue me).  How about The Living Kid?  No?  Survival Man?  Still no?  Oh oh oh I got it, how about Duraboy!  No no, I got it - Existo!

Hey, it's a better super power than "I have a cave and a car and a grappling hook on my belt."

Unvaluable lesson

I try my best to find valuable lessons in dealing with trauma patients.  As I've told my children repeatedly, any day you learn something is not a wasted day.  Many of these life lessons are easy - use your seat belt, slow down, don't drink and drive, don't attack the police, don't be stupid - but some of them can be slightly more obscure and difficult to discern, and it takes me a while to figure out what I've been able to take away.

As you have probably guessed, this story definitely falls into that latter category.

I know I write a lot about gun violence, and it must seem to you that anyone around me can walk into a corner store, buy a gun of his or her choosing, and immediately start firing at everyone and everything for any goddamned reason.  The truth is that it isn't nearly as common as I make it sound (fortunately).  If it were, it would be like the OK Corral with bullets whizzing around my head constantly (I assume - I wasn't actually there despite how old my children think I am).  Luckily reality isn't quite like that and guns aren't that easy to obtain.  I just write about those stories more than the 84-year-old who fell off her toilet and bonked her head on the bathtub, because who the hell wants to read about that crap.  I just re-read that last sentence and almost deleted it because it's so stupidly boring.

Oh, and before I go on and before anyone starts a pedantic comment regarding the title, I fully realise that "unvaluable" is not a real word.  Unfortunately due to a remarkably stupid quirk in the English language, "invaluable" is actually a synonym of "valuable", much like "inflammable" means "flammable".  There just is no good antonym.  So I made one up.  Sue me. 

Now where was I?  Ah right, guns and valuable lessons.  That is where our story starts.

Nancy (not her real name™) was brought to me as a Level 1 (high level) trauma, and unlike many of my Level Ones who are unresponsive because they are drunk, she was a real Level 1.  

"Hey Doc, this is Nancy.  She's 25, multiple gunshot wounds.  We saw one on the right chest, two in the right arm, two in the left wrist, and two in the neck.  She's been stable, complaining of right chest pain and shortness of breath."

Obviously. 

With all those holes you might expect Nancy to be near death (I certainly did), but she wasn't.  Not even close.  Sure, she was uncomfortable and unhappy, but her vital signs were fine.  My evaluation (read: where I found holes) was consistent with what the medics had told us:

• Right chest
• Right upper back
• Right upper arm (2)
• Left wrist (2)
• Back of neck (2)

A quick examination of the neck (since that seemed the most immediately life-threatening injury) revealed it was a simple graze wound somehow.  Lucky girl.  An X-ray of all the other various Parts With Holes showed no fractures in the wrist or the arm (LUCKY GIRL), but she did have a few broken ribs and a haemothorax (blood in the right chest).  A simple chest tube and some pain medicine should suffice, and she would most certainly live to tell her tale. 

Which left only her tale.  What made someone shoot this young lady four times?  What had she done to deserve this?  

Nothing, it turns out.  It was her boyfriend Will (not his real name™) who has caused this. 

The police told me later that Will had wanted a gun, but instead of figuring out which hoops to jump through to buy one legally, he decided to buy one from Some Guy With Guns In His Car.  I don't think Some Guy With Guns has a permit, but that didn't stop Will.  Oh no, not at all.  

But Will had another problem.  In addition to a severe shortage of guns in his possession, he also had no money.  Most idiots who want to buy a gun illegally but have at least half a functional brain would probably find some just-as-illegal way to find some money, and that's exactly what Will did.  Sort of.  Will did acquire some money illegally, but that illegal money he illegally obtained in order to acquire his illegal gun illegally was counterfeit.

You probably see where this story is going. 

Will drove with Nancy to buy his gun and gave his funny money to Some Guy With Guns In His Car.  Unfortunately (and despite his choice of occupations) Some Guy was somehow bright enough to recognise the fake bills.  Even more unfortunately Will hadn't foreseen the very slight problem with trying to trick a guy with guns: THE OTHER GUY HAS GUNS.  So Some Guy did the only logical thing for a guy in his position: he used the gun on Will, who did not survive long enough to earn a trip to my trauma bay.  He then used it on Nancy, who did. 

WE AIN'T FOUND SHIT!

After this episode I went back over it with a fine-toothed comb to find the learning point.  What could I take away from this?  How could I enrich my life and the lives of those around me?  It took quite a while of searching, but the only thing I could glean, the only lesson I found, was "Don't buy an illegal gun with fake money".  A valuable life lesson?  Hardly.  

Unvaluable.

I somehow wonder why Aesop never wrote a fable about that little moral. 

P.S. For any of you playing on the last post, the correct answer (not counting duplicates) was 20.

Jerk

In trauma I see all kinds of patient imaginable - male, female, old, young, educated, uneducated, nice, and asshole.  There are other types too, but I'll leave the rest to your imagination.  Of all those types, the nice ones are the easiest to take care of, but they make for very boring stories.  That's why you rarely hear about them here - they just aren't very interesting.

The assholes, on the other hand, make my time in the trauma bay much more entertaining.  I can't say I prefer them per se, but this blog would frankly be impossible without them.

And thus enters Jack (not his real name™).

When Jack was first wheeled into my trauma bay, he immediately rubbed me the wrong way.  It wasn't so much that he was acting obnoxiously, because he wasn't (at least not at first).  Actually when he first got there, he was happy and giddy.  I could almost describe him as spunky.  He was smiling sharply, almost demoniacally so.  He seemed to be muttering rhythmically under his breath.  It took me a few seconds to realise he was singing.

"Hey everybody, this here is Jack," the medic started as he helped Jack off the gurney.  "He crashed his car into a tree for some reason, don't know why.  He refused to get out when the police got there, so they kinda roughed him up a bit.  I think they whacked him on the left leg a few times, but I didn't take his pants off to look at their handiwork." 

"They choked me too," Jack tossed off as the police officer shook his head No, we didn't.

He had definitely been beaten about his head, but he had no other obvious injuries.

Unbeknownst to me, Jack was well known by the emergency staff as a bit of a wanker, a jerk.  Ok, that's putting it mildly - he was an asshole.  He was also a frequent flyer - he seemed to come to our hospital on a regular basis whenever he took PCP, which was often.  I examined him from head to toe, and other than having been spanked around a bit, by some stroke of luck Jack didn't look too worse for the wear.  He tugged on my lab coat as I tried to walk away.

"Doc, they beat me.  They beat me good."

I had to hand it to him, he was definitely persistent.  But something about Jack's behaviour was rubbing me the wrong way.  I just couldn't quite put my finger on it.

About a half hour later Jack's X-rays were all done, and they were (shockingly) all normal.  I walked back in to give Jack the good news, but what greeted me was not was I expected.

Jack's hand was at his groin under the sheet, moving rather quickly.  Wait, is he . . . It took me about 0.298 seconds (I didn't count) to realise what he was doing.  Oh fucking hell, he is!  There was no mistaking it and I wasn't imagining it - this was actually happening.  Now at this point I had three options:

1. Turn right back around, walk out, and pretend I didn't see anything.
2. Stand and stare, completely bewildered.
3. Ask him politely to stop.

I chose #3.

"Jack," I said, not believing the words coming out of my mouth.  "Please stop masturbating."

No one had been looking at Jack before, but as soon as I said it, every set of eyes in the room turned immediately to Jack.  "Jeez. . ." I heard several people mutter under their breath.  For me it was hard just standing there as Jack sat smiling for just a moment, obviously pondering his options.  And a second later it became obvious that the option that he went with was keep going.

Um . . . now what?  What the hell do I do now?  I was unprepared for the situation to begin with, and completely unprepared for this eventuality.  He was supposed to have stopped!  Unlike most situations, I had no prepared statements, no social norms I could fall back on, no fucking clue what to do.

So I shook my head and walked out.  I had no other ideas.

Apparently he finished a few minutes later, because when I went back, he was getting dressed and preparing to leave with the police (he was under arrest for the car accident, not for, you know, that other thing).  He had no shame on his face, no sheepish smile, seemingly no sense of remorse.  He almost looked proud of himself.  My staff, on the other hand, looked downright thrilled that he was leaving.  Obviously.

I've said it many times here before, but just when I think I've seen it all, just when I think the Call Gods can't possibly think of anything new to throw at me, they come up with something.  However, the day that the Call Gods call it quits is the day that I retire SftTB, because my source material will have officially dried up.

Note: A special prize will not be awarded to whoever finds the most.  If you don't know what I mean by "the most", then you are guaranteed not to win.  And by "special prize" I mean my undying esteem and respect.  Not really. 

4

I have a very nice story about an incredibly stupid person (who is not my patient) who did something incredibly stupid that lead to his death, but it will have to wait.  In lieu of a stupid patient story, I'm going to have a little fun this week.  What kind of fun?  The kind that will make little sense to some of you at first but that most of my long-time readers will catch on to almost immediately:

• If you were to stack 4 million 1 euro coins, it would reach 9.3 km (almost 6 miles) into the troposphere.
• If you put 4 million 500 ml Coke bottles (no particular reason why I chose that particular bottle, of course) end to end starting in Copenhagen, Denmark, they would stretch 20km past Brussels, Belgium.
• 4 million people signed a petition calling upon the UK government to hold a second referendum on Brexit.
• If you had $4,000,000, you could buy an 800 square meter (8500 square feet) 5-bedroom, 7-bathroom mansion in Dallas, Texas and still have $10,000 left over to pay someone to clean it for a few months.
• 4 million dollars was the budget for the movies Lost in Translation and Annie Hall.
• 4 million is the approximate population of Panama.
• The four millionth digit of pi is 0.

And if you had come to this stupid blog at this time last month, you would have been the four millionth visitor.  How is that even possible?  Who are you people and why do you keep coming here?  

In all seriousness, I know I've said it many times before, and I hope no one is surprised when I say it again:

No really, thank you.  If no one came here to read my stupid stories, then I would have no reason to keep writing them, I would have no outlet for the insane amounts of stress I endure, and I would probably be forced to move to a private island (Bastardia?) with no stupid people to addle my already-addled brain.  

As a little bonus (not that you asked), here are the top 10 countries that have provided me and my ego with viewers:

• United States
• Canada
• UK
• Australia
• France
• Germany
• Russia
• Ukraine
• New Zealand
• Singapore

To which I feel obligated to reply . . . really?  The first four don't surprise me one bit, but Russia?  Ukraine?  Singapore?

This past week India, South Africa, and Greece are in the top 10, and Holland appears in the top 10 in the past month.  Fascinating.

I'm literally in awe of every single one of you who has taken time out of your day to spend a little time with me over the past several years.  As I've hypocritically and humbly requested with my other milestone posts, please take a second and let me know where you're from and how you found me.  If you don't have an account and don't have the time to make one, then GO AWAY AND NEVER COME BACK.  

Just kidding.  Or am I?

In all seriousness though, thank you, everyone.  Thank you.  I'll see you at 5 million.

Best,
Doc