Monday, 27 February 2017

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."

24 comments:

  1. Damn,that guy IS a superhero.
    Wasn't there nothing you could do for the Thoraco-Abdominal nerves?(probably not but just in case)

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  2. So Uri survived a bullet to his aorta plus 4 other critical wounds but ended up paralyzed? You're the Superhero for having the skills to save him!

    Not to be a bitch, but I would rather have died on the table than survive a shootout with multiple injuries (which sometimes cause lingering health problems) & end up in a wheelchair for the rest of my life. No more dancing, no more horseback rides, no more driving, no more walks... that would be unbearable.

    But maybe that's just me.

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    Replies
    1. Amazing how in one fell swoop you dismiss the lives of paraplegics.

      A lot of people in the world wind up in a wheelchair for the rest of their lives, but are glad to be alive. Indeed, many of them lead a more fulfilling life than those who believe that life revolves around dancing and horseback rides.

      Cheerio
      Softship

      Delete
    2. Many people lead fulfilling lives while in a wheelchair but it is not for everyone. Still nice save by DocBastard.

      Delete
    3. I don't know why my response posted a few posts down... maybe when I signed in, it dropped down.

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    4. I agree with melissa: some people adapt and thrive with a life changing injury, and some people cannot cope. for a person to be honest and say they don't think they could cope is no dismissal.

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    5. To state that "I would have rather died" than survive not only dismisses the lives of the people who do survive (and possibly thrive), it dismisses the efforts of those who give their best effort to save your life.

      Ultimately nobody knows how they'll deal with a disability (or terminal illness) until they have it.

      Cheerio
      Softship

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    6. Maybe this is another agree to disagree situation.

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    7. I suspect you're right.

      This conversation reminds me that I need to get that living will and OOH DNR together though. I'd hate for a doctor to put a lot of effort into saving my life in a circumstance where my wish would be to die.

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    8. This reminds me of the age old random question: what would you rather lose the use of (or have amputated etc), your arms or your legs? Most people will say legs because you can be far more independent if you still have your arms, but theres always those people still who would insist theyd rather keep their legs.

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    9. K, though I understand where you're coming from... Even if from your current perspective it might very well be your wish to die if faced with the propect of being (for example) a paraplegic, that doesn't mean you would still want to die if that actually happened to you.

      In this case it appears that Doc Bastard at no time needed do resuscitate Uri, so a DNR would have changed nothing in the outcome (provided you were lucky enough to have Doc Bastard there to save your life).

      Embrace life!

      Cheerio
      Softship

      Delete
    10. I appreciate your perspective, Softship, but there are very deeply rooted beliefs behind my choices. My view is not at all idle consideration or ableism, prone to change with circumstances; it's the result of years of reflection and a part of my identity. It's unlikely that I'll give it up.

      Delete
    11. K, I didn't assume your view was idle.

      Becoming disabled can be sudden (as in the case of Doc's Uri), or it can be a slow process, giving you the opportunity to adapt to your diminishing physical abilities. Had I known in advance what path my life would take after my diagnosis in 1999, I would have declared myself incapable of dealing with it. Of course I have sometimes mourned the loss of the life I thought I was going to have, but usually I am simply grateful for that "new" life (which was only possible due to the generosity of others). I have met wonderful people I would never have otherwise known. I have also discovered own strengths that I never suspected I possessed, which has also been very rewarding.

      K, at least you recognize that it is only unlikely, but not impossible.

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    12. perhaps, you should keep in mind, softship, that we all have our experiences.

      my experiences include people who have chosen to kill themselves rather than carry on with a life situation they couldn't cope with. shall I accuse you of being dismissive to them?

      Delete
    13. Ken Brown, of course I keep in mind that we all have our own experiences.

      No, I am not at all dismissive of those who choose to kill themselves. My paternal grandfather, a paternal uncle, my mother and a couple of dear friends killed themselves - I respect their decisions.

      IMO there is a huge difference between (for example) a paraplegic deciding s/he cannot bear to continue living, it is something else entirely for an able-bodied person to declare not wanting to live as a paraplegic without having *experienced* what it is actually like.

      Cheerio
      Softship

      Delete
  3. Maybe Uri's superpower is being considerate to his trauma surgeon.

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  4. This needs a follow up, Doc. This kid needs it.
    Thank you for another amazing story, doc. I enjoy my Monday night specials before bed.
    <3
    Fen

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  5. I truly don't think RC was discounting the lives of paraplegics. I think she was honestly just stating what her preference would be if this was happening to her.

    I think it comes down to what is important to you and what you can and can not deal with... if you can handle your new normal. I read this book 'Before You' and the exact debate you and RC are on different sides of was the basis of the book. I think it's a hot button topic that people feel really strongly in one way or another and there's not a lot of middle ground.

    Either way, I am always impressed by Doc's ability to stay calm and be rational in the face of injuries I definitely wouldn't want my hands on.

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    Replies
    1. Melissa, of course everybody would prefer to die perfectly healthy at the age of 100... :-) But RC's post states that s/he would find death preferable to a life in a wheelchair. The last sentence "MAYBE that's just me" sounds a like "I can't really imagine ANYBODY could feel differently about life in a wheelchair"...

      Of course people feel strongly about their own theoretical disability in one way or another, but I maintain that nobody in good health can predict what their life with a major disability or terminal illness will be like until they are dealt that life.
      I find my disability/terminal illness has enriched my life beyond measure.

      Cheerio
      Softship

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    2. "when I die, I want to go peacefully in my sleep, like my grandfather did.

      not screaming in terror like the passengers on his bus."

      unknown.

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    3. Haha omg Ken... I haven't heard that before but it is funny lol

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  6. That's the downfall of the internet... not ever really knowing what people have been dealt in life because there's two computer screens and miles in between.

    My personal beliefs are neither here nor there but I am so glad that you have been able to thrive in your new normal.

    Maybe I am too literal and I really don't look much into anything beyond what is written but again, I truly don't think RC meant any offense to you or anyone else who has learned to accept their circumstances or been grateful to those who saved their lives.

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