Tuesday 27 June 2017


If you are a regular reader here (or even an irregular reader) or if you follow me on Twitter (and if you don't, WHY THE HELL DON'T YOU), it probably seems like I get angry on rare occasions.  Ok, sometimes.  Alright, often.  OK ALL THE GODDAMNED TIME.  The truth is that anger is just a facade, a face that I put on to make my words seem more compelling.  I'm actually a very level-headed person and I manage to keep my composure in nearly any situation no matter how infuriating it gets.  Yes, I rarely yell at my children when they do something particularly egregious (though I have kept my 2017 New Year's Resolution for the most part), and yes my wife and I have the very infrequent argument which never escalates past what I would consider a minor tiff (and we never go to bed angry - excellent advice for anyone not yet married).

So no, in reality I'm not angry all the time.  In fact, I very rarely am.  It takes a lot to get me angry.

Roscoe (not his real name™) got me angry.  VERY fucking angry.

Some people don't talk much as they enter the trauma bay, and the reason for this is varied:
  1. Brain injury
  2. Intoxicated
  3. Asshole
  4. Scared of the police
  5. Deaf
Severely brain-injured patients typically do not open their eyes, and I can only recall one deaf patient in the past decade or so, so when Roscoe was brought to me with his eyes wide open yet refusing to say a word, I strongly suspected some combination of 2, 3, and 4.

"Hi there Doc, here we have Roscoe.  He's 19, we think.  That's the only thing he'd say to us, and he had no ID on him.  He wrapped his car around a pole at around 100 kph (62 mph), we think.  He isn't saying much, so we don't know if he has anything on board {"on board" is medic speak for "drugs/alcohol"}, and we also don't know if anything hurts.  We haven't found much in the way of outward trauma.  Have fun, Doc!"

I hated that medic just then, but I wasn't angry.  Yet.

Roscoe looked like a healthy young man, he didn't smell of alcohol, and he barely had a scratch on him, just an abrasion or two on his left knee and elbow.  All his limbs seemed to be intact, he didn't groan as I pushed on his chest or abdomen, and his back and neck appeared normal.  The biggest problem I had to assess was his brain: was his lack of speech a product of a drug other than alcohol or did he have a brain injury?  A CT scan should tell me quite quickly.

And it did - his brain appeared as normal as the rest of his exam.

However, this didn't answer my question fully.  A CT scan will show a subdural haematoma, subarachnoid haemorrhage, or haemorrhagic cerebral contusion very nicely, but a concussion doesn't show up on any scan as it is purely a clinical diagnosis.  I walked back to the trauma bay from radiology with my mind working frantically, trying to figure out what was going on from the information I had.  And as I walked back into the trauma bay, the amount of information I had suddenly jumped up several notches: Roscoe was talking.

I overheard him tell the nurse in a very hushed voice that he had taken something that a friend of his had given him after they had smoked several joints.  He wasn't sure what the pill was, all he knew was that it was round and white and made him sleepy . . . which explains why he fell asleep at the wheel.

I was annoyed, but still I wasn't quite angry.

Roscoe's mother showed up (with a little boy in tow) a short while later after his lab work had come back.  It was all normal except for his urine tox screen, which was positive for marijuana and diazepam (Valium).  Roscoe's mother was cooing over her son, obviously (and rightly) thankful he was uninjured.  Her cooing quickly stopped when I told them about his tox screen.


Wait, kill your younger brother?  What?  

It turns out Roscoe (who was only 17, not 19, not that that made a damned bit of difference) was on his way to pick up his 7-year-old brother from a birthday party but decided it would be a great idea to stop at a friend's house, smoke a few joints, and take a random pill just before getting back in the car.

NOW I was angry, and I was sure glad I wasn't the only one as Roscoe's mother continued her well-deserved tirade.

I get angry when innocent people are put in jeopardy because of the stupid decisions of others.  Sure, Roscoe had put his own life on the line, but he had also endangered the life of his little brother as well as all the other people on the road around him.

Normally I try to calm family members down so they don't yell and disturb the other patients in the trauma bay and the rest of the department, but not this time.  Nope, not a chance.  I let Roscoe's mother give him the business as long as she wanted, and boy did she.  I have no doubt whatsoever that this wasn't the last Roscoe would hear of it from her.  She continued berating him as they left the trauma bay, the little boy still walking silently behind them.

Having proofread this post several times, I feel myself getting angry again.  Does anybody know a homeopathic remedy I could use to calm me down?

Oh, never mind.  I found one.

Tuesday 20 June 2017

Too old

I'm sure everyone reading this has heard the adage "Age is just a number".  To most, this aphorism means that you're never too old to have fun.  To a trauma surgeon, however, it sounds like an excuse for older people to do stupid shit that should be left to younger idiots.

Now before anyone accuses me of being "ageist" or something, just stop a minute and think.  Is it "ageist" to expect a 20-year-old kid to understand how the world works?  No, of course not.  Young kids just aren't old enough and therefore don't have the necessary experience.  That's why we (generally) don't elect 20-somethings to elected office; they just don't know any better.  On the other hand, it also is not ageist to expect a middle-aged person to have accumulated enough firsthand knowledge of things to avoid doing seriously stupid shit.  Older people should just know better.

Quincy (not his real name™) should just know better.

I should start by saying that Quincy is not a stupid man, or so I found out later.  That was not the initial impression I got, however.

It was early afternoon on a beautiful bright warm Saturday afternoon when Quincy was brought to my trauma bay in a rather sorry state.  I rarely get the full story from the medics, relying only on rough bits of information.  This case was no different.

"Hi everyone, this is Quincy.  54 years old.  Helmeted rider of a motorcycle, crashed at around 70 kph (about 45 mph).  Brief ell oh see (LOC: loss of consciousness), awake and alert now.  Complaining of severe abdominal pain, right hand pain, left hip pain."

Quincy was mostly awake and mostly alert, and he groaned audibly as he was moved from the gurney to our stretcher.  My Inner Optimist started whispering at me as Quincy was hooked up to the monitors, revealing a heart rate of 120 but a normal blood pressure.  "It's probably nothing.  He's probably just very amped up from the accident is all."

My Inner Optimist is annoying as hell.  And often wrong.

My initial exam showed an open fracture of his right hand and significant tenderness in his left hip.  But what really struck me was his abdominal exam.  He kept pushing my hand away whenever I pushed on his belly, something he didn't even do when I was examining his obviously badly fractured hand.  And when I did push, his rather rotund abdomen felt like a board, and it hurt a lot more when I released pressure compared to when I pushed.

1) Voluntary guarding.  2) Board-like rigidity.  3) Rebound tenderness.  All signs of peritonitis.  Quincy had something seriously wrong inside his abdomen that was killing him, and he needed surgery.  Now. 

I rather gleefully pointed out to my Inner Optimist that he was wrong again. 

Quincy's blood pressure held steady in the normal range for the next ten minutes as he was packaged up and brought down to the operating theatre.  Expecting the worst I made a large vertical laparotomy incision, and I was not disappointed.  What struck me first as I entered his abdomen was the smell of vomit, clear as day.  What struck me second was the lack of BIT (Blood In There).  Something, most likely his stomach, was clearly perforated, but somehow that something wasn't bleeding.  Perforations are bad, bleeding is bad, and the two together are worse.  Perforations without bleeding are still bad, but only slightly less bad.

Starting in the upper abdomen I began literally scooping out handfuls of onions, chicken, and corn (WHY THE FUCK IS IT ALWAYS CORN), reinforcing my assumption that his stomach had a large hole in it.  And when I finally got my hands on it, my suspicion was confirmed - a 7 cm laceration across the fundus and antrum (the lowest portion near where the stomach empties into the small intestine).  I initially controlled it with atraumatic clamps to stop any more stuff from leaking out, and I then fired a stapler across the injury to repair it.  His descending colon also had a partial-thickness laceration which did not penetrate the entire wall (fortunately) which I also repaired.  Nothing else was injured, which explained the lack of BIT.

Normally at this point in a trauma operation I would close and everyone would high-five and congratulate each other for another life saved (not really), but not today.  No, now came the really fun part: cleaning up.  

You would be surprised how large and deep the peritoneal cavity is, so now knowing that you would probably not be surprised how easily and in how many places corn (GOD DAMN IT, WHY ALWAYS CORN) can hide.  Several litres of irrigation later, I was still pulling out bits of . . . stuff ("What is that, carrot?").  This left me feeling wholly unsatisfied that he was clean enough to close, so I didn't.  I created a temporary vacuum closure and brought him to intensive care with plans to bring him back in a day or two, clean him out again, and possibly close.  IF he was clean.

Two days later his peritoneal cavity was surprisingly nearly spotless.  There were only a few partially digested bits of food left, and after irrigating with more litres of saline irrigation, I closed him.

A couple of days later after Quincy was extubated and off the ventilator, I finally got to ask him what I had wanted to know since he arrived: why had he crashed.  His answer was something I would expect from a teenager.

"Well you see Doc, I was showing off to the guys in my motorcycle club, doing a wheelie, and . . ."

"Wait," I interrupted, "you were doing a wheelie?  At 70 kph?  Are you aware you're 54 years old?"

He smiled weakly and laughed even more weakly.  "Yeah, it was probably stupid."


He laughed again.

I had a very long chat with Quincy and his wife about his recklessness and how he was too old
for this shit.  I could almost excuse this kind of nonsense behaviour with a 20-year old kid (almost) because that's what 20-year old kids do - stupid shit.  But not Quincy.  It turns out he was a highly intelligent, articulate, competent middle aged man who just had a momentary lapse of judgement that nearly ended his life.  Quincy's wife looked me dead in the eye and assured me that his motorcycle was already up for sale at a bargain price.  I suspect it will be sold to a reckless kid who will probably do something equally stupid with it.

But that's probably just my Inner Pessimist talking.

Tuesday 13 June 2017

Stupid update

This is the update you've all been anxiously awaiting - the update on last week's near-catastrophic near-career-ending story.  Or maybe you don't really give a fuck and I'm just being overly dramatic again.  In any case, if you missed it I did a Very Stupid Thing and tried to grab a chunk of Japanese maple that was spinning on my lathe at 750 RPM.  Ok, I didn't really try to grab it - it wasn't intentional, I was just trying to prevent the machine from jumping off the table because the log was unbalanced.  Regardless, my hand contacted the spinning log resulting in a deep gouge in my left hand that required three sutures.  Here is the offending log:

And here is the part of the log that actually hit my hand:

The irregular portion in the middle of the picture is where a rather large chunk of wood tore off and lodged in my hand.  And before you sick bastards say anything, no, there's no goddamned blood on it.  I withdrew my hand fast enough that the blood went on my floor, not the wood.  Fortunately.  I guess.

If you aren't saying "OW OW OW OW" right now, then you haven't been paying attention.

Of course in hindsight I should have bolted the lathe to the table when I first bought the lathe and built the table, but I hadn't intended on turning big rough logs at the time.  And then I changed my mind but didn't change the setup.  This rather (completely) silly (idiotic) manoeuvre led to the nearly-career ending injury about a week and a half ago.  Fortunately it did not actually derail my career.

Or my hobby.

What, you didn't think I'd let a goddamned log beat me, did you?  As soon as I got home from the hospital I disassembled the lathe table, installed some bolts, and then bolted the damned machine to the damned table like I should have done in the first damned place.  And as I was finishing, the lidocaine wore off.

Ow.  Ow.  OW.

I stayed out of the shop for a few days after that, not so much to protect my hand but more so Mrs. Bastard wouldn't have to remind me to be careful.  If that makes it sound like she was nagging me, I assure you she wasn't.  I was just being restless and stupid and anxious to return to creating stuff.  But then yesterday I decided that enough was enough - it was time I got back into it.  And when I did, the maple log was staring at me, daring me to work with it again.  So I did.  I put on the appropriate safety gear, grabbed my bowl gouge, and got to work.  And here's what came out of it:

That's right, log.  I beat you.  I WIN.

Fuck you, log.

Monday 5 June 2017

Stupid, stupid, stupid

I think I make it clear that I see a lot of people who do stupid things.  Some of these people doing stupid things are actually stupid so can hardly be blamed for acting stupid, while some have simply made a stupid choice.  These choices may endanger their own lives or the lives of those around them, depending on A) what particular flavour of stupidity they've decided to commit, and B) how stupid that stupidity is.  But of all the stupid patients I have ever treated, few have come close to matching the stupidity of my least favourite patient:


Yes, the trauma surgeon became the patient a few days ago.  Fortunately I didn't put my life in danger, but I did stupidly threaten my career.

If you don't already know, I'm an avid do-it-yourselfer.  I paint, fix, create, mend, build, really anything that involves anything around the house.  If there is a tool that doesn't involve metallurgy or automobiles, there is a very high probability that I have it.  For example, when our automatic coffee machine went bad about two years ago, Mrs. Bastard bought a new one, but I wouldn't let her take it out of the box.  Instead, I bought a new solenoid and installed it (I didn't even know what a solenoid was at the time, but it's amazing what you can learn on YouTube).  And when the water pump on that same machine started making funny noises two weeks ago, I installed a new one.  Yeah, the new coffee machine is still in the box.  Boom.

Anyway, in addition to fixing most anything (people included, apparently), I also am an amateur woodworker.  Name a woodworking tool, I have one (or three).  I've built most of the new furniture in my house over the past 10 years, but my newest wood hobby is turning.  Last fall I bought a lathe and made myself some turning tools, and I've been getting to know the machine and its capabilities, making several little bowls and cups in the process.

You can probably see where this is going, even if I couldn't.

Four days ago I upped the ante and decided to try a bigger bowl.  I installed the maple blank on my lathe, knowing it would be unbalanced and that I had to balance it by turning it round while it was spinning at relatively low speed (around 600 rpm).  What I didn't realise was exactly how unbalanced it would be, because the lathe started bouncing all over the place.  My split-second reaction was to try to grab the machine to stop it from falling over, but in that instant my left hand came in contact with the spinning wood, not the machine.


I felt the wood hit my hand near the thumb, but I didn't immediately feel any pain.  My second reaction (which should have been my first reaction) was "TURN IT OFF, STUPID!".  The wood came to a stop, and I then assessed the situation.  These were the thoughts that came into my brain in order:
  1. Whew, the lathe is ok.  Good.
  2. Hm, I didn't get that balanced very well.
  3. Why the hell does my left hand hurt?
  4. What's that red stuff on the floor? 
I looked down at my hand, and there was a lovely jagged laceration on the thenar eminence (the fleshy part of the palm at the base of the thumb).  As I should have done from the start, I went into Trauma Mode.  I was able to move my thumb - good.  I could feel the tip of it - good.  The laceration was deep, and I could see some subcutaneous tissue.  Not so good.  It was bleeding - not so good.  Um, was that exposed bone?  Shit . . . let me explore the wound to see if there are any foreign bodies in there -


As I grabbed a paper towel to stanch the bleeding, I started to catalogue the supplies I have at home to suture it up.  Lidocaine - check.  Needles and syringes - check.  Gauze - check.  Suture material - check.  Needle driver, forceps, and scissors - check, check, and check.

Sweet, it's my left hand and I'm right handed, so I can suture this myself.  

Wait wait wait . . . how am I supposed to tie a knot in the suture with one hand.  God damn it.  Just go to the hospital, idiot.

Mrs. Bastard has a rather eerie ability to sense when things are going awry.  More than once she has called me when something is amiss, not actually knowing 1) that something is wrong, or 2) what that something is.  If I believed in psychic abilities (no, I do not), I would believe Mrs. Bastard has them.

My mobile literally rang as I was getting out of my car at the hospital (100% true).  I didn't even have to look at it to know that it was my wife.  Somehow.  My exact first words to Mrs. Bastard before I even said "Hello" were:

Me: Ok, well on the bright side, I decided not to put in my own sutures.
Mrs. Bastard: . . .
Me: . . .
Mrs. Bastard: . . .
Me: Hello?

It wasn't so much a question as a statement.  I told her I was fine, I still had all my fingers, but that my lathe had sort of bit me.  She sighed.  It wasn't an "Oh well, I love you, dear" sort of sigh, but more of a "You're an idiot and we'll talk about this when I get home" sort of sigh.

An hour later I had a numb thumb, a large chunk of maple (that I had initially mistaken for bone) in my pocket as a souvenir (ok, "large chunk" may be a slight exaggeration, but 7 x 6 x 3 mm is HUGE for a splinter), a tetanus (Tdap) booster, and several polypropylene sutures in my hand.  It wasn't until I was driving home that it dawned on me just how close I came to ending my career in that moment.  I've seen some horrific life-altering woodworking accidents in my trauma bay, and I just as well could have lost my thumb (or even several of my fingers).

I got lucky.  That was it.  Nothing but dumb luck saved my hand (and my career).  But as I've said innumerable times in my life, I'd much rather be lucky than good.  My hand will heal up in a few more days, I'll take out my own sutures (at least that I can do myself), and I'll get back to turning that bowl, having relearned an extremely valuable lesson.  Every now and then one of my tools teaches me to treat them all with utmost respect and never let my guard down, even for a split second.

And if anyone is wondering about the tetanus vaccine, no, I'm still not autistic.

Not dead

I'll start this post by answering a few questions that may or may not be burning in your mind: No, I'm not dead.  No, I didn't g...