Tuesday, 27 June 2017

Rare

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.

"WHAT?  YOU TOOK WHAT?  WHERE THE HELL DID YOU GET THAT!  YOU'RE ONLY 17 YEARS OLD!  YOU COULD HAVE KILLED YOUR BROTHER!  WHAT THE HELL WERE YOU THINKING, ROSCOE!"

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.

27 comments:

  1. I don't follow you on twitter because I don't follow ANYBODY on twitter. the same applies to facebook.

    and yes, being angry for a patient refusing to divulge information is perfectly justified. emergency responders NEED TO KNOW what a patient already has onboard, because that helps them in their diagnosis, and it helps them choose a medicine that will help the patient feel better without causing a bad, bad combination.

    and ANYBODY deciding to impair themselves while driving deserves everything their mother can dish out.

    ReplyDelete
    Replies
    1. addendum: homeopathic beer? one drop of beer in a gallon of water?

      Delete
    2. The trick is to use 100% ethyl alcohol at the diluting medium. It retains the 'memory' of beers intoxicating effects surprisingly well.

      Delete
    3. ROLF @ Andrew! Good one.

      And Doc, not for nothin', but back when you were 17, didn't you ever ingest a few substances that would've pissed your parents off if they found out? Not to say that what Roscoe did was smart -- I've NEVER taken a pill from anyone who couldn't tell me the name of the drug. (Altho' weed was my drug of choice back in the day.) But once he landed in your E.R., I'm sure Roscoe was terrified of A) getting arrested, B) getting his homeboy arrested if he ratted him out &/or C) having his mom kick his ass once she found out he got high & wrecked her car. In Roscoe's young mind, his best choices were to lie or remain silent. So he opted to exercise his 5th amendment right -- until an attractive nurse over-rode his mental process. Roscoe was lucky, as only the young & dumb can be in this world. But I suspect he learned his lesson.

      Delete
    4. Actually no, I never drank or did any drugs of any kind. I've still never used drugs, not even once. I understand that they appeal to kids, but not to me.

      For the record, the nurse to whom Roscoe confessed was a man. And not an attractive one.

      Delete
    5. I've also never seen the benefit to recreational drugs. I've also seen a few drawbacks while on duty.

      Delete
  2. That's so awful. I'm a chronic pain patient with multiple disabilities all causing pain. I quit driving years ago. It wasn't because of the medication, I'm cleared to drive because I've used narcotics for a long long time. I stopped because my pain makes me eternally sleep deprived, and I refuse to drive like that as it's reckless.

    There's stupid thinking (especially teenage), and there's STUPID thinking. Roscoe was STUPID.

    ReplyDelete
  3. Anything homeopathic just makes me angry!

    Ugi

    ReplyDelete
    Replies
    1. dilute a homeopathic remedy a hundred times and take one drop a day to cure your anger, homeopathically.

      Delete
  4. This stupid behavior reminds me of the stunt my mother-in-law pulled some years ago. She was upset that her doctor wasn't taking her knee pain seriously (her doctor didn't want to do any surgery until she lost some weight), so she got a friend to drop her off at the Emergency Room. There she proceeded to give everyone the silent treatment. Wouldn't say a word. Since my name was on the list of emergency contacts I got the call and headed to the emergency room, where initially she wouldn't talk to me either. She just stared at everyone with an intense glare and wouldn't say a word. So with her inability to speak, there was brain injury suspected -- maybe a stroke? When she came back from the MRI, she finally whispered to me that she was fine, and that she hoped to be admitted overnight and then would tell them in the morning that her knees were bothering her. Of course I told her that was insane and I was going to tell the doctor what was going on, and I did, but from then on all she did was respond with gibberish or stares, and they did admit her, by which time I left in disgust and said her son or daughter could deal with her now, but that I'd had quite enough!

    ReplyDelete
  5. And then there was the time she was being prescribed a blood thinner. She read the possible side effects and decided she was not going to take the medication. Now, of course, she was supposed to go in for a test to check the level of medication. So she said to me, "I'll just take the medication the day before the test and tell the doctor I've been taking it as directed." I told her the whole point of the test was to check on the levels after she had been taking the medicine for a week, so taking one the night before the test was going to give bad results. She said she didn't care because she had no intention of taking the medication anyway.
    I could go on with stories about her...
    About the time she complained that her finger was horribly infected and oozing pus and I needed to take her to the doctor because she was in such pain she couldn't hold a fork or a cup to eat or drink -- and when the doctor took off the bandage, it was perfectly fine. Or the time she complained after a fall about a wound on her leg that would not heal -- and when the doctor took off the bandage there was a perfectly normal scab. Fortunately, at age 94 she's finally seems to have stopped that crazy behavior because she doesn't want to leave the house anymore. How doctors and nurses deal with a person like this...

    ReplyDelete
  6. The reason I don't follow your twitter is that it is a little too full of rants against anti-vaxxers and the like for me to be interested. I've heard it once I've heard it all, they're bad!

    I think you could sell the rights to the title "stories from the trauma bay" for a nice movie or tv series

    ReplyDelete
    Replies
    1. I think it would really need Doc to write it as well.

      Delete
    2. The actor Ken Jong tried that with his recent tv show as it was based on his actual days as a doctor. Its already been cancelled
      Connor

      Delete
    3. just more evidence it needs a good writer.

      Delete
  7. Don't have twitter nor facebook account. My life is better without them.

    Al

    ReplyDelete
  8. I don't do Twitter, I deal with enough anger in my life and don't want to see that little Johnny or Amie had a bowel movement today, people over share..

    I'm a culprit on Facebook, but my Facebook is my macabre diary of sorts. Dear diary, some asshole called me an asshole and I damn near throat punched him to see what it would feel like to collapse a wind pipe again..
    Dear diary, my cats are terrorists and refuse to let me sleep, they have some vendetta against me sleeping and are using their songs of their people to keep me on the edge of sleep deprivation. Tonight one slept on the right side and the other slept on the left and fist fought in the middle, I swear they thought my face was a bingo.

    Ken!! Speaking of macabre, got a fatality last night over a block from work, two way traffic, busy busy thorough way for commercial traffic, person impatient with traffic decided to pull in to WB traffic in front of an EB travelling semi. Sigh, it's going to be a long summer..

    ReplyDelete
    Replies
    1. Btw *Bongo* for the love of everything evil..
      I did the silent treatment a couple times in life, the pharmacist freaked out.. I just handed him my script, and he asked if I ever filled there before, shook my head no, he asked if I had a name so I handed my license, he asked me if anyone was abusing me.. I gave him the queer eye and shook my head no, they brought over a sign language person and I shook my head no, he asked if I had dental work or my throat worked on today, and I shook my head no.. He was starting to get panicked, did I have a stroke, and more shaking the head no.. Where you seen in the mental health department today, I look at him like he had just had a kitten jump out of his forehead.. He finally frantically says, did I offend you, why won't you talk to me.. I said, because I don't want to talk. He said why, just talk.. I said I just lost a baby, I don't want to talk because I can only cry if I make my face move, and I went into full sobs.
      My script was done with a pharamcist guiltily saying I'm sorry about a dozen times.. and then everyone stepped away from me like I had the plague which made me cry harder..

      Fast forward, my coworker would sexually harass the shit out of me, verbally abused the shit out of me, and bosses thought I was making it up, and one day I decided to go silent, for a week I didn't talk to him, had someone around me the whole shift, that 500lb slob went to the bosses and demanded they make me talk to him.. I do it to people all the time, I was a counselor for 15 years, 15 years of talking and every once in a while I like being free of talking..

      Delete
    2. I assume and hope the semi was not the fatality. I don't much mind if a stupid person kills themself. it's when a stupid person kills somebody else I get irritated.

      Delete
    3. usually, if I am being silent, it is because I don't have anything I feel needs saying.

      however, I've always liked "I haven't spoken to my wife in years. I don't want to interrupt her." (Rodney Dangerfield, I think)

      Delete
    4. and my 4th of july workday has officially started. last night, I cooked pasta and bacon bits for pasta salad, and put them in the fridge to chill overnight. woke up a half hour ago, and finally decided to get up and mix the salad, and may be be able to get a couple more hours sleep after. well, before I can mix up the salad, I have to cook bacon bits, and chill them.

      now I'm pretty much up for the day, and my day will end in about 23 hours, instead of the 18 I was aiming for. at least Mrs Ken has learned to ask if I am in a bad mood.

      Delete
  9. Light up a cigarette it'll calm your nerves.

    ReplyDelete
  10. Just when you thought it couldnb't get any worse for Charlie, they now want him to be a guinea pig.

    Great Ormond Street Hospital has said "claims of new evidence" in the treatment of terminally ill baby Charlie Gard have prompted it to apply for a new court hearing.

    In a statement, the hospital said: "We have just met with Charlie's parents to inform them of this decision and will continue to keep them fully appraised of the situation.

    "Two international hospitals and their researchers have communicated to us as late as the last 24 hours that they have fresh evidence about their proposed experimental treatment.

    "And we believe, in common with Charlie's parents, it is right to explore this evidence."

    Researchers at the Vatican children's hospital have sent a letter urging Charlie's doctors to reconsider an experimental treatment.

    They said there had been "dramatic clinical improvements" in people and mice with a condition similar - though not the same - to Charlie's.

    An American hospital has offered to bring an experimental drug to the UK to treat him.

    Leaving Great Ormond Street on Friday evening, Charlie's mother, Connie Yates, said: "We're hopeful and confident that Charlie may get a chance now."
    Charlie has mitochondrial DNA depletion syndrome which causes progressive muscle weakness and brain damage.

    He is only the 16th person in the world ever to have been diagnosed with the condition.

    Ms Yates told ITV on Friday that her son was "not in pain and suffering".

    She said: "I promise everyone I would not sit there and watch my son in pain and suffering, I couldn't do it."

    Great Ormond Street said in its statement that it was "bound by the ruling of the High Court which expressly forbids us from transferring Charlie for nucleoside therapy anywhere".
    It said the ruling had been "supported unequivocally by some of the world's most distinguished clinicians and scientists".

    The hospital described Charlie's condition as "exceptionally rare, with catastrophic and irreversible brain damage".

    It added: "Our doctors have explored every medical treatment, including experimental nucleoside therapies.

    "Independent medical experts agreed with our clinical team that this treatment would be unjustified.

    "Not only that, but they said it would be futile and would prolong Charlie's suffering. This is not an issue about money or resources, but absolutely about what is right for Charlie.

    "Our view has not changed. We believe it is right to seek the High Court's view in light of the claimed new evidence."

    A family spokesperson said: "The decision by Great Ormond St Hospital to apply for a fresh hearing in the High Court regarding their son Charlie marks the end of an extremely traumatic and distressing week for his parents and the rest of his family.

    "Connie and Chris are like any loving parents. They have always put Charlie's needs first and will continue to do so as they only want the very best for him.

    "They are optimistic their son will soon get the treatment he needs and want to thank those people from around the world who've sent them so many moving and touching messages of support."

    http://news.sky.com/story/great-ormond-street-hospital-applies-for-new-charlie-gard-hearing-10940914




    ReplyDelete
  11. I am just hoping that GOSH are doing this just to shut the parents up and prevent them suing saying "that treatment could have worked..."
    The therapy would have to cross the blood- brain barrier which non of the treatments previously done has had to do.
    They were treating similar diseases NOT the exact same disease.
    His parents are trying to compare like with unlike.

    The mother is also in deep denial as to how sick Charlie is and what is anything the treatment will help.

    She said: "There is potential for him to be a completely normal boy but we don’t know, you just don’t know until you try. There’s 18 people on this medication already. The only side effect is diarrhoea. There’s been some amazing responses very, very quickly."

    Apparantly she seems t0 think his irreversible and profound brain damage can be reversed.

    I feel for poor Charlie.

    ReplyDelete
  12. Would it have been legal for someone to report that little buzzed shit to the police for impaired driving? Or is this against the law?

    ReplyDelete

If you post spam or advertisements, I will hunt you down and eliminate you.

Comments may be moderated. Trolls will be deleted, and off-topic comments will not be approved.

Web-hosted images may be included thusly: [im]image url here[/im]. Maybe. I'm testing it.