Tuesday, 22 August 2017

Prison

I don't typically think of my job as dangerous.  Quite the opposite, actually - the trauma bay is supposed to be a safe place where people who have done something particularly dangerous and/or stupid come to get something fixed.  Whenever we get a rowdy patient (who is usually either A) drunk, B) high on PCP, C) an asshole, or D) some combination of the above), everyone in the trauma bay knows that, with one quick phone call, several very burly men who could easily pass for moderately large bears will descend upon the asshole and defuse the situation in approximately 4.72 seconds. 

Sometimes, however, even that isn't enough. 

Unlike the trauma bay, prisons are violent places, and violent things tend to happen there.  Granted my information regarding the violence inherent in the penal system is mostly limited to what I learned in The Shawshank Redemption and O Brother Where Art Thou, but that knowledge base expanded significantly recently when I met Ervin (not his real name™). 

I don't usually get too worked up when my trauma pager alerts me to an impending "assault".  That may sound callous, but it's for several good (I think) reasons: 1) When people are assaulted, it is most commonly limited to the face, 2) if these people suffer any injuries (past lacerations and contusions), it is most often a broken nose or other facial bone, 3) those fractures rarely require surgical intervention, and 4) if they do, I call the maxillofacial surgeon to do it.  So when my pager alerted me to an assault arriving in 8 minutes, I sighed and put away the blog post I had been trying diligently (yet failing miserably) to make sound less stupid. 

But then something caught my eye - the patient was arriving by air, not ground.  Hm.  That could mean it was more serious than I was imagining.  Or it could mean the patient was injured further away than an ambulance could drive in a reasonable amount of time.  Or it could mean something else.  Yes, the dreaded "other".  

And of course it was "other". 

When Ervin was wheeled in, the first thing I noticed was the prison jumpsuit.  The second, third, fourth, and fifth things I noticed were the various handcuffs and shackles pinning him to the stretcher.  The next thing I noticed was the mask over his face (think Hannibal Lecter).  Finally came the bevy of police officers accompanying him.  This bodes poorly, I thought. 

And I didn't even know the half of it yet. 

"Hi there, Doc. This is Ervin.  Ervin has been (god damn it Ervin, stop fighting!), uh he's been tussling with the prison guards for the last (damn it, Ervin! Stop fucking spitting!), um for the last two days.  He's being transferred, and (fucking hell guys, he's trying to claw my arm again!), he's being transferred to another facility and doesn't want to go I guess." 

Imagine trying to wrangle a cat into a pet carrier.  Now imagine the cat is extremely angry.  Now also imagine that cat is 2 meters tall, weighs 110 kg, and can curse constantly.  Yeah, that's Ervin. 

He was covered head to toe in abrasions and contusions, and he had obviously earned every single one of them.  Ervin continued fighting as we moved him to our stretcher, and I've rarely seen such a relieved medic crew get the hell out of my trauma bay so quickly.  The officers, on the other hand, thankfully stayed. 

"You want us to uncuff him, Doc?" one of the officers asked me. 

"Hey wait," one of the nurses said.  "I know this guy!  Yeah, Ervin!  He was here as an 'assault' two days ago after he fought with the prison guards!  He injured two techs and a nurse, and he tried to kick me in the face!" 

The police officer looked at me askance. 

Uncuff him? Seriously? 

"Hell. Fucking. No.  Under no circumstances.  NO."  Yes, those were my exact words. 

The tech moved towards him to place an IV, and I immediately stopped her.  I made it clear to everyone in the room that no one was to come near this guy with anything sharp, and all we were going to do was get a quick 5-second CT scan of his brain, see that it was normal, and then send him right back from whence he came.  Fortunately when we brought Ervin to the scanner, he decided the CT doughnut wasn't as threatening as a roomful of cops, so he stayed still long enough for me to see a normal brain. 

Thank you for this one small thing, Call Gods

As I was chatting with a few of the guards a short while later, one of the nurses beckoned to me.  "The radiologist is on the line for you.  He has a critical finding he needs to tell you about." 

Oh come on, no. No. NO. 

It turns out I had missed a tiny subdural haematoma and an even tinier cerebral contusion.  I looked at the scan again and still couldn't see it, so I had another radiologist look at it.  He confirmed that I was indeed not a radiologist and the other radiologist is.  The finding was, in fact, real.  

God. Damn. It. Fuck You, Call Gods. Fuck you. 

So now I was obligated to admit this asshole, put an army of security guards and police officers on him, start an IV, try to do neuro checks on him every hour, repeat the CT scan in a few hours . . . 

Fuck. Just, fuck. 

I did exactly that, apologising to everyone involved in the process.  No one wanted to take care of Ervin, though we all did dutifully and respectfully.  Ervin, however, was not nearly as accommodating.  There were two very large police guards inside his room at all times, and fortunately his outbursts were mostly limited to hurling verbal abuse at anyone he could see.  

The following day his repeat CT scan was stable, his neuro exam was stable (read: he was still a violent asshole), and I kicked him the fuck out of my hospital before he could injure anyone else. 

I have no doubt I will see him again. Soon.

Friday, 11 August 2017

Surreal

Those of you who are regulars here or follow me on Twitter know my feelings on pseudoscience (otherwise known as "bullshit").  Depending on the day, my opinion wavers somewhere between "Pseudoscience is potentially dangerous nonsense" and "What the fuck are you idiots thinking".  Fortunately I've had very few interactions with pseudoscientific nonsense in my professional career, though several years ago I did have one woman ask me about Dr. Oz and an "olive oil flush" for gallstones.  Since I've been ranting and raving about various bullshit modalities like chiropractic, homeopathy, and acupuncture, I've often wondered how long it would be until my next encounter.

Wonder no more.

I was asked to see Barbara (not her real name™) late one evening for what sounded like typical acute cholecystitis - several days of right upper quadrant abdominal pain, fever, nausea, and vomiting.  Before going in to examine her I looked at her abdominal ultrasound, which showed multiple large stones in her gall bladder along with thickening of her gall bladder wall and inflammation surrounding the gall bladder itself.  Checking her bloodwork, her liver function tests were all normal (so no sign of a biliary tract obstruction - good), and her white blood cell count was mildly elevated as would be expected.  It seemed like a slam dunk, and it was.

Mostly.

When I entered Barbara's room, she had a friend with her, which is certainly not unusual.  I examined her carefully, and the only abnormality was fairly severe tenderness in her right upper abdomen, typical of someone with a gall bladder infection.  I explained the treatment protocol, which would be giving her IV antibiotics overnight followed by a laparoscopic surgery the following morning to remove her infected gall bladder.  I went through my prepared speech which I've given hundreds of times, including the risks, benefits, and alternatives.  And as usual I ended with my normal conclusion: "Do you have any questions?"

It was one of the few times I've regretted it.

Barbara whipped out a little notepad with myriad hand-written notes, and I was immediately bombarded with approximately 1,058 questions, everything from the mundane ("How long will I be out of work?") to the somewhat-strange-but-still-almost-normal ("What anaesthetic agent will I be given?") to the completely bizarre ("What are your instruments made of?").

Then she hit me with one that was so far out in left field it may as well have come from a different country:

"Can I keep my gall bladder?"

Um.  Uhhh.

I had to explain to her that I was obligated to give the gall bladder to the pathologist, who would cut it into thin slices and make sure she didn't have something wacky like gall bladder cancer, so, um, no, you can't keep your disgusting infected gall bladder.  I offered her the option to keep one of her stones instead, which she readily accepted.

And then her friend started asking questions.  Approximately 792 more.

Sigh.

After what seemed like two hours (but was probably closer to 8 minutes), I finally made my way out of her room, where her nurse caught my eye.  She rolled her eyes and smirked in a plainly obvious "Oh, she got you too?" look.  I merely smiled back weakly, feeling lucky to have escaped.

The following morning I went to see Barbara, and she still looked uncomfortable.  Regardless, she told me she was ready for surgery, which was scheduled for later that afternoon.  I went back to my office to see patients for a few hours, returning to the hospital about 30 minutes before her operation was due to begin.  I figured she would be in the pre-op area, which she was.  What I didn't figure was who would be with her.

The only way I could properly describe Barbara's visitor would be to say that she looked like she stepped directly out of 1967 into a time machine, landing in my hospital in 2017.  She could have easily passed as someone who went to a costume party dressed as a hippie and then forgot to remove the costume, so she simply continued living as a hippie.  She had one hand on Barbara's right shoulder and another on her back, and it looked like she was giving her some kind of weird massage.

"Oh, hi Dr. Bastard," Barbara smiled.  "This is Rena (not her real name™), my reiki master."

Your . . . your what?

I had no idea how to reply, and the anaesthesiologist could sense the palpable awkwardness growing by the second.  He gave me a knowing look, rolled his eyes, and clearly trying to break the tension said, "Yeah, I missed my last two reiki appointments."

Heh, good one.

"I KNOW, ISN'T IT AMAZING?" Rena replied with a broad smile, obviously missing the obvious sarcasm, which was obviously obvious.  Barbara smiled too, missing the fact that now both the anaesthesiologist and I were staring at each other, our mouths agape.

It's difficult to render me speechless.

In case you aren't aware of what reiki is, it's bullshit.  It's pure, unadulterated bullshit.  Here, I'll give you the rundown: take prayer, add running your hands over someone to transfer energy to them, and you have bullshit.  I mean reiki.  No, I was right the first time.  Bullshit.

I had never seen reiki actually practiced in real life, so I watched agog as Rena ran her hands over Barbara's right shoulder, muttering encouraging words (I guess) and supposedly transferring some universal life force into her.  This was happening as her very modern IV antibiotic was running through a very modern plastic tube into her very physical vein.

I couldn't think of anything else to say, so I quickly signed my paperwork, muttered something about changing into scrubs, and walked out.  The anaesthesiologist looked jealous.

Barbara's surgery was moderately difficult though uncomplicated.  Her gall bladder was quite inflamed, but it was no different than most any other case of acute cholecystitis I've handled through the years.  She went home the following day feeling somewhat better, but still in some pain.  My typical gall bladder patients go home the same day as surgery and are back to their usual activities within a day or two, relying on ibuprofen (if anything) for pain.  Barbara, on the other hand, emailed me several times a day over the next few days to describe the progression of her pain, nausea, appetite, temperature, and anything else she managed to quantify.  She finally started feeling better just over a week later, to her (and my inbox's) great relief.  She came for her follow-up visit two weeks after surgery, Rena tagging along.  Of course.

With that goddamned notepad.  Of course.

After conducting my exam (everything looked absolutely fine), I dutifully answered all of her remaining questions, including "When can I start juicing again?".  Barbara and Rena both profusely thanked me for my patience and warm bedside manner, and they left looking quite satisfied.  If they only knew what I had really been thinking.

Now I realise that this is only an N of 1 and anecdotes are not data, but it sure seems to me that Rena's energy transfer didn't fucking work.  Of course it's possible Barbara's surgery would have been even more difficult, and her recovery much more protracted, if she hadn't had the reiki treatment done.  Right?

Ha!  No.

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