Friday, 1 September 2017

Diversity

This probably goes without saying, but the world of trauma is pretty damned diverse. I don't mean to say that trauma is different from other medical specialties in that way, because I'm sure every doctor feels the same way about his or her chosen field. However, all those other doctors are wrong. Trauma is clearly the best.

I kid, I kid. Sort of. Not really.

Think about it though - GPs see mostly elderly people with chronic diseases like hypertension and diabetes and high cholesterol, but also the odd patient with back pain, a sniffle, various other aches and pains, or a vague sense of unease. Not so diverse. Specialists only see patients in their particular chosen area. Trauma, on the other hand, is so varied is because we see every and any manner of traumatic injury, intentional, accidental, and otherwise: car accidents, motorcycle crashes, falls (from standing, off ladders, out of windows, from bed, from pub stools), stabbings, assaults, gunshot victims, bicycle crashes, animal attacks (these stories are usually the best), industrial accidents, sports accidents, and other. Diversity.

I can't really categorise Mauricio (not his real name™) in any other way, so he must therefore be an other.

If there is one thing I've learned from watching crime shows, it is don't run from the police. Don't run on foot, don't flee in a car, don't speed off on a motorcycle, just don't fucking run. No matter how fast you think you are, even if the officers themselves are not terribly swift, the police dogs and helicopters are faster than you. Mauricio apparently either never watched these shows or isn't smart enough to pick up the message.

My bet is the latter.

The walk-in clinic is an off-shoot of A&E/ED in which I have very little involvement. If you think I avoid the emergency department and their "I just, I don't know, I just don't feel right" patients, you better believe I avoid this part of it. This area is reserved for the non-emergent emergencies (ie the patients who can usually wait to see their GP the following day or week or year), but unfortunately I still get the occasional call from docs there about patients with facial fractures they can't deal with or lacerations they don't want to deal with. The stories are rarely good, which is why I never tell them.

Until Mauricio.

Mauricio had been brought to the walk-in clinic by police after what they called a "fall".  They are not medics, so I can't really fault them for not giving an appropriate consultation, but I will anyway because Mauricio was not a fall, as we all found out later. Regardless, the emergency physician's workup on Mauricio included a CT of his brain which found two surprising results: 1) he actually had a brain, and 2) a subdural haematoma, which was why I was called. He was complaining of a headache (obviously) though he was neurologically intact. Despite the rather ugly looking scan, he had no weakness, numbness, or any other complaint. He ultimately would not need surgery, but he still needed to be closely watched in intensive care to make sure that his brain didn't swell and the bleeding didn't worsen.

Despite the two surprises we already had, the diagnosis wasn't the real surprise. It was the mechanism of injury that was.

Mauricio had been caught trying to steal a car. I say trying because he apparently is a shit car thief and could not even get in the door. A bystander apparently saw him using a clothes hanger to try to unlock the door (yes, really) and called the police. When they arrived about 15 minutes later, he still hadn't figured out that 1) the hanger would never work on that particular model car, and 2) a rock would have broken the window and gotten him into the car much more easily. Anyway, when the police told him to freeze (or whatever the hell they actually yell in 2017), he did not freeze. No, he ran.

And ran.

And ran.

Right into a brick wall.

Now last time I checked, brick walls are neither small nor particularly mobile, so surely Mauricio was just so drunk that he stumbled into it, right? Nope. His blood alcohol was negative, as was his urine tox screen. He actually literally just ran into a brick wall.

I can add this to the pile of "Well, I doubt I'll ever see that shit again."

28 comments:

  1. and I can add it to the pile of "did you really just throw that challenge to the call gods?"

    ReplyDelete
    Replies
    1. And lo, they all said "hold my beer and watch this"
      THE CALL GODS HATH SPOKEN

      Delete
    2. shouldn't that be "Holdeth thou mine bier and behold mine wonderment"

      Delete
    3. "...saith the Call Gods." Do not thou forgettest that phrase.

      Delete
  2. I walked into a tree once. Just out for walk and was looking to the left at some crows and pow! Guess I don't walk straight when I am not looking straight ahead. Just glad nobody saw me.

    ReplyDelete
  3. I'm pretty sure I understand how it happened as I've watched someone almost do something similar:

    He was looking over his shoulder at the cops rather than looking where he was going.

    (In my case it was Shanghai, maybe 8:30pm--dark, streets pretty much empty. Note that I am white, she is Chinese, Shanghai-born. We were walking along, holding hands--but it was chilly out so our hands were in my jacket pocket. This was back when you saw little affection in public. A guy came along on a bicycle and was looking at us far more than looking at where he was going--and at the last instant realized he was about to hit a telephone pole and just barely avoided doing so. Unlike Mary he was going straight at the time, he just hadn't looked far enough ahead.)

    ReplyDelete
  4. I walked into a parking meter and said "Excuse Me" after leaving a Mexican restaurant in Redondo Beach CA when I was young and foolish and had way too many Maggies and beers. I was not driving but boy was I looped. Paid for it at work on Saturday....
    My husband is a locksmith and he tells all sorts of tales about car lockouts. He's got a special tool that he got from a locksmith tool manufacturer that he can open a car in 20 seconds.He has to have a special security license to do these things. He can pick a door lock in 30 seconds.
    Guess Mauricio needs to get glasses, or maybe he was looking behind himself when he hit the wall. Love it!

    ReplyDelete
    Replies
    1. I have a special tool that gets me in quicker than that, but it's kind of rough on the window.

      Delete
    2. We have a kit for our trucks with about 12 tools, however summer time cops gave us permission to unlock a car Ken's way if we find an animal or baby locked in a car.. My boss won't let me pick the windshield or the owners face..
      I have face planted it in to sliding glass doors and sliding screen doors, I have walked in to things and said sorry or excuse me.. Christmas time isn't a holiday I much enjoy, I was belligerent drunk and walked in to the Christmas tree, and proceeded to fist fight it, the kill shot was when I curb stomped it..

      Delete
    3. windshield saws are fun, too. but we don't use them as much - we cut the roof off from back to front and leave the windshield working like a hinge - once the patient is out, we can simply fold it back closed and the car can go away all in one piece.

      Delete
    4. Sorry doc for going off subject as always..
      Ken are you watching the fire on i84, it's now on to Corbett.. I'm waiting for my neck of the woods to go on full alert, the smoke is invading my apartment and the cats are sneezing half to death.. I smell like a good ole camp fire, so there is that..
      Good thing I work north of I84 by ten blocks because I didn't want to breathe for the rest of the day..

      Delete
    5. the smoke's clear down here. - not low enough to have to smell it, but thick enough to affect the sun.

      Delete
  5. Soo can we have an animal attack story? The best you've got? Pretty please?!

    ReplyDelete
  6. At least we know why the bleeding/swelling didn't affect his brain - plenty of room inside that skull!

    I once walked into a parking meter - I had turned to the right to chat to a friend and when I turned forward again it was below my line of vision so I just walked straight into it. Either that or it sprang fully-formed from the pavement in front of me.

    Ugi

    ReplyDelete
  7. you would think trees are live pretty sedentary lives, too, but you would be amazed how many people around here are driving along minding their own business and a tree jumps out in front of them.

    ReplyDelete
  8. Mauricio sounds like half the guys from the neighborhood. The half that ended up in prison or dead. Like the kid across the street, whose 'small business' once brought a SWAT team to his door. (They didn't find him. Maybe try showing up some time other than noon on a weekday.)

    ReplyDelete
  9. When our son was in second grade, he was playing tag at recess. He ran into the school building wall and broke his wrist. It happens.

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  10. This comment has been removed by a blog administrator.

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  11. Hey Doc. The Dumbness rolls on
    Published: 15:42, 7 September 2017 | Updated: 21:04, 7 September 2017

    A Northern California judge has said Jahi McMath, who was declared brain dead more than three years ago after a tonsillectomy, may still be technically alive.

    The judge ruled Tuesday that Jahi McMath's lawsuit against Children's Hospital in Oakland can proceed.

    Alameda County Superior Court Judge Stephen Pulido said it will be up to a jury to decide whether the girl is dead or not.

    He questioned whether the teenager: 'satisfies the statutory definition of "dead" under the Uniform Determination of Death Act,' according to East Bay Times.

    The McMath family, under the influence of their attorney, believe Jahi is owed more than $250,000, which is the cap in California on the amount of damages that families of children killed by medical malpractice can collect.

    After seeing almost 50 videos of Jahi moving particular fingers when ordered to do so Pulido said she doesn't qualify as being brain dead.

    Emeritus professor Alan Shewmon from UCLA, who specializes in pediatrics and neurology, said Jahi: 'is a living, severely disabled young lady, who currently fulfills neither the standard diagnostic guidelines for brain death nor California’s statutory definition of death.'

    Shewmon says videos recorded by the McMath family from 2014 to 2016 show the teenager, who was born in 2000, is still alive.

    The case has been at the center of national debate over brain death since her mother refused to remove her daughter from life-support when the girl was 13.

    Jahi was born in 2000 and had a tonsillectomy in 2013 to cure her sleep apnea, however hours after the operation she suffered a cardiac arrest and was declared brain dead.

    Three doctors urged a California courtroom in 2014 to take her off life support but her parents took her to a New Jersey facility that let her stay on life support.

    She is currently in New Jersey.

    http://www.dailymail.co.uk/news/article-4862356/California-judge-Girl-thought-brain-dead-alive.html


    Presumably there will be court ordered exams such as MRI scans, Apnoea tests and the like.

    ReplyDelete
    Replies
    1. tests? why would there be tests? that would involve a judge making a decision.

      Delete
    2. This comment has been removed by a blog administrator.

      Delete
    3. They can buy a house in BH.

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    4. I see your reading comprehension is still as bad as when I first crossed paths with you.

      the judge decided nothing - everything is still the same as it has been for the last three years. no judges have enough backbone to make a ruling so they just kick the can down the road.

      Delete
    5. With a swimming pool and a yacht. Nailah is shopping around for a 2017 Bentley. She's thinking of changing her name to Nelly too.

      Delete
    6. you never did answer whether you prefer canned corn to frozen corn.

      Delete

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