Monday, 9 October 2017

Fool me once again

I've written before about not learning from mistakes. In case you missed that episode, please go back and read it. I just did, and that story is fucking hilarious (if I do say so myself).

Anyway, it seems that in my trauma bay I see more than my fair share of people who are either unwilling or unable to learn from what they've done wrong so that they don't do it again.  Everyone makes misteaks (myself included, naturally), but unlike many of my patients I try to refrain from making the same misteak twice.  This is a lesson that I beat into my children (NOT LITERALLY) on a daily basis.  After all, I tell them, if you don't learn from your mistakes, then what the hell is the point of making mistakes.  Right?  Of course right.

I have to assume that Lacey (not her real name™) didn't have such caring and knowledgeable parents.

Lacey was brought to me in a bit of a heap one fine late evening, the police trailing just behind.  That is, as you have probably guessed, never a good sign.  When she was wheeled into the trauma bay, she was completely unresponsive, unable even to open her eyes.  When I see such a patient, I think of the three Most Likely Possibilities:
  1. She has a severe brain injury,
  2. She is drunk (or otherwise intoxicated) as hell,
  3. She is faking to avoid talking to the police.
It's my job to differentiate among the three.

"Evening, Doc.  Here we have Lacey.  She's 29, history of anxiety and depression, allergy to penicillin, takes one medication for anxiety though she doesn't know which one.  History of heroin abuse.  We found her like this, unresponsive, outside her car on the side of the road.  Basically no damage to the car, but, you know, we can't tell if she hit her head or oh-deed or what.  She's been unresponsive like this since we found her, though her vitals have been rock stable."

A quick glance at Lacey revealed no outward sign of trauma, not even an abrasion.  She literally had not a single scratch on her.  I strongly suspected Most Likely Possibility #2.  She had a grossly abnormal neurological exam: her pupils were pinpoint and she did not respond to painful stimuli, so I could rule out Most Likely Possibility #3 (though #1 was very much still in play).  Her physical exam was otherwise completely normal.  X-rays of her chest and pelvis were normal.  An ultrasound of her chest and abdomen showed no sign of bleeding around her heart, lungs, liver, spleen, kidneys, or bladder.  A full-body CT scan was negative.

This did not seem to be Most Likely Possibility #1 either.  Shocking.

A few minutes after seeing her normal scans, her lab work finally came back.  Her chemistry and complete blood count were (are you sitting down?) totally normal.  Finally I saw what I was looking for: something.  Something.  Anything that could explain why she was out cold.

Her urine tox screen was positive for heroin.  I hate the term "Duh", but really.  DUH.

Now clearly no one in the trauma bay was surprised, but as we started to discuss the sheer stupidity of driving after injecting way-too-much heroin (though to be fair, any amount of heroin is way too much if you plan on driving), something occurred to me about the medics' presentation that hopefully occurred to you too.  I cocked my head as I thought about it, wondering.  

Fortunately the ambulance crew was still milling around the hallway, so I decided to ask them the question that was noodling around my brain: If she was unresponsive when you found her, how the hell did you know her medical history other than heroin use and that she was allergic to penicillin??

The medics turned to each other, laughed, turned back to me, laughed in my face, and then started high-fiving each other.  Not really, but that's what it felt like as he chuckled politely and said,

"Oh, because we picked Lacey up for a heroin overdose earlier this morning too."

Wait, you . . . what?  Of course you did.  Somehow, that made total and complete sense.

Unfortunately for the general public, the police left without arresting her.  I have no idea why and no reasonable suspicion other than that the officer got bored of waiting for Lacey to wake up.  So instead of going to jail for endangering every single person around her, Lacey got away with it.  Again.  She woke up, got dressed, asked me for a prescription for narcotics (HA!), and went home.

I can guarantee that she learned absolutely nothing from this episode, and I can further guarantee with near 100% precision that I will see her again.  Probably soon.

Tuesday, 3 October 2017

Guns

I'm angry.

I'm sad.

I'm thoroughly upset.

If you don't know what I'm talking about, go google "Las Vegas" right now and you'll be instantly updated.  If you're reading this after October 2017, well, just click here I guess.

A man whom I will not name went on a shooting rampage from an elevated vantage point in Las Vegas, killing 59 people (so far, not including himself) and injuring about 500.  I will repeat: HE KILLED 59 INNOCENT PEOPLE AND INJURED OVER 500 MORE.  In an hour.  With an arsenal of guns.

All of which were obtained legally.

In addition to the 23 guns found in his hotel room, police found 19 more firearms in his home along with several thousand rounds of ammunition.  A terrorist, right?  A maniac with a long history of mental illness, right?  A career criminal who got all the guns illegally, right?

NO.  He was a wealthy gambler who purchased these guns legally.  All of them.  He had no criminal background.  He passed an FBI background check.  And he was able to amass an arsenal and then kill several dozen people with it.

And predictably, infuriatingly, people are defending his right to do so.

As someone who deals with gun violence on a daily basis, I am sick to fucking death of people (looking at you, 'Muricans) shouting about their second amendment rights.  Their right to defend themselves.  Their right to own a gun.

Yes, you have the right to bear arms, just like others have the first amendment right to say "FUCK YOU" for it.  But for those of you about to comment to that effect, that amendment you seem to idolise was written in 1791 when guns were fucking muskets and took 5 minutes to reload.  Do you think your founding fathers would have been ok with semi-automatic rifles being converted into automatic rifles with legally purchased parts?  Do you think they would have passed that law knowing what we have now, knowing that a rifle can be purchased online in less time than it takes to reload a musket?

And above all, do you really think that law can't be changed?

IT'S CALLED A FUCKING 'AMENDMENT'!  OF COURSE IT CAN BE CHANGED!

And as for your right to protect yourself, give me a fucking break.  Look at the actual statistics.  For every "protection" gun death in the US, there are 34 gun-related homicides and 78 gun-related suicides.  You don't even have to look it up, because I've done the work for you.  Just click anywhere in this paragraph  Those are FBI statistics.  Read them.  Understand them.  Yes, guns protect people, but at a very high cost.

The second amendment was written so that the people could protect themselves against a tyrannical government.  When was the last time the second amendment protected the people of the United States against the government?  When?  Any gun advocates care to answer that one?

FUCKING NEVER.  (No, the Whiskey Rebellion doesn't fucking count.  Not a single shot was fired, and the people were protesting a tax on alcohol that they didn't like.  And even if it did count, that was also way back in 1791.  Muskets, remember?  And neither does the American Civil War, because the South was trying to fucking defend slavery.  And they rightfully fucking lost.  And if you'd like to bring up Cliven Bundy, just don't.  He was wrong, and he also lost.)

I'm not even going to expound on gun violence in Australia, where over 650,000 guns were bought back by the government after the Port Arthur massacre in 1996, and there have been a total of ZERO mass shootings since then.  In contrast, in the US I can think of at least a dozen mass shootings in the past year alone (SO FAR), and a dozen more last year.  Is the US the same as Australia?  No.  Do I think the same policy adopted in Australia would work in the US?  YES I DO.  And do I have evidence to back up this belief?

YES I FUCKING DO.
Now do I think banning all guns is the answer?  Of fucking course not.  First off, anyone who thinks that it is even remotely feasible to go out and round up even 1% of the 350 million guns in the US is a certified lunatic.  Let's be honest, just changing the law would be difficult enough, and rounding up any guns would be nigh-on impossible.  But the state of affairs as it stands now is absolutely untenable, and I categorically refuse to believe that tougher restrictions wouldn't lead to less access to guns, and that less access to guns wouldn't lead to fewer gun deaths.

One final thing.  I am sick to fucking death of everyone's "thoughts and prayers" for the victims.  I'm tired of hearing about vigils.  I've had it with moments of silence.  I've never seen a thought or a prayer stop a mass murderer.  Vigils don't mean jack shit.  I've never heard of silence changing a law.  It is WAY PAST TIME for American politicians be silent.  It is time for them to stop the thoughts, ignore the prayers, give up the goddamned moments of silence, and GET UP AND DO SOMETHING.

Note: I realise that I will rile approximately 50% of the population with this, and I am absolutely 100% fine with that.  I hate guns.  Gun owners and fanatics are free to leave whatever comment you like.  I understand that you can be rabid in your defence of guns and gun ownership.  But understand that I will delete any comment I deem inappropriate.