Monday, 30 October 2017

The Speech

One of my favourite things to do is to lecture people.  By "lecture" I don't mean lecturing medical students, which I am unfortunately contractually obligated to do.  It turns out I'm a terrible teacher; I just have absolutely no patience for people who just don't get it.  Ironically, my backup plan if my medical career fizzled was to be a biology teacher.  Yeah . . . that would not have gone well.

No, what I mean is lecturing patients, most notably drunk drivers.  I love it.  I relish it.  I enjoy every opportunity to tell people that what they just did was stupid, reckless (though not wreckless, har har), irresponsible, and their thoughtless act endangered not only their own lives but the lives of everyone around them.  In case you can't tell, I have a canned speech in my head that I've used several hundred times, and it keeps getting better every time I give it.

Unfortunately I don't always get to give The Speech.  Sometimes the bad guys leave before I get the chance, and rarely there just isn't time.  Even more rarely, however, I don't need to.

Like with Edwin (not his real name™).

Being awakened in the middle of the night is a pain in the ass.  Not only do I have to shake out the mental cobwebs to make sure I am alert enough to deal with whatever is coming in, I also have to rinse my mouth a bit and make sure my hair doesn't look completely insane.  Don't misunderstand, I don't care if I look a bit like Albert Einstein, but trust me when I say you absolutely do not want your trauma surgeon looking like Yahoo Serious.  Anyway, when my pager goes off at 3 AM on a Friday night telling me I have a car accident victim on the way, I can be well assured it's a drunk driver.

Enter Edwin the Drunk Driver.

I like to think that Edwin, who was 22-years-stupid, would have been a Type I Drunk had he not been quite as intoxicated as he was.  However, with the amount of alcohol in his system, he could barely keep his eyes open let alone yell at people coherently.  Everything that did come out of his mouth was mumbled worse than Muttley.  I was absolutely astounded he had even been able to find his car keys let alone drive.  Though he couldn't really speak, what he could do was fight: with the medics, with us, with literally anyone who came within arm's reach.  He had blood on his face which clearly came from somewhere, but he was completely unable to cooperate with any sort of workup.  We were therefore forced to sedate him and intubate him to complete (or start) our evaluation.

Once he was sedated the entire team let out a collective huge sigh of relief as the trauma bay immediately quieted.  What was most obvious was the relatively small laceration on his forehead which had already stopped bleeding.  What hadn't stopped bleeding, however, was his spleen.

His splenic laceration was first diagnosed by a bedside ultrasound and was then confirmed by CT scan.  It wasn't the worst I'd ever seen, but it was certainly there.  He also had a few minor fractures in his pelvis, none of which would be anything more than really annoying for the next few weeks.  But as I was going through his blood work, one number stood out that caused my ire to rise.  It was a foregone conclusion that his blood alcohol would be elevated (it was about 4 times the legal limit), but even though the number didn't really surprise me, for some unknown reason it still made me angry.

Actually, no it isn't an unknown reason.  The reason is very known.  It's because my wife drives my children around on the very roadway Edwin was screaming his way through that night.  Edwin put everyone's lives around him at risk, and he was incredibly lucky that only he was injured, luckier still his injuries did not end up being life-threatening.

The Speech was already being prepared in my mind.  I just needed to let him sober up overnight.  No sense in wasting it on a slurring puddle of whiskey or beer or whatever the hell he had been drinking.

By the following morning, Edwin was sober, awake, and breathing on his own, and the breathing tube had been removed.  I stood outside his room readying The Speech with steely resolve, hoping his mother/wife/girlfriend/anyone would be there to hear my scathing lecture.  I took one final breath, turned around, and walked in.

What greeted me was not at all what I expected: Edwin, the loud, brash, obnoxious, out-of-control drunk from the night before was talking softly, almost meekly, with his mother, who looked mildly anxious though not angry.

Well . . . that was unexpected.

After perfunctorily asking him how he was feeling ("Sore, doctor"), if he was having any new pain ("No, sir"), and if he remembered anything from the previous night ("No, sir"), I was about to launch into The Speech when he cut across me gently.

"Doctor, did I hurt anyone last night?  Is everyone ok?"  Tears started to well in his eyes.

My steely resolve was starting to turn into oatmeal.

It only took a minute or two of talking with Edwin to discover that he was truly and genuinely mortified at what he had done and what could have been.  The last thing he remembered from the previous night was drinking at the pub, and the next thing he remembered was waking up in his hospital bed this morning.  He was terrified he had hurt someone, and he had nothing but regret and remorse behind his eyes. 

Yeah yeah, I can already hear a lot of you cynics screaming "But Doc, come on!  He was faking it!  How could you fall for it?  He just feels bad because he wrecked his car!"  No.  I saw his eyes.  This was no act.  I see a lot of drunk drivers and I've heard the lot of them tell me how they've never done it before, they'll never do it again, blah blah blah blah.  I can see right through the charade, and it doesn't impress me in the least.  But Edwin was different.  Edwin impressed me.  He looked instantly relieved when I told him it no one else was hurt, but he was still visibly shaken.

"That just isn't me, Doc.  I don't know why I did that.  I just have no idea."  The tears continued, real tears of penitence.  "I swear that just isn't me.  I just have to learn from this, learn from this mistake.  Never again.  NEVER.  This is a real turning point for me, Doc.  It has to be.  I just don't know what I would have done if I had hurt someone."

And I absolutely believed him.

Edwin was stealing my opportunity to give The Speech, and I let him.  He went on for several minutes beating himself up much more effectively than I possibly could have.  His mother sat behind him, nodding here and there, wiping a tear away every so often.  When he was done he looked up at me.

"At least I didn't hurt anyone.  Right?"

I saw Edwin in my office about a week later.  He was limping slightly and the swelling around his right eye had almost disappeared, though his black eye had not yet.  His laceration had healed well and I removed his sutures.  Before I could even bring it up, Edwin said, "Doctor, thank you for taking care of me.  I've given up alcohol completely.  This was a real wake-up call for me.  I just, well, I just wanted to say thank you.  Thank you."  True remorse is a rare thing for me.  But learning from a mistake that quickly is even rarer.

Now before any of you  just on my case for being a big softy, don't worry - I got to give The Speech just 2 days later.  And I let it rip with no hesitation.

41 comments:

  1. once in a while we get one who learns the relatively easy way. a man I knew learned by driving a classic car across a railroad track without a grade crossing, and then waking up in jail.
    others, well, I've heard of recognizing the suspect used as grounds to assume the suspect was driving under the influence.

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  2. Driving death wish Drive snakes through trafic at high speed. Not even drunk.

    https://twitter.com/AwardsDarwin/status/923971966490562560

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  3. Don't be too quick. I was in a crash 3 years ago, and everyone assumed (before blood tests, people) that I had been drinking. But I hadn't. I had incurred two broken ribs and a punctured lung two days before, had not known how badly I was hurt, and passed out from lack of oxygen.

    No one else was hurt, thank God. Be sure the person you rip into is in fact guilty.

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    1. Not sure how this is relevant when doc here would have access to the blood tests that you didn't.

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    2. Yes considering BAC tests were developed in the 30’s.

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    3. I keep thinking about this, and I keep coming back to the point that butt-chewings usually aren't irreversible.
      and with that, I hope your doctor gave you a butt chewing about not getting whatever it was that broke your ribs checked out, because surely broken ribs don't quit hurting like hell in just an hour or so.

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    4. Susan, it takes about 30 minutes to get the blood alcohol level back. I never tear into them until I am sure.

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  4. Doc- are you able to speak your mind to these kinds of patients or are you limited somewhat by the patient satisfaction surveys? In our Hospital, we can’t tell the frequent flyer fat fella that wants pain medicine for his bad knees to lose weight with diet and exercise because it might hurt his feelings and give us a bad review on the survey, even though it’s sound medical advice. Just wondering if you’re able to give The Speech worry free

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    1. the more I hear about patient satisfaction surveys, the more I think they need to be strictly regulated or that doctors and staff should also file surveys on each patient.

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    2. Elle - I don't give a damn about patient satisfaction surveys. I am there to make people better, not happy.

      That said, in all the years I have been doing this, I have had exactly zero complaints from patients about my various lectures. Mostly what I hear is some iteration of "Thank you for speaking so plainly". Sometimes people need brutal honesty.

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  5. Doc, with the recent terrorist attack in New York City. If you were the surgeon assign to perform surgery on Mr. Uzbekistan Terrorist. Would you do it?

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    Replies
    1. fr my part, humanity aside, I want him to live to answer questions.

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    2. but beyond that, while I admit I would not take saving the patient as seriously as with, say, a child who wasn't buckled in, (buckle your children up, damnit)

      I'm better than he is.

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    3. (by he, I mean the driver, not doc, if that isn't obvious)

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    4. Someone suggested leaving an instrument or sponge inside after surgery.

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    5. Id rather hed of not made it to the hospital the bastard. Sadly doctors have a duty to do what they can no matter who it is. And hes included in that list.

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    6. I can’t speak for Doc, but I like to think that I would perform surgery on him to the best of my ability, were I a surgeon. It’s simply not my place to decide who lives or dies.

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    7. Anon - Absolutely 100% yes. I have operated on everyone from murder suspects to their victims. It is not my job to judge people on what they've purportedly done.

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    8. Doc you do judge people based on what theyve done. This blog is proof.
      You just dont let it Affect your job

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    9. I'd probably do it too. But I'd be twisting all his colon in an unimaginable shape. Let him survive that one.

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    10. I think of a trauma bay like an arena where a team is literally fighting death. Death is always the enemy of a physician/healthcare team.

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    11. Not in some acute care hospitals for the elderly. "She's old and suffering from dementia." Let's not be aggressive in treating her mild pneumonia. However, we can always start her on morphine drip to make her comfortable. If she crashes, it wouldn't matter since she's already a DNR.

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    12. Anon - that's called compassionate care. Not everyone needs saving.

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  6. We all make mistakes and hopefully 'Edwin' is grateful enough that he won't drink & drive again.
    You include simple things in 'The Speech' like how to take an Uber/Lyft, call a cab, call a friend, or just simply walk?

    NOT drinking and driving is about the most simple thing a person can do.

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    Replies
    1. Assuming his area has lyft and uber. For example some cities in the US due to taxi unions and other bullshit are still hold outs on legalizing uber in their areas. Like first time i went to new orleans, no uber the taxi unions were adamant against it. Few months later kn a return visit bam uber was everywhere.

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    2. usually those are a case of taxi unions requiring Uber drivers to conform to the same rules Taxi drivers and other people who drive for hire have to conform to.

      you know, like vehicle safety inspections, having the correct license in states that require people who drive for hire to have a special license, that sort of thing.

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    3. In new orleans, uber drivers dont have those special requirements. Its the same requirements as here in california- fill out a form. Even though it was one of those cities that was forced to hold off on that.

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    4. You always have the option of
      NOT DRINKING AND DRIVING.

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    5. My secondary job is dispatcher for a towncar service, at night I dispatch for three companies, trust me when I say we have to get all kinds of licenses and do all kinds of city and state background checks and tests, we moonlight as town-car drivers when we are over booked.. We have city police numbers so passing the city/state background bullshit was easy.. Lyft and Uber are killing the town-car company.. Our cars are so ridiculously old and ratty pieces of shit (most the vehicles have over 500k in miles). I don't understand why the cheap fucks don't try to bump our image and get new cars or lease a fleet besides the two new Teslas that can't go over 230 miles on a full charge. I think they are waiting for Uber/Lyft to bankrupt the company..

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    6. it's one of those cases of why make the investment when the "ride sharing" companies are going to undercut you, anyway.

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  7. the issue with Uber is that they have a history of trying to dodge any law they don't want to be inconvenienced by.

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    Replies
    1. And the problem with taxi companies is rather than keeping up with the times they try to cripple new competition

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  8. Doc, you should be more compassionate. Some people have an addiction and yelling at them could make them drink more/resent you rather than feel like they should stop drunk driving. Clearly even with the number of speeches you have given, if there are still many drunk drivers, you speeches may not have your desired effect.

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    1. a little resentment is a small price to pay for saving a life. and if their drunk driving habits are bad enough to land them in the trauma bay, a lecture is not going to be able to make them significantly worse.

      and with the number of lives I know that have been permanently affected by drunk drivers, to say that a person should not do everything in their power to discourage a drunk driver is what lacks compassion.

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    2. 1) I lecture, not yell. Raising your voice in a hospital is disrespectful and unprofessional.
      2) Compassion for drunk drivers? Absolutely not.

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    3. Lecture with a stern voice I hope, no one has to yell to get a point across, sternness has a more desired affect..
      My job can't differentiate between being stern and yelling, my pos boss wrote me up for screaming and yelling at my call taking retards. I asked them to replay the illegal video of the office they have live streaming at their homes, and not once could the moron hear me speak let alone scream and the camera is above my head and they could hear that tattler scream because she was barked at to sit down and shut up because I couldn't hear my radios and I had two drivers on massive wrecks and the CFO and I were trying to figure out what to do with one of the massive wrecks, funny to watch the office tattle tale try to explain what she actually meant by her exaggerated lies and being caught doing what she claims others do..

      My father was killed a month before I was born by a drunk driver, my father was a passenger in a t-boned car that wrapped passenger side around a telephone pole..
      If my guys take more than half an hour on scene they get to charge additional fees per 15 minutes, sometimes drunks have a higher bill than an accident of the same manner where the person wasn't drunk.. If you have to pay 100 extra, it's cheap compared to what will happen the next time because sadly a very small percentage of narcissistic shit bags learn the first time..
      I released a car to a DUI bitch, she got real lippy with me, talking shit while bobbing her head, rolling her eyes, implying that I was a useless thief with nothing better to do (she had boyfriend with her).. I cordially asked her if she remembered why she was towed in front of boyfriend and it shut that lippy bitch up, she got snarky when boyfriend left. I went and grabbed an activator bar and reminded her that releasing her car to some that I felt was still impaired was illegal and that her car was on my property at that moment and I had possession of her keys.. Back story- driving drunk during our massive ice storm- ice on a few inches of snow on first layer of ice, went off the road in front of a cop and got stuck, tried to run drunk and was caught..
      I have seen the carnage of a drunk driver crossing 4 lanes on a freeway and going head on with a car, killed the innocent person..
      I went on a DUI few night ago, carseat in the back and kids backpacks and kids toys and clothing, I died a little inside of heartbreak for those kiddos..

      Got one a week before it, found out she was her nieces babysitter, she was freaking out because her sister needed to use the carseat..

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    4. I don't know if the news up there showed the one we had a week ago.

      we airmailed two of three kids up to our regional DocB, and sent the third by ground express.

      BUCKLE UP YOUR KIDS, DAMNIT.

      Delete
  9. "....when he cut across me gently" is evocative and perfect. Most especially because it's authored by a wordsmith surgeon in the telling of his stern/soft story. You placed the your scalpel in the hands of your patient brilliantly. Thanks for this hidden present. M in NC

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  10. Edwins are very rare birds. I am wondering if this could have been his first experiences with alcohol.

    I dealt with a drunk driver that came to the perfect solution of drinking and driving. He suggested setting up traffic cones in a parking lot and let drunks "practice" driving drunk. I think it must have been alcohol induced encephalopathy doing the talking.

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    1. It might show them how dramatic the effect of even quite small amounts of alcohol is on driving. Although it's cheaper and easier to just try playing mariocart drunk (Rainbow road when over the limit.. no chance)

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