Wednesday 23 May 2018

Likely story

I read a little story on the internet some time back (and because it was on the internet, it simply must be true) about a young man who was brought to the trauma bay (not mine) after being shot, and though he definitely looked like he was up to no good, he claimed he was shot while waiting for his grandmother to pick him up to take him to church.  No one in the trauma bay believes his ludicrous story, of course, until Grandma shows up a short while later in her Sunday Best, looking for her grandson to take him to church.

We often joke about what nefarious deeds our trauma patients have been perpetrating immediately preceding their injuries, and I have no idea if that vignette is true, but whether you believe it or not, it makes for a great fucking story.  This story is kind of like that.

Not really.

Mondays are supposed to be slow, easy trauma days.  After all, the Call Gods should be exhausted after harassing the unlucky weekend trauma surgeons for 72 straight hours (Friday counts as a weekday in the Call God Calendar for some damned reason), but this Monday was most definitely not easy.  The chaos started exactly 2 minutes after I walked through the door (fall), and it continued with a new fall or car accident or motorcycle crash every 30 minutes or so for the next 10 hours.  For a while it appeared that I would break my personal record for trauma patients in one shift, but finally right around dinner time it slowed down, giving me just enough time to shovel a cold hamburger (leftover from lunch) into my face before my pager started screaming again:

level 1 GSW 5 minutes

God damn it.

Exactly 12 minutes later (damned rush hour) Ryan (not his real name™) rolled through the door.  Screaming.


"Hi Doc, this is Ryan.  19 years old.  We've found 3 gunshot wounds - one to the right upper chest, looks like an exit wound in the right upper back, and one in the right hand.  Vitals stable, decreased breath sounds on the right.  Got two large bore IV's in his AC's."


I knew at once Ryan and I would get along swimmingly.

On my initial assessment, his breath sounds sounded clear and equal to me (I don't know how the hell the medics hear anything in those ambulances with the sirens wailing), so I doubted he had a pneumothorax (collapsed lung).  He indeed had a gunshot wound to the anterior right shoulder and a corresponding wound (entry? exit?) in the back of the shoulder.  Fortunately he was moving his shoulder and arm perfectly and had a bounding radial pulse, so I seriously doubted the bullet hit his humeral head or the neurovascular supply to the arm (which is much closer to the armpit).  His hand, on the other hand (har har har) was Seriously Fucked Up.

X-rays confirmed that he had no injury to the bones of the shoulder and no pneumothorax, but what he did have were several broken bones and lacerated tendons in his hand.  As I was consulting the hand specialist, I overheard Ryan giving his story to the police:

"I was sitting in my kitchen eating dinner when I heard a bunch of shots outside, and I guess a couple of them hit me."

Yeah, sure you were, Ryan.  I wonder if they actually expect anyone to believe this bullshit story.

After I patched Ryan up temporarily until the hand specialist could come in, I went back to reassess the last 172 traumas (or so it seemed) who had come in that day, suture up some lacerations, and discharge a few who had managed to sober up.  About 3 hours later I was finally nearly caught up when my pager went off again:

level 1 GSW 7 minutes


We cleared the trauma bay and readied ourselves for the next young man who was about to arrive.  Or at least we thought we did.

The 67-year-old woman who rolled through the door was not what we were expecting.  Nor did she really look like she had been shot.

"Hey Doc, this is Doris (not her real name™).  She was sitting in her kitchen eating dinner with her grandson a few hours ago when a bunch of bullets came through the window.  I think her grandson was brought here earlier, wasn't he?  Anyway, she has one gunshot wound to the left buttock.  No exit wound.  Bleeding is controlled."

Uh . . .

Ahem.  Hm.

I assessed Doris while eating some serious crow, and all I found was a single wound with the bullet retained in her rather voluminous left buttock.  A CT scan confirmed no serious injuries, and a short while later she was walking upstairs to visit her grandson.  I, on the other hand, had several days of making rounds on Ryan and Doris (who was always there visiting) to remind me just how stupid and wrong my stupid and wrong preconceived notions usually are.

If you're wondering about the three hour delay, Doris initially decided to forgo medical treatment when the medics arrived to pick up Ryan because, as she explained it, her wound wasn't really bleeding, she was walking normally, and she thought a few paper towels would do the trick.  And she was probably right.

Anyway, I guess this story proves once again what happens when you make an assumption: it makes an ass out of you and umption.  Or something.  Whatever, I just need to get some goddamned sleep.  Fuck you, Call Gods.

Tuesday 8 May 2018

The Resident, part 2

I can't remember if I promised I would never watch an episode of The Resident ever again, but if I did, I am officially rescinding that promise.  Don't worry, it's for a very good reason.

If you have no idea what "The Resident" is, I urge you to click here and read this.  In short, it is a very terrible TV show written by a very terrible writer about very terrible doctors doing very terrible things.  I got into a bit of a feud with the show's creator and writer, Amy Holden Jones (which is detailed in the post linked above), regarding the blatant and rampant anti-doctor rhetoric that suffuses the entire first episode.  As bad as the pilot was, I told myself I would never watch another episode.

Until now.

Amy seemed to take great offence at my twitter profile picture (if you're not familiar with it, it's right over there).  She seemed to think it was an example of patient shaming and that its use would somehow prevent people who inserted a foreign object into their rectums from seeking medical care.  I have no idea if Ms. Holden has ever had any foreign objects impacted in her rectum, but in my experience with many patients who have, they do not tend to wait long, nor do they allow profile pictures from anonymous trauma surgeons on the internet from finding someone to remove the offending object as quickly as fucking possible.

But I digress.

During my little tiff with Amy a few months ago, she threatened to write an episode of her soap opera that related to shaming of rectal foreign object patients and/or an incompetent trauma surgeon (unfortunately I believe that was in a series of tweets which have since been deleted or which I otherwise cannot find).  I laughed it off at the time.

And I'm still laughing it off, because she did.

Dr. Mark Hoofnagle is a general surgeon in Philadelphia, and he has taken it upon himself to fall on his sword and watch The Resident each week, live tweeting as he does.  It is a very amusing take on the show, and it has also gotten him blocked on Twitter by Ms. Holden.  According to Dr. Hoofnagle's assessment, his past week's episode appears to feature, well, me.  Or at least a very poorly done spoof of someone like me:
Of course I had to check this out.

Literally 14 seconds into the "Previously, on The Resident" recap, someone says "York, what did you shove up your rectum this time, and this flashes on the screen:
Hmmmmmmm.  Does this look familiar?  No, I can't possibly be seeing what I think I'm seeing.  I'm sure this is just an unfortunate coincidence, right?  Let's move on.

On second thought, let's temper my torture (and yours) and move way on.  In fact, let's skip all the regular soap opera bullshit and just get to the scenes in question.

A woman is struck by an ambulance and brought to the trauma bay, and the trauma surgeon, Dr. Nolan, somehow diagnoses a ruptured diaphragm from a pelvis X-ray.  I'm trying my best to ignore the pseudo-medical bullshit, so I'll simply say that while this is a major injury, we see this regularly and repair them routinely.  Dr. Nolan, however, appears confused by the diaphragm rupture, so instead of, you know, fixing it like a trauma surgeon, he calls in Dr. Austin, a cardiothoracic surgeon, to do it.  "He'll probably . . . save her life", he says.

Wait, what??

During the surgery, the trauma surgeon stands on the opposite side of the room looking at the monitor while Drs. Austin and Bell (the dangerous surgeon from the pilot) perform the trauma surgery.  Sigh.  Austin finds a lacerated spleen.  "Do you need a trauma surgeon, or . . . ?" the trauma surgeon meekly asks.  "NO", Austin replies while Nolan pathetically holds his hands in front of him, turns around, and wanders away like a chastised child.  He then stands idly by as Austin and Bell do . . . something to stop the spleen from bleeding.

I had to skip about 30 minutes of routine soap opera bullshit to get to the part I was seeking.

Dr. Austin is doing an aortic valve replacement on a nice old lady (who happens to be the mother of York, the rectal-foreign-object patient from earlier) and who, of course, codes on the table and appears to be in imminent danger of dying.  Austin coolly stands in the corner with his arms folded during the code and calls for . . . Nolan, the trauma surgeon.  When asked why he's calling for a trauma surgeon when there is no trauma, he replies gruffly, "I have my reason".  Nolan comes in a few seconds later, hands scrubbed, ready for surgery.  "I'm here.  What's going on?  What do we got?" he asks as he bursts through the doors.  He looks around confused.

"Am I needed for this surgery?" he asks hesitantly.

"No you are not needed for this surgery, Dr. Nolan", Austin chides.  He doesn't need a trauma surgeon, he merely makes him look like an idiot and uses him as an example of "someone who listens, who learns, and who understands", whatever the hell that means.  Understands what?  I have no idea, even after watching the scene five times.  Nolan then starts to quote Nietzsche before Austin cuts him off with, "You've served your purpose.  Now get out."  Nolan again turns pitifully and leaves.

Cut to advertisement.  That's the end of our trauma surgeon experience on The Resident.

I  have no idea what this scene was supposed to represent or what the message here was other than "HAHA, look at this idiot!  Trauma surgeons are totally lame!"  The scenes seem to have been poorly cobbled together for the sole purpose of making the trauma surgeon look bad, and by extension to make me look bad.  It is yet another glaring example of Amy Holden's utter contempt for doctors.

I find it amusing and rather pathetic that Amy Holden would go to these lengths to prove a point.  What that point is, I'm still trying to figure out, but I strongly suspect she watched the episode back and said, "There!  I sure showed him!"

Perhaps I'm over-reading this.  Maybe I completely misread the message being delivered.  Maybe I'm just really egotistical and this has absolutely nothing to do with me whatsoever, and the bottle-in-the-rectum X-ray and the feeble trauma surgeon appearing in the same episode just a few months after our spat are nothing but a huge coincidence.  Maybe Ms. Holden had this episode written years ago and has just been biding her time, waiting for the opportunity to present it.

But I somehow doubt it.

Not dead

I'll start this post by answering a few questions that may or may not be burning in your mind: No, I'm not dead.  No, I didn't g...