How many true surprises are there in life? This was the question I asked Mrs. Bastard when she was pregnant with our first child and wanted to find out the baby's gender (and I didn't). Now I've heard the counter argument that the gender of a baby is not a true surprise, because it's either going to be (except in extremely unusual circumstances) an A or a B, so that essentially eliminates the surprise. I wholeheartedly disagree for reasons I find very difficult to elucidate because I'm right and you're wrong and shut up.
Regardless, I suspected my first child would be a girl. Mrs. Bastard "just knew" it was a boy.
The birth turned out to be one surprise after another. To start, after Mrs. Bastard was struggling with labour for about 10 hours, the baby-to-be began showing signs of foetal distress. The "normal" delivery was immediately converted to an emergency C-section.
My wife was very calm (and very awake) throughout the surgery, which was so violent that her blood got on her face, the anaesthesiologist's scrubs, and even the ceiling (yes, really).
The baby was unceremoniously extracted from my wife, and the first thing I noticed (YES OF COURSE I was in the operating theatre) was the full head of hair followed immediately by decidedly female genitalia. As I leaned down with a grin and said in my wife's ear "I told you it was a girl", the delivery nurse yelled "IT'S A BOY!"
It was NOT a boy. MiniBastard Number One was, and still is, a girl, though her actions occasionally make me suspect she is actually a monkey.
Without question the most surprising aspect of that entire experience was that the nurse, whose job is literally taking care of newborn children, could not tell the difference between a girl and a boy. And before anyone comments about ambiguous genitalia, it wasn't. At all. The nurse was just plain wrong.
Now in case you're wondering why the fuck I'm telling this story and how the fuck it relates to trauma, I will now risk giving everyone whiplash and move on to my seemingly-unrelated-but-still-somehow-related gunshot victim story.
It should come as no surprise that the overwhelming majority of my gunshot victims are young males. I get a few women, most of whom have been shot by ex-boyfriends, but the demographic is fairly uniform. So when I was told I would be getting a gunshot to the chest at 3 o'clock in the afternoon, I was 1) surprised it wasn't at 2 AM, and 2) naturally assuming it would be another young man who would be actively dying.
Wrong and wrong.
When the medics wheeled in 78-year-old Bertha (surprise!), she was awake, alert, and, uh, smiling. Every single person in the room immediately turned to each other and quizzically said the exact same thing: "This is supposed to be trauma, so what exactly the fuck is this?"
"Hello everyone, this is Bertha. She was eating lunch when she heard a gunshot and was hit in the arm and chest. No one else in the house could give us any information. The police are on it. Anyway, she's been awake and alert the whole time. Vitals have been stable."
Bertha turned and smiled at me. Surprise!
Any gunshot-wound-to-the-anything immediately gets a full head-to-toe exam, because where there is one hole, there could be two or three or more. Bertha had a through-and-through gunshot wound to her right upper arm, clearly below where the humerus and neurovascular bundle are found. She was also moving her arm just fine, and her radial and ulnar pulses were both normal and equal to the opposite side, so there was obviously no serious injury there. After going through her arm, however, the bullet had entered her right chest around the level of the 6th rib. And there was no exit wound to be found.
Uh oh . . .
No exit wound means just one thing: the bullet it still in there somewhere. Unless I happen to be able to feel the bullet just under the skin somewhere, I have no way of knowing if it went up, down, sideways, diagonally, backwards, or frontwards. Fortunately, however, we have X-rays to help solve the mystery. Two minutes later I was looking at her chest X-ray, which showed . . . nothing. No pneumothorax, no haemothorax, no fractured rib . . .
And no bullet. Nothing. Unfortunately this could mean that the bullet had gone south into her abdomen, though I doubted it since her abdominal exam was normal. An abdominal X-ray a few minutes later confirmed that this had not happened either. There was no bullet.
I re-examined her chest, and there was clearly and undoubtedly a bullet hole there. She had definitely been shot. I also re-examined her from head to toe in an attempt to find the missing hole, but I again came up empty. So where the hell was the bullet?
Bertha smiled pleasantly at me.
With my Inner Pessimist yelling that the bullet had probably entered her heart and embolised to her leg (no it didn't, shut up), we wheeled her over to the CT scanner where the surprises continued. The scan from head-to-toe also revealed no bullet. It also showed no injury to her thorax. It then became apparent that the magic bullet did indeed hit her in the chest, but it had lost enough kinetic energy while traversing her arm that it had simply struck her 6th rib and bounced out.
The bullet bounced out.
As I explained to Bertha that she had a few holes but no actual injuries and that she was incredibly lucky, she just smiled at me and said "Thank you. I think my lunch is probably cold now."
And then I sent my gunshot-wound-to-the-chest patient home.
I got home the next morning and told this story to Mrs. Bastard, and she just nodded her head and said "Blog post?" because nothing I tell her about what I see in the trauma bay ever surprises her anymore. I told it to my daughter (who has exactly zero interest in going into medicine) later that afternoon when she got home from school. All she could say was "Wow".
As for me, I just thought of the question I asked my wife when she was pregnant: How many true surprises are there in life?
At least one more.
Stories about general surgery, trauma surgery, dumb patients, dumb doctors, and dumb shit from the dumb world around us.
Wednesday, 1 May 2019
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