Thursday 31 October 2019

Well armed

Violence is unfortunately part of my job. I'm not talking about workplace violence, though several of my trauma nurses have been victims of that. No, I mean just regular violence - stabbings, shootings, slashings, animal bites, human bites, and assaults with deadly weapons. And sometimes also assaults with not-so-deadly weapons.

Based on the title of this post you may think this story is about guns or the second amendment. I can assure you it is not.

I'll explain.

I sometimes get excited when I see "LEVEL 2 ASSAULT" on my pager, but rarely because of the injuries. Don't misunderstand me, serious injuries can happen with blunt assaults, but they are almost universally some combination of facial lacerations, facial fractures (especially the mandible), and brain injuries ranging from mild concussion to severe intracranial bleeding. I don't fix facial bones (facial reconstruction surgeons do that), and I obviously don't fix brains (brain surgeons do that), so all I can do initially is manage any initial life-threatening cerebral oedema until the brain surgeon arrives. Or apply ice to the face. Fucking wheeeeee. That isn't exactly why I spent {redacted} years training as a trauma surgeon.

No, the singular reason I get excited at blunt assaults is the story. Was this a drunken pub brawl? A fan of the opposing team? A fight with a guy over an ex-girlfriend? A fight with an ex-girlfriend? A robbery gone awry?

Or something even better? 

Rufus (not his real name™) was something even better. Don't worry, before you get concerned that I am a bit too excited over someone getting seriously injured, he wasn't. I don't celebrate serious injuries. Much.

Just before midnight on Saturday night is prime time for drunk assault victims to slosh into the trauma bay, usually having pissed off (or pissed on, occasionally) the wrong guy for the wrong reason. But 10 AM on a Tuesday is just slightly less common. However, that is exactly when Rufus decided to get the shit kicked out of him. The trauma bay immediately filled with the aroma of stale whiskey, old cigarettes, and mothballs (for some strange reason) when the medics rolled an extremely drunk Rufus through the doors just past Coffee Part II Time. They looked not-at-all-concerned (though obviously bemused), because while they were trying to give me their report, Rufus was continually, loudly, unashamedly, and slurredly singing:
He mussst have been an admiral a sssultan or a king, and to hisss praisssses we sall alwaysh sssing. . .
"Sigh. Hey Doc, this is Rufus.  He was assaulted about the face with some object, not sure what it was and he won't tell us because we can't get him to stop singing. He's 62, history of hypertension, untreated. Obvious swelling around his left eye, has a laceration there. Bleeding is controlled. No other injuries as far as we can tell."
Look what he hass done for us he'ss filled ussup with cheer. . .
Ugh. This was obviously not going to be one of those "fun" stories, just another drunk asshole who pissed off the wrong guy. A quick but thorough evaluation of a very slovenly Rufus showed no injuries below his neck, only what I could only assume was several years' worth of built up grime beneath his fingernails. Clean that shit up, people. Seriously.

It was becoming painfully obvious that this would be 1) a boring story, 2) a quick run through the CT scanner, 3) a few sutures, 4) a litre or four of saline to sober him up, and 5) a discharge to whatever cave Rufus called home.

Lord blessh Charlie Mopsh, the man who invented beer beer beer . . .

I was only 4/5 correct.

His CT scans showed no brain injury and no facial fractures, as expected.  He continued singing (he may have gotten one note on key, possibly as many as two) as I tried to renovate him to his former glory and place a few sutures in his creased face. Well, my Innter Pessimist reminded me, at least his singing career can continue, though his modeling days are clearly over.

My Inner Pessimist can be a bit of an asshole sometimes.

At 11 o'clocks we'll ssstop for 5 short sheconds, we'll remember Charlie Mopsh . . .

By the time the police arrived to take his statement, I was already filling out his discharge paperwork. I guess Rufus had finally sobered up to the point where he could speak rather than sing, because he told them a story I was not expecting:

"Well you see officer, there I was at the pub minding my own business when this guy comes over talking shit to me. Now I'm a little drunk {HA!}, but he's real drunk, REAL drunk you see, and I'm not the sort of man to take that kind of shit, so I talk shit right back to him. He gets up in my face real close, so naturally I take a swing at him. You know. Well, he takes his arm off and . . . "

He . . . wait, what?  

"Yeah, he takes his fake arm off and starts beating the hell out of me with it."

I'm glad I was on the other side of the room, because I somehow doubt my agape look was terribly becoming. Nor was the ensuing laughter from everyone within earshot of this conversation.

After Rufus was finished with his story, the police confirmed that they already had in custody both the suspect and his weapon of choice: his prosthetic arm. The next 20 minutes were filled with pretty much everyone over the age of 35 asking if Rufus' real name was Richard Kimble.

Alas, it wasn't. I only know that because, unbeknownst to me, I was about the 14th very uncreative and not-quite-as-clever-as-I-thought person who asked.

Wednesday 23 October 2019


Yeah yeah yeah, I know I've been gone for over four months, and my Inner Egotist has been yelling at me regularly that my loyal readers (the few I may still have) have probably been missing me and wondering what may have happened. I have also taken several months off Twitter (as you may or may not have noticed), and when my brother recently asked me why, I replied simply, "Sanity". I realised that I was taking inordinate amounts of time writing, and that isn't fair to my family, and it isn't right. They deserve better.

Writing this blog isn't difficult, but it can be time consuming. Coming up with a patient to write about is easy, but making a blog post out of it can be cumbersome, because I don't want my stories to be trite, boring, or repetitive. So instead of putting out boring short stories, I consider it better to put out nothing and keep people wondering.

Well wonder no further, because the patient I'm writing about today was easy to come up with.

It is I.

No, I wasn't in a car accident, and I wasn't stabbed or assaulted, and no I didn't cut off my finger with my table saw or have any other kind of traumatic injury. But over the past few months I have seen three different doctors, including a specialist, a sub-specialist, and a sub-sub-specialist, and I now have an official diagnosis.

In the interest of my own privacy, I will not be revealing what the diagnosis is or the type of doctor that I've been visiting. I will, however, divulge that just this past week I was diagnosed with a very rare degenerative disease that is incurable, progressive, and potentially disabling, though it is not in any way deadly. It's not multiple sclerosis, and it's not ALS or any other motor neurone disease.

I'm not dying.

The good news is that this condition was diagnosed very early, and it was only found based on a hunch that the second doctor had. He very easily could have chalked up my symptoms to aging and let it go, but he decided to investigate further. Usually this disease isn't diagnosed until much later in life once significant and irreversible damage has already been done, but mine was found before any of that happened, so my long term prognosis seems to be good.

The bad new is that no one knows the cause of this disease because it is so rare. It was only first described about 30 years ago, but no one took it seriously until about 15 years ago when it was discovered that it was indeed progressive. Because of that, there is no textbook treatment. The disease is thought to be autoimmune, so I will be taking immunosuppression medication for the rest of my life to keep it at bay. Hopefully.

I'm not looking for sympathy. I'm not interested in anyone's thoughts or prayers. Yes this sucks, but I have accepted the diagnosis and am hitting it with everything I can. Ignoring a problem like this won't make it better, and pretending it doesn't exist will only make it worse.

If you're looking for a silver lining like I was, consider this: if you thought I railed against antivaxxers before, just imagine how I'll treat them now that I am one of those immunosuppressed patients they put at risk with their bullshit.

You're on notice, antivaxxers.

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...