Monday, 18 November 2019

Unpredicted

I often look at my pager sitting next to my mobile phone and think, "How the fuck are we still using this 1950's technology in 2019?" But we still unfortunately rely on these outdated, grossly obsolete prehistoric monstrosities. Regardless, if my pager tells me I'm getting a car accident, I can predict that I will be getting some kind of car accident - rollover, car vs tree, car vs car, etc. If it says I'm getting a fall victim, I can predict with at least 90% accuracy that it will be either an elderly person who lost his footing and fell from standing position, a drunk person who fell from standing position, or a construction worker who fell off a ladder or partially completed building. If I see I'm getting a stabbing victim, I can be fairly well assured it will be a young man in his late teens or early 20's. What I do when they get to my trauma bay varies based on the location and severity of the injuries, of course, but the patterns remain the same.

Until they don't.

This particular day's pattern had been falls. Over my previous 42 hours of call (24 from the last shift and 18 from this one . . . wait, carry the 1 . . . yeah, 42), my last fourteen patients had been falls. ALL of them. Elderly falls from standing, elderly fall off a roof (yes, really), elderly fall off a ladder (yes, really), elderly fall off a toilet, elderly fall out of a wheelchair . . . you get the idea. As you may (though probably don't) remember from earlier posts, I don't much care for falls because they are very rarely exciting or fulfilling (though I did have one guy rupture his bladder jumping off a roof while trying to jump into a swimming pool (and missing) several years back, but that's another story). I was beginning to think that everyone over the age of 70 in the entire {redacted} metropolitan area had decided to fall that day, until my pager finally told me my next trauma would be a level 1 stabbing. My Inner Pessimist seemed excited.

YES! FINALLY!

I know, I know.  It's awfully macabre to want someone to get stabbed, but there are only so many nonagenarian falls I can see in one day before going completely insane. Technically I didn't really want anyone to get stabbed, I just wanted to see someone who had been stabbed. Sort of. Technically. Dammit, you know what I mean.

As my team and I prepared for the patient's arrival by donning our personal protection gear (masks, gowns, and gloves, that is, not guns), I was also mentally preparing for said patient to be another 20-something male rolling through the door with various and sundry stab wounds. So you can imagine my surprise when that 20-something male turned out to be a 70-something female. My Inner Pessimist began pestering me:

They made a mistake! This is obviously yet another elderly fall! Will I ever get anything other than a fall? Am I now officially an Elderly Fall Trauma Surgeon?

As these thoughts rolled around my brain and the medics transferred her from their gurney to mine, the blanket fell from around her neck, revealing a large, bloody bandage. My Inner Pessimist refused to back down, trying to convince me "She probably just fell in the shower against something sharp!"

Shut up, Inner Pessimist.

"Hi Doc, this is Bess.  She's 72, stabbed once in the right neck.  No loss of consciousness.  Bleeding is controlled.  It's pretty big though."

Other than my elderly lady several years ago that was nearly decapitated by her seat belt (that's yet another story for yet another time), this was the first elderly female stabbing victim I could remember. Ever.

Bess was stunningly calm for someone with a 10 cm laceration on the side of her neck. She was also completely alert and sharp as a tack, which made her somewhat different than most of my septuagenarian patients. Her laceration was on the posterolateral aspect of her right neck over the posterior cervical triangle. Whew. I breathed a small sigh of relief. If you simply must get stabbed in the neck (which you shouldn't), that's a good place to do it, mainly because the only really important structures in the area are the transverse cervical artery and accessory nerve (and a few sensory nerves), none of which were close to this particular laceration.

There was no active bleeding and the laceration was well above the subclavian artery, and her neurological exam was normal, so I was not worried about any major vascular or nerve injury. I started to tell her that she would just need a whole bunch of stitches when my pager went off again.

Another fall? Nope, another level 1 stabbing, arriving in 2 minutes.

Hey, at least it isn't another fall! That's two in a row! Woo!

Shut up, Inner Pessimist.

Rhys (not his real name ™) arrived exactly 2 minutes later and looked much more like what I had been expecting with Bess - young, male, healthy, thin, and 25 years old. I was back in my comfort zone. Until Rhys started talking. Well, ranting actually:

"I'm Tupac Shakur's son! You hear me? Tupac's son! You can't hurt me! YOU CAN'T HURT MEEEE! Tupac ShaKUUUUR!!!"

Hey, at least it isn't another fall!

SHUT THE FUCK UP, Inner Pessimist. I fucking hate that guy sometimes.

"Ok Doc, Rhys is 25. Healthy, no meds, history, or allergies. Single stab wound to the right upper abdomen, we think self-inflicted. He's been talking like this the whole time. Oh, and he stabbed his grandmother in the neck too."

Yeah. Because that's what you do to, especially to your own grandmother.

Rhys had a single stab wound to his upper right abdomen, directly in The Box.This is a danger zone where nearly anything in the chest and/or abdomen could be hit, depending on 1) where exactly the patient was in the respiratory cycle when the knife went in, 2) the angle of entry, and 3) how deep it went. Heart, great vessels, lung, diaphragm, liver, gall bladder, colon, stomach, and small intestine are all potential targets.

Fortunately (or unfortunately, depending on how you look at it) Rhys had managed to do significantly more damage to himself than to Bess. He managed to lacerate his right lung, right diaphragm, and liver. Liver lacerations (especially penetrating ones) tend to stop bleeding by themselves, and small right diaphragm lacerations rarely need to be repaired. All he needed was a chest tube, a few sutures, and a few days in hospital to make sure his liver and lung stopped bleeding (they did).

Oh, and restraints. And a psychiatrist. And one metric fuckton (that's the technical term) of sedatives.

Rewind to Bess who, on the other hand, merely needed a few sutures and a new grandson. Ok, a lot of sutures. But yeah, definitely a new grandson. Still, she was completely fine, though sporting a new badass neck scar. Though she had no idea why Rhys stabbed her, she nevertheless remained incredibly stoic (though perplexed) as I fixed her up. As I was placing the dressings and giving her her discharge and follow up instructions, she said probably the most grandmother thing any grandmother has ever said in the history of grandmothers:

"I'm still giving him that shirt and tie I bought him for Christmas. It'll look so nice on him."

16 comments:

  1. healthy, other than thinking he is tupac shakur's son... and stabbing his grandmother in the neck...

    as regular readers know, I have an above average amount of contact with paramedics - which delivered the gem, one night, that their patient at my time of contact was noteworthy - in that the patient wasn't trying to assault them while in the ambulance.

    ReplyDelete
    Replies
    1. How sad is it that not being assaulted is now the rarity. Big hugs xx

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    2. that was just the one night. there was another time when the entire day and night were filled with AVG calls (Age Vs. Gravity)

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  2. I love the beeper. I can turn it off on weekends and vacations and, since I give my cell phone number to no one EVER but family, no one can call me/get a hold of me if I am not on. If they have your cell number, you are never really free of work.

    ReplyDelete
  3. Can someone do a fact check for me to lazy to check but didnt tupac die in 1990ish?
    Id of loved to see someone point out to him he was born about 5 years to late

    ReplyDelete
    Replies
    1. September 13, 1996 to be precise.

      Delete
    2. Oh a day after i was born. Huh.
      But then ok hey maybe you Did meet his son?

      Delete
  4. I always heard the beepers are around partially because cell signal in hospitals can be absolutely shite. It definitely is at the one I just gave birth in at least, and that hospital is pretty darn new.

    ReplyDelete
    Replies
    1. funny how making your building out of concrete and steel makes problems for low powered radio systems.

      the advantage beepers have is they use a slightly more powerful radio transmitter - and don't have to get confirmation from the receiver to deliver their message.

      Delete
    2. Tell me about it ken. My family's house is all concrete and up until a couple years ago phone service inside of it was TERRIBLE unless you were on the 2nd floor.
      God forbid should you be in the basement.
      Still screws with our internet so we have to have hardwired nodes throughout the house to ensure we can actually Use your wifi

      Delete
    3. Also one of the reason cell signal is so poor is that the radiology and nuclear medicine department have to be shielded against radiation and that stops the signal pretty effectively. All the areas around radiology tend to have poorer signal.

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    4. by a near coincidence, my local high school effectively blocks cell signals - and not coincidentally, the public wifi filters out sites with no educational value.

      meanwhile, I live out in the sticks where any digital signal has to be beamed in from outer space.

      Delete
  5. At least the tie gives him the opportunity to accidentally hang himself, which seems an appropriate fate for someone who stabs their own grandmother in the neck!

    ReplyDelete
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