More motorcycle madness

**WARNING: REALLY HORRIBLE PHOTOGRAPHY AHEAD.  YOU HAVE BEEN WARNED.  PROCEED AT YOUR OWN RISK etc etc**

In case you missed my recent post on motorcycle safety, what the hell is wrong with you?  I put the link right there!  Go read it! 

Ok fine, you lazy ass.  My point in that post was that motorcycles are incredibly dangerous.  And shortly after writing it, I found more pictures I had taken of several other patients who utterly and completely proved my point beyond any reasonable doubt. 

A man in full protective gear crashed his motorcycle after taking a turn too fast.  Not only did he still end up with road rash (despite his complete full-body "protection"), it didn't help his femur at all:

Ow.  Leather and kevlar DO NOT PROTECT BONES.  Got that?

A few days later a woman was riding her death trap, also in full protective gear, when she hit some gravel, lost control, and crashed.  Did all that leather save her?  See for yourself:

That metal rod running up and down is the temporary splint.  And the bone underneath the rod is what used to be her knee.  The end of her femur is completely shattered, and you can see several shards of bone protruding through her skin.  The medics brought me a chunk of bone the size of a plum that they found on the road.

And yet another idiot was riding his murdercycle when he was hit by a car.  Had HE been in a car, he would have been fine.  But his leg took the brunt of the impact, and it was far from fine:

So what's my point?  Yeah, you get it.  Motorcycles are dangerous. Blah blah blah.  I'm not sure if I'm beating a dead horse or driving my point home here.  Maybe both.  Either way, it's my damned blog and besides, I just needed an excuse to post these pictures.

Are you high?

Just based on the title I can already hear the stoners complaining.  "Oh great, here goes Doc preaching about pot again!  We get it!  You hate weed!  Get over it, you sanctimonious prat!"

Congratulations, you can read.  Yes, it's another post about pot.  No, I haven't changed my mind.  I still think recreational marijuana is stupid and dangerous. 

"No it's not!  It's safe when used correctly!"

Maybe, but who the hell uses it "safely"? Certainly not the people I see. 

I heard over the box (the citywide emergency services communication system) that we were getting three car accident victims at the same time.  It seems a car veered into oncoming traffic and hit a van head on.  They brought me a passenger from the van and two people who were in the car.  

The first woman (from the van) had a concussion and some broken glass in her foot.  The driver of the car that hit the van had several lacerations around her eye.  The passenger in the car (her boyfriend) had a broken leg and a lacerated spleen.  

So what's the point?  Well I'm glad you asked.  If you were paying attention (and are not high), you've probably already guessed that the driver of the car was high on marijuana, something she failed to tell me even when asked directly about drug and alcohol use.  

And if it wasn't bad enough that she caused her boyfriend's broken leg (and the other woman's injuries), apparently she was so high that she didn't bother to put her 4-year old daughter in her car seat.   The little girl suffered a depressed skull fracture, and I'm not sure if she will survive. 

Recreational marijuana use is stupid.  IT IS STUPID, and I see this kind of thing on a regular basis.  Is anyone really surprised that I feel this way about pot?  Anyone?  After everything I've seen, how could I possibly think anything different?  I freely welcome any marijuana advocate to tell me why I should change my stance on pot.  If you can convince me, I solemnly swear I'll buy you a big bag of weed. 

(Though it'll probably be dandelions and ragweed.)

TMI

TMI means different things to different people.  I did some research (AKA a 0.2728 second Google search) on the definition of TMI:

- Thinking Machines Inc., manufacturers of super computers

- TMI Associates, a Japanese law firm

- Three Mile Island, a nuclear power plant that had a partial meltdown in 1979

To most people, however, TMI stands for Too Much Information, ie when someone tells you something that makes you wish you had ear bleach.  I will be focusing on that definition for reasons that will (hopefully) become clear soon.  When is too much information too much?  More information is usually better than less in my line of work, right.  Well, sometimes too much is just too damned much.

One of my recent patients was a 50-ish year old man who was found lying face down in the street next to his bicycle.  I have no idea if he crashed or if he was hit by a car, and I quickly determined that it didn't matter one bit.  He reeked of alcohol and his face looked like he had gotten into a nasty bar fight (and lost).  Our extensive workup showed multiple facial fractures and a blood alcohol level over 3 times the legal limit. 

I went to see him the next day as he was waiting for the maxillofacial surgeon to repair his face.  I passed by his girlfriend in the hall as she was leaving - she was worried, in tears, and obviously cared for him a great deal since she had been at his side all night.  As soon as I got to his room he launched into his entire life story, including several excuses for why he drank heavily every night.  I tried to use body language (slowly inching towards the door) to let him know subtly that I didn't give a fuck, but he kept on going until I thought my ear would fall off.

Too much information!  Please stop talking! I said to myself. 

"Things are bad at work.  I'm probably going to lose my job.  And my home life is really hard with Sally (not her real name) right now, Doc."

I don't care. Please stop, I thought.

Then he leaned in close...  

Oh god, no, I silently begged him.  Please stop...for fuck's sake don't say anything more...

"And there's another woman that Sally doesn't know about..."

Fuck.  FUCK. 

I politely told him that the facial surgeon would be in to see him soon, and I finally extracted myself from his room, wishing the antiseptic hand gel worked on brains, too.  And for the cherry on top of this shit sundae, as I was walking away, he yelled after me,

"Oh yeah, Doc!  Don't tell Sally about...you know!  You know..."

I'm pretty sure doctor-patient confidentiality doesn't cover infidelity.  I'm pretty sure Sally already knows.  And I'm pretty sure I should keep my big mouth shut and keep my nose out of his personal business.  But I'm absolutely positive that was too much information. 

More things I don't understand

I consider myself a pretty smart guy, but there are certain aspects of the world that continue to baffle me despite heavy rumination on the subject.  Yes, rumination.  Look it up.  I shall now expose even more of my fallibility by admitting to yet more things I will never understand:

- women

- where the fuck that lost sock went

- why that moron in front of me won't get out of my way

- how anyone eats pickled herring

- why some idiot patients feel the overwhelming need to lie to me

- why these idiots think I'll actually believe their ridiculous stories

To wit, a fine young gentleman (read: idiot) was brought to my fine trauma bay after he was allegedly assaulted.  Assaults are often amusing because of the preposterous stories they tell.  Fortunately this guy was no different (and no smarter) than the rest.  His story was just slightly different than the one the police told.  Let's see which one is more believable: 

Patient's version: So I found this set of keys on the ground outside my apartment, right?  And I thought I would be a good citizen and return them to the rightful owner, you know?  So I did what any Good Samaritan would do - I tried the keys in a bunch of doors until I found the one it would fit in so I could give them back.  I should get the Nobel Peace Prize and stuff because I'm such a good guy.  But a group of thugs thought I was trying to break in, so they beat the shit out of me with a hammer. 

Police's version: He stole a set of keys and was trying to break in to a house when the neighbours saw him and beat the shit out of him with a hammer.  

Hm...it's hard to decide whom to believe.  

Giving up

Not everyone makes it.  Not everyone who gets to me makes it back out alive.  A few people come to me in the midst of dying, and they finish their journey shortly after arrival.  One of the most difficult things in medicine is determining who is lost, who has traveled too far down the path to eternity to bring back.  I don't like giving up, but sometimes I have to give in.

I had just such a patient recently.  I'll call her Bertha.  She looked every bit of her 80+ years, and those years had not been kind to her.  Decades of smoking cigarettes had ravaged her lungs to the point where she required oxygen at home. There were numerous other medical problems as well, but that didn't stop her from driving.

I wish it had, and so did the tree she hit.

It seems Bertha passed out while she was driving, probably because her oxygen level had dropped too low.  She woke up as the medics were extracting her from her car (the tree was fine), and she immediately started complaining of difficulty breathing.  Her breathing was so difficult that she didn't even feel the broken bones of her lower leg poking through her skin.  When she got to me, it was clear that she was in very bad shape, and I got that sinking feeling that never seems to end well.  She had severe pain in her chest (I suspected rib fractures), and she had a very nasty open fracture/dislocation of her ankle.  For her own protection she needed to be placed on a ventilator immediately, because she looked like she was going to go into respiratory arrest any second.

Unfortunately Bertha wasn't my typical car accident patient (young and healthy).  When older people suffer massive chest trauma, a contusion to their heart can be life-threatening (or even life ending).  When that older person also has lungs that have been destroyed by cigarettes, it's usually game over.  Bertha got her breathing tube, and just a few minutes later, my worst fears came true: her heart stopped.  We started CPR and gave her medications to try to restart her heart.  After a few minutes, it restarted, but I was afraid the damage to her heart and brain was too much for her system to bear.  I was also afraid that when those medications wore off, her heart would stop again.

And just 5 minutes later, it did.  We did CPR again and got it restarted, but then it stopped once more.  As my team continued doing CPR for the third time, I ran to talk to Bertha's daughter.  I told her exactly what was going on, and that it was probably time to give in.  I didn't think Bertha was going to make it.  Her trauma was too severe, and she had no physiologic reserve to tolerate it. 

"Please don't give up, Doc," she said.  "Please."

I decided to respect her wishes and keep going despite my grave doubts. 

I ran back to the trauma bay, and we got Bertha's heart restarted for the third time.   I waited for it to stop again...and waited...and waited... but this time, it didn't stop.  She required two medications to keep her blood pressure elevated, but her heart kept on going.  The next day the orthopaedic surgeon fixed her ankle and she no longer required those medications to keep her heart pumping.  The next day she woke up.  Two days later her breathing tube was removed and she started breathing on her own.

Bertha's daughter hugged me a few days later as I told her that her mother tried really hard to die.  And I admitted that I had been ready to give in.  Bertha just smiled, coughed weakly, and said, "But I wasn't ready."

What the...

There are some things I just can't explain:

• The Bermuda Triangle
• The disappearance of Amelia Earhart
• The Nazca Lines

And there are some things I don't want to even try to explain.  This definitely falls in the latter category.  Unfortunately I have to admit that this is not my patient, and I am shamelessly stealing this from a hospital in Canberra, Australia.  

You have to understand...

It's just that...

I just want to start by saying...

Oh, fuck it.  Just read it.

Caberra Times:

"Doctors in Australia have removed a 10-centimetre fork from inside an elderly man's penis after a bizarre sexual mishap.
The 70-year-old arrived at the Canberra Hospital emergency department with a bleeding sexual organ.
He told doctors he had inserted the 10cm dining fork into his urethra almost 12 hours earlier in an attempt to achieve sexual gratification.
But the utensil became stuck.
The fork was not visible but doctors were able to feel it from the outside and X-rays showed its position.
Doctors considered several retrieval options before deciding to pull the fork free using forceps and "copious lubrication" while the patient was under a general anaesthetic.
The elderly patient was then sent home.
The medical emergency was so rare the team of three doctors published the case in The International Journal of Surgery last month.
The paper, titled "An Unusual Urethral Foreign Body", said it was rare to see objects lodged in the lower urinary tract.
It went on to list strange objects found inside other parts of the body, including needles, pencils, wire, allen keys, toothbrushes, light bulbs, thermometers, plants and vegetables, leeches, snakes, cocaine and glue.
"It is apparent that the human mind is uninhibited let alone creative," the authors wrote.
The medical team - Krishanth Naidu, Maurice Mulcahy and Amanda Chung - said the fork case was published to create discussion among the medical fraternity "given the great management challenge faced by the oddity and infrequency with which a fork is encountered in the penile urethra".
The doctors said the motives for inserting objects into the sensitive region were difficult to comprehend.
"The practice manifests primarily during states of pathological masturbation, substance abuse and intoxication and as a result of psychological compounders.
"Autoerotic stimulation with the aid of self-inserted urethral foreign bodies has been existent since time immemorial and have presented an unusual but known presentation to urologists."
They said embarrassed patients usually attempted to retrieve the item themselves, risking urethral injury and foreign body migration.
The real danger was infection leading to death, because ashamed patients often delay medical treatment, they said.
Doctors generally try to avoid surgery in such situations, instead choosing an option that would minimise urothelial trauma and preserve erectile function.
The authors said self-inserted male urethral foreign bodies are rare emergencies that urological and general surgeons face on occasion.
While the insertions are unusual, the paper said "any imaginable object is known to be implicated". 

Yeah.  I have nothing further to say, so I'm just going to leave it like that.

Wisdom

"You'll understand when you're older."

I always hated when my parents said that.  When I was younger I refused to believe that older people could possibly know things that I didn't.  It just didn't make sense.  I was smart!  I knew everything!  I had wisdom beyond my years.  Right?

What I didn't understand is that anyone can open a book and learn facts.  But learning about how the world actually works can only be learned through experience.  And experience can only come with time.  The longer you survive on this wild, wacky planet, the more wisdom you gain. 

There are, unfortunately, exceptions to this rule.

The patient from my surgical training was older, in his early 70's.  He had the look of a university professor: unkempt white hair, 2-day old beard stubble, dark circles under his eyes, the smell of stale cigarettes and gin.  He was in the hospital for atherosclerosis of both his carotid artery and his coronary arteries and was teetering right on the brink of a heart attack, a stroke, or both.  He was scheduled first for a carotid endarterectomy (an operation to remove an atheromatous plaque from the wall of the carotid artery, thereby removing the blockage and reducing the risk of a stroke), and he was to have a coronary bypass surgery a few days later.  The carotid surgery was to be done first to prevent him from having a stroke during (or after) his bypass surgery.

His carotid surgery went very well, and I went to see him the following day to discuss his upcoming heart surgery.  But what greeted me was an empty room.  I continued on my rounds, figuring he was out taking a walk, getting a snack, or perhaps visiting with family in the reception area.

What I did not figure was that he had walked out of the hospital and gotten a taxi home so he could do a few lines of cocaine.  Apparently over his 70 years of life he never bothered to gain enough wisdom to figure out that cocaine is a very potent vasoconstrictor and can cause heart attacks, especially in people who are supposed to have coronary bypass surgery the next day.

Shockingly, he never made it back to the hospital.

No matter what you do, wisdom comes with age.  Everything you encounter and every experience you have adds to it. The problem is that wisdom is just like money - it doesn't make a difference how much of it you have.  It is only valuable if you use it.