Inspiration

People can be inspired by the strangest things.  Artists can be inspired by a beautiful woman, a screenwriter may be inspired by war, a musician may be inspired by a particularly nice ass.  I know of many people in the medical profession who were inspired to go into the field because of something that happened in their own lives.  People with diabetes pursuing diabetes research or becoming an endocrinologist, people with severe allergies doing immunology research, people who had surgery at a young age going into surgery.  I was inspired to go into surgery by my father who was also a surgeon.

Little did I know that *I* could be an inspiration, even from afar.

Mr. R (not his real name) wrote me a few days ago, and after reading his letter, I asked if I could share it.  Fortunately he agreed.

Hi DocBastard.  I have been debating writing this post for quite some time. Let me start by introducing myself.  My name is [name redacted] and I'm 20 years old from [location also redacted] but born in raised in [damn it, stop making me redact things].  I have been beset by health care problems my whole life.  It started at 3 months old with tracheomalacia [a congenital weakness of the windpipe] and lived with a tracheostomy until the age of three.  In addition to this I suffered heart failure until roughly the age of six.  From approximately the age of 7 to 14 I broke eight bones and had at that point fourteen surgeries.  For a brief three years I had no issues to speak of.  Then on February 22, 2011 my world was turned upside down.  I had just finished working out and wasn't feeling too good, and I noticed that my arm had gone numb and I couldn't speak. Five hours later I was informed that, even though I was only 18 years old, I had suffered a transient ischemic attack [basically a mini-stroke] due to an atrial septal defect [a hole in the heart].  The news turned my world around - I had to turn down over $100,000 in scholarships.  I went through depression...and then I found your blog.  (Now I know what you're going to say - "Thank god, he's finally getting to the point!")   

I want to thank you for providing me a source of relief when I was stopping myself to pieces.  Thank you for reminding me that even though I've had it rough, it could always be worse.  Thank you DocBastard, for even though you didn't know it you convinced me to apply to medical school so I can help others like the wonderful doctors in my life have helped me.

I am profoundly honoured that my writing could inspire someone to pursue medicine, though I don't think I can claim full credit.  I have a distinct feeling that Mr. R's experiences had a lot to do with it too.

There are many great reasons to go into medicine - doctors are generally very well respected, we are among the most highly-educated people, and we get to cure diseases and help people get better.  There are even better reasons to go into surgery - mainly, I get to fix things instantly with no waiting, and I get to save lives, often in dramatic fashion.  So it always worries me that young people would look at a potential career in surgery and see only the bad things.  Sure it's a difficult lifestyle with long hours, a lot of time away from home and family, long and difficult operations, we are often underpaid...wait, why do I still do this to myself?

Surgical secrets

After recently debunking some medical myths, I thought it only fair to spill some secrets that most surgeons don't want you to know. I have to tread lightly here, because what I'm about to tell you might get my licence revoked.

Ok, there's a remote chance that maybe that could possibly be a slight exaggeration.

1) We are not interested in your life story.  I'm here to fix whatever problem you came in for, so please tell me everything about that.  But I really don't care about how your Aunt Myrtle is doing or how many cats you have. Your primary doctor may care about what vaccinations you had as a child or how often you pee at night, but I just want to get the information I need and leave your room so I can get started fixing you, so please get to the point.

2) I have no idea when breakfast is actually served.

3) I hate seeing patients in my office.  I went into surgery to fix stuff, not to sit behind a desk and do tedious paperwork while wearing a suit.  I'd much rather be fixing something or banging my head against the wall or sticking hot pokers in my eye than doing office hours.

4) There are thousands of medical conditions, and sometimes we can't remember one or haven't heard of Whatever-You-Have Syndrome since medical school.  Dr. Gregory House doesn't actually exist, so sometimes we have to google it.

5) We see you completely naked during surgery, and we talk a lot while you are asleep.  If you have stupid tattoos, we will see them.  It isn't because we don't like you, but if you have "YOLO" in big letters across your chest or "The Pleasure Zone" with an arrow pointing to your vagina (yes, I've seen these), we will talk about them.

6) Whatever embarrassing problem you think you have, we've seen it (and much worse) before.

7) We really do treat everyone the same.  Whether you're a homeless guy off the street or a CEO in an Armani suit, Ferragamo shoes, and a Rolex watch, you will get the same surgery, the same pain medicine, the same postoperative treatment, the same everything.  I don't care who you are - you are NOT getting more narcotics or any special treatment compared to the poor guy next door with the same problem no matter who you threaten to call.

8) Obesity makes surgery much more difficult in every respect.  Your risk of every possible complication is higher, and we dread operating on you because of that.

9) I have no idea how often the curtains in your hospital room get washed, but they are probably dirtier than the toilets and the floors combined.  Don't touch them.  In fact, don't even go near them.

10) For people who demand certain narcotics or tell me that you need antibiotics when I know that you don't, I wish I could give you a shot of saline and tell you it's actually medicine just to get you to shut the hell up.  I've actually fantasised MANY times about doing just that, but I'm told it's an "ethical violation" to lie to a patient like that.

Can any of you other medical types (emergency personnel, nurses, internists, emergency physicians, pharmacists, medical students, etc) think of any others I missed?  Please email them to me at docbastard1@gmail.com and I'll do a followup.

This is top secret stuff I just divulged, so I hope you appreciate my taking this risk of revealing them..  If this update disappears and there are no more blog updates after this, that means "they" found me.

Backup plans

I will confess that I had trouble deciding on a title for this post.  It was either going to be "Backup plans" or "WHAT ARE YOU, SOME KIND OF FUCKING MORON??!"  I thought the second one was a bit overly dramatic, so I chose the first.  The reason will become clear in just a second.  Backup plans are very simple concepts that most people have heard of, especially skydivers.  If you're going to jump out of a perfectly normal plane on purpose...

By the way, just as an aside, why the hell would you jump out of a plane??  ON PURPOSE!  What is WRONG with you people?

Ahem, as I was saying, if you're going to jump out of a plane, first make sure you have a parachute.  That's obvious, of course.  Second, in case that first parachute fails, you'd better be damned sure that you have a backup parachute.  Having a solid backup plan in place when your first plan is potentially deadly should be obvious, right?  Since I'm writing this, it obviously is not to some people.

My pager woke me out of a very deep slumber at 3AM, which happens to be exactly that time of morning that makes me want to either throw the pager against the wall or pretend I didn't hear it and go back to sleep.  Instead, I acted like a nice boy and trudged down to the trauma bay to see what the cat dragged in.  The scent that greeted me at the door was reminiscent of a pub on a Saturday night - a combination of cigarettes, booze, and dreary desperation.  The 48-year old woman (whom I shall call "Boozy") that was emitting this odor greeted me with, "HEY YOU, GET THIS SHIT OFF ME!"

That sound you just heard was me groaning from all the way over here.

Boozy (not her real name, though it was her real scent) had been a passenger in a car that had gone off the road and had an unfortunate encounter with a tree.  (HINT: the tree always wins.)  Luckily she had no major injuries, though she was thoroughly intoxicated (please, try to control your surprise).  Remember, however, that she was a passenger in the car.  Have you noticed anything strange?

Right - where was the driver?  Why hadn't he been brought in for evaluation?  Had he refused treatment?  Had he been abducted by aliens?   Had he died in the wreck?

No, no, and no.  Boozy's friend had been the designated driver, and after hitting the tree he pulled his friend Boozy out of the car and took off running.  But why would he do such a thing?  Why leave your drunk friend literally lying bleeding on the side of the road?

Because he was drunk too.  Boozy's brilliant backup plan consisted of getting in a car with someone drunker than she was.  I'm not sure who is stupider - him for getting drunk while being the designated driver or her for getting in his car.

If you have no backup plan, then you have no plan.

P.S. To all those who took the time to either post a comment on the last update or send me an email (and to those of you who didn't but come here nonetheless), I give you my sincerest thanks.  I hope you continue to follow along this ridiculous, merry little journey with me.  - Doc

How many zeroes?

My wife was the one who convinced me to write these stories down.  It seemed that every day when I came home, I would have yet another stupid story to tell her.  Finally one day she said, "Doc (not his real name), why don't you keep a journal or something so you don't forget these stories?"

Hm.  Interesting idea.  So I started this blog for myself and my kids, but other people (this means you) have caught wind of it and started reading it too.  A lot of you.  So many of you, in fact, that as of today this blog officially has over one million page views.

A million.  1,000,000.  ONE FUCKING MILLION.

Never in a million years (hardy har har) did I ever think that my blog would be viewed a million times.  I'd like to thank each and every one of my readers for keeping up with my teeny tiny little corner of the internet and spending a little bit of your valuable time with me sharing my experiences.  It is a true honour, one that I wish I could repay somehow.

To everyone bothering to read this, please leave a comment telling me where you're from.  As always I welcome any email (docbastard1@gmail.com), even if it's just a few lines to let me know you were here.  Stories are even more appreciated, and pictures with your stories are almost sure to be published at some point.

Once again, thank you.

Best,
Doc

Leave him alone

I'll be blunt, a lot of the patients that I get in my trauma bay are bullshit. I don't mean the patients themselves are, but the "trauma" that they've suffered is often not enough to cause any significant injuries, and I end up sending them directly home. But I found out recently that some bullshit is even bullshittier than the rest.

I was informed that my first patient of the day was a fall from a standing position, and I groaned audibly. Unless you are elderly and fall on your hip, or unless you fall face first on pavement, it's difficult to do any real damage in a ground-level fall. But this guy apparently did fall flat on his face, so I was hopeful the Bullshit Factor would be low.

Wow, was I ever wrong.

He rolled in on the gurney looking less sick than I did that day. Other than a scratch on his forehead, he was absolutely fine. So why the hell was he there?

Brace yourself.

He tripped on the curb while waiting for his bus and fell forward, catching himself before any significant impact occurred. But some Good Samaritan bystander saw him fall and called emergency services, who (unluckily for him) showed up before his bus. He tried to tell them he was fine, but they insisted he come with them. So he ran away from them. He ran a whole kilometer away from them. So they did the only sensible thing - THEY CALLED THE POLICE. Once the police arrived, they convinced him to come to the hospital and get evaluated.

It took a trauma surgeon to clean up his scratch and put on a Band Aid, which any 5-year old playing doctor could do.

If any medics are reading this, for fuck's sake if a patient tells you he's fine and can run further than you can, unless he's bleeding from his eyes or has an arm missing, just leave him the hell alone and go find someone who really needs you. And who really needs me.

Memories

Many people don't remember exactly how they arrived at my trauma bay.  I believe amnesia from a concussion is the brain's way of protecting you from the memory of a traumatic experience.  Let's face it - do you really want to remember exactly what it looked like when your car hit a truck head on?  If you can't remember the trauma, you can't relive the trauma.

Because of this, a lot of my patients have asked me about the exact nature of their accidents.  I just look at them blankly and tell them that I wasn't there, so I have no idea.

On the other hand, some people remember everything vividly and in great detail.  And for some incomprehensible reason, they feel an overwhelming desire to share these details with me or the staff.  And for an equally incomprehensible reason, I'm going to share them with you.

Don't you feel lucky?

A 35-year old man was brought to me recently accompanied by a police officer.  This usually means that the person is under arrest, and I often get good stories from the arresting officers.  The man was bleeding from his lip, so I guessed that he had gotten in a scuffle with the police and lost.

Nope.  He immediately launched into his story about how he was kidnapped, held hostage, and beaten unconscious by his kidnapper.

Oops.

During his workup, several police officers kept interviewing him and taking pictures and generally making everyone in the room feel uncomfortable.  Other than a small lip laceration, his workup was negative, he got a few stitches, and he went home.  A few bit later while working up the next patient, one of the nurses said with a smile, "Oh by the way, did you hear the real story behind that last patient?"

Whenever anyone says that, I know something REALLY good is about to come out.

It turns out that he was living with his boyfriend and his boyfriend's brother, but since he had no job, he paid his share of the rent in beer and marijuana. How he came by this beer and weed with no money and no job, I have no idea. Apparently the boyfriend's brother thought the boyfriend was getting more beer and pot than he was, so he confronted him about it. I suppose he didn't get the answer he wanted to hear, so he punched him.

THAT'S IT? I hear you asking. Well no, he also wouldn't let him leave the house, hence the "kidnapping" accusation.

Sometimes I wish I could erase MY memory of these things.

NPO

Everyone who has ever worked at a hospital knows what "NPO" means.  And if your doctor has ever starved you, you found out the hard way that NPO is Latin for "nil per os", or "nothing by mouth".  That means you get nothing to eat, nothing to drink, nothing except IV fluids.  There are several reasons why you might be kept NPO -

• You are about to have surgery - it's important for the anaesthesiologist for your stomach to be empty when you are put to sleep
• You have an infection in your abdomen
• You have an obstruction in your intestines
• Your intestines aren't functioning properly
• Your surgeon hates you

Ok, that last one is a joke...mostly.  We never keep food out of your mouth if we can help it.  Believe it or not, we do actually enjoy seeing our patients get better, and good nutrition is always part of that recuperation.  But unfortunately there are those rare times when we need you not to eat or drink, and that's where NPO comes in.  Most people are understanding and follow the plan despite how difficult it is.  But others...well, let's just say that hunger and thirst can drive people to improvise.

I admitted a man in his 50's with what appeared to be a bowel obstruction. This is most commonly caused by scar tissue in the abdomen from prior surgery, and the usual treatment for it is IV fluids, inserting a tube through the nose into the stomach to decompress the GI tract, and the dreaded NPO, and the obstruction usually goes away by itself.  We did exactly this for this man, but he immediately pulled the tube out of his nose.  The nurse reinserted it, and he immediately pulled it out again.  This cycle repeated itself several times, and he continued to be generally uncooperative and obnoxious.  Finally I realised that I wasn't going to win this battle, so I decided to keep the tube out, but the NPO order stood.  Despite my orders he kept asking for something to eat or drink, and I told him repeatedly that he couldn't.

When I came to see him the next day, he had taken matters into his own hands. Overnight he took his IV bag down, unplugged the IV tubing from it, and had poured his bag of saline into a cup so he could drink it.

Yes, seriously.

Sometimes people get better despite their own best efforts to derail the process, rather than because of our best efforts to make them better.  Luckily this guy got better and went home a few days later.

I made sure the nurse gave him a cup of coffee on his way out so he didn't try licking a puddle in the parking lot.