Confessions

I should get this out of the way at the very beginning (since hopefully everyone reads the title before the story): NO I WILL NOT BE CONFESSING TO NOT BEING A DOCTOR.  I'm fairly sure that will not come as a surprise for most of you (since, unlike the people who still don't believe me, your IQs are greater than that of a fruit bat), but I'm a bit more sure that it will disappoint my critics.  And I'm absolutely positive that I seldom give a flying fuck about what any of my critics think, but I remain amused that people like that even exist.  Regardless, over the past 12 months there have been some things that I felt I should confess but haven't had the inclination.  Well, since this is a new year and all, I think it's high time to get a few things off my chest and start 2015 with a clean slate.

So without further ado, allow me to present the Official DocBastard Confessional.  Some assembly required, batteries not included, please allow 6-8 weeks for delivery, your results may vary.

• Though my stories are real, there is one that I nearly wholly invented.  No, I will not reveal which one, because what's the fun in that?
• I was never really considering dumping my anonymity, though I did have a passing thought about it.  I just wanted to gauge everyone's response to the idea, and I confess it was the exact opposite of what I had expected.  Sorry for using you good people as guinea pigs.  Not really.
• I love building furniture almost as much as I love performing surgery.  If I could make as good a living doing woodworking, I would retire from medicine faster than a 50-50 thinned coat of lacquer dries. 
• I hate hospital politics and actively avoid any and all committee meetings. 
• After a particularly stressful day, I sometimes come home and take out my frustrations on my wife.  She knows what I'm doing and why, and she always lets me do it because she knows it makes me feel better.  This is just one of the approximately 6,836,356 reasons I've identified (so far) why I love her. 
• I love cold, rainy days because it keeps the idiots indoors and out of my trauma bay. 
• I enjoy taking care of people, but every now and then I'd like a day where the Call Gods have mercy on me and let everyone stay blissfully uninjured.
• I wish I could hit some of my patients, but only the ones who really deserve it. 
• Finding and writing new stories for this blog that I think won't be boring and/or repetitive is becoming increasingly difficult.
• I wish some publisher would stumble across this blog and ask me to make a book out of it. 
• I like the smell of cauterised human tissue.
• I'm not sure if that last one makes me a cannibal, but I am sure I don't really care. 
• I have a not-so-secret man-crush on Neil DeGrasse Tyson.  Seriously Neil, call me. 
• Sometimes it seems ibuprofen and coffee are the only things that get me through the day. 
• I love getting fan mail, and I have kept all of the emails I've gotten. 
• I love getting hate mail even more, though I haven't gotten any in a while.  No, I'm not asking anyone to write me any, thank you very much. 
• One of my colleagues left a bottle of wine in my call room as a Christmas gift, and I was tempted to drink it while on call.  No, I did NOT drink it.  I know this is supposed to be a confessional, but come on.
• I sometimes speak more kindly to my female patients.  Sorry gents, but that's just human nature.
• I still tell my idiot female patients that what they did was stupid. 
• I've never once actually felt remorse for telling my idiot patients that their actions were stupid.
• There have been a few times during an operation when I've thought, "What the fuck do I do now?"
• While I enjoy challenges, I'd MUCH rather do a simple appendectomy than a complicated perforated appendectomy with an abscess.  
• I'd rather watch "Keeping Up With The Kardashians" while making out with Miley Cyrus and listening to Justin Bieber than do a dead bowel case.  Dead bowel is the worst possible smell in the world, and even if I double-glove and wash my hands repeatedly afterwards, the stench stays on my hands for days.  Forget any finger food for a week. 
• One of these confessions isn't true.  No, I will not say which one, because what's the fun in that? 

Well folks, there you have it.  I'm sure there are other more egregious sins I've committed, but either I have forgotten or am too bashful to confess them.  Hm . . . I think that's the first time I've ever described myself as "bashful".

• Believe it or not, I can be bashful.

Ok, now I'm done.  Really.  If any of you have anything you'd like to confess, leave it in the comments below.  But I warn you that I will not assign you any Hail Marys, Our Fathers, or any other Penance, and you will not be absolved of any of your sins.  And I confess that people may be amused by your confession, but you might just feel better nevertheless.

And . . . go.

Even more things I don't understand

Despite the fact that I've written a handful of complimentary posts about myself, I'm not one to toot my own horn very often.  That said, though I rarely claim to be smarter than anyone, I have to admit that I'm a fairly intelligent guy.  Despite this, I've written about things I don't understand in the past, and it's been quite a while since I have, so I feel it's high time I embiggen the list of things I just can't seem to wrap my mind around.

• women (yes, I still don't understand them)
• the appeal of mushrooms
• how anything got done before the Internet
• Twilight
• smoking

Of the myriad things I just can't fathom, I think I understand smoking the least.  With all of the health problems that cigarettes cause, I simply can't understand how anyone these days could possibly begin (or continue) smoking.  Now before anyone starts yelling and screaming that nicotine is addictive, I ALREADY KNOW.  I know how easy it is to become addicted to cigarettes, and I know how difficult it is to quit once you're hooked.  But it's a rare soul who doesn't know at least one person who was affected adversely by cigarettes - lung cancer, emphysema, chronic bronchitis, oral cancer, cataracts, heart disease, stroke . . .

And yet, people still smoke.

"GET TO THE POINT, DOC!" I can hear you screaming.

I will.  I promise.

I got a call from an emergency physician some time back for Samuel (not his real name©), a gentleman in his 50s who had a history of severe peripheral arterial disease.  If you've never heard of PAD, it's very similar to coronary artery disease, except that instead of the arteries of the heart getting blocked by gunk and causing a heart attack, it's the arteries in the rest of the body (including the legs, intestine, etc) that become blocked, causing all the tissue downstream to die.  The most common causative agents are smoking, diabetes, hypertension, and high cholesterol, all of which Samuel had or did.

About a month prior to coming to my hospital, Samuel's aorta, that rather-important artery that comes off the heart and supplies blood to the entire body, had become completely blocked at the point where it splits to supply blood to the legs, so a bypass surgery was done at an outside hospital.

Today Samuel was having severe abdominal pain, so the emergency physician correctly presumed that he was having a complication from that surgery.  He promptly ordered a CT scan of his abdomen which fortunately ruled out any complication of his bypass (such as a leak or infection or blockage of an artery), but it surprisingly showed a small bowel obstruction.  His small intestine was dilated to about 8-times its normal diameter, but more even more ominous was that it looked like the blood supply to a segment of the bowel had twisted on itself, an entity called intestinal volvulus.  Any tissue whose blood supply is twisted will eventually die, so this is a dire surgical emergency.

Thirty minutes later he was in the operating theatre, and 30 minutes after that I had successfully untwisted his intestine, which was perhaps an hour or so from dying.  As you can probably imagine, that's not a good thing.  I watched it for a few minutes, waiting for the colour to normalise (it did), and then I closed him up.  Another life saved!

Maybe.  (Cue the dramatic music.)

I went out to the waiting room to find his wife and let her know that everything went well.  As I was chatting with her and letting her know how I expected his recovery to go, a familiar odour reached my nostrils - cigarette smoke.  After I was done, I asked her if she had any questions.  When she said "no", I told her that I had one:

"When are you going to quit smoking?"

Her smile immediately faded, and she looked at her feet.  "We're trying to quit," she almost whispered.

Wait . . . we?  Are you telling me this man who nearly lost his legs a month ago because of his smoking is STILL SMOKING?

With a stern look and not even a hint of mirth, I told her that she and Samuel had to quit.  NOW.  "I don't care if you go cold turkey, use nicotine gum, a nicotine patch, prescription medicine, chewing gum, e-cigarettes, meditation, yoga, hypnosis, acupuncture, or voodoo," I said, trying not to yell.  "Your smoking was making him smoke, and his smoking is killing him, slowly but surely."

I sent Samuel home a week later, repeatedly beating my point into his skull daily.  Unfortunately (though perhaps not surprisingly) he never showed up for his follow-up appointment.

I don't expect perfection, except from myself (though I rarely attain such heights).  But I do expect people to help me help them get better.  Why can't (or won't) so many people do that?

Yet another thing I don't understand. 

Spirit of the season

In the interest of peace, love, and goodwill toward idiots, I've decided to forgo a formal update this week and leave everyone with a few thoughts:

1) We're approaching 3 million page views here.  That's just unfathomable.

2) I'll probably do a post soon about personal confessions.  I have plenty from which to choose. 

3) I've been contemplating dropping the anonymity.  

With that said, Merry Christmas, Happy Chanukah, Joyous Festivus, and Happy Holidays.  

I would like to sincerely wish everyone who reads this a happy, healthy, and safe 2015. 

Best,

Doc

Compliments

WARNING: I WILL BE SHAMELESSLY RISKING SPRAINING MY SHOULDER BY PATTING MYSELF ON THE BACK IN THIS POST.  

Admittedly this blog is dedicated to idiots and stupidity, and as I've said numerous times my favourite idiot remains me.  So having told several stories where I am the goat, I think I've disparaged myself enough to have earned myself a complimentary update.

If you want more idiot stories, you'll have to wait.  Probably not very long.

Since finishing my training I have spent very little time around other doctors in clinical situations, so I therefore have no idea how my colleagues speak to patients.  I don't know what kind of terminology they use, if they have prepared speeches for certain situations, or how they treat patients in general.  I have a fairly well-established bedside manner, and it seems to serve me very well in the vast majority of situations.  Though my demeanor rarely changes much, every now and then I have to tailor it for certain types of patient (those who are very difficult, very drunk, very upset, very young, very old, etc).  Some people need a bit more care, some need a stern talking-to, others need massive doses of sedatives to shut them up.

Kidding, kidding.  Sort of.

Generally speaking, my philosophy is this: If you're nice to me, I'll be nice to you.  Because of this ideology, every so often patients tell me (compliment warning) that I make them feel better just by sitting with them for a few minutes, talking with them, and explaining everything in excruciating detail, probably more detail than they want or need.

Apparently this is not the norm for surgeons.

Nathaniel (not his real name©) was the unfortunate driver of a petrol (gasoline) tanker truck.  In the wee hours of the morning Nathaniel swerved to avoid another driver, and his truck lost control and flipped on its side.  Incidentally, I hate the term "wee hours".  "Small hours" is no better.  I don't know why it bothers me so much.  Non sequitur over.  Anyway, sparks began to fly from the now-exposed underside of the truck, and despite debilitating pain in his chest, Nathaniel wisely decided not to be anywhere near his truck when those sparks interacted with the several thousand gallons of highly-explosive fuel he had been hauling, and he ran.

When he was brought to me about 30 minutes later, he was clearly agitated, clutching his chest and having trouble breathing.  When I pushed lightly on his chest, he grunted and looked at me as if I were Satan.  His chest felt unstable to me, and an X-ray confirmed that he had 4 fractured ribs.  Fortunately his lung had not collapsed, he had no bleeding in his chest, and he had no other serious injuries.  I explained that his injuries were painful but not life-threatening and that the only treatment was pain medicine and time.  That seemed to calm him somewhat.

Over the next several days, I quickly assessed that he would be a patient who required a bit more TLC than my typical patients.  My daily rounds with him, which should have taken no more than 3 minutes to press on and listen to his chest, assess his pain, and go over his X-ray, took at least 15 minutes while I sat with him, listened to him describe his pain, and reassured him that he would heal, but it would simply take time.

A few days later his pain had improved to the point where he could walk without difficulty, and he no longer needed IV narcotics.  I discharged him, telling him he could continue his recovery at home, though it would be several more weeks until he felt completely better.

As I was sitting in my office about a week later, I got a call from Nathaniel, asking if he could transfer his care to me.  Confused, I told him I was already his doctor, so I asked him what he meant.  "Well, I really liked the way you cared for me in the hospital.  You were so patient with me and you really listened to me, so I want you to be my primary doctor."

I told him that while I don't do primary care, I was truly honoured by the request, and that simple question was one of the best compliments a surgeon could get.  I gave him the phone number for an internist whose philosophy is very similar to mine - be direct and honest, and above all else listen to the patient.

To the medical students reading this, I hope you take this vignette to heart and learn a valuable lesson that DadBastard and GrandpaBastard taught me a long time ago.  Ultimately all patients want the same thing: to be treated like a human being.  What I did isn't difficult, it isn't special, and it isn't unique.

All I did was treat Nathaniel like I treat everyone - with respect.

Just when you think...

Ok, NOW I've seen everything.

That's a phrase that enters my brain almost every time I am on call.  After seeing children shot in the head, grown men crying like babies over minor abrasions, a woman kicked in the head by a deer, a man impaled in the boy-parts by a piece of his broken motorcycle, fingers cut off by power saws, and every conceivable traumatic injury in between, it seems like the Call Gods can't possibly find something I've never seen.  I think that everything that could possibly happen has happened, and I've seen it.  But then the Call Gods throw me a curve ball, something that even my wildest imagination couldn't envisage.
Yes, it happened again.

My second patient of the day was another fall victim.  The first one had been an elderly lady who fell down the stairs and broke her back.  This one, however, had fallen from a standing position.  When I heard that mechanism of injury, I groaned.  Audibly.  LOUDLY.  For patients like these, I think of it this way: if you fall from a standing position badly enough to pass out, you probably are A) drunk, B) drunk, C) drunk, or D) otherwise unhealthy enough to have passed out merely from falling down.  They are usually not the worst injured patients, and I rarely get too excited at the prospect of seeing another elderly ground-level fall "victim" with bumps and bruises and little else.

A few minutes later Arthur (not his real name©) arrived moaning and groaning, yelling that his hands hurt, his head hurt, his neck hurt, his legs hurt . . . pretty much everything from the tips of his hair to his toenails hurt.  He was a rather burly guy, about 120kg, but he was acting like a 15kg toddler.  His only outward signs of trauma were some abrasions on the bridge of his nose and his forehead, but whenever I touched his hands or legs, he screamed.

His workup was essentially negative - bumps and bruises, a cervical strain (whiplash), and a concussion.  So if he sounds like most of the other ground-level falls, why the hell am I writing about him?

Because he wasn't drunk.  He didn't trip and fall.  No, Arthur was wrestling with his wife who got the better of him, jumped on his back, and put him in a choke hold until he passed out and fell flat on his face.  Five minutes later when he still hadn't awakened, his wife freaked out and called emergency services.

As he explained what had happened, his wife walked in.  She couldn't possibly have been as tall as Arthur's chest, and she might have weighed 1/3 what he did.  I listened to Arthur intently, my eyes flitting from him to her, trying to look him in the eye while all the time doing my best not to break out in a fit of raucous laughter.

Did he let her win, or is she some kind of human honey badger?  I have no idea, but fortunately the little Tasmanian devil didn't do any major damage.  As I walked out, only one thought crossed my mind:

NOW I've seen everything.

Sign from above

Based on the title you may be worried this post will be some theistic diatribe.  Nay, never fear, intrepid readers.  I would never subject you to such nonsense which I would never want to read and which, I'm fairly certain, violates several portions of the Geneva Conventions.  However, Mrs. Bastard has often told me that everything happens for a reason and that things may be signs from above, so while I don't have any idea what those reasons may be, I sometimes wonder if she's right.

What happened recently with Claudette (not her real name©) made me rethink things and wonder if Mrs. Bastard could be right.

Claudette was the passenger in a car accident early one morning.  Incidentally, why is it always 1 AM?  Doesn't anyone want to get into an accident and let me take care of them at 2 o'clock in the afternoon?  I'm fully awake, I'm done with lunch, I have nothing better to do, so get into your accidents then!  Come on!  Wait, where was I?  Oh right, 1 AM.  Apparently her boyfriend (who was driving) fell asleep at the wheel and went off the road, hitting a tree.  The tree, which was not moving at the time of the accident, didn't give one flying fuck that a car just hit it at 120 kph and remained exactly where it had been before the car hit it.  Trees are kind of funny that way.  Anyway, I have no idea what happened to her boyfriend, but Claudette was brought to me in a bit of a daze.  She didn't have a scratch on her, but she clearly had a concussion.  A CT of her brain showed a small subarachnoid haemorrhage.  Fortunately she had no other injuries, and three days later she went home, sore as hell, but otherwise ok.

She followed up with me in my office about a week later.  When I walked into the examination room, the first thing I noticed was the sheaf of papers from the hospital sitting on the exam table, along with her mobile phone and a cigarette lighter.

Bad move, Claudette.

If you know anything about me, you know that I look for any reason to get on people's cases for smoking, but I knew my "WHY THE FUCK DO YOU SMOKE?!" tirade would have to wait until I finished my exam and explanation about what she should expect as she recovers from her brain injury.

Wait wait wait, aren't you going way off topic here, Doc?  Quitting smoking is great and all, but since when is this post about that?

Oh pipe down, you.  I'm getting to it.  Stop being so damned impatient.

As I was saying, after a thorough physical examination, I explained how her symptoms may last for several more weeks, but that I expected a full recovery.  She told me how she couldn't bring herself to drive yet, and that she still freaked out whenever she tried to get in a car or saw headlights.  She went through her long list of questions for me, and when she was finally done, I took a deep breath and gave her my best "STOP SMOKING, DUMMY!" speech.  She looked rather embarrassed the entire time, but she nodded along compliantly.  When I was done, she looked up with a sad little smile and said,

"You know, it's funny . . . when we got in the accident, we were on our way to the store to buy cigarettes."

. . . Aaaaaaaaaaaaaaand there it is.  If that isn't a clear sign that she is supposed to stop smoking, I don't know what is.

Danger

I'd like to start this post by stating in no uncertain terms that I don't advocate people hurting themselves intentionally in any way.  That being said, IF one ever decided one really wanted to hurt oneself, here are a few reasonable options one could consider:

• Boisterously proclaim your hatred of the home team in any football arena in Ireland
• Go 150kph on a motorcycle through rush-hour traffic with your eyes closed
• Attend a New York Yankees game wearing a Boston Red Sox hat and jersey
• Jump out of the Eiffel Tower without a parachute
• Walk barefoot on Legos

Or you could simply do what Sammy (not his real name©) did.

It had been a rather boring day for me.  So far I had gotten only 1) an 80-year old woman who had mistaken her accelerator for the brake pedal, crashed into a wall, and fractured her ankle, knee, and wrist, and 2) a 20-year old who had gotten hit by a bus and had a broken ankle.  Since I don't do bones, I called the orthpaedic surgeon so he could work his magic on both of them, and I waited until something truly epic arrived.

My wait would be long and tragically fruitless.

Around 10 PM I got a call that my next patient would be a 15-year old boy who had been hit by a car while riding his bicycle.  Fifteen years old.  Ten o'clock at night.  On a bicycle.  I'll give that a second to sink in.  

Ok, ready?

Hopefully you're all thinking the same thing I was at the time - What the hell is a 15-year old boy doing riding his bicycle at night?  If you were thinking anything else, I'd like to invite you to leave now, since we're clearly not on the same page.  Anyway, for those few of you still remaining, as I waited without bated breath, I had already started mentally reviewing the lecture I would surely be giving him about not being stupid.  Sammy arrived a few minutes later looking entirely uninjured.  It took me all of  about 18.2 seconds (I timed it) to discover that his only outward sign of trauma was a small abrasion on his right ankle.  About 5 minutes later I was looking at his completely normal X-ray, so I gave him the good news that all he had was a sprained ankle and opened my mouth to start the diatribe.

And then Mom got to to the hospital.

She had a look of sheer panic on her face, and I immediately realised that she had no idea what had happened and was imagining her son dead in a ditch.  I put my harangue on hold and quickly ushered her in to reassure her that Sammy was fine, but that I needed to talk to them both.

Ready.  Steady.  GO.

"My first question for you," I asked Sammy, "is what the hell you were doing riding your bicycle at night."  It wasn't so much a question as an opening statement.

Sammy looked a bit stunned, hung his head, and sheepishly turned away, clearly choosing not to respond rather than giving an answer that he too knew would be stupid.  I looked at Mom who was staring intently at her son with the painfully-obvious "WHAT THE HELL DID YOU JUST DO?  ANSWER THE MAN'S QUESTION!" look (Note to MomBastard: yes, I remember that look well).

But I wasn't nearly finished with him yet.  Not remotely.  I waited a moment until he looked back at me, and then I fixed him with a stare dead in his eye.

"I see a lot of injured patients in this trauma bay, and most of them have done something really stupid that landed them here.  You just did something REALLY stupid."  He looked away again.

I glanced up at Mom, expecting her to look shocked at my words, but she only nodded, silently giving her consent for me to continue.  I obliged.

"Were you wearing a helmet?"  He shook his head no.  "THAT was stupid.  Riding your bike at night?  THAT was stupid.  Riding your bike A) at night, B) without a helmet, and C) while wearing black sweatpants and a black shirt?  THAT was REALLY stupid."

He couldn't even bring himself to look me in the eye.

"You got lucky, Sammy.  This time, you got lucky.  Next time you do something stupid you might not be so lucky.  I do NOT want to see you back here in my trauma bay.  Understood?"

He nodded, almost imperceptibly.

I turned to go and caught Mom's eye.  She mouthed "Thank you" to me and started crying as I walked out without another word.

Sammy is still a young, impressionable teenager, one who still has the capacity to learn from a mistake that was indeed very stupid, though fortunately not costly.  This time.  Perhaps next time he won't be so lucky.  But with a little reinforcement from Mom after my little tirade, maybe there won't be a next time.  Maybe, just maybe, I gave Sammy something he can take with him forever.