Crossy road

One of my favourite bumper stickers says “HANG UP AND DRIVE!”  There are very few phone calls that absolutely must be made while driving, and even fewer text messages that simply must be sent.  Even using a hands-free device doesn't help you keep your concentration where it belongs nearly as much as you may believe it does.  Probably 99.99% of mobile phone-related accidents could be avoided if people simply set their phones aside and concentrated on the road like they were taught to do.

But I saw a similar bumper sticker recently that infuriated me, and I'll be goddamned if I'm going to keep my stupid mouth shut about it:

HA HA!  It’s totally hilarious, right?  HA HA!  Oh my, I laughed and laughed.  Har dee fucking har har.  Make a fucking knee-slapping joke about drunk driving, something that kills and maims thousands of people every single year.  I wanted to jump out of my car onto their hood, climb into their car, rip off their steering wheel, and beat them with it.

Fortunately I was parked in a lot and the driver of the offending car was nowhere to be seen.  Even more fortunately, I wouldn't actually ever assault anyone.  I don't think.

Anyway, after screaming and fuming and ranting and raving like a deranged lunatic, I started actually thinking about why I was so incensed.  And after ruminating for a while, I realised that the reason I was so angry is that the bump you just hit that caused you to spill your drink might have been a pedestrian who wasn’t looking where he was going because he was looking down at his phone while crossing the street.

I think everyone would agree that drunk driving is bad, and distracted driving is bad, and drunk walking is bad.  But what everyone on the planet seems to be forgetting these days is that distracted walking can be just as bad.

This leads (yes, finally) to my point:

LOOK. UP.

Unless you live in the Brazilian rainforest, it is impossible to walk around without seeing people looking down at their phones - playing games, texting, tweeting, instagraming, snapchatting, or whatever the hell people do instead of looking up.  I’ve seen people walk into walls, trip over curbs, walk into people, and nearly get hit by cars, all because they weren’t looking where the hell they were going because they just had to update their Instagram with whatever the fuck they just ate.

Do you really think anyone gives a flying fuck how omg totally delish your lunch was?  Does anyone actually want to see a picture of your salad?  And if so, do you really need to upload the picture while crossing 4 lanes of traffic?

The number of pedestrians I’ve seen getting hit by cars has been skyrocketing over the last decade, and most of these traumas are preventable because these folks either 1) are still using their goddamned phones as they are wheeled into my trauma bay or 2) immediately ask where their goddamned phones are.

“just got hit by a car going 2 hospital lol”

Seriously, people?  Is everyone that willfully oblivious?  Is it really more important to take your next turn on whatever stupid game you're playing than to make sure you don’t get run down trying to cross the street?  Even Frogger was paying better attention to traffic than you are, and he was a goddamned 1980s 8-bit frog!

This is you on your goddamned phone

If you want to tune out your family and watch the latest fail video compilation on YouTube while you’re out to dinner, fine.  The only things you'll miss are conversation and real social interaction.

But when the meal is over, put it the fuck down and look the fuck up.

Crazy

There’s a very good reason why I don’t treat children, and I can sum it up in one word: parents.  I don’t mind the kids themselves (remember I have two of my own), but the parents can either be so overwhelmingly crazy in trying to protect their children that the craziness metamorphoses into sheer lunacy, or not show even an iota that they care about their child at all.  I’ll admit to understanding the crazy feeling when my own child had croup as a toddler, but I never let myself (or my wife) go completely down the rabbit hole, staying rational while also remaining right by her side every second she was in hospital.

So on the one hand you have crazy overprotective parents who constantly interject, thereby not allowing me to work effectively or efficiently, and on the other you have parents who obviously don’t care one way or the other, which is even more infuriating.

And then you have parents like Yvonne (not her real name©) who have no reservations whatsoever and allow their emotions to completely override any rational part of their brain and are JUST.  FUCKING.  CRAZY.

A laughing emergency physician is a dangerous emergency physician.  When he chuckles as he starts to tell me about a patient, it means it’s either A) something so completely stupid and irrelevant that even he knows he shouldn’t be consulting me, B) something so bizarre that he doesn’t have the foggiest notion how to handle it, or C) a rectal foreign body.  Sadly for me (and for you, I’d imagine), it was not C, but rather B this time when Dr. Mike (not his real name©) called me:

Dr. Mike: Hey Doc, so I have this very nice young lady who clinically has appendicitis, and I’d like to order a CT scan to confirm it, but her mother isn’t consenting to the scan.
Me: Oh, she must be very young then.  But I don’t do kids, Mike.  How old is the patient?
Dr. Mike: 22.
Me: Months?
Dr. Mike: No, years.
Me: ...
Dr. Mike: Are you there?

Apparently Yvonne (the patient’s mother) was afraid of the radiation because her daughter Lilly (not her real name ©) was, and I quote, “so young”.  Mike politely asked me (with a very nervous chuckle) if I would come assess the young lady and talk with her mother.

I audibly groaned, and Mike laughed again.

Fuck you, Mike, I thought.

When I got to her room a few minutes later, Lilly looked mildly uncomfortable, but her mother looked significantly worse, pacing around the room as nervously as a bank robber in a police convention.  On examination, Lilly was definitely tender in the right lower quadrant of her abdomen (right where the appendix is supposed to live).  Her history was consistent with appendicitis and her pelvis was nontender, all things pointing to a single diagnosis.  However, I explained to both Lilly and Yvonne that in a young lady of childbearing age, the right thing to do is a CT scan to confirm the diagnosis.  It could be a Girl Part Problem (like an ovarian cyst or abscess, ovarian torsion, ectopic pregnancy, pelvic inflammatory disease, endometriosis, etc) and confirming appendicitis with a CT scan would reduce the risk of an unnecessary surgery from 20% to less than 5%.

“No,” Yvonne said adamantly, “I don’t want her getting that much radiation.  She’s too young.”

I very calmly explained that the radiation from CT scans is much lower than most people think, and the amount from a single scan would only be a concern if Lilly were an embryo (yes, I actually said that).

Lilly sat there quietly looking at me while her mother shook her head and not-so-politely continued to refuse adamantly.  Resigned to this overarching stupidity, I explained that because her history and examination and blood work were all consistent with appendicitis, and because Lilly was so uncomfortable, the correct next step would be immediate surgery, even though there was still about a 20% chance I was wrong about the diagnosis.  I also explained again about reducing the risk of unnecessary surgery is as easy as a 10-second CT scan. 

"No, absolutely not.  But," Yvonne continued, "I’ve been reading online about treating appendicitis with antibiotics”.  

Oh, shit.

After describing her research at Google University, she then went on to explain how her own appendix had ruptured when she was 7-years old.  I just stared at her, mouth agape, as she recounted how she had needed multiple operations and nearly died because her parents had waited too long before seeking medical care.

"Wait just one goddamned second, you insufferable twit.  You’re actually asking me to make the same mistake your parents made and wait to operate on your daughter until her appendix ruptures and threatens her life?  Are you that mind-numbingly stupid?"  

Ok, there's a chance that I only said that in my mind.  But I wish I had the balls to say it aloud because that’s exactly what was going through my head as I tried to explain patiently and rationally why waiting to operate was the wrong move without using the words “FUCKING MORON”.  Finally, shockingly, she agreed.  Lilly had remained silent the entire time, merely nodding occasionally.

And if that weren't bad enough, that's when the real craziness started: “Have you had enough to eat today?  Are you well hydrated?” Yvonne asked me.

Wh . . . what?  I’ve never been asked that before in my entire medical career.  And before you think this was real concern over my well-being, it clearly was not.  It was just lunacy.

About 30 minutes later Lilly was brought up to the operating theatre, where the anaesthesiologist witnessed Yvonne again asking me if I had had a bite to eat.  “Yes madam," I forced myself to say, "I had a granola bar and a Coke.”

“Ugh, COKE?  Oh dear!  Oh my!  I’m a nutritional microbiologist, you see.  You drank Coke?  Really?  Ugh!”

The anaesthesiologist glanced quickly at me with a look that clearly said, “What the fuck is this lunatic raving about?”  I laughed politely and said nothing, worried that one of the truly revolting thoughts that had been percolating over the previous half hour would come spilling out of my brain through my mouth.

Finally it was time for surgery.  I inserted my laparoscope through a tiny 1cm incision, hoping to find a nice, plump, juicy, inflamed appendix, and the first thing that I saw was . . .

. . . a normal appendix.  There was perhaps a slightly engorged blood vessel on its surface, but not the nice chunky inflamed organ I was expecting.  DAMN IT.  I guaran-damn-tee that this girl's mother is going to accuse me of doing an unnecessary surgery now.  FUCK ME.  I took out the appendix, hoping that there was inflammation inside that I just couldn’t see (this has happened to me in a handful of appendicitis cases).  While I had the scope in there, I examined the ovaries (normal), uterus (normal), colon (normal), small bowel (normal), liver (normal), and gall bladder (fucking normal).

I heaved a great sigh and finished, bracing myself for the conversation to come with Yvonne.  I went out to the waiting room to talk to Yvonne.

Deep breath, Doc.  Deep breath.

I explained what I had found and that I couldn't be sure it had been appendicitis.  I explained the other possible explanations, including food poisoning (which is due to toxins produced by bacteria), a "stomach flu" (which is actually a viral infection, not the flu), mesenteric adenitis, pelvic inflammatory disease (though I had seen no evidence of that intraoperatively), or possibly appendicitis that I just hadn't appreciated.

"So are you saying this was an unnecessary surgery?"

And there it is.  Of course she would ask that.  Deep breath.  No, I told her, even without the CT scan, it was the right thing to do, and this was exactly why I had explained the possibility that it wasn't appendicitis even though her symptoms all fit.  And why the CT scan would have been useful, idiot.  We would just have to wait until Lilly woke up - if she felt better, it was appendicitis.  If not, then we would have to keep looking for other causes and wait for the pathology report, which would still take a few days.  I thought the insanity was over until she asked her followup quesions:

- Could she have room-temperature water when she woke up?  Yes.

- Should she stop eating corn after surgery?  Uh, what?  I mean, no.

- Could this have been caused by the organic quinoa she ate last week?  Ah, no.

- Could this have anything to do with a pain Lily gets in her chest whenever she's sleep-deprived and which goes away after a good night's sleep?  What the ever-loving fuck are you talking about?  I mean no.

Lilly woke up feeling great, and she went home from the recovery room.  Her pathology report came back two days later:

"MILD ACUTE APPENDICITIS"

I don't think I have had that deep a sigh of relief in years.

Listen

I wish there were remedial medical school courses.  Like detention or summer school, except for doctors.  I wish I could send some idiot docs I’ve encountered back to Medicine 101 so they could learn some things that somehow escaped them.  Some of the more important issues that I see way too often are 1) Examine your patient thoroughly, 2) Abdominal pain is not a surgical indication, and 3) Treat patients with respect.  I’ve said it here before, but probably the most important lesson for any doctor (that should be readily self-evident to anyone with an IQ greater than that of a fruit bat) is to listen to the patient.  If there were such thing as Medicine 101 (and perhaps there should be, as this story would suggest), that lesson would be taught on Day 1, and it would then be repeated EVERY SINGLE GODDAMNED DAY until it finally sank in, even into the most hard-headed idiot doctors.

Perhaps Dr. Hugh (not his real name©) would benefit from such a course.

I get calls from Outside Hospital every so often - these are usually small community hospitals that are not equipped to deal with trauma patients because they don’t have the personnel, the proper resources, or both.  The facility where Dr. Hugh is an emergency physician is not one of these hospitals, but for some reason on this fateful night they had no trauma surgeon available.  So I became their trauma surgeon.

Lucky me.

At 7:45 PM (at least it wasn’t 2AM - thanks, Call Gods), Dr. Hugh called me with an emergency.  He had a 70-year old woman who had fallen down the stairs and landed on her left side, and now she had a dangerously low blood pressure.  Normally putting such an unstable patient in an ambulance and transferring her to another hospital would be considered ill-advised, but he wanted to do exactly that anyway.

“We don’t have anyone willing or able to take the case, so I need to transfer her to you,” he explained.

Lucky me.

Since she had fallen on her left side, Dr. Hugh suspected she had ruptured her spleen, but he went on to explain that their CT scanner was old and would take over an hour to scan her, so he couldn’t even rule out internal bleeding before shoving her into the back of an ambulance.  But because her blood pressure was so low, he was very concerned she was bleeding to death, and he was shipping her to me whether I liked it or not.  

Wait, what?

He hadn’t bothered to consult me to ask if this was a very bad idea (it is), he had simply called one of the emergency physicians at my hospital (instead of me), gotten the ok from him (not from the actual doctor who would be seeing the patient . . . you know, me), and stuck her on an ambulance.  But it should be fine, he told me, because his hospital was only 15 minutes away from mine.

My blood pressure was rising.

I was afraid the patient would bleed to death in the ambulance, but something about this whole thing just felt wrong.  I had the distinct feeling that something just wasn’t right here.  Little did I know just how right I would be, though for entirely the wrong reason.

Exactly 115 minutes later (yes, I timed it and NO, that is NOT a typo - it took almost 2 hours), Bertha (not her real name©) arrived looking in better shape than most patients half her age.  She wasn't pale or sweating and she wasn't in pain, she was just sitting up on the gurney smiling, like she knew some big secret but wasn't about to spill it.

I liked her immediately.  

I wasn't too upset that Dr. Hugh hadn't told me about the bruise on Bertha's left arm, but it sure would have been nice for him to have mentioned the huge 20-cm (8-inch) laceration on her left lower leg.  

In his defence, he probably hadn’t actually examined her.  

Though her blood pressure was still quite low (about 80/55) when she got to me, her heart rate was completely normal, as were the examination of her heart, lung, and abdominal.  No pain, no tenderness, no bruising, nothing.  In fact, her only pertinent findings were the bruise and laceration. 

My Inner Pessimist kept telling me that something was definitely awry, though I immediately suspected the problem was more with Dr. Hugh than with Bertha.

“Bertha, do you have high blood pressure?” I asked, the suspicion building rapidly.

“No doctor, I never have.”

I had suspected as much.  Now the big question:  ”Do you have low blood pressure?” I asked with one eyebrow raised.

Her smile widened.  “Yes, ever since I can remember.”

And there it is.  “How low does it usually run, ma’am?”

“Oh, usually around 75-80 over 50.”  I looked at the monitor, which now read 84/45, exactly where it had probably been for the past 7 decades.  “I tried telling that to that doctor at the other hospital, but he wouldn’t listen to me.  My husband tried to tell him too, but he wouldn’t listen to him either!  He just sent me over here!  Couldn't they just give me stitches over there instead of taking all night sending me here?”

I touched her shoulder and smiled gently.  “Don’t worry, Bertha.  We’ll listen here.  I promise.”

Fifteen minutes later I was looking at her completely normal CT scan of her chest and abdomen, and thirty minutes (and 20 sutures) later I was discharging her home with her husband, still smiling. 

Many people think stethoscopes, CT scanners, ultrasound machines, and X-ray machines are the most important instruments doctors can use to make a diagnosis.  But those people would all be wrong.  So what is the most valuable instrument we have at our disposal?

Ears.

Foreign body

NOW I've seen everything.  No, I'm really seriously serious this time.

I know I've said this before, but this time I really really mean it.  I just don't see how the Call Gods can make up anything new.  Surely they are reaching into the very depths of their imaginations now, scraping the absolute bottom of their creative barrels, and they must be completely out of ideas.

But wait, I'm getting ahead of myself.  My apologies.  I'll start from the beginning.

I get some bizarre phone calls at 1 AM.  Nothing good ever happens in the middle of the night, and surely the emergency physicians know this.  In an attempt to soften the blow, they almost always start out the conversation with "Hey Doc (not your real name©), I'm sorry to bother you, but . . ."  Sometimes with difficult cases they know the blow can't be softened, so they begin with something more like "Hey, sorry but I got a complicated case for you."  That's never a good sign either.  But when they lead off with this:

So, uh, I have a weird question for you. . .

That is Guaranteed Not Good©.  Very very not good.  Whatever it is will be so not good that I am tempted to retire on the spot, just so I don't have to hear the end of that sentence and then deal with whatever catastrophe they're about to drop in my lap.

As I'm sure you've guessed already, I got just such a call recently.  And you've probably also surmised that I didn't give into early retirement.  There's no good way to summarise the conversation, so I'll simply present it exactly as it happened with as little paraphrasing as possible.

Emergency physician: "So, uh, I have a weird question for you."
Me (under my breath): Oh, fuck.
EP: What was that?
Me: I said 'What can I do for you?'
EP: Right. Must be a bad connection.  So anyway, I have this young lady here who, uh . . . she, uh . . . I don't know exactly how to say this.
Me: . . .
EP: She, well, uh . . . she swallowed her glasses.
Me: . . .
EP: Hello?
Me: . . .
EP: You there?
Me: Yeah.  I'm sorry, I thought you said she swallowed her glasses, but that must have just been the peppers I had for dinner, right?  Right?
EP (laughs): No, that's exactly what I said.
Me: Ok, she swallowed . . . did you say her glasses?
EP: Well not the whole pair of glasses.
Me: Of course not.
EP: Just the arm.
Me: Well of course.

If I wasn't awake before, I certainly was then.  I paused and thought about it for a few seconds, trying to figure out A) how the fuck that was even possible, and B) what the hell I was going to do about it.  Once something is in the stomach, there are only three ways to get it out: 1) Make an incision in the stomach and remove it directly, 2) get it out the way it went in, or 3) wait until it comes out the other end.

I told the emergency doc that if I had swallowed some glasses, I would want a gastroenterologist to try to remove it non-surgically (with an endoscope) before a surgeon cut me open.  If I had swallowed glasses.  If I had . . .

I couldn't believe I had actually just said those words in that particular order.

First thing the next morning after I woke up and had my cappuccino (yes, I spent 4 minutes making and enjoying a cappuccino.  I do love my morning cappuccino), I went straight to her room to check on her.  Her nurse informed me that she was already in the endoscopy suite with the gastroenterologist.  PERFECT!  I walked down one floor to endoscopy and ran right into my friend and colleague Dr. Ken (not his real name©) just as he was leaving the procedure room.

"Hey Ken, did you get it out?" I asked him.

Without a word (and with a big grin) he held a specimen bag right up to my face.  I expected to see one of those glasses arm covers in it:

HAHAHA no.  Instead, I saw one of these:

Yes indeed, an entire glasses arm.  As is usually the case with these foreign body patients, I was rendered nearly speechless.  I did manage to stammer out one nearly-coherent phrase:

"But . . . but . . . how?"

Ken affixed me with a look that clearly said, "Don't ask questions to which you don't want to know the answers."

And so I didn't.  I shook his hand, turned around, and left without another word.  But as I walked away, thankful that I wouldn't have to operate on this young lady, I realised I did have one more question:

Ok Call Gods, what the fuck is next?

Tired

"I'm so tired." - Lili von Shtupp, Blazing Saddles

I'm fucking tired.  Not sick and tired, just tired.  Sometimes it feels like I haven't had a good night's sleep in years, though that's probably a gross exaggeration - it's more like decades.  The day after I'm on call (especially a rough one where the Call Gods have their deranged fun at my expense), I'm less than useless.  My eyes constantly feel like they're being dragged down to the floor harder than Yoko Ono dragged down the Beatles.

I don't sleep enough, and even when I do it usually isn't good quality sleep.  I constantly worry about my patients, and I constantly worry about my children.  I don't worry about myself much at all - Mrs. Bastard takes care of that for me.  Of course, that doesn't leave anybody to worry about her, but don't feel too bad for her - she's a very tough lady, as her bout with pneumonia last year clearly demonstrated.

Anyway, my brain always runs at full speed, and that isn't conducive to anything even remotely resembling real rest (alliteration is cool).  Naps are out of the question - I invariably wake up more tired than when I went to sleep, completely defeating the purpose.  So I don't even bother trying.  I think the last time I took a nap, bell-bottoms were in style.  The first time.

Oftentimes when I'm not-as-tired-as-usual, I find my awake-self talking to my nearly-asleep-self, since at least I know I'll be good conversation.  Some time back I started keeping a log of things that Awake Doc says to Sleepy Doc (with apologies to Disney for hijacking two of their dwarves' names).  What follows are the things I wish I could say to myself as I find myself slipping into a sleep deprivation coma.

"The light is green. Go, idiot."

I haven't fallen asleep at the wheel in over 10 years (and fortunately that was at a red light), but the prospect of doing so again scares the shit out of me.  The last thing I want to do is end up a trauma patient in my own hospital.  Or any other hospital for that matter.  Drowsy driving is just as dangerous as drunk driving, so I try not to do it.  If I find myself falling asleep, I pull over for a few minutes.  And I always try to have a coffee before I leave.  Speaking of which . . .

"No, don't pour that into your coffee.  What do you mean 'Why not?'  Because it's orange juice, dumbass."

I've done this.  Believe me, it isn't pleasant.

"Stop mixing up your children's names."
One is a girl, the other is a boy.  Neither name is androgynous, they don't start with the same letter, and they sound nothing alike.  There's no excuse.

"Milk does not belong in the cupboard."

More than once I've woken up in the morning to find a nice, cold empty plate in the refrigerator exactly where the milk belongs, and room-temperature milk in the cupboard.

"Don't forget to set your alarm, stupid."

I have enough trouble remembering to do this when I'm not dead tired.

"Brushing your teeth with shaving cream won't get them very clean."
Speaking of which . . . 

"Don't shave while you're half asleep."
Gentleman, do you enjoy intact skin on your face? I apparently don't, because I still try to do this.  Speaking of which . . .

"You really want to shave now?  Fine.  Wondering why your razor isn't working, dummy?  Maybe you should stop shaving with the back side of the razor."

Doing this is surprisingly ineffective, as I've learned the hard way.  Multiple times.

"Hey, you forgot your belt."
No this isn't a huge deal, unless I'm wearing that one pair of pants I own that are just slightly too big.  Speaking of which . . .

"Hey, you forgot your pants.  Again."

Yes . . . again.  Seriously.

"Eat something."

I can also hear my mother (MomBastard) telling me that I'm wasting away, I'm only skin and bones, I need to eat something, what do I have in the refrigerator.  But sometimes I get so tired I either forget to eat or am just too damned tired to make myself chew.  It's a very effective diet plan, but not one that I would recommend to anyone.

"Put the seat back down."
Fine, I will admit I sometimes forget to do this even when I'm not tired. 

"Get some sleep.  Because you have to do this all over again tomorrow."

No matter how much I get done, there's always more to do, and some things get put off until the next day.  Fortunately Mrs. Bastard has a way of getting me to pack it in for the night and go to sleep.

10 Commandments of Trauma

Being a trauma surgeon is hard.  I am constantly dealing with idiots who have usually done something very stupid that put them in my trauma bay.  But I also multitask, performing life-saving surgery, talking to families and telling them their loved one has died, and babysitting drunk idiots, all while trying to keep Mrs. Bastard happy and trying to find time to see my little Mini Bastards (not their real names©) before they're fully grown.  Mrs. Bastard may argue with me that her life is even more difficult, since she also works full time and is the one mainly responsible for trying to tame my little monsters, and to be honest, she has a fair point.  

Before you think I'm just boo-hooing and being all melodramatic about the difficult life that I chose for myself, no this isn't a "Feel Sorry For Doc and Mrs. Bastard" post, so don't even think about dumping any unwarranted and unwanted pity on us.  Besides, this post isn't really about me (or her) anyway. 

After giving it much thought, though being a trauma surgeon and a trauma surgeon's wife may both be difficult, I've decided that being a trauma patient is the hardest job of all.

I understand that my trauma patients have it rough.  They are whisked from their car or home or McDonald's (yes, really) in an ambulance at breakneck speed, sirens blaring, weaving through traffic, often with no recollection of what has transpired.  They may regain consciousness en route without any clue how they got there.  One minute they're enjoying a Big Mac and Coke (mmmm . . . Big Mac and Coke . . .), the next moment they wake up with a hard collar around their necks and a haematoma on their forehead, strapped to a hard backboard which prevents them from moving, and they're screaming down the road towards the hospital.  Then once they get to me, all their clothes are cut off as they are stripped completely naked, IV's are shoved unceremoniously into their arms, and strangers start asking them questions while poking and prodding every square inch of their bodies.

Holy.  Shit.  This is what many people consider to be their ultimate nightmare, and rightfully so.

Yet, despite how difficult a time I know these people are having, I still expect a certain level of consideration and tact from my patients.  However, many (ok, most) of my patients fail to live up to even these admittedly low standards.

So with that in mind, I'd like to propose a list, a 10 Commandments of Trauma if you will, of how you should (and shouldn't) act with your trauma surgeon. 

Thou shalt not lie       
This goes without saying.  Or at least it should.  Don't tell me you weren't driving when you were.  Don't tell me you didn't smoke marijuana when I smell it on you.  Just tell me the damned truth.  I am not the police, I'm just trying to take care of you, so lying to me will avail you nothing.

Thou shalt not omit
If I ask you what medical problems you have, don't leave anything out.  Do you have diabetes?  Tell me.  Are you on blood thinners?  Tell me.  Do you have untreated HIV or hepatitis C?  Then FUCKING TELL ME before I am exposed to your infectious blood. 

Thou shalt admit to alcohol consumption
This ties in to commandment #1, but somehow everyone who is wheeled in smelling like The Pub at 2AM claims to have only had two beers.  I'm going to check your blood alcohol level anyway, so you may as well be honest.

Thou shalt not curse at me
I don't care how drunk you are, you will not swear like a sailor in my trauma bay.  My nurses and assistants and I will speak to you respectfully, but we damn well demand that you do the same, asshole.  I mean sir.

Thou shalt not argue with me about seatbelts and helmets
No, you are not safer by not wearing your seatbelt.  This is a ridiculous argument with absolutely no veracity whatsoever, and the fact that anyone actually believes this horseshit boggles the mind.  And helmets save lives and brains (just in case anyone making this argument actually has one), though if you actually are thinking about arguing this with me, then obviously the very existence of your brain is up for debate.  Not wearing a helmet or seatbelt is stupid and indefensible.  Full fucking stop. 

Thou shalt not say 'no'
Don't misunderstand me - I'm not saying that you should blindly follow anything your trauma surgeons says.  HOWEVER, if you find yourself in the care of a trauma surgeon and he (or she) tells you that you need immediate surgery, there is a very high likelihood that you will be dead soon.  Listen carefully, then say 'yes'.

Thou shalt not say 'I don't know'
What medicines do you take?  What do you mean 'I don't know'?  What's that scar on your abdomen? Oh, it's from the last time you got shot'?  Great, what did they do when they were in there?  What do you mean 'I don't know'?  It's your body - fucking KNOW IT.  If you don't care, don't expect anyone else to.

Thou shalt not whine about needles
Unless you actually are a child, don't act like one.  Yes, you're getting an IV.  Yes, it will hurt for 2.13 seconds.  Yes, I will give you morphine through that IV if you need it.  No, I will not put you to sleep to suture that tiny laceration on your arm.  And if you are covered with tattoos and tell me you're scared of needles, I will fucking slap you.  Not really, but in my head I will fucking slap you.

Thou shalt learn something
Ok, you made a mistake and did something stupid.  Fine, you're human just like the rest of us.  But if this is the third time your horse has kicked you, maybe you need to learn more about horses (or get a new horse that isn't an asshole).  And if this is your fifth time crashing your motorcycle, maybe you shouldn't be riding. 

Thou shalt be appreciative
We work long hours and spend the night in the hospital in a tiny call room away from our spouses and children just so we can be available 24 hours a day, seven days a week, 365 days a year (366 next year) to save you and your drunk ass.  Fucking say 'Thank you', at least once.

***
I plan on printing these out in a very large font and posting them on the door of my trauma bay, though I don't expect them to last long.  I have a feeling the administration wouldn't approve.   To hell with it, I'm going to do it anyway.

Bad drivers

I'm a good driver.  I don't drive too fast, I signal before I change lanes, I follow at a safe distance, and I don't distract myself by fiddling with my phone.  That said, I think I'm the only person in my entire area (other than Mrs. Bastard) who follows these very simple rules.  It seems that no one else within a 100km radius of me can drive for shit.  Some drivers are so bad or so reckless that there are two things I wish I had: 1) the power to revoke a driving licence on site, and 2) a giant roof-mounted laser to blast the most egregious offenders into oblivion.  Mostly I would probably end up using these on BMW drivers.  Assholes.

Under normal circumstances everyone around me can't seem to drive safely, but some of these idiots actually do various things to erode their already piss-poor driving skills even further.  A few ordinary idiots drink and drive.  Some slightly more creative idiots text and drive.  Every now and then some really special idiots do their makeup and read the newspaper while driving.

And then you have the rare mind-numbing, slap-yourself-in-the-face, what-the-fuck-are-you-thinking idiots like Nina (not her real name©).

Nina was brought to me one fine morning after she ran her car into a ditch.  As she was wheeled in, she was screaming, "OH MY FOOT!  OH MY GOD, MY FOOT!  OOOOOH MY FOOT MY FOOT MY FOOT!!"

Hm, it seemed her foot was hurting.  Ok, so she has a broken foot, I suppose.  Simple, I have an orthopaedic surgeon on call who can fix that.

We transferred her from the gurney to our stretcher, and the first thing I noticed was the surgical shoe she was wearing on her left foot.

Hm.  That was unexpected.

I asked her which foot hurt.  "THE LEFT!"

Well that solves that mystery.  But she wasn't done.

"I JUST HAD SURGERY ON IT 3 DAYS AGO!  OW OW OW OW OH MY GOD OH MY GOD OH OH OOOOOOOOOOH!"

Well that explains that.  The next question was perhaps the most obvious - was it hurting more compared to before the accident.

"NO!" she screamed.  "IT'S THE SAME AS BEFORE!  THAT'S WHY I WAS IN THE CAR!"

If that doesn't make much sense to you, you're not alone.  It didn't make sense to me or anyone else in the room at the time either.  While shaking my head, I completed my workup which revealed no other injuries.  X-rays of her foot were entirely negative, of course.

Several minutes (and several nurses encouraging her to breathe) later, she calmed down enough to explain what the hell was going on, since none of us had been able to figure it out.  You see, she had run out of her prescription pain medicine after her surgery, and she was on her way back to the pharmacy to get more.

Ooh, that makes sen. . . wait . . .

But, I thought, it's only been 3 days since the surgery.  So how had she run out of her pills so soon?  Had she misplaced them?  Had her surgeon just not given her enough of them?  Did her dog flush them down the toilet?

Hahahahaha no, how embarrassingly naïve of me to even consider a normal explanation.  No, apparently it was because she had been taking 2-3 times the normal dose, including SIX of them that morning just before getting in the car and driving.

And just when I thought the stupidity had ended, she had one more surprise in store for me in her urine tox screen: she was also high on PCP.

Maybe she thought the PCP would let her fly to the pharmacy instead of having to walk on her recently-operated-on foot. Who knows.  I didn't ask her before I perfunctorily discharged her.

If you're wondering, no I did not give her a new prescription for pain medicine.  I only give those to people who A) need them, and B) I am reasonably convinced will not abuse the shit out of them.