Statistics

Statistics are a funny thing.  Some are completely true though difficult to believe:

• You are much more likely to get struck by lightning than win the lottery 
• In 2009, almost 20% of all books sold in the United States were written by Stephenie Meyer.  Yes, really.
• The average person has one ovary and one testicle.  (Think about it.)

. . . while other statistics sound completely plausible yet are complete twaddle:

• Men think about sex every 7 seconds
• Humans use only 10% of their brains
• The average person swallows 8 spiders while they sleep during their lifetime

And then there are some statistics which look so ridiculous, so preposterously unlikely, that it is simply beyond the realm of possibility for them to be remotely plausible:

• This blog has been viewed 3 million times.

Despite my gaffe a few months ago about being near 3 million hits (my aging eyes somehow erroneously saw "2,960,000" instead of "2,690,000"), as of today SftTB has officially hit 3 million pageviews.  Somehow over the past 4 years, there have been 3,000,000 distinct occasions that someone on this planet has thought, "Hm, I wonder what DocBastard has to say."  THREE MILLION TIMES.  I don't know how many of those people actually stayed to read my silly stories, but I can tell you what sites referred them here:

• 76% have come from Google.com
• 5% from Google.ca
• 3% each from Google.com.uk and Google.com.au
• 2% from sprocket-trials.blogpost.com

I can also tell you where they live:

• 66% USA
• 10%  Canada
• 6% each UK and Australia
• 1% each France and Germany
• <1% Singapore, New Zealand, Netherlands, and Ukraine

Some other statistics:

• Most popular post (surprisingly): "That sinking feeling"
• Most commented-upon post (not surprisingly): "Jahi McMath update . . . sort of"
• Top three browsers: Safari (62%), Chrome (18%), Firefox (8%)
• Top three operating systems: iPhone (41%), Windows (20%), Android (17%)

So whoever you are, wherever you live, and however you got here, I sincerely appreciate the company.  The internet can be a pretty lonely place, and you people are the only reasons I continue to write.  Please keep coming back and commenting, and please do encourage others to join us.  And as with my other milestone posts, I humbly (and hypocritically) request that you leave a comment with your (approximate) location and how you found me.  

See you at 4 million.

Best,

Doc

Healthy not healthy

No offense, but if you ever hear anyone start a sentence with “With all due respect . . .” and expect what follows to be respectful, then you’re an idiot.  No offense.  It’s one of those phrases that is intended to deflect disrespect and immunise you from blame.  Whenever I hear it (or it’s bastard cousin “I don’t mean this in a bad way, but . . .”), I wish that the person would just be an adult and come out and say whatever offensive thing is on his mind rather than veiling it in a shroud of dismissal.

“Sorry not sorry” is similar - you are sort of apologising in advance, but at least when people use this one, they know in advance that you’re not really sorry.

So what the hell does any this have to do with Gerald (not his real name©)?  With all due respect, stop being so damned impatient and complaining so much.  You’ll just have to wait and see.  No offense.

Being on call for general surgery is usually mundane.  Since common things happen commonly, I can typically predict at least one or two patients with appendicitis, perhaps one with an infected gall bladder, maybe a bowel obstruction, or diverticulitis.  Pretty normal stuff, really.  Very seldom do I see anything really bizarre, but it does happen . . . hence, this blog.  Gerald (as you’ve probably guessed by now) falls firmly under the category of "bizarre".

“So I, uh . . . I got this guy with this . . . this . . . thing.”

When an emergency physician leads off with that, I am guaranteed to be presented with something odd, so I sit down and prepare myself for whatever hideousness is about to be dropped in my lap.  My brain cogs immediately started spinning as they usually do:  What kind of "thing"?  A bleeding thing?  An infected thing?  A needs-to-be-removed-from-his-rectum thing?  The emergency doc continued, and I must say I was more than a little disappointed that it wasn't a rectal foreign body.

“So this guy is 70 and healthy, no medical problems," he went on.  "But he came here because his co-workers were telling him that he was starting to smell like a rubbish bin.”

Well that was . . . unexpected.  The cogs spun a bit faster.

“And, well, he has this . . . thing on his back.  It’s kind of, um, big.  And, uh, bleedy.”

Bleedy?  What the . . . That's not even a real goddamned word!  The cogs spun yet faster.

“So I don’t really know what to do with it, so I’m hoping you do.”

The cogs flew off the machine.  Fucking greeeeaaaat.

I got to the hospital a short while later, and Gerald was sitting on his stretcher, smiling, chatting with his neighbour, and looking absolutely fine.  However, I could immediately see (and smell) why his co-workers had been concerned.  As I walked in an odour like death punched me in the face like walking into Ronda Rousey's fist (Ronda - call me).  The nurses were all wearing surgical masks, but the look on their faces told me that even that wasn’t nearly enough.  Having removed dead colons before (stories to come in the future, I promise), I’ve smelled worse, so it didn’t bother me quite as much.

“Hi, Doc!  How are you today?” Gerald greeted me with a big, warm smile.

Nauseated, I almost said.  I chatted with him for a few minutes, somehow resisting the urge to retch.  He told me that he was never sick a day in his life, took no medicine, had no allergies, and had never had surgery.  “I’m just a healthy guy.  I haven’t been to the doctor in 50 years!”

Considering the stench, that last part didn’t surprise me one bit.

He certainly didn’t look sick, but his fetid odour told me otherwise; healthy people don’t smell like a garbage dump.  When he removed his gown and turned around, what greeted me reminded me of this:

He had a mass on his back at least 20 cm in diameter.  It was cracked and bleeding in places, draining pus in other places, and it smelled like it belonged in a horror movie.  All around it were numerous smaller dark lesions, each around 1-2 cm.

Weeeeeeeell this isn’t good.

Within the first 0.253 seconds of seeing it (I timed it), and even without a biopsy, I was 99% sure that this was a large melanoma and that all the smaller lesions around it were satellite lesions, signs that the melanoma was spreading.

Gerald was quite clearly not the perfect specimen of health he thought he was.

It took a bit of encouragement and convincing before Gerald actually believed that there was something seriously wrong with him.  I informed him that, assuming my suspicion was correct, he would need an extensive surgical resection followed by a large and difficult reconstruction, best done by a team of specialists at a university hospital.  Despite maximum efforts, it was still nearly a certified guarantee that his melanoma would kill him in the next few months.  “But Doc, I’ve always been healthy!” he kept arguing, somehow still in disbelief.

No, Gerald.  You haven't been healthy for many years.  You just didn't know it because you've been ignoring the fact that your body has been screaming at you for all this time.

Gerald inspired me to coin my own new phrase: Healthy not healthy.

See, I told you I’d get to the point.  Sorry for making you wait.

Not sorry.

Weekly Troll Update

WARNING: IF YOU ARE NOT INTERESTED IN A TROLL UPDATE, TURN BACK NOW.  

I generally don't feed trolls, nor do I give them much thought.  I liken them to pocket lint - you mostly don't even notice it's there, but when you do it's very mildly annoying (if at all) but nearly impossible to get rid of permanently.  Ever since I altered the commenting policy here about a month ago I have been ignoring my personal troll, deleting all (almost) of his comments as they have come in.  But that didn't stop The Troll from nearly soiling himself trying to get a comment through.  Since initiating his ban I have deleted no less than 40 of his comments (though it may actually be as many as 50).

It really was quite amusing for several days - he continued commenting not just on the Jahi McMath posts but on multiple other posts as well, each comment less coherent than the last.  Perhaps his addled little mind allowed him to think I'd let a bit of his idiocy slide through, but he just couldn't seem to crack the code (though I did let a couple through just so I and others could debunk them).  I kept imagining his spittle-flecked lips screaming at the screen as he tried to squeeze another ridiculous screed through my bulwark.  So in lieu of actually allowing his nonsensical comments, I took a few screenshots of his insane ramblings to share with the group.  They may be a bit difficult to read, so I apologise in advance.

We start with "an actual real example" of his which is, of course, complete and utter cow manure.  Somehow The Troll, who still claimed to be a surgeon and lawyer, believes that a patient who presents to the emergency department would be seen by two surgeons (no he wouldn't), one of whom is a trauma surgeon (no he wouldn't) because there could be a rupture of the diaphragm (that wouldn't cause sepsis), the trauma surgeon would then assist the general surgeon (that would never happen because a trauma surgeon would never be called for this), and that this is "standard of care" in the US (that isn't standard of care anywhere).  This was on my "Crazy" post, which ironically describes his comment perfectly.  Wow, starting off with a bang!   Next!

---

He's trying to scare me by claiming to have reported me both to the AMA and JCAHO (in addition to several other physician groups).  This is rather cute, but let's stop and think for a moment.  I don't suspect anyone at the AMA would be interested in the musings of an anonymous blogger who calls himself "DocBastard".  And why does he suppose JCAHO, an organisation that accredits hospitals and health care organisations in the US and has nothing to do whatsoever with how any individual physician acts, would have any interest whatsoever in a lone doctor's blog?  This is so ridiculous I actually laughed out loud.  In case you're wondering (I hope you're sitting down), no professional groups have contacted me.  Please do control your surprise.

---

Here he doubles down on the "two surgeons in the OR is standard of care" bilge, and he nonsensically misuses "pontificate" and misspells "roughshod" in the same comment.  Somehow he expects me to believe he is a lawyer and a doctor yet has no understanding of grammar or syntax.  Oh, and he and thinks this "incites" me.  Amuses?  Yes.  Incites?  Hardly.  There are also some rather incoherent ramblings that are a bit concerning, but I'm apparently a fraud and a "proven liar" (this is a recurring theme in his comments).  Oh, and I'm an idiot too.

---

Apparently he believes Ken Brown is a dummy-account that I operate (or vice versa).  I'm sure Ken will be very disappointed to hear that, just as I'm sure that Mrs. (misses?) Bastard will be upset to find out she doesn't exist either.

---

"Kim" (who he mentioned in at least 2 other deleted comments) apparently is a surgeon to whom he has shown my blog, and she has supposedly laughed at my writing.  And this guy (who is supposedly a surgeon yet clearly knows nothing about medicine) continues trying to claim that CT scans are mandatory before surgery (they most assuredly are not).  And I'm still an idiot. 

---

"I have no shame in who I am", he posts anonymously.  Irony at its finest.  But I wasn't aware that I was torturing anyone.  Perhaps he should report me to the UN also for crimes against humanity.  He won't back down, he claims.  Yet two days later he did exactly that.

---

He's claiming that I stole the picture from my post Indefensible from Figure1.com, a medical-picture-sharing site I had never heard of until I read this silliness.  A 0.211 second reverse Google image search proves him wrong, obviously.  {Though this is another laughable bit of wackiness, unfortunately he's right about one thing- someone did create a profile with the username "DocBastard" on that site, even with the same capitalisation I use.  However, that usurper is a medical student (according to his profile).  It's very frustrating, but it's not the first "DocBastard" usurper I've encountered around the 'net.}

---

Wait wait wait, is he actually claiming to have reported me to the International Olympic Committee?  What the . . . And that was supposed to scare me?  Well regardless, it seems like he's failing at preventing me from posting just like he's failing at convincing anyone of anything.

---

Really?  We never lounge?  Ever?  So what he's claiming is that we have patients rolling in 24-hours a day and never have time to relax?  How strange then that every hospital has a lounge, and every trauma surgeon has time to take breaks throughout the day (and night), though some call days are busier than others.  Sometimes those breaks are short, but they always exist to some extent.

---

I think it's clear that though The Troll may be adept at googling, he has no idea how to understand or apply the vast amount of knowledge with which he is then confronted.  Nor does he have any idea how to construct sentences or coherent thoughts and arguments properly.  If he did in fact go to law and/or medical school (HA!) I would strongly suggest that one or both institutions revoke his diplomas immediately.

I wonder if this post will provoke The Troll to start commenting again.  Though I'm glad he's gone (mostly), I almost hope he does start again, only because I get a good chuckle at his expense.  Not to worry, though - the stupid patient stories will resume again immediately.

Lifestyle

When it comes to a healthy lifestyle, the phrase that I do my best to live by is "Practice what you preach."  Unfortunately I rarely live up to this lofty standard, and the phrase that much more closely resembles my reality is "Do what I say, not what I do."  Yes, I freely admit that I am terrible at taking care of myself, and even Mrs. Bastard's efforts often aren't enough.  She always encourages me to eat a balanced diet, exercise, floss my teeth . . . you know, all the stuff we all know we really ought to be doing but just don't.  Because of reasons.  Instead, my diet usually consists of skipping breakfast, a Coke for lunch (fuck you, Pepsi), and a ridiculous dinner that provides me an entire day's calories and several day's worth of fat and cholesterol.  Mmmm . . . fat and cholesterol.

Any semblance of real exercise has been difficult for me to achieve ever since I finished medical school.  I used to run or play basketball almost every day, but then life just . . . happened.  I got married, had children, and chose a career that precludes nearly everything other than my family.  I tried to keep up with staying active; I even tried yoga.  Yes, I tried yoga.  Fuck yoga.

These days the only exercise I get is running from idiot to idiot while trying to keep my head screwed on straight.  I can't say this actually gets my heart rate up very much, so in lieu of actual running, I decided some time ago to take advantage of my busy work situation.  Instead of taking the lift (elevator), I now take the stairs whenever possible.  It may not be much, but at least it's more than nothing.

Perhaps not surprisingly I've found that walking up from the ground level to the 8th floor has gotten progressively easier as time as elapsed (what an amazing thing), so I decided to start giving this excellent activity advice to my busy, overworked patients.  I thought the first time would go over well.

I thought wrong.

I was asked to see Otis (not his real name™) by one of my internal medicine colleagues due to severe abdominal pain.  It had come on rather suddenly and rapidly, encompassing his entire abdomen.  Though he had no prior similar episodes, he did have some rather pertinent medical history, including a myocardial infarction (heart attack) and subsequent coronary artery bypass graft three months prior.  As soon as I heard this, the alarm bells started ringing in my head:

WOOP!  WOOP!  Acute mesenteric ischaemia!  Acute mesenteric ischaemia!  Operating theatre, stat!

I feared that the blood supply to his intestine was compromised just like the blood supply to his heart had been three months ago.  The same mechanism that had caused the blockage in his coronary arteries may very well also be happening in his gut.  The treatment for ischaemia is the same everywhere in the body- get rid of the blockage before tissue starts dying.

For confirmation, I got him down to the CT scanner rather quickly, as I did not want surgery to be delayed.  However, what greeted me was a bit of a surprise, and not a bad one for a change.  His mesenteric (gut) vasculature had some atherosclerotic disease, but it was mostly open.  However, his ascending colon was inflamed.  His clinical picture was consistent with chronic mesenteric ischaemia, a longstanding decrease in blood supply to the intestine that had gotten slightly (and temporarily) worse.  Fortunately for Otis this is treated with supportive care and bowel rest rather than surgery.  Otis was unsurprisingly pleased that I would not have to whack out half his colon.

Over the next few days Otis improved rapidly and was discharged home with his colon intact.  He came back to see me in my office several days later for a follow-up visit, and he reported continued improvement.  After I finished my examination, I began discussing how his lifestyle choices, including smoking, poor dietary habits (ahem), and lack of exercise (AHEM), had all contributed to both his recent heart attack and subsequent intestine attack (yes, "intestine attack".  Why not?  It's the exact same as a heart attack, just with the intestine, damn it).

"Yeah but Doc, I'm really really busy.  I work 12 hours a day and I got no time for exercise."

Fully expecting that excuse (which I use with regularity), I immediately launched into my prepared activity speech.  As soon as I got to the "take the stairs and avoid the lift" portion, he stared at me intently.  And silently.

"Um, did I say something?" I asked him after an uncomfortable silence.

Otis continued to stare at me.

I started to fear that I had inadvertently said something patently offensive and started silently reviewing every word I had just said.  What was it?  What did I say?

And still he stared.

Just as I started to open my mouth to apologise for saying . . . whatever it was I had said, his lips curled into a smile.

"Doc, that would be kinda hard for me.  I'm an elevator repairman."

He laughed.  I laughed with him.  Because he actually was an elevator repairman.  Really, what are the odds?

For me: 100%.

Musings on Jahi McMath

While I can't say the Jahi McMath news is coming fastly and furiously, at least it's coming.  Before anyone mentions it, yes I realise "fastly" is not a word, but dammit it should be.  Why isn't there an adverb form of "fast" anyway?  "Slow" has "slowly" and "quick" has "quickly."  Why not "fastly?"  But I digress, as usual.

The latest in the saga is Jahi's family's response to the demurrers by the hospital and Dr. Frederick Rosen.  The demurrers, in case you missed them, were the hospital's and Dr. Rosen's challenges of the legal sufficiency of Nailah Winkfield's case against them.  On July 17th, Nailah Winkfield's lawyer Bruce Brusavich (love that name, by the way) filed his response to their response (thanks to Professor Thaddeus Pope for posting the documents).  The way the US legal system seems to work, I expect that there will be responses to the responses to the responses, then responses to those responses, and then even more responses, and eventually the whole system will collapse under the weight of 81 million tonnes of paper.

But I digress again.

I've reviewed Brusavich's response, and a few things stood out immediately.

It seems Brusavich is taking a note from Dr. Paul Byrne's notebook and is now putting "brain dead" in quotations.  Furthermore, and even more surprising, he is continuing to claim that Jahi is "very much alive".  The rationale for this opinion is elucidated a little further on:

Yes indeed, they are saying she is not dead because her hypothalamus is functional and she has "intermittent responsiveness to verbal command".  Hypothalamic function does not equal life, though responsiveness does.  It would, however, mean that her entire brain is not dead.  Whether that would change anything is up to the lawyers to argue.  I hope that they have proof other than a few vague videos released late last year that show her moving.  If she is in fact responding to verbal commands, then that does indicate consciousness.  I will reserve judgment on that until I actually see it.

Then Brusavich goes over the details of the case with a few rather comical errors. 

I would have thought Brusavich would have learned the difference between "pallet" and palate" since the last time he made this exact same mistake.

Maybe I'm the only one who finds that funny.

Brusavich then goes on to criticise Dr. Rosen for not informing anyone about his suspicion of a medialised carotid artery.  I've been criticised by a certain someone for downplaying this point as well, so if you would indulge me for a moment, please allow me to clarify my position:  A medialised carotid artery without question increases the risk for intra-operative or post-operative bleeding after this sort of surgery.  That is not at all in doubt.  However, informing anyone in the recovery room of his suspicion was unnecessary and irrelevant, because any bleeding that occurs after ENT surgery is easily diagnosable.  Jahi obviously had a massive haemorrhage after the procedure, and everyone around her obviously knew about it.  Jahi knew, the family knew, the nurses knew, hell the custodians probably knew.  So how would informing anyone of this possible anatomic anomaly have helped?  Would it have helped them diagnose bleeding?  No.  Would it have prevented the bleeding?  NO.  Would it have stopped the bleeding?  NO.  Would it have changed anything in any way?  NO.  This is a non-issue.  Full stop.

The nurse responsible for caring for Jahi that evening recorded in her chart (several days later, mind you) that she repeatedly informed the PICU doctor about Jahi's condition, but no action was taken.  Dr. Rosen stated in his demurrer that he was not aware of Jahi's haemorrhage because he was not contacted.  I find both of these points very difficult to believe, though I am not claiming either is untrue because I was not there.  I just think it highly unlikely that intensive care doctors would ignore a bleeding patient for hours, refusing to see her.  I find it just as unlikely that the surgeon who performed the procedure wasn't called during any of this to let him know that his patient was haemorrhaging.

Was a PICU doctor called?  Probably.  Was Dr. Rosen called?  He claims not.

Unfortunately Brusavich then enters a legalese Twilight Zone and starts referring to other cases, using terms such as "judicially noticeable", "prima facie evidence", "res judicata", "collateral estoppel", andsnkseio ZZZZZZZzzzzzzzz  ZZZZZZZZZZZzzzzzzzz ZZZZZZzzzzzzz

*snort*

Wha . . . what?  Oh, sorry.  I think I fell asleep there for a bit.

Anyway, Brusavich concludes (sort of) that Jahi is alive due to some MRI results, EEG results showing neuroelectrical activity, Jahi's supposed responsiveness, and the fact that she started puberty.  Is any of this true?  We'll have to wait and see.

What I will say (yet again) is that if they can actually prove that Jahi is alive, she will be the first documented patient in history to have survived and recovered from brain death.  

I'll believe it when I see it.

Pain and humour

The amount of knowledge medical students are forced to acquire in a limited amount of time is simply staggering.  Most of the basic science courses in medical school are vitally important to the practice of medicine: pathology, anatomy, pharmacology, and physiology.  Some others are seldom useful once we are in practice, such as genetics.  And some have little (if anything) to do with the practice of medicine, like biochemistry.   We learn about how the various systems of the body work: circulatory, pulmonary, gastrointestinal, renal, endocrine, and immune.  Most medical schools are now even teaching students how to talk to patients and deliver news, both good and bad.

But one thing we are not taught in medical school is humour.  I've met far too many straitlaced doctors who wouldn't know funny if it walked right up to them and slapped them in the face with a fish.  But in my experience, patients appreciate a well-placed joke, even if it's at their expense.  "Is there any chance you could be pregnant?" is my standard bit when performing a trauma ultrasound on a man.  A few of them have looked at me like I have two heads and a pair of antennae, but most of them laugh even as they try to ignore the pain of their fractured leg.  It's a small token of humour, but even that is often enough to break tension and calm people significantly.

But several years ago John (not his real name™) taught me that humour in medicine is not just for the doctors, among other things.

John was in his late 70s when he was referred to me with a colon mass that had been found on colonoscopy after he had noticed blood in his stool.  He walked into my office with a big smile on his face, something I found unusual and concerning for someone meeting the guy who would ultimately be whacking out half his colon.  However, as soon as he began speaking, any concern I had evaporated rapidly.

"Hiya, Doc!" he greeted me with a very firm, warm, friendly handshake, the type normally reserved for your favourite uncle or your company's CEO.  "So you're the one who's going to be cutting me open and saving my life, eh?  I have five grandkids, so I need to be around to spoil them, you know."

I liked him instantly.  This is my kind of guy.

After going through his medical history and biopsy results, I explained the procedure to him in great detail, including all the potential risks: bleeding, infection, anastomotic leak, anaesthesia, reoperation, death.  He nodded along, listening intently.

"So if you take out half my colon, would that make it a semicolon?" he said with a perfectly straight face, followed immediately by a crooked grin and then a solid guffaw.

I couldn't help but laugh with him, and we traded jokes for the next 10 minutes before saying goodbye.

John's surgery soon thereafter was uncomplicated, and when I went to see him in hospital the following day, his sense of humour hadn't faded one bit despite his postoperative pain.  I took off his bandage to look at his incision (which I had closed with surgical staples), and he winced slightly as he chuckled through his pain.

"You know I've always wanted a belly button ring.  This isn't exactly what I had in mind, though.  Maybe I can hang a charm from the staples like a bracelet!"

I laughed and palpated his abdomen gently, and he winced again.  I apologised for hurting him, as I explained that I wasn't trying to hurt him, I was merely performing my routine postoperative examination.

John apparently had a visceral reaction to my word "hurt".  He suddenly got serious for the first time since I met him.  He then held up his forearm and showed me a rather faded tattoo.  As faded as it was, the string of numbers was still legible even after the passage of so many decades since the Nazis had put it there.  "Son," he almost whispered, "I've already been through more pain than you could possibly imagine," he said, his kind smile returning rapidly depite his wet eyes.  "Nothing you can do will ever hurt me."

A few days (and many jokes) later, John went home to finish recuperating, which he did.  His daughter and I kept in touch over the next few years.

I found out several years later that John died of old age, peacefully in his sleep, at home, surrounded by his family.  His daughter told me that his jokes never stopped, even after he lost his wife, and up through the very end.

There were few people left on Earth who had as much reason as John to be bitter and angry.  If he had been the biggest curmudgeon I'd ever met, I could not have faulted him one bit.  However, John instead chose to use humour instead of melancholy, puns instead of pain.  

And in doing that, he became one of my favourite patients, indeed one of my favourite people, I have ever had the good fortune of meeting.

Timing

Probably the most difficult aspect of being a trauma surgeon is not being able to control my schedule.  I don't necessarily mean my call schedule itself, though that is often outside my control as well.  What I mean is that other specialties have the ability to see patients on the days that they choose and at the hours that they choose.  I, on the other hand, get whatever patients I get whenever they decide to come in.  I can't choose to get a guy who falls off his bar stool and bonks his head at 1 PM, because those idiots don't fall off their bar stools at 1 PM, they do it at 2 AM.  What I've discovered over the course of my career is that surgery and trauma patients usually have terrible timing.  No one seems interested in letting me sleep, so instead they get appendicitis at 11 PM or stabbed at 3 AM.

Such was the case with Michael (not his real name©) and his series of friends.

My pager woke me from a dream about Scarlett Johansson (at least I wish it had been about Scarlett Johansson.  Seriously Scarlett, call me) to tell me that I would be getting a high-level stabbing victim in five minutes.  I looked at the clock and was completely unsurprised by what I saw.  

Of course.

As I was walking briskly downstairs, my pager went off again, telling me I would be getting another high-level stabbing victim in four minutes. 

My walking pace quickened.

Over the next few minutes my pager would go off three more times, all stabbing victims who, I learned later, had all been at a house party when two cars full of lunatics arrived with various sharp stabby things and a thirst for random violence.  

At least that's what Michael, who turned out to be victim number four out of five, asked me to believe.

I ran from room to room to room trying to determine who was the worst injured.  Two of them appeared to be completely fine, and two looked to be slightly less fine though still seriously injured.  And there was one whose wound looked like it should have been actively killing him, though in reality he looked as though he could have walked home. 

That, of course, was Michael.

His rather scary-looking injury was a single stab wound just to the left of his sternum.  Though it was a potentially dangerous (ie lethal) area, his heart rate was 70, his blood pressure was 120/65, and he looked calmer than I (though the fact that I kept running back and forth among four other victims may have riled me slightly).  He kept asking when I was going to patch him up and send him home.  I did a quick ultrasound which showed a bit of fluid around his heart, and a CT scan done a few minutes later (as I was putting a chest tube into Victim #3) confirmed a hemopericardium (blood around his heart).

Uh oh. 

There's only one place that blood could be coming from, so he went straight to the operating theatre where we found a small injury to his heart muscle, but no active bleeding.  His myocardium was repaired, and he was closed up.  Success!

Except that I still had 4 other victims to tend to.  Fortunately #1 and #2 just needed a few stitches and #3 and #4 both needed only chest tubes.  Nothing else life threatening.

When I went to see Michael the following morning in the intensive care unit, his very pregnant wife was sitting next to him.  When I say "very pregnant", I mean she looked like she could have popped at any second.  They asked all the usual question, including how long I expected Michael to be in hospital.  I told them probably three or four days, and his shoulders slumped.

Michael started to speak, but his wife finished the sentence for him:

"But I'm having the baby in three days!"

I asked if it was their first child, and of course it was.  I told them that I would do the best I could to get Michael to see his first child's birth, but I also told them I would make no guarantees.  I promised I would send Michael home as soon as he was ready, but not a minute before.  They were both visibly disappointed, but they also understood.

Fortunately Michael's hospital course was completely uneventful.  Over the next two days he recovered rapidly and smoothly.   By day three his chest tube was out, and he was ready to go home. I thought I would have to physically restrain him from running out the door.

I found out sometime later that I had discharged him just in time for him to make it to the other hospital to see his son being born.

Well, at least one of us has good timing.