Some of the questions I get most often via email are about medical training - not necessarily my medical training, but about medical school in general, surgical training, and what it takes to do what I do. In the past day I've gotten email requests for blogging about both my training and medical school, so it seems like these might be some good topics to discuss.
Let me start by saying that being a doctor is pretty damned cool. I can think of very few professions that get as big an "OOOH!" as when someone asks me what I do for a living, especially when I tell them I'm a trauma surgeon and explain what I do. Yes, I'll admit it's glamorous as hell, and it's a hell of a lot of fun.
I didn't know that when I decided to become a doctor at age 5. I remember visiting my grandfather's office (he was a general practitioner) and playing with all his cool instruments and thinking, "I want to use these when I get older!"
Getting to medical school was difficult, as expected. There is a lot of competition, and everyone who applies is just as good as you. I was near the top of my class in high school, and medical schools select the cream of the crop. Even though you may have been used to being at the top of everything, once you're there, you're just like everyone else. EVERYONE is just as smart as you.
Medical school itself is just as difficult as you've heard. The workload is heavier than anything you've ever experienced, and the sheer amount of material you're expected to learn seems impossible. However, somehow you manage to learn it. ALL of it. A few people drop out every year, but for the most part, everyone passes despite the difficulty. The running joke in medical school is this:
Q: Do you know what they call the person who graduates last in his class in medical school?
A: Doctor.
I entered medical school expecting to become a pediatrician or a psychiatrist. I always loved working with kids, and the human mind has always fascinated me. But having done my third-year clerkships in both pediatrics and psychiatry, neither of them seemed to be a good fit. Then on my first day of my surgery clerkship, I scrubbed into my first surgery, put on my gown and gloves, and laid my hands on the anesthetised patient. YES - THIS FEELS RIGHT! And that was it - a feeling. A feeling like I belonged right there and nowhere else.
I'll discuss my surgical training in my next post. I'd hate to bore anyone by making this too long.
Thursday, 6 September 2012
Tuesday, 4 September 2012
Rednecks
We all know them no matter what they are called where you're from - rednecks, yokels, bumpkins, chavs, bogans, pikeys, carrot crunchers, worzels, etc. I just call them idiots. These people have a very special way of acting completely ridiculous and getting into trouble in very creative ways.
The call on "the box" told me I would be getting a victim of a car accident. What arrived 5 minutes later was a 175kg (385 lb) redneck (for lack of a better term), screaming at the top of his lungs for his wife.
"WHERE'S MY WIFE? WHERE'S MY WIFE?? STELLAAAAAA! STELLAAAAAAA!!!" (not her real name)
The medics then told me he had actually been thrown out of a moving car, not in a car accident. He was clearly drunk, though whenever anyone mentioned alcohol, he violently thrashed around and vehemently denied drinking anything. It took 8 men to hold him down while we established IV access and sedated him so we could perform our assessment.
The medics then said his wife would be coming in another ambulance in 5 minutes. She had been stabbed.
Wait...what?? He was thrown out of a car, and she was stabbed? The story made no sense.
When she arrived, she did have three very small, superficial stab wounds in her shoulder and leg, and she had then been pushed out of the same car. Because she had bruises all over her body, the medics believed that she had been sexually assaulted, and they believed her husband had been thrown out of the car while trying to protect her. It was a tragic, sweet, sad story.
If only it were true. Did you really think I was going to tell a sweet, tragic story? HA!
I found out the next day what actually happened. These two are from out of town, and they were visiting some friends here and drinking heavily, despite his claims to the contrary. One of the friends accused Stella (still not her real name) of sleeping with another man, and her husband, with a blood alcohol level of 0.27, decided to beat the shit out of her (her blood alcohol level was 0.21). The four "friends" then piled into the car and in true idiot fashion began fighting in the moving car. In the scuffle Stella got stabbed, and both of them were thrown out of the car. He was screaming for his wife when he first arrived not because he was concerned for her safety, but because he thought he hadn't given her a sufficient beating.
Fortunately neither of them was seriously injured, and they're both back home now. She refused to press charges against him for the assault, and he still believes that she cheated on him. It makes me wonder how Hollywood movie writers seem to be out of ideas for movies - the writers just need to spend one day with me.
The call on "the box" told me I would be getting a victim of a car accident. What arrived 5 minutes later was a 175kg (385 lb) redneck (for lack of a better term), screaming at the top of his lungs for his wife.
"WHERE'S MY WIFE? WHERE'S MY WIFE?? STELLAAAAAA! STELLAAAAAAA!!!" (not her real name)
The medics then told me he had actually been thrown out of a moving car, not in a car accident. He was clearly drunk, though whenever anyone mentioned alcohol, he violently thrashed around and vehemently denied drinking anything. It took 8 men to hold him down while we established IV access and sedated him so we could perform our assessment.
The medics then said his wife would be coming in another ambulance in 5 minutes. She had been stabbed.
Wait...what?? He was thrown out of a car, and she was stabbed? The story made no sense.
When she arrived, she did have three very small, superficial stab wounds in her shoulder and leg, and she had then been pushed out of the same car. Because she had bruises all over her body, the medics believed that she had been sexually assaulted, and they believed her husband had been thrown out of the car while trying to protect her. It was a tragic, sweet, sad story.
If only it were true. Did you really think I was going to tell a sweet, tragic story? HA!
I found out the next day what actually happened. These two are from out of town, and they were visiting some friends here and drinking heavily, despite his claims to the contrary. One of the friends accused Stella (still not her real name) of sleeping with another man, and her husband, with a blood alcohol level of 0.27, decided to beat the shit out of her (her blood alcohol level was 0.21). The four "friends" then piled into the car and in true idiot fashion began fighting in the moving car. In the scuffle Stella got stabbed, and both of them were thrown out of the car. He was screaming for his wife when he first arrived not because he was concerned for her safety, but because he thought he hadn't given her a sufficient beating.
Fortunately neither of them was seriously injured, and they're both back home now. She refused to press charges against him for the assault, and he still believes that she cheated on him. It makes me wonder how Hollywood movie writers seem to be out of ideas for movies - the writers just need to spend one day with me.
Wednesday, 29 August 2012
Hypocrite?
I feel like I've been letting the readers down lately, posting inspirational stories and thank-yous and such. BUT NO MORE! I'm getting back to stupid patient stories, and this one certainly qualifies. I'm not really sure what to make of this next patient though. Maybe some of you can help me. I'm truly at a loss for words.
A 30 year old woman was brought to me having fallen down the stairs. She apparently struck the front of her neck on the banister and passed out briefly. When she arrived she was awake and talking normally, and she was complaining of a headache and neck pain. She also said that she had just found out a week ago that she was pregnant.
And she also admitted to having several vodkas that night. And to smoking marijuana.
She must have seen the ire rising in my face, because she quickly explained that she didn't even like the taste of the vodka, so it was ok.
That's when the steam started to shoot out of my ears.
In my mind, I started beating the shit out of her for being such a clueless cretin. In reality, I quickly and firmly explained that alcohol is extremely dangerous at this early point in the pregnancy. Despite the pregnancy, I told her that we needed to get a CT scan of her brain and neck to make sure she hadn't seriously injured anything, and we could shield the fetus with a lead shield to minimise any risk.
"Oh no, I can't expose my baby to radiation! I won't get those scans. Uh uh, no way!"
But dousing the embryo in vodka is ok??
I just asked the nurse to have her sign "Against Medical Advice" papers and leave. Then I walked out of the room without another word.
A 30 year old woman was brought to me having fallen down the stairs. She apparently struck the front of her neck on the banister and passed out briefly. When she arrived she was awake and talking normally, and she was complaining of a headache and neck pain. She also said that she had just found out a week ago that she was pregnant.
And she also admitted to having several vodkas that night. And to smoking marijuana.
She must have seen the ire rising in my face, because she quickly explained that she didn't even like the taste of the vodka, so it was ok.
That's when the steam started to shoot out of my ears.
In my mind, I started beating the shit out of her for being such a clueless cretin. In reality, I quickly and firmly explained that alcohol is extremely dangerous at this early point in the pregnancy. Despite the pregnancy, I told her that we needed to get a CT scan of her brain and neck to make sure she hadn't seriously injured anything, and we could shield the fetus with a lead shield to minimise any risk.
"Oh no, I can't expose my baby to radiation! I won't get those scans. Uh uh, no way!"
But dousing the embryo in vodka is ok??
I just asked the nurse to have her sign "Against Medical Advice" papers and leave. Then I walked out of the room without another word.
Saturday, 25 August 2012
NEVER give up
What's the first thing that comes to mind when you think about a trauma surgeon? Patience? Good hands? The ability to stay calm under pressure? Perhaps. Persistence may not seem like an obvious attribute of a good trauma surgeon, but it should. Just when all seems lost, the willingness to keep going under the direst of circumstances despite overwhelming odds against you may mean the difference between life and death.
There's a certain "look of death" that some patients have - they just look like they are about to die. It's impossible to describe, but trust me when I say that it scares the shit out of me. I had such a patient roll through the doors a while back. He was a 16 year old kid who was stabbed once in the upper right portion of his abdomen. The medics called in and said he was stable, but as they rolled through the door, the boy looked at me, his eyes rolled back, he went pale as a ghost, and he slumped back against the bed. He had that look.
Uh oh.
We quickly transfered him to our gurney and looked over him quickly - all he had was a tiny 1cm stab wound just below his right ribs. But he had no pulse - he was dead. I assumed he had bled to death in his abdomen, so I quickly made the decision to perform a resuscitative thoracotomy - so-called "cracking the chest".
"But Doc, why open the chest when he was stabbed in the abdomen?"
An excellent question! The idea in this situation is to preserve blood flow to the brain, and the best way to do that is to clamp off the aorta to shunt blood upwards. The quickest and easiest way to do that is through the left chest.
When we opened his chest, his heart was empty and still. He had bled to death internally. We had started pumping blood into him, and I started internal cardiac massage - basically CPR directly on the heart. After a few minutes, my assistant looked at me, frowned, and motioned for me to stop.
No. NO. This kid had just died a minute ago, and I was NOT about to give up yet.
About a minute later his heart started beating...weakly. But that was enough for me. As we continued transfusing him with as much blood as we could get our hands on, we wheeled him quickly down to the operating room. When we opened his abdomen, his entire blood volume was in there. As I suspected, there was a 1cm laceration to the liver, but no other injuries. I quickly sutured his liver laceration, but his heart stopped beating again.
GODDAMMIT!
I did internal cardiac massage again and shocked him, but during all this my assistant again tried to convince me that it was a lost cause. I realised at this point that this boy's chance of survival was around 1%. That's it. But my stubbornness had the best of me, and I kept massaging his heart and transfusing him as fast as possible. A minute later his heart restarted again. This time, it started for good.
A week later the boy walked out of the hospital. A week after that he walked into my office.
"Thanks for saving my life," he said with a shy smile.
My wife likes to call me stubborn sometimes. She's right...and I think it's one of my best traits.
There's a certain "look of death" that some patients have - they just look like they are about to die. It's impossible to describe, but trust me when I say that it scares the shit out of me. I had such a patient roll through the doors a while back. He was a 16 year old kid who was stabbed once in the upper right portion of his abdomen. The medics called in and said he was stable, but as they rolled through the door, the boy looked at me, his eyes rolled back, he went pale as a ghost, and he slumped back against the bed. He had that look.
Uh oh.
We quickly transfered him to our gurney and looked over him quickly - all he had was a tiny 1cm stab wound just below his right ribs. But he had no pulse - he was dead. I assumed he had bled to death in his abdomen, so I quickly made the decision to perform a resuscitative thoracotomy - so-called "cracking the chest".
"But Doc, why open the chest when he was stabbed in the abdomen?"
An excellent question! The idea in this situation is to preserve blood flow to the brain, and the best way to do that is to clamp off the aorta to shunt blood upwards. The quickest and easiest way to do that is through the left chest.
When we opened his chest, his heart was empty and still. He had bled to death internally. We had started pumping blood into him, and I started internal cardiac massage - basically CPR directly on the heart. After a few minutes, my assistant looked at me, frowned, and motioned for me to stop.
No. NO. This kid had just died a minute ago, and I was NOT about to give up yet.
About a minute later his heart started beating...weakly. But that was enough for me. As we continued transfusing him with as much blood as we could get our hands on, we wheeled him quickly down to the operating room. When we opened his abdomen, his entire blood volume was in there. As I suspected, there was a 1cm laceration to the liver, but no other injuries. I quickly sutured his liver laceration, but his heart stopped beating again.
GODDAMMIT!
I did internal cardiac massage again and shocked him, but during all this my assistant again tried to convince me that it was a lost cause. I realised at this point that this boy's chance of survival was around 1%. That's it. But my stubbornness had the best of me, and I kept massaging his heart and transfusing him as fast as possible. A minute later his heart restarted again. This time, it started for good.
A week later the boy walked out of the hospital. A week after that he walked into my office.
"Thanks for saving my life," he said with a shy smile.
My wife likes to call me stubborn sometimes. She's right...and I think it's one of my best traits.
Friday, 24 August 2012
The ER
ER stands for "Emergency Room". Yes, I understand you know this already. And I used to think that was common knowledge. The key word here is EMERGENCY. If you have acute pain or trouble breathing, if you're bleeding, if you can't move your arm, the ER is the place you should be. However, if you have the sniffles, a sore throat, or some vaginal discharge, go see your doctor. The ER is NOT the place for you! It is NOT a walk-in clinic to serve your every need and whim, and all you're accomplishing is making the person with a real problem wait for 4 hours to be seen. Unfortunately, too many people these days just don't get it.
On my last trauma call, "the box" went off around 11PM. This is the emergency medical response system that is connected to all the local hospitals, and it's what the ambulances and helicopters use to call in. Usually when it goes off it means I'll be getting another idiot, er, I mean another patient. I wearily ambled over to the box to listen in and see what I would be getting.
A gunshot victim? A stabbing? HA...no.
The ambulance driver came on the box, explaining that he was transporting a young man with a history of bipolar disorder. His vital signs were all perfectly normal, and he was acting perfectly normal. But earlier that evening when he was supposed to take half of his prescription pill, he had accidentally taken the whole pill, and he was coming in to get checked out.
Incredulous, I looked at the nurse taking the call. She looked right back at me with a straight face. "We get these all the time," she said.
REALLY? I wasn't sure who I should be more angry at - the patient for having the audacity to call an ambulance for something so ridiculously frivolous, or the ambulance team for actually agreeing to bring the moron in.
Listen up, people - believe it or not, ER does NOT stand for "Everything wRong", "Every Rash", or "Exceptionally Ridiculous"!
Well, maybe it does.
On my last trauma call, "the box" went off around 11PM. This is the emergency medical response system that is connected to all the local hospitals, and it's what the ambulances and helicopters use to call in. Usually when it goes off it means I'll be getting another idiot, er, I mean another patient. I wearily ambled over to the box to listen in and see what I would be getting.
A gunshot victim? A stabbing? HA...no.
The ambulance driver came on the box, explaining that he was transporting a young man with a history of bipolar disorder. His vital signs were all perfectly normal, and he was acting perfectly normal. But earlier that evening when he was supposed to take half of his prescription pill, he had accidentally taken the whole pill, and he was coming in to get checked out.
Incredulous, I looked at the nurse taking the call. She looked right back at me with a straight face. "We get these all the time," she said.
REALLY? I wasn't sure who I should be more angry at - the patient for having the audacity to call an ambulance for something so ridiculously frivolous, or the ambulance team for actually agreeing to bring the moron in.
Listen up, people - believe it or not, ER does NOT stand for "Everything wRong", "Every Rash", or "Exceptionally Ridiculous"!
Well, maybe it does.
Tuesday, 21 August 2012
Thank you
When I started this blog back in October, I didn't really think anyone would care enough to read it. It seems I was wrong - somehow this blog has developed a fairly steady readership. I'm not sure where all of the readers come from, and I suppose in the end it doesn't really matter. Because as of today, "Stories from the trauma bay" has 500,000 pageviews.
If someone had told me back in October that in only 9 months I would have half a million pageviews, I would have had a good laugh. But here we stand today at 500,286.
So to all my readers - a very gracious and heartfelt thanks. And to all the people who have taken a few minutes of your valuable time to write me an email - questions, comments, stories, thank-yous, fanmail - I sincerely appreciate every single one. Please keep the feedback coming, and please feel free to share the blog with your family, friends, and coworkers. I hope we can reach 1,000,000 soon!
If someone had told me back in October that in only 9 months I would have half a million pageviews, I would have had a good laugh. But here we stand today at 500,286.
So to all my readers - a very gracious and heartfelt thanks. And to all the people who have taken a few minutes of your valuable time to write me an email - questions, comments, stories, thank-yous, fanmail - I sincerely appreciate every single one. Please keep the feedback coming, and please feel free to share the blog with your family, friends, and coworkers. I hope we can reach 1,000,000 soon!
Monday, 20 August 2012
Tolerance
In my line of work, we have to be tolerant of a lot of things, stupidity being one of them. There are so many stupid things I see, many of which I share here. But there are a few things I just can not tolerate.
I'm sure there are more, but this is a good start. If you happened to be one of the few who saw the repeated post that I deleted, I apologise. I couldn't remember if I had told that story yet or not, so thanks to the two people who reminded me.
- Drunk drivers
- Grown men crying
- Women who howl
- Pregnant women who use drugs
- Patients who spit
I'm sure there are more, but this is a good start. If you happened to be one of the few who saw the repeated post that I deleted, I apologise. I couldn't remember if I had told that story yet or not, so thanks to the two people who reminded me.
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I tried my best, I really did. I've seen the article, I read it, and I tried to ignore it. I had fully intended to leave it alone unti...
