Monday, 25 August 2014

Kids

Several of my patients are immediately confused when I introduce myself.  Hi I'm Doctor Bastard, and I'll be your trauma surgeon today.  What the hell is a trauma surgeon, they ask.  That's like an ER doc, right?

I have to resist the urge to slap them.

After I'm finished explaining that I'm NOT an emergency physician, I describe to them that I fix soft squishy stuff - spleens, livers, intestines, stomachs, etc.  I also have to explain that there are several things in trauma that I don't do -
  • bones - there is a reason why orthopaedic surgeons exist
  • brains - no one really understand how they work, least of all me
  • burns - burn centres exist for a reason too
  • kids
Believe it or not I actually strongly considered going into paediatrics when I was in medical school.  On my short list . . . ok ok, you can stop laughing now.  I'm serious.  As I was saying, on my short list was paediatrics and surgery.  I've always loved kids, so what could be better than helping them?  This philosophy remained until one fateful day during my paediatrics clerkship in medical school.  I was in the clinic seeing a 3-year old girl who had an earache.  I was dressed in my perfectly pressed white coat, freshly-laundered white shirt, and a Winne-the-Pooh tie that Mrs. Bastard had given me for just this occasion.  I walked into her examination room, got down on one knee, and said with a smile in my kindest, warmest voice, "Hi there.  What's bothering you today?"  The girl looked at me, turned to her mother, turned back to me, shut her eyes, opened her mouth, and let out the loudest, most blood-curdling scream I've ever heard.

At that very second my list immediately changed to this:

Paediatrics
Surgery

Even though my hospital isn't supposed to treat paediatric trauma (ambulances are supposed to take these patients to the local children's trauma hospital), every now and then they bring a little tyke to me for evaluation.  And every single time it reminds me exactly why I didn't choose paediatrics.

Little Mary (not her real name) was clearly heard screaming way down the hall as she was wheeled towards my trauma bay.  As soon as I saw her, I saw that her distress was fully justified - she had obvious scald burns over her chest, shoulders, back, and half her face.  My first thought was "WHAT THE HELL HAPPENED TO THIS POOR GIRL??".  My second thought was, "Wait, I don't do burns, and I don't do kids.  I sure as hell don't do kids' burns!"  Regardless, here she was being deposited on a gurney that appeared much too large for her.  Mary's mother accompanied her, looking none-too-upset while she chatted to someone on her mobile phone about a household bill.  A quick (but thorough) evaluation revealed an adorable 3-year old girl with second-degree burns over approximately 15% of her body, but thankfully no third-degree burns.

Mom was now talking on her phone about a post on Facebook.  I turned to ask her a few questions about Mary's medical history.  I actually had to stand in front of her, staring at her, for at least 30 seconds before she acknowledged my presence.

"Hang on a second, the doctor wants something."

'Wants something'?  Yeah, I want to know what the hell happened.

Mary's mom told me that Mary was a healthy girl with no medical problems.  When I asked her what happened, the story she told made me want to jump on her and tear her hair out.

"Well you see, I was cooking noodles on the stove, and I don't like to use the back burners because it's too far away when I have to stir.  So anyway (yeah, hang on, I'm talking to the doctor) I walked out of the kitchen to check something on my phone, and I couldn't have been away  for more than, like, a minute when I hear a crash and Mary screaming."

You read that right - Mary's mother left a boiling pot of water on the front of the stove, well within the reach of any curious 3-year old, and then she inexplicably walked away.  TO CHECK HER FUCKING PHONE.

There were no words to say.  I guess the incredulous look on my face made no impact, because mom went right back to her conversation about her hair appointment later that day, which she may have to call and postpone because of this.

We bandaged up Mary and gave her some pain medicine, and once she was comfortable we transferred her to the children's hospital for further care.  I didn't think she would need any skin grafts, but burns have a tendency to deepen over the ensuing 24 hours after the injury, so only time would tell.

Mary's mom almost became my next trauma patient, because every nurse in the room nearly attacked her.  I couldn't get her out of my trauma bay fast enough.

Saturday, 16 August 2014

Vacation

I can neither confirm nor deny the rumour that for the next week I will be relaxing on a warm beach with warm white sand with a cool drink in my hand that may or may not have various tropical fruits and/or festive umbrellas in it. 

This message will self destruct in 5 seconds. . . 4. . . 3. . .

Tuesday, 12 August 2014

Predictions

I am asked to make predictions all the time, and it is always a difficult proposition.  I can't see into the future, but that doesn't stop people from asking.  "How long will I have to be in the hospital?"  "What are the chances my cancer will spread?"  "How much longer until I poop?"  That last one is the most common, believe it or not.

Unfortunately I don't have a crystal ball in which to gaze.  If I did, my job would be a whole lot easier.  Hell, if I did I would have won the lottery years ago and retired to some beautiful island in the Caribbean.

Regardless, I am often forced to make predictions anyway, but fortunately instead of wild guesses they ultimately end up educated estimations based on a combination of statistics, years of experience, and sheer dumb luck.  Usually I'm pretty close, but sometimes I'm way off the mark.

And sometimes I hit a direct bull's-eye.

There wasn't anything terribly interesting or unique about Clarence (not his real name©).  He could have been any obnoxious 20-year old kid - skinny, brash, covered in tattoos.  And thoroughly obnoxious.  Did I mention obnoxious?  The main thing that separated Clarence from his colleagues was the fact that Clarence had a gunshot wound in his left lower abdomen.  I don't know the details of the shooting, and I didn't really care.  And for a change I was smart enough not to ask.  When he arrived (at 1 AM, of course - thanks a bunch, Call Gods) he was clutching his abdomen and complaining of severe pain, and when I rolled him over to look at his back I saw that the bullet had exited through his left buttock.

Oh.  Shit.  There are a lot of very important structures between those two holes.  That's the way my brain always runs when I'm looking at gunshot wounds.

I told him that he needed immediate surgery or else there was a good chance he could die.  Even with surgery, I continued, he may still die.  But I also promised that I would do everything in my power to prevent that from happening.  You know, the usual thing I tell all my patients in this situation.  (*** I'll get back to this little speech in a future post.  Don't forget to remind me.***)

"Whatever," he said as if I were seriously inconveniencing his Saturday night plans.  "Just hurry the fuck up," he demanded.

Hurry up?  Wait just one damned minute - you've been in the hospital less than 5 minutes, I've already done a full evaluation, decided you need emergency surgery to save your life, called the operating theatre to schedule you, packaged you up, and gotten blood drawn, and you're ordering me to hurry up?  Did you expect me to go play 18 holes of golf at 1 AM before doing your emergency potentially-life-saving surgery?

I shrugged off his rudeness and wheeled him down to the operating theatre, doing my best to ignore his rotten attitude as I continued calmly talking to him, trying to tell him what I might find and what I might have to do to fix it.  I tried to explain about removing or repairing bowel, possibly doing a colostomy, repairing or removing a kidney . . . anything I had to do to get him through this event.

"Whatever, doc," he mumbled without even bothering to look at me.  I felt like if he had his cell phone with him, he'd be on it just then, telling his friend how annoying his surgeon was, blathering at him incessantly.  Now there's only but so much crap I'm willing to take as I'm pushing a patient down the hallway towards an operation that I really don't want to be doing in the middle of the night.  His attitude was so lousy, so rude, so utterly infuriating that I just wanted to get him to sleep so I didn't have to talk to him anymore.  Note to anyone reading this: be polite to the person who is trying to save your life.

As we got him to sleep, I mentioned to my assistant how incredibly contemptible his entire demeanor was.

"And I bet he won't even say 'thanks' afterwards," I finished.

Yes, finally, there is the prediction I predicted in the beginning of this story.

I opened him up and (for a change) was pleasantly surprised at what I found.  By some stroke of luck the bullet had only passed through his sigmoid colon then into his psoas muscle before going through his buttock and exiting back into the outside world.  I repaired his colon (no colostomy) and thanked his lucky stars that his injuries were not as serious as I had predicted, though he still would have died without surgery.  However, despite expecting a full and smooth recovery, I still did not expect any appreciation from him.

The next morning I was rewarded with exactly what I had predicted - nothing. 

I explained to Clarence everything I had found and done for him, and with a warm smile I gave him the good news that I anticipated he would go home in only 3 or 4 days. "Whatever, just get me some water.  I'm fucking thirsty!" Clarence barked at me.  As predicted, he had no complications and went home in 4 days.  And just as predicted, he said "thank you" exactly zero times while he was in hospital.  And even when I saw him back in my office 2 weeks later for his follow-up appointment, he showed absolutely no gratitude whatsoever, no acknowledgment at all for the guy who saved his life.  I may as well have trimmed his shubbery or shined his shoes for all the thanks I didn't get.

The good news out of all of this is that it seems I'm getting better at making predictions.  Maybe I should look into that lottery thing again.

Thursday, 7 August 2014

Too much

Taking a trauma shift is a bit strange.  It's difficult to describe the feeling of sitting around, waiting for something to come in, not knowing what that "something" is or when it will be here.  The mantra in the Trauma Universe is "Eat when you can, and sleep when you can."  Growing up with two much larger brothers certainly taught me to eat quickly, otherwise I'd have starved to death.  But unfortunately my body has never properly embraced the "sleep anywhere" concept.  I regularly see my colleagues catching a 5 minute catnap in the lounge with their head in their hands, but unless I'm in a dark, quiet room, my brain likes to do things like try to come up with new palindromes and anagrams despite my efforts to tell it to shut the fuck up.  Though my body likes to sleep, my brain likes to keep me awake and doesn't know when enough is enough.

On one such night after a fairly uneventful day, I had just put my head on my pillow in my dark, quiet call room when my brain thought it would be a perfect opportunity to have a lively philosophical debate about why nothing much had happened that day.  Barely five minutes later . . .

"BEEP BEEP BEEP BEEP BEEP"

Of course.  At 11:30 at night, what else could the call possibly be but a high-level gunshot victim.  Oh Call Gods, you are a funny bunch of bastards.  Your sense of comedic timing is absolutely spot-on, and I love how I can always count on you to give me a big "FUCK YOU" whenever I need one.  Sleep would obviously have to wait.

You win this round, brain.

I walked quickly down to the trauma bay, and the young guy that arrived a few minutes later looked like he was on the verge of death.  "Ok Doc," the medic started.  "We have an 18-year old kid.  Multiple gunshot wounds to the head, chest, abdomen, back and thigh."

"Someone sure wanted him dead," my Inner Optimist told me.  "But he still has vital signs!  Maybe he'll be ok!"

Now is not the time, Inner Optimist.  Fuck off, I have work to do.

The anaesthesiologist immediately got to work getting a breathing tube in and there were a dozen people milling around his head, so I looked at him from the feet up.  There was a rather large hole on the front of his left thigh and another (possibly an exit wound) on the inside of his thigh.

"Not too bad, maybe a fractured femur.  Away from the femoral artery, at least.  That won't kill him."

Shut up, you.  In the abdomen there was a gunshot wound just below the rib cage on the right and a second one just above the lower edge of the ribs on the left.

"Uh oh, that's not good.  There's potentially a lot of very important stuff between those two holes - liver, stomach, small intestine, colon, spleen, diaphragm, lung.  Any or all of those could kill him, but don't worry, we can fix it!"

My Inner Optimist was starting to piss me off.  Continuing upward he had two holes on the left side of his chest, but they looked like simple graze wounds.

"At least we won't be cracking his chest.  That's something, right?" 

Two holes on the back of his left shoulder.

"Who cares.  That's not serious at all.  Move up.  Look at his head.  It's probably nothing!"

By now I was ready to throw my Inner Optimist out the window.  I got up to the patient's head and saw an entrance wound in his right temple and an exit wound on the left.  That was the exact point when my Inner Optimist ran out of the room yelling "SHIT!!!!!".  Finally.

Transcranial gunshot wounds are almost universally fatal.  There are some surgeons who wouldn't bother operating on patients like this to repair damage to the abdomen, simply because there is such a low probability, right around 0%, that he would survive the brain injury.

I'm not one of those surgeons.  While it's true that most patients die within hours, I've seen a handful of patients with severe brain injuries survive and even wake up to varying degrees.  My heart had to admit to my brain that this kid's chance of living was fleetingly low, and even though my brain may have been ready to give up on him, my heart wasn't.

This is one of those times when I wish I could have listened to brain instead of my heart.

When I opened him up I found almost exactly what I was expecting - the bullet had ripped off a chunk of his liver, gone through his colon twice, torn 4 holes in his small intestine, and gone through his diaphragm before finally exiting.  I repaired every hole I found, only losing about 100ml of blood in the process (that's a bit over 3 oz, a very small amount for this big an operation).  I was starting to feel pretty good about myself until I looked down at my shoes and saw that I was standing in a puddle of blood.

What . . . where . . .

While I had been repairing the damage in his abdomen, he had poured about a liter of blood from his ears onto the floor.  Needless to say, that's not good.  Despite the multiple blood products the anaesthesiologist had given him and normal blood counts, his blood pressure was bottoming out and his heart rate was slowing down.  His pupils were fixed and dilated.  It was glaringly, painfully obvious that, because of the injury to his head, his brain had swollen to the point where it had lost its blood supply.  He was dying, fast, and there wasn't a damned thing I could do to stop it.

I closed up and resigned myself to his fate.  My brain had been right - the head injury had been too much.  Way too much.  I had done everything I could do, and it wasn't even close to enough.  I went out and talked to his family and told them the bad news, that it was time to start saying their goodbyes.  His mother was desperate, asking if anything else could be done.  "Would antibiotics help?"  I couldn't blame her for the question in this moment of despair.  I calmly explained that he had too many injuries.  It was just too much.  Too much.

She seemed to understand and went to her son to say goodbye.  An few minutes later, he was gone.

My brain didn't allow me to sleep at all the rest of the night.

Friday, 1 August 2014

Worst story ever?

I will fully admit that the stories that I post here are among my best - the stupidest patients, the best saves, the worst injuries.  I could post all the boring stories about yet another drunk driver who hit a tree, sobered up overnight, and went home.  I could post all the inane stories about elderly folks who lose their balance, fall, and bonk their heads.  But who the hell wants to read that?  I know I sure don't to write them, so I can't imagine that anyone else would want to read it.  So all I do is post the most glamorous, sexiest stories I have to offer.  It probably makes my life seem much more fascinating than it probably is.

The unfortunate reality is that I get a lot of bullshit trauma.  A lot.  A LOOOOOT.  Out of 20 patients I may see in a 24-hour period, perhaps 3 or 4 will actually be critically injured, requiring some kind of life-saving treatment or manoeuvre.  That leaves (if you're following along the arithmetic with me) about 79.9999% of patients who at least have some sort of injury that, while it won't kill them, at least needs some sort of attention by a medical professional.

"Wait just one damned second, Doc.  What happened to that other 0.0001%?  Sixteen divided by twenty is 0.8, not 0.79999!  Did you fail maths?  Lawl!"

Settle down there, math wizard.  That 0.0001% belongs to the 1-in-1,000,000 patient like Howard (not his real name©).

Howard was playing basketball.  Howard got poked in the eye.  Howard was brought to me.

No seriously, that's it.  That's the whole story.  He didn't fall, didn't hit his head, didn't lose consciousness, didn't sprain his ankle, didn't have any other injuries.  He just got poked in the eye.  Hell, I injured myself worse than Howard that morning while I was shaving.

But that's the wile story - the medics brought him to my hospital . . . to my trauma bay . . . to me . . . because he got poked in the eye.  His eye wasn't hanging out of his head, it wasn't bleeding, it wasn't swollen, there were no lacerations.  Oh, and his vision was of course totally normal.  How's that for glamorous?

I felt bad taking 5 seconds to look over him and send him home, but that's all I could do.  I couldn't justify doing any blood work, X-rays, CT scans, or anything else for that matter.  I should be happy to get such an uninjured patient, but it left me feeling annoyed and strangely empty.

I think the next time I nick myself shaving, I'll call an ambulance.  It'll probably be a quicker way of getting to work than driving myself.

EDIT: My apologies for the arithmetic error.  I made a mistake that a reader caught.  I then corrected the mistake incorrectly, and the new mistake was caught by another reader.  It should be fixed now.  

In the future, if any readers catch any errors, kindly email me so I can correct it rather than posting a comment.  

Tuesday, 29 July 2014

A story of survival

After {redacted} years of practice, I've certainly seen my fair share of severely injured patients who seem incredibly lucky to have survived.  Young men with gunshot wounds to the abdomen that turn out to be graze wounds.  Stabbing victims where the knife miraculously misses every major organ.  Car accident victims where everything seems to be broken but they somehow make it out alive.

Natalie (not her real name) fits quite neatly into that last category.  She emailed me a few day ago and told me her harrowing tale.  Since she emailed me, I suppose I've already given away the ending in telling you that she survived.  But then again I've never been good at keeping spoilers to myself (take note, Whovians).

I've said repeatedly that most of what I do is fixing holes.  I'm usually not terribly interested in the exact nature of how the injury came to be - I don't care what kind of car you were driving, I don't care that the knife was 8cm long.  I only care how many holes were made and in what.  So with as many trauma patients as I've seen, seldom (if ever) have I heard the stories of their actual injuries as completely as I have this one.
Hey Doc!
I hope you don't mind me contacting you and taking up some of your time. I'm one of the many people frequently visiting your blog for the past 2 years or so.  I love the many stories of stupid people doing stupid things in this stupid (but oh-so-wonderful) world.  But I never really thought it would ever hit so close to home for me.  All it took was one stupid person to upend my world. 
I was just a normal 21-year old woman living a normal life.  I was leaving my university after a long exam and was looking forward to getting home.  I had been invited by some mates to go to the uni bar to blow off some steam after my exam but I thought of my liver - and opted to have a quiet dinner with my sister instead.  The irony of that thought still haunts me months later. 
I was crossing a pedestrian crossing on the green "walk" signal when a man in his 4-wheel-drive didn't wait for the pedestrians to finish crossing.  Maybe he just didn't see me?  Maybe he was in a rush and didn't think that he had to give way first?  I didn't see him as he came from behind me.  I didn't hear any car horns or screech of tires. He accelerated, didn't slow down, and hit me with the front of his vehicle, knocking me to the ground and then continuing to drive right over the top of me.  I remember everything: the wind being knocked from my lungs as he struck me, the world spinning as I hit the ground, the crunch of my ribs shattering beneath his tires, the crushing feeling of having a 4WD on my body.  (Later in his statement, he informed the police that he "felt he hit something, but decided to continue to move his car off the road.  That is when he felt the car drive over the top of "something".  Yeah, that something was me.  Thanks buddy.) 
I couldn't move and I couldn't breathe.  The pain was only secondary because I couldn't seem to fill my lungs with air anymore.  I was like a goldfish out of water.  I remember confessing to a bystander that I was dying.  I stayed awake until the paramedics arrived.  I unhelpfully pointed to my tummy and my chest when the paramedics asked me where I hurt the most.  I was conscious for about 5 seconds after that, finally passing out knowing that help had arrived.
While all this happened, the driver of the car sat in the gutter by his vehicle.  Not once did he bother to come and check on me. 
My injuries were as follows:
  • Multiple left and right-sided rib fractures and lung contusions

  • Pelvis broken in six separate places 

  • Multiple lumbar spine fractures 

  • Broken left humerus 

  • Bilateral pneumothoraces {collapsed lungs} 

  • Ruptured diaphragm 

  • Grade 5 liver laceration

  • Splenic lacerations 

  • Acute kidney injury

  • Pancreatic tail injury
To put it simply, I was smoodged (no, I don't care that this isn't a real word).  The docs told me they almost lost me that night.  I needed to be transfused 15 units blood.  Apparently one of the doctors had one look at me and gave up.  "Don't bother.  She is already dead.  A waste of time." he said.
The more stubborn trauma surgeons paid him no heed and kept on working.  My family was told I had a 5% chance of making it through the night, that they should come as soon as possible to say goodbye.  After the trauma surgeons fixed what they could, I was transferred to ICU where my family and friends were gathered.
But somehow, I made it through that night.  And the next day.  And the next.  The sedation was removed to see if I would wake up.  And wake up I did.  
Ever since I haven't looked back.  Yes there have been complications (clots, fluid always building up behind my lungs and on my liver, discovering a bile leak, bowel obstructions, infections . . . and plenty more) but I made it.
I have been out of hospital for just over a month now and am expected to make a full recovery. I had no brain or permanent spinal damage, my face was unscathed, and I can walk!  Unless I told them, no one would be able to tell that just a few months ago I was given up for dead.
So on behalf of the patients that you (and other trauma surgeons) treat, thank you.  I am here on this earth today because of a group of stubborn doctors I'll probably never see again.  Here on this earth to spend with my loving family because of people like yourself.  Here to enjoy another day with my friends. 
So from the bottom of my unresolved-tachycardic-heart . . Thank you.
P.S. I no longer think being "stubborn" is a bad personality trait. I now think of stubborn people as simply determined :)
P.P.S. I relish the chance to attend the court cases for the stupid driver behind the wheel of that 4WD.  He is being charged with quite a minor traffic infringement - undue care and attention where the police prosecutor thinks he will get away with just a small fine and a driving suspension.  To make it all worse, he is a barrister {that's what people in the Old Country call scum-sucking bottom dwellers.  I mean lawyers).  Immoral prick.  I hope he remembers me every time he drives over a speed bump. 
Regards,
Natalie
And as an added bonus (I almost felt like I won the lottery), she sent a picture of her initial chest X-ray showing just how severe her injuries were:



It doesn't take a radiologist to tell that's Natalie's X-ray on the right and a normal one for comparison on the left.  What I hope is plainly obvious is that Natalie's chest is FUBAR (yes, that's the technical, medical term for it).  I've seen many people with injuries as severe as Natalie's, and I can say quite definitively that not all of them make it.  When you have that many organ systems that severely injured, it takes a highly-skilled trauma team, a ruthlessly motivated patient, a lot of support, and a shitload of luck to come out the other side.

My heartfelt congratulations to you, Natalie.  And thanks for sharing your story with us.

Wednesday, 23 July 2014

Premonition

Before I start this, no I can't see into the future, and yes I'm a damned pessimist.  But then you probably knew that anyway.  If I could see the future I would have sunk every penny I had into Apple stock in 1982 and I'd be retired by now.  Despite this severe shortcoming, I do get premonitions now and then.  You know, that overwhelming feeling that something really bad is about to happen.

You guessed it - my Inner Pessimist reared his ugly, stupid head again recently. 

"I have a bad feeling about this," I said to my assistant just prior to my patient being wheeled back into the operating theatre.  Those are 7 words you never want your surgeon to think, let alone say aloud.  Esther (not her real name) was 50ish and not terribly healthy coming into her ordeal, having had a stroke and heart attack in the past several years.  And now she was actively dying in front of my eyes.  By the time the emergency physician called me, she was floridly septic - her heart was racing, her blood pressure was dangerously low, her kidneys were failing, and she was delirious, barely able to keep her eyes open.  When I got there her entire family had gathered around her bedside, looking more like a funeral procession than anything else.  They could tell by the look on my face that the situation was grave.

Why was Esther dying?  Well, if you ever needed proof that perforated appendicitis is a different disease than regular appendicitis, Esther is your proof.

As I waited for the staff to ready the operating theatre, I thought back to the last patient I had who developed sepsis from perforated appendicitis.  He was half dead by the time he got to the hospital, and over the next two days he completed the process.  Now the seconds ticked by interminably, and with each passing minute I had a stronger and stronger feeling this case would be a tough one.  Little did I know how right I would be . . . sort of.  Well, not really.  Kind of.  Ok, the case itself wasn't hard, it was just that, well . . .

Hang on, let me back up a moment. 

We finally got Esther into the room and placed her on the operating table right at midnight (since appendicitis always happens in the middle of the night, apparently).  After putting on the appropriate monitoring equipment, the anaesthesiologist was supposed to quickly put the patient to sleep, put a breathing tube in, and let me get to work.  But that's not precisely what happened.  Ok, that's putting it mildly - it's not even remotely what happened.  Instead, this is exactly what I heard, word-for-word, as Dr. C (not her real name) tried putting the tube in:

Nurse: "Do you see something?"
Dr. C: "Yes, but I don't know what it is."

Wait, what the hell is going on up there?

She tried to put the breathing tube in five times, and five times she managed to get it into the oesophagus rather than the trachea.  WRONG, WRONG, WRONG.  After nearly an hour of trying, she called a second anaesthesiologist, who had to drive in from home, to assist.  While she was waiting, she tried putting in an radial arterial line so she could monitor her blood pressure directly.  True to form, she couldn't get that in either.

At this point my blood pressure was rising even more than Esther's was falling. 

The second anaesthesiologist arrived as Dr. C tried again.  Finally after an hour and 26 minutes, a temporary tube finally was in the trachea.  Her oxygen saturation, which had been hovering around 88%, increased to 97%, and I started prepping.  And then, trying to exchange her temporary tube for the permanent tube, she pulled the tube out.

GOD.  DAMN.  IT.  Back to square one. 

As I fumed in the corner of the room, trying to regain my sanity and keep my blood from boiling, she tried again.  A minute later I heard her yell "The tube is in something!" (her exact words).  Wait, something?  SOMETHING??  There are only two tubes there!  Which something is it in?!

It was the wrong something.  Again.

I wanted to scream "JUST STICK IT IN THE GOD DAMNED HOLE ALREADY!" but as the only man in the room, I didn't think that would go over too well.  So, taking a note from almost two decades of marriage, I wisely kept my mouth shut. 

Finally, FINALLY, after trying for 1 hour and 51 minutes (yes, I timed it), the endotracheal tube was in (the right something this time), and I could finally start the actual procedure.  The surgery itself, which consisted of removing the necrotic (ie dead) appendix and draining her pelvic abscess, only took 35 minutes.

We kept her on the ventilator overnight as a precaution and removed the breathing tube the next day.  Esther's vital signs, bloodwork, and kidney function all improved rapidly once the infection was controlled, and a week later she walked out of the hospital and went home.  Not surprisingly, her biggest complaint as she left wasn't abdominal pain; it was a sore throat. 

I can't for the life of me imagine why.