Friday, April 11, 2014

Nanny

There are only 162 hours in a week, and it seems that some weeks I work approximately 161.5 of them.  Mrs. Bastard works too, so that leaves no one to watch my young son during the day.  Instead of letting him run wild around the house, we realised we have two choices 1) take him to day care where he will be constantly doused in snot, vomit, slime, and muck containing every virus and bacteria known to man on a daily basis, or 2) hire a nanny.

Hmm . . . tough choice.

We love our nanny - she's wonderful.  She truly loves my son, and she cares for him as if he were her own.  She reads to him (in two languages), she plays with him, she paints with him, and she chases after him when he runs out of the house naked.

Best if you didn't ask about that last one.

It can be very difficult to find a nanny you can trust with the care of your children, who are (or at least should be) the most precious things in the world.  We got incredibly lucky with ours.  Some people aren't quite as fortunate.

The theme of this particular trauma call day seemed to be "falls".  Everyone was falling down for one reason or another - falling out a fourth floor window, falling off the back of a fire engine, falling down while gardening, falling while shopping, falling off a bar stool.  Sandra (not her real name) was no different than the others who dutifully followed the theme - she was found at the bottom of the stairs.  She was in her late 50's and a nanny for the 4-month old daughter of a local family.  Her husband called her in the early afternoon to let her know that he would be picking her up around 3 PM after he ran a few errands.  Incidentally, is running the only way to do an errand?  Can you walk a few errands?  Amble a few errands?  Mosey a few errands?

Anyway, when he arrived at her employer's house and knocked on the door at the appointed time, Sandra didn't answer.  It was a beautiful day outside, so he figured she was taking a walk with her charge and decided to wait in the car.  About 15 minutes later her boss came home, and they entered the house together, only to find Sandra crumpled in a heap at the bottom of the stairs in a pool of blood.  The infant was screaming in her crib in the next room.

The medics were called, and a few minutes later they brought her to me.  She was breathing, but she was a mess - she was unconscious, unable to talk, and her face was covered in blood.  Based on the overall picture, I was convinced that she was bleeding into her brain.  I looked over at the on-call list and noted the name and phone number of the neurosurgeon on call, since I had a sneaking suspicion I would be calling him just as soon as I saw her brain CT scan.

Then as I leaned over her head to find the source of all that blood covering her face, a familiar scent hit my nose.  It was vaguely familiar, but I hadn't smelled it in a while.  I just couldn't place it.  What was that smell?  It took me a moment before I recognised . . .

Ok fine, I'm lying my ass off because at the time I just couldn't believe what my nose was telling me.  I didn't want to believe it.  I refused to believe it.  Surely my nose was deceiving me . . . but no, it was clearly the pungent odor of alcohol.  A LOT OF IT.  I leaned in again and inhaled deeply.  Yes indeed, she smelled like she had bathed in vodka and then used tequila as deodorant.

I did a full head-to-toe examination, and I quickly discovered that the blood had come from a tiny laceration on the bridge of her nose.  I looked at her brain CT as it was being done, and I felt a feeling of relief when I saw a completely normal brain.  By the time the scan was done, her bloodwork was back, and my relief was quickly replaced by a sudden rush of anger.  Her blood alcohol level was 0.47, nearly 5 times the legal limit for driving in most countries (6 times the limit in some).  Unfortunately there is no legal limit for Taking Care Of An Infant While Intoxicated.

As I gaped at the computer screen with my jaw on the floor and my eyes surely bugging out, I imagined what my reaction would be if I had come home and found our nanny in such a state, with my son screaming in the corner.  Fear, rage, shock, fury, or some combination thereof.

I went out to the waiting room to talk to her husband, and he was unaware of his wife's drinking problem.  I told him that many people would be dead with a blood alcohol level that high, so this was most definitely not her first time drinking that heavily.  Her brother called in later and confirmed that yes, she drank heavily.  Often.

That she got blindingly drunk while supposedly "caring" for a helpless, innocent baby made me irate, but the fact that she was devious enough to be able to hide such a vice from both her employer and her husband made me even angrier.  But even more than that, it scared the shit out of me.  I'm not generally a paranoid person, but this made me want to buy 218 security cameras and set them up in every corner of every room in my house.

If anyone wants employment as a nanny, contact me.  I have a strong feeling there's a job opening here.

Sunday, April 6, 2014

Common cold

I have a cold.  I have a god damned cold.  I realise everyone hates having a cold, but I HATE having a cold.  I can't take sick days, so I have to fake it and pretend that everything is just hunky dory.  But I can't decide what my least favourite symptom is -
  • a sore throat that feels like I'm swallowing razor blades 
  • that dry, hacking cough that keeps me (and Mrs. Bastard) up for nights on end
  • nasal congestion that makes me feel like I'm trying to breathe through a pillow
  • the general feeling of shittiness like I want to crawl directly into a coffin and close the lid
Despite thousands of hours of medical education, I still can't figure out how or why a cold makes me feel like such shit.  I weigh billions of times what a virus weighs.  How the hell can such a tiny virus take me down?  Granted, there are millions of them working and only one of me fighting them, but I should still be able to fight it and GOD DAMN YOU ADENOVIRUS YOU FUCKING EVIL PIECE OF #*(&!@^$)@%&#

Ahem.  Sorry about that.  Where was I?  Right, my cold.  At work I do my damndest to keep myself presentable and not snozzle on my patients.  Yes, "snozzle" is the technical term.  Unfortunately I suppose I wasn't doing a good enough job of faking it, which prompted my patient to turn the tables and give me some helpful (yet unsolicited) medical advice:

"Doc, you should go get some Oscillo!  It works great whenever I have a cold."

She must have seen the blank look on my face (though I may have just been daydreaming of my impending death), so she said, "You know, oscillococcinum.  It's wonderful!"

Oscillo?  The name sounded familiar, but I couldn't place it.  Was it a brand name of a new cold medicine?  Had I seen an advert somewhere for it?  Had I taken it as a child perhaps?  I thanked her for the recommendation, and on my way home I stopped at my local apothecary/pharmacy/drug store/chemist to have a look and find my salvation.

I walked down the "Cold and Flu" aisle and saw the usual suspects, the medicines with the long, unpronounceable names which had become my best friends since my plague began - phenylephrine, guaifenesin, pseudoephedrine, dextromethorphan, doxylamine.  And then . . . I spotted it.

Aaah!  Yes there it was, shining up at me like a beacon from a lighthouse directing me to shore!  At last, my relief!  My cure!  My . . . wait just one goddamned second, does that say "HOMEOPATHIC"?

GOD.  DAMN.  IT.

I think I actually said "FUCK!" out loud when I spotted it, much to the chagrin of the elderly lady behind me looking at the selection of laxatives.  For those of you unfamiliar with the concept, homeopathy is based partly on the outdated and wholly-unscientific concept of "similia similibus curantur", or that like cures like (in case you forgot your Latin).  In other words, if you have an ailment, it can be treated by giving a small dose of the causative agent.  Hippocrates (yes, he of the oath) is said to have started the practice by treating mania with small doses of mandrake root, which can also cause symptoms of mania when give in larger doses.  Samuel Hahnemann expanded the idea in the 1800's when he ate some cinchona bark (which was used to treat malaria) and developed symptoms similar to those of malaria which the cinchona was supposed to treat.

In a brilliant feat of psuedoscientific flatulence, Hahnemann postulated that if small doses are good, then smaller doses should be better.  He began diluting things like salt, arsenic, and bushmaster snake venom by factors of 100 (which he oxymoronically called "potentisation") and then striking the solution against an elastic object in a process he called "succussion" (his object of choice was a wooden board covered by leather and stuffed with horse hair - yes, seriously).  He would then dilute it by a factor of 100 again.  And then again by 100.  And again.  And again.  And . . . you get the point.  Followers of homeopathy believe that despite the dilution, the water somehow "remembers" the property of whatever is being diluted . . . which of course is physically impossible and firmly enters the realm of magic.

As I remembered this information, I looked at the box to see what the ingredients were, and what I saw actually made me laugh.  I may even have uttered the word "LOL" aloud by accident (the lady behind me was still choosing her laxative).  Directly from the box:
Active Ingredient: Anas Barbariae Hepatis Et Cordis Extractum 200CK HPUSTo Reduce the Duration & Severity of Flu-Like Symptoms
What the hell does that mean?  Well if you had paid more attention in Latin class (haven't we been through this already?) you'd remember that "Anas barbariae" is a type of duck, and that "hepatis et cordis" means "liver and heart".  To prepare this concoction, they first take...

"Wait wait wait.  Duck liver and heart?  What the fuck are you on about, Doc?  I thought this was supposed to be a flu remedy?"

Ok, let me explain.  No, there is too much.  Let me sum up.  You see, Joseph Roy, a French physician practicing during the 1918 influenza pandemic (which killed about 5% of the world's population) looked at the blood of flu victims under a microscope and saw some oscillating bacteria which he called "oscillococcus".  He postulated (incorrectly) that this was causing the flu (as well as rheumatism, measles, cancer, and tuberculosis).  He then continued his search for a cure until he found the mysterious oscillococcus again, this time in duck liver.  Operating under the premise of "similia similibus curantur" he prepared a remedy by serially diluting bits of duck liver and heart.  Now other than Dr. Roy, no one in the history of mankind has ever seen this oscillococcus, so I don't know what the hell he thought he was seeing.  Regardless, we now know that the cold (and flu) are caused by a virus, not bacteria.  As ridiculous as it is, it at least lends a whole new meaning to the term "quack", though.  Har har.

Anyway, I looked back at the description of Oscillococcinum.  See that "200CK"?  That means it's been diluted by a factor of 100 not once, not twice, but 200 times.  It is so dilute that you would need to take 2 billion oscillo tablets to even get ONE MOLECULE of the "active ingredient", which doesn't even have any medicinal property anyway!  Then I took a look at the ingredients on the back of the box:
The inactive ingredients are sucrose (that's table sugar) and lactose.  Each tablet, which weighs exactly 1 gram, contains 1 gram of sugar according to the box.  SO THE WHOLE FUCKING TABLET IS SUGAR.

But wait, it gets more absurd - go back and look at the "drug" facts.  It warns against giving a pure sugar pill to pregnant or breastfeeding women.  It also recommends consulting with a doctor before giving a sugar pill to children under 2.  Since when do we not give sugar to pregnant women or children?  My daughter would be heartbroken if she could never again eat M&Ms (which have exactly as much medicinal properties as oscillococcinium, by the way).

And it gets even worse.  The box says it "Works Naturally with Your Body", is "Non-Drowsy", has "No Side Effect:", and has "No Drug Interactions".  OF COURSE it won't interact with anything, put you to sleep, or have any effect whatsoever.  It is, quite literally, a sugar pill and nothing else.

I put the box back on the shelf with no intention of wasting my money and went home.  When I got there I started digging a bit deeper, and I realised it gets even worse.  These tablets are available for sale on Amazon for the low price of $15.21 for 12 tablets in the US,  CDN$33.94 for 30 in Canada., or ¥1,731 for 30 in Japan.  Sadly, they are not available (on Amazon, at least) in UK, France, Australia, Germany, China, Austria, or Spain.  Yes you read that correctly - they are actually MORE expensive than actual cold medicines which actually DO have actual active ingredients (ie medicine) in them.

The absolute worst part is the comments people have written about the product:
  • anything homeopathic is good
  • excellent flu remedy
  • NO medicinal negative side effects (because it's homeopathic)
  • It sounds to good to be true, but this method as been used and refined for 2000 years in countries far older than our U.S.A.
  • Placebo Power? Maybe, but it seems to work for me.
  • Homeopathic meds remember memory of water basically.
  • Oscillococcinum is a life saver!   
It is extremely disheartening that there are so many people who have been duped into buying this garbage.  People's understanding of basic science has deteriorated to the point where too many people actually believe that a product like this has any chance of doing anything therapeutic.

Now if you'll excuse me, I have a coffin to crawl into.

Tuesday, April 1, 2014

April Fools' Day

Christmas is ok.  New Year's Day is satisfactory.  My wife and children's birthdays are fine.  My birthday is usually tolerable.  My wedding anniversary is alright.  True, those are all mornings when I wake up in a fairly good mood, knowing that the day will be full of metaphorical sunshine and rainbows.  But none of those is my favourite day of the year.  Not by a long shot.

Yes my friends today, April 1, is my favourite day of the year.  Think about it - when else can you say or do whatever the hell you want and get away with it just by yelling "APRIL FOOLS!"  It's great!  Pranks, jokes, and puns abound.  Sarcasm is the theme of the day.  What could possibly be better?

So to celebrate the day, I'm going to review a few of my favourite all-time pranks, starting with . . .

Gmail Paper

Those jokesters over at Google advertised a service where your emails would be printed and mailed to you for free.  To defray the costs, adverts would be printed on the back of each page in bold, red 36-point Helvetica font.  Ha ha ha!  Great, right!  Well if that is good enough, how about . . .

Squeez Bacon

I will readily admit that I got more than just a little excited about this product when I saw it.  I started drooling at the prospect of squeezing bacon-flavoured goo all over anything and everything . . . until I remembered it was April 1.  Yes, ThinkGeek had tricked me for at least 2 seconds, and I truly felt duped and disappointed.  But it's April Fools' Day! It's a day for trickery and deception, not sadness and melancholy, so we move onto . . .

Vaccination Information Network

And then there's this little gem from our friends over at the Vaccination Information Network, those intrepid truth seekers who only want to rid the world of vaccines and expose how evil vaccines actually are and will tell whatever lies and half-truths they have to in order to expose us malevolent, corrupt doctors for trying to, you know, prevent deadly diseases and stuff:
kj..... mike said.... Hi, remember me? I posted an angry message a few months ago and I had been pro-vaccination... Until recently. I have been receiving payments via several of Big Pharma to try and promote questionable new drugs... But after having recently received a vaccination for a bad case of Dutch Elm Disease - one of the worst cases the doctor had ever seen - my doctor says i am now showing signs of autism. Please forgive me, i didn't know the extent of their corruption.

Haha!  It's hilarious, right?  Dutch elm disease is a fungal infection which only affects trees, and it's just hysterical that an adult is showing signs of autism after getting a vaccine for a tree disease!  Hahahaha I just laughed my ass right off!  I at least had to give these idiots credit for trying to make light of an otherwise sensitive subject.  Good on them for a bit of self deprecation.

And then I read the comments, and I immediately felt the blood drain out of my face:
  • Samantha Norris: Joking is fine, but this isn't even funny & autism isn't something to joke about - especially autism caused by vaccines. But that's just my opinion.
  • Kelly Renee Bryant: Hmm I was about to give heartfelt encouragement n tell fellow believers don't be a troll-now I see this is made up? Sad to joke about. Why? Aren't there real cases to be sharing? Wow??!!
  • Ali Burleson: I think it's funny that I had an ACTUAL POST over a week ago, seeking REAL information, and it never got posted....but this sarcastic, condescending bullshit gets posted. I realize it's an April fool's troll. But anti vax families have a hard enough time finding support and dealing with ignorance and stupidity, and it's shitty as Fuck for this page to post stupid shit like this. Call me a kill joy but some things aren't funny. 
  • Elizabeth Mathiak: Wow- so sorry it took you being injured to realize it. But now you're in a great position to spread the word! Thanks for your honesty!
And my personal favourite: 
  • Ryan Ciantar: I'd go get vitamin C and B-12 IV therapy stat, cut gluten out of your diet completely as well.
Yes, seriously.  This rocket scientist not only failed to realise it was a joke, he actually suggested that Vitamin C (which can cure alcoholism, arthritis, ruptured discs, diabetes, and cancer, according to Natural News) could also be used to treat a fake tree-to-human disease that also somehow causes autism in adults.  I understand that people are clueless, but there are others who are so off the mark they may as well be living on Venus.

But this is antivax.  This is who they are and what they do.  These are people who think vaccines are not only ineffective but also cause everything from autism to diabetes to cancer, and many of them believe Vitamin C, homeopathy, a chiropractic realignment, and a gluten-free diet can cure anything.  They don't bother with silly things like science and reality, instead relying on fear-mongering and the advice of online idiots who wouldn't know a fact if it whacked them in the face with a bag of golden rice.

Now for those of you downtrodden folks who actually like the idea of Squeez Bacon and feel like crying, fret not my friends, as I now present you with this:

Baconost
Feast your eyes and bask in all its bacony glory, for that is an actual real squeezable bacon-flavoured cheese spread.  You're welcome.  Enjoy!

Happy April Fools' Day!

Sunday, March 30, 2014

Drunk driver

I suspect most people know someone who has been affected by a drunk driver.  I also suspect that everyone who has more than 18 brain cells knows that every other driver on the road has the capacity to be one of those dangerous idiots.  Every time I get into my car, I do it with the firm belief that I'm the only good driver out there, and every single other car around me is being driven by a besotted moron on his way back from a night of liquor-soaked debauchery.  You can call it pessimism, you can call it defensive driving, or you can call it paranoid and delusional.  Whatever gets me and my family safely from point A to point B is what matters.

But what happens when you encounter a drunk driver when you're not behind the wheel?  Sound impossible?  This story I got from Mariel (not her real name) proves otherwise:

Hello, Doc. I've been reading your blog for a while now and I thought I could share my story. I'll try to make this as easy to understand as possible. I'm not sure I will succeed.

My parents and I were leaving my grandparent's house. The house is downhill, just after a turn. My mom and I were waiting by the porch and my dad and my grandpa were talking in front of the garage. That's when a car turned the corner and, instead of slowing down, it went faster, lost control, and hit my dad and grandpa.

My dad hit the car's windshield and managed to fall on his feet, but due a fractured sacrum and pubic tubercle, he couldn't stand up. My grandpa was thrown against the garage and hit his head.  The impact was so strong he was turned around so his head was facing the car. He was in cardiac arrest by the time the ambulance got there.

My father is mostly fine, but my grandpa died due the head trauma. The driver of the car that hit them was drunk. 

My grandma is alone now because a stupid 45-year old man thought he could drive after wasting himself in booze.

I don't really think I have a whole lot more to say about that.  Drunk drivers are menaces not only to other drivers, but to pedestrians and everyone around them as well.

Mariel, my sincerest condolences to you and your family.

Wednesday, March 26, 2014

Mass casualty

Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me.

The above poem, "The New Colossus", was written by Emma Lazarus in 1883, and it became one of the world's most famous verses after being inscribed on a plaque in the Statue of Liberty outside New York City.  Thousands of immigrants were greeted by this poem upon entry to the United States, but the words could just as easily be inscribed above the door to my trauma bay.  I seem to have a knack for attracting the huddled masses, but my forte is definitely attracting the wretched refuse, and they all appear to enjoy coming to meet me on the same night.

A trauma surgeon's worst nightmare is a mass-casualty event - a train derailment, a plane crash, a collapsed apartment building, a Justin Bieber concert.  Fortunately in most places around the world, these events are fleetingly rare, but we run training simulations on such possibilities nevertheless.  One of the most difficult things to do in a mass casualty event is triage - rapidly assessing which patients are the most severely injured but who are also salvageable.  Taking too much time 1) doing CPR on the guy with the open head wound and brain matter leaking onto the gurney, or 2) suturing a knee laceration on the lady who is otherwise mildly injured, decreases the survival chance of the guy with a metal pole sticking out of his abdomen.  The first patient has essentially no chance of survival no matter what I do, and the second patient clearly will be fine.  But the third patient also has a decent shot of living, but only if he receives immediate attention.  That is the art of the triage - not only who needs fixing, but who needs it first.

So naturally the burning question in everyone's mind at this point is (or should be), "Have you ever been in such a situation, Doc?"

Well, no.  Not exactly.  Actually, sort of yes.  Not really.  Kind of.  Ok, a bit.

After a boring first twelve hours of a 24-hour shift, it seemed nothing exciting would happen that day.  Fortunately I knew better than to taunt the Call Gods by mentioning that little tidbit.  The Call Gods, in all their malevolent glory, didn't need any such taunting, however.  At 8:30 in the evening my pager interrupted my viewing of the latest episode of "Sherlock", telling me I would be getting a level 2 (not as serious as level 1) gunshot victim in 5 minutes.  My pulse quickened slightly as I made my way to the trauma bay, but it quickened even further a minute later when my pager informed me of a second gunshot victim, this one a level 1, also in 5 minutes.  As I walked into the trauma bay, my pulse reached very near Full Blown Panic Mode when they wheeled in a third gunshot victim, also a level 1, who had been dropped off at the hospital by his buddy.

SHIT.

I started looking at the first victim, and the second guy (the level 2) was wheeled in less than a minute later.  I started my silent internal triage as I examined the first one - he had been shot in the abdomen, but it was a seeming glancing blow from near his flank through to his back.  His abdomen was soft and essentially pain-free when I pushed on it, a sign that he was probably not seriously injured, and I triaged him to the back of the line for now.  As I was running to see the second guy (who was now vomiting blood on the floor), the third one was wheeled in, a medic straddling his pelvis while performing CPR.

SHIIIIIT

A 2-second glance at the second victim revealed two gunshot wounds in his abdomen, one near the umbilicus (belly button) and a second (presumably an exit wound) in his left flank.  But as opposed to the first victim, this guy's abdomen was rigid and he screamed when I touched him there, a sure sign of peritonitis.  My silent triage continued - this guy was salvageable, but something extraordinarily bad was happening inside his belly, and I clearly needed to be in there RIGHT NOW.  But I also needed to see what was going on with the third victim RIGHT NOW.

SHITSHITSHITSHITSHIT

I instructed the nurse to wheel victim #2 directly down to the operating theatre, and I yelled to one of my assistants to call the operating room and tell them the patient was coming.  I then ran to the third victim who had been shot in the left chest.  He had no pulse, but I had no idea how long he had been down.  What I DID know was 1) I had around 10 minutes while victim #2 was wheeled to the operating theatre, put to sleep, and readied for surgery, 2) this guy statistically had a 99% chance of dying, and 3) his chance of death increased to 100% if I didn't do anything.  My only option was to do a resuscitative thoracotomy (ie "crack his chest") to expose his heart and lungs and try to do something . . . anything to bring him back to life.

It took me about 30 seconds to put on my gown, gloves, and mask, another 60 seconds to get into his chest, and then an additional 2.17 seconds (I counted) for his entire blood volume to pour out of his chest onto my feet (which were mercifully covered with shoe covers).  I did a quick survey of his chest, and the bullet had ripped through his left lung, tearing a major branch of the pulmonary artery and causing him to bleed to death internally.

One minute later I was halfway to the operating theatre, having declared victim #3 dead as I removed my shoe covers, then re-examined victim #1 to make sure my initial assessment was correct (it was), and finally barking various orders to the nurses and assistants.  I got into the operating theatre just as the nurses were finishing applying the sterilising solution to his abdomen.  I took a deep breath, realigned my chi and chakras, and slashed his abdomen open with the ferocity of a 1000 lions.

An hour later I had successfully repaired several holes in his stomach and colon, so I started congratulating myself on a job well done.  Then my Internal Pessimist reminded me that I had just pronounced a man dead (and still needed to inform his family), I still had a gunshot victim in my trauma bay who may or may not need surgery (he didn't), and there were still 10 hours to go in my shift.

I fucking hate my Internal Pessimist.  But the little shit was right - I had two more gunshot victims later that night.  One of them was shot in the leg, the other in the head.  One of them survived.

This was a night I won't soon forget.  It's the closest I've come to a mass casualty event, and hopefully the closest I'll ever come.  

. . . Until my daughter asks to go to her first One Direction concert.  Maybe I can get my Internal Pessimist to take her, and I can stay home and watch "Sherlock".

Saturday, March 22, 2014

Death of a patient

During my training one of the surgeons I worked with told me that every surgeon has his own personal graveyard that he visits every night where he tours all his failures in his dreams.  It seemed like an overly dramatic bit of histrionics, and I have to admit I chuckled softly to myself at the time.  A few years later after I had finished my training, my graveyard started slowly filling, and I stopped laughing.  Fortunately DocBastard Memorial Gardens is small and new gravestones are rarely added, but it is definitely there, and I visit often.  Every tombstone I see is an opportunity to learn, to avoid making the same mistake twice.

Sadly, I added a new tombstone last night.

As certain people get older they may look like they are aging well, but underneath the surface there is skin that isn't as smooth and taut as it used to be, organs that aren't functioning as well.  My patient was no different - she was not too old, but she was definitely starting to show her age.  Sure she looked pretty good on the outside, but she had been getting slower and slower over the past few months.  She had been in her usual good state of health until last night, when she suddenly got sick.  It seemed that everything inside her had suddenly stopped working all at once.  I took one look at her and knew immediately that something was seriously wrong, and she needed immediate surgery.

A few minutes later I opened her up, and what greeted me was confusing at best, and horrifying at worst.  I've been inside many patients just like her, but somehow she was just different.  Nothing was where it should have been, but I still couldn't immediately identify what was making her shut down.  I started dissecting carefully, moving things around, taking things apart where I had to, removing other things that also obviously needed removing, trying to identify the problem.  It was very delicate work, and I knew that one false move could spell the end.

And then it happened.  One tiny movement that should have been more delicate than it was, wasn't.  One slight misstep was all it took, and just like that it was all over.  I suppose I could have tried to repair the damage, but it was obvious that even though the injury was tiny, it was also unfixable.  I dropped my head, cursed silently under my breath, and closed up without another word.  Nothing anyone could have said would have changed a damned thing.

I know I don't ever release patients' names, and I risk raising a few eyebrows doing this, but I'm going to make an exception in this case.  I hope this can serve as a cautionary tale to any other surgeons (or anyone else, for that matter) who decide to be less careful than they should be.

RIP, iPhone 5.  You will be forever in my personal graveyard.

Monday, March 17, 2014

Surgery must be stopped!

A reader alerted me to this article in the newspaper The Times a few days ago, and I thought I would share it:
LONDON (Reuters): In a shocking announcement, the United States Department of Health and Human Services, the UK Department of Health, and the Canadian Ministry of Health have all agreed to suspend recommendations for laparoscopic cholecystectomy, a minimally-invasive removal of the gallbladder that is among the most common procedures performed worldwide.  US Secretary of Health and Human Services Kathleen Sebelius quoted the enormous number of patients seriously injured and killed by this procedure each year as the reason for withdrawing their recommendation, and she demanded more research into why so many people have this operation performed.

"In the United States alone," Ms. Sebelius reported to a joint session of congress last week, "there are approximately twenty million people living with gallstones.  There is only about a 20% chance of these patients developing gallstone pain over a 20 year period, yet 500-600,000 people still have their gallbladders surgically removed each year in the US.  Every one of those patients is at risk of hemorrhage, infection, bile duct injuries, blood clots, and even death."

Indeed, statistics show that up to 15% of patients undergoing laparoscopic cholecystectomy, which was only first done in 1985, are converted to the "open" technique, which is the old-fashioned procedure and involves a much larger incision, slicing across the abdominal muscles and causing much more pain and an increased risk of bleeding and wound problems.

In addition to bleeding and infection, up to 3 in 1000 patients undergoing this incredibly dangerous surgery will accidentally have their main bile duct accidentally torn, cut, or clipped, and these injuries are often not identified until days after the surgery.  Almost 1 in 500 have a hole punctured in their stomach, colon, or small intestine, and unbelievably the overall complication rate is as high as 1 in 20.  As many as 1 in 250 undergoing the procedure die due to complications, and if you happen to be lucky enough to survive, you have a 40% chance of developing bloating, abdominal pain, and indigestion, possibly permanently, after surgery.

"These injuries and deaths could all be prevented if people would just opt to live with their gallstone pain," Canadian Minister of Health Rona Ambrose told Reuters yesterday.  "Surgery just shouldn't be necessary.  I've heard a few anecdotes of people who read a story on Natural News and bought some kind of magic potion on Amazon or something which promises to flush the body of toxins and gallstones and other evil humours.  Surely this is a better option than letting sadistic surgeons cut you open and remove an organ.  These people were trained by barbers as recently as last century!  It's truly barbaric." 

UK Secretary of State for Health Jeremy Hunt went even further, stating "More investigation into the dangerous and lethal practice of surgery is needed.  We cannot in good conscience recommend anyone have this surgery, and possibly any surgery, until we can be sure that no one will ever again suffer a complication of any kind.  To my knowledge there has never been a double-blinded study done on gallstones, and until that is done we feel the practice should be stopped.
Sibelius, Ambrose, and Hunt all suggested trusting a random website which touts the healing power of cilantro and turmeric than some doctor who spent 20 years getting educated in the cutting-edge science of healing people.

Now for those of you whom have never read A Modest Proposal by Jonathan Swift, I suggest you click on the link and read it before you go any further.  I'll wait.  No seriously, go read it and I'll wait here.

All done?  Good.  The above Times article I just quoted is satire and entirely fabricated.  It never appeared in any newspaper, because I just wrote it.  However, the statistics I quoted are actually 100% true, and I presented them in a way to make the procedure seem as terrifying as possible.   

So why am I making it sound like my colleagues and I are butchers who routinely maim and kill innocent people?  Because I want to put myself out of business?  No, it's simply to illustrate a point.  People undergo surgery knowing that it is relatively safe, though not 100%.  The risks of surgery are small, but patients undergo it anyway, because the benefits far outweigh the risks.

"So what's the point, Doc?  What does this have to do with anything?"

My point is that many people these days are opting not to immunise themselves and their children against preventable diseases, even though vaccines are orders of magnitude safer than surgery.  There is a large (and growing) faction of anti-vaccinators who forgo vaccines against measles, hepatitis B, tetanus, the flu, and others, many of them potentially-fatal diseases, because there are infinitesimally small risks.

What these people fail to realise is that there are risks with everything.  There is a risk that your car will explode when you start it.  There's a risk a meteorite will fall on your head and kill you.  There's a risk that a sinkhole will swallow your house.  There's a risk a squirrel will maul your face in your sleep.  But that doesn't stop us from living our lives.  It does make me close my windows at night, though...fucking evil squirrels.

But this is just how absurd anti-vaccination zealots and their arguments against routine vaccinations are.  Vaccines are very safe, and this has been studied and documented over many decades.  But vaccines are also not 100% safe, and this has also been well documented over the same period.  Just like with surgery, a few people are injured, and a few people die.  But vaccines are far safer than surgery.  Of the millions upon millions of doses of vaccinations given per year, a handful of people are seriously adversely affected.  By far the most adverse reaction is pain at the site of injection, but headaches, malaise, and flu-like symptoms are also very common.  The serious reactions (including death) are fleetingly rare.

The anti-vax faction wants people to believe that these serious reactions are much more common than they are, making their stories sound as alarming and as terrifying as possible just as I did with my story about gallbladder surgery.  They are also desperate to link vaccines to everything from autism to diabetes to other auto-immune disorders.  But there is no conclusive evidence linking vaccines to any of these.  Stories and anecdotes abound ("I got the flu vaccine, and the next day a train crashed into my house!  It must have been the flu vaccine!"), and everyone seems to know someone who knows someone whose child developed autism 2.4 seconds after getting a vaccine.

The most telling aspect of anti-vax lunacy is how they claim that vaccines don't work.  They have graphs that show how the death rate of various diseases was already dropping before vaccines were introduced, so obviously vaccination is a hoax!  I mean, just look at these graphs and see for yourself!
"Oh my god!  Vaccines really haven't saved us!  It's all been a lie!"

Now wait a second and think.  Look at the dates on the graphs.  The advancement of medicine and antisepsis and supportive care were exploding in the early-to-mid 1900's, so of course the mortality rate would improve independent of vaccines.  What the anti-vax people don't want you to see is the trend of the actual incidence of the diseases:
As they say, a picture says a thousand words.  You can clearly see the normal annual fluctuations in incidence, but you can also clearly see how the rate dropped to near ZERO after the vaccines were introduced.  There is just no doubt that vaccines do exactly what they are supposed to do, and they have successfully eliminated (or nearly eliminated) many potentially-deadly illnesses, including polio and smallpox, which killed between 300 and 500 million people in the 20th century alone.

Despite this seemingly-overwhelming evidence, these groups of people, medical professionals included, continue to denounce vaccination programs, believing the minimal risks outweigh the concrete benefits.  These nurses and doctors are advising their patients not to immunise themselves and their children, recommending instead various foods, potions, herbs, and other hocus-pocus voodoo magic, which may all be perfectly healthful, but will protect you from polio exactly as much as a boot to the head will.  As the movement grows, outbreaks of these entirely preventable diseases are becoming more and more common

I would never be so duplicitous as to say that vaccines are 100% safe, because they are not.  But they are pretty damned close.  They are probably the second-most safe and effective preventative measure (next to soap) medicine has ever known.  Parents need to understand that there are risks, no matter how minuscule, before they come to a decision about immunising themselves and their children.  But they also need to understand how the benefits far outweigh those risks.

Now who is ready to have their gallbladder removed?  I have an opening next week.