Tuesday, 3 March 2015

Head transplants

Please allow me to introduce the opening scene of a science fiction film to you.  If you don’t like science fiction, just pretend it’s another a formulaic Kate Hudson or Katherine Heigl rom-com or a Daniel Craig 007 action flick.  Whatever floats your boat, just stay with me here.  This is important.
We fade in on a top-secret laboratory, beakers bubbling, computers beeping, screens displaying complex mathematical formulae.  A mysterious set of feet walk across the screen toward what must be a refrigeration unit.  The door opens, and dry ice fog quickly streams out and dissipates eerily.  Our mystery man picks up a small box and walks to a waiting table.  He opens the box to reveal . . . Cue dramatic music . . . a human head.  The camera zooms in on the box, where a sticker says “LIVE HUMAN—FOR EXPERIMENTATION ONLY.” 
Live human head? What? 
The mystery man picks up the head and turns to reveal an awaiting headless body covered in medical gadgets lying on an operating table.  The head is placed on the body.  A team of white-robed doctors descends with scalpels.  The music peaks . . .
It sounds completely ridiculous, something straight out of Hollywood, right?  Well, not exactly.  If a doctor from Italy is to believed, science fiction may soon become science fact.

Want to read the rest?  Well then unfortunately you need to head over (har dee har har) to The Daily Beast because they own me now or something.

I'm not sure if I should be shamelessly promoting my TDB articles here or not.  I still have yet to decide if I'll continue doing it.  I'd appreciate your thoughts, not only on the head transplant (that phrase just looks weirder and weirder every time I type it), but on putting teasers for my TDB articles here.

UPDATE: Just to clarify, I have no intention of giving up this blog, or reducing or otherwise diluting the content in any way.  My first responsibility (after my family and my job, of course) is maintaining a repository for my stories, which was the whole reason I started this stupid blog in the first place.  I never expected anyone to actually read it, I just wanted to be able to remember this stuff.  I have no doubt that the idiocy around me will continue, so the weekly updates should as well.

Thursday, 26 February 2015

The Daily Beast

I have a doppelganger.

Someone on The Daily Beast is masquerading as me and using the name "DocBastard" to write a column.  He sounds like me, his opinions seem to be exactly the same as mine, and he even looks like me.

Before anyone mentions anything about it, my editor changed the British English spellings to the American English spellings.  Because she's, you know, American.

So this is my first paying job as a writer.  I'll be a regular contributor over there at DB.  Yes, I'm actually getting paid for it, which is more than I can say for this place, where all I earn is your undying and everlasting adoration.

Heh . . . I have an editor.

Sunday, 22 February 2015

The Vaccine "Debate"

WARNING: THIS IS BY FAR MY LONGEST BLOG POST EVER, AND FOR GOOD REASON.  YOU MAY GET BORED, ANGRY, FRUSTRATED, OR OTHERWISE DISCONTENTED BY WHAT FOLLOWS.  TURN BACK NOW ETC ETC.

To someone in the medical field, very little has been more in vogue to discuss lately than the supposed vaccine "debate".  I say "supposed" (and put "debate" in quotations) because, considering the evidence, there really should be no debate.  In science circles the vaccine "debate" is often likened to the flat earth vs round earth "debate" or the evolution vs creation "debate".  Unbelievably there are some loons who believe the earth is only 6000 years old, and if you look hard enough you'll even find some geologists and astronomers who support that position, despite overwhelming evidence to the contrary.  Similarly there are even fewer loons (fortunately) who believe the earth is flat despite this:
How anyone in 2015 could possibly believe the earth is flat is completely beyond me.  How anyone in 2015 could possibly believe that a magical omniscient omnipotent everlasting being willed the entire universe into creation only 6000 years ago is completely beyond me.  And how anyone in 2015 could possibly believe that vaccines aren't one of the best five inventions in the history of humankind (soap, plumbing, AC electricity, and bacon rounding out the top five, of course) is completely beyond me.  However, much to the chagrin of the vast majority of the medical world, people like that do exist, and despite all the evidence presented to them, they either flatly and/or willfully refuse to understand or lack the brainpower to do so (I strongly suspect the latter).

While I readily admit that medicine, like any other science, never considers itself settled, there simply should be no further vaccine "debate".  Vaccines DO work and they do NOT cause autism (evidence is below), though they do have fleetingly rare serious side effects.  The fact (not hypothesis, not theory, FACT) is that vaccines have revolutionised preventative medicine and healthcare in general.  Unfortunately, in addition to the hardcore antivaxxers who are, for one bogus reason or another, completely against vaccines, there are also individuals who seem to enjoy stirring the pot to supposedly "improve the dialog".  These are disingenuous people who purportedly hold themselves above the fray, supposing themselves higher or better than the strictly pro-vax and pro-disease (excuse me, anti-vax) folks, because they just want to ask questions and discuss.

Kevin Geary is one of those people.  On February 9, 2015 medium.com published an opinion piece by Mr. Geary titled "Bringing Much-Needed Sanity to the Vaccine Debate".  While this sounds like it should be a logical, objective, scientific approach to the topic, it is nothing of the sort.  Instead, Geary resorts to hypotheticals, logical fallacies, overriding literalism, and "questions" in an attempt to justify and validate the antivax argument, which deserves to be neither justified nor validated.  Someone tweeted his article to me asking my opinion on it, and I brought my evaluation to his attention quite by accident (not realising that his Twitter ID was included on my tweet):
Mr. Geary immediately replied:
I criticised his content, not the author or how he wrote it, so of course what I wrote was in no way an ad hominem attack.  I pointed this out to him:
His response was no better than "Whatever!"
An empty internet opinion?  You challenged me to write a rebuttal Mr. Geary, so there was only one possible response:
Because Geary openly welcomes the rebuttal, I will be quoting liberally from his dreck article.  Put on your wading boots, folks.  It's about to get deep.

I'll preface this by quoting a few comments Geary made to the readers of his article:
This article is not a claims-making article. It’s a question-raising article. Because there’s too much over-confidence and too little inquisition in this debate.
First of all, I haven’t declared a side. 
Sentences ending in question marks are typically “speculation.” Statements that end in periods are often conclusions.
In other words, he claims not to be making arguments on either side, simply asking questions.  That's a very feeble (and thinly-veiled) way of trying to protect yourself by making it seem like you aren't taking sides, even though you unambiguously are.

Geary starts by saying that he wanted to avoid the vaccine "debate" but for some reason felt that he had to engage.  He uses questions, hypotheticals, and illogical analogies to make his points.  Hey, he is saying, I'm not saying vaccines DON'T WORK, I'm just saying WHAT IF they don't work?

At the outset, he apparently feels that people on both sides of the "debate" have problems with critical thinking (a point of almost laughable irony):
As the title says, I want to bring sanity to the discussion. That doesn’t mean I want to change your position on vaccines…it means I want people to stop acting irrationally.
It sounds good and I had high hopes . . . until he actually started his argument.  And it starts deeeeeep.
Let’s fix the misuse of the word “consensus.” The Definition: An idea or opinion that is shared by *all* the people in a group
First of all, this is wrong.  According to the dictionary (you know, Mr. Geary, that big book that contains definitions of words and also exists online and would have taken you 0.289 seconds to look up), "consensus" means:
  1. majority of opinion: The consensus of the group was that they should meet twice a month. 
  2. general agreement or concord; harmony.


So it's a general agreement among most members of a group, not everyone agreeing about everything.  Geary thinks that the pro-vax camp is wrong saying that the consensus among doctors and scientists is that vaccines are safe and effective.  Well they are not wrong in saying that, he is in denying and questioning it.  The vast majority of doctors and infectious disease experts consider vaccines safe and wildly effective.  That is exactly what a consensus is.

If that literalism wasn't bad enough, he then dives straight into a typical antivax trope:
Why it matters: There have been countless times in history where the majority of scientists and researchers agreed…and were wrong.
He relates the story of Dr. Ignaz Semmelweis, a Hungarian doctor who argued that hand-washing could drastically reduce puerperal fever.  His hypothesis was rejected by doctors of the time (mid 1800s) because of a lack of evidence.  The alternate form of this trope is:

The analogy Geary is quite obviously trying to make without being too overt, of course, is that vaccines simply haven't been studied enough, so the link to autism just hasn't been found.  Geary is very clearly saying "Science has been wrong before, so maybe they're wrong about vaccines too!"  But remember, he's just asking questions.  I'll address this a bit later, so for now I'll move on to his next bit of too-literal nonsense:

While we’re at it, let’s make sure we’re using the word “eradicated” correctly.
The definition: destroy completely; put an end to.
How it’s used in the vaccine debate: It was significantly reduced.
According to the CDC, Measles has never been eradicated, though the term is thrown around pretty loosely.
Wrong again.   Yes, that's what "eradicated" means, and no measles is not eradicated from the planet.  But that's only a small part of the story, because thus far vaccines have eradicated two diseases completely - smallpox and rinderpest.  Rinderpest was a disease of cattle.  WAS.  Due to vaccines, it's gone now.  And smallpox, which killed approximately 500 million people in the 20th century alone, has been eradicated.  Because of vaccines, IT IS GONE.  Let me repeat that: a disease which killed HALF A BILLION PEOPLE JUST LAST CENTURY is GONE due to vaccines.  Read that yet again and let it absorb into your brain.  That's what "eradication" means, Mr. Geary.

Geary also seemed to miss that measles WAS considered regionally eradicated from the Americas in 2002.  And the incidence of measles decreased by over 99% from 1990 to 2002.  Is measles completely gone?  Of course not.  But it is pretty damned close, and a complete eradication is fully possible were it not for antivax sentiment.  Several other devastating diseases could possibly be eradicated off the face of the planet with vaccine programs, including mumps, rubella, polio, and malaria.

Geary isn't just satisfied with being overly literal and just plain wrong, he also likes to appeal to your sense of freedom and fear:
Let’s get something else out of the way: violence can’t be your answer.
Not everyone advocates for vaccinating people against their will, but many do. One of the [legitimate] fears among those who don’t vaccinate is that vaccine advocates will use the power of government to force vaccination compliance.  Sell your position with reason, don’t cram it down people’s throats (or lock them in rooms and inject their children with it).
He actually argues that people shouldn't be locked up and forced to undergo these shots.  No one (no one sane, at least) advocates forceful vaccinations.  I would expect that type of silliness from grade schoolers.

Next he delves into another antivax trope, that antivax parents just want what's best for their children:
Reality: Both sides want the same thing.
An unfortunate charge often wielded by vaccine advocates is that those who choose not to vaccinate are “reckless,” “stupid,” and “thoughtlessly endangering others.”
Vaccine advocates are vehemently protective of their family…and so are the parents who choose not to vaccinate. Both sides want the same thing: to make the best decision possible for their family.  A key difference is that it often takes more thought to reject the status quo than it does to accept it.
Yes, because only thinking parents reject the opinions of the vast majority of doctors and scientists, right?  This is the whole "I've done my research!" argument that antivaxxers are so proud of and use so commonly.  Sorry Mr. Geary, but reading stuff online (especially on the NVIC website, which you reference in one of your comments), does not constitute "research".  Research is done by scientists in labs and by doctors and researchers in the community.  The research has been done (and is still ongoing), and it shows overwhelmingly that vaccines are safe and effective.  Speaking of which . . .
So if you’re a vaccine advocate, I certainly hope you’ve done extensive research. Otherwise, you’re not just injecting your loved ones with something you know relatively nothing about, you’re doing so at the behest of a group of people you largely know nothing about.
Do I "research" my car's inner workings when the "Check Engine" light comes on?  Or do I just take it to an expert that I trust to take care of it?  Though I drive my car daily, I know pitifully little about internal combustion engines, but fortunately my mechanic is an expert.  Similarly most people know pitifully little about human anatomy, physiology, and immunology.  Fortunately your doctor (who has done his "research" and is extensively educated on the subject) is such an expert.  Sometimes trusting the experts is just the right thing to do.

Then Geary goes so deep that I can barely see the top of his head above the muck:
Question One: Do doctors receive any benefits from vaccine manufacturers?
Question Two: Does the government receive any benefits from vaccine manufacturers?
Question Three: Do researchers and educators receive any benefits from vaccine manufacturers?
Those are important questions, wouldn’t you say? Do you know the answer? Just be honest with yourself.
Ah yes, the typical antivax "Doctors are in BIG PHARMA'S pocket" trope.  He doesn't come right out and say that doctors get paid by BIG PHARMA (Oh no, he's just asking questions, remember?), but he certainly insinuates it strongly enough.  He claims to be merely asking questions, but it is only an attack on doctors, the pharmaceutical industry (which is no bastion of innocence, admittedly), and medicine in general, which he only insubstantially tries to hide.

He then continues his attack on vaccine manufacturers:
Speaking of: Is it legitimate that the government passed a federal law prohibiting lawsuits against vaccine manufacturers?

It’s not a statement, just a question.
If you’re a vaccine advocate, it would help your case if vaccine manufacturers weren’t themselves immune from the repercussions of putting out a potentially dangerous product. Then you could at least make the argument, “Hey, if your kid dies or gets seriously injured, at least you’ll be rich.”
But it begs the question: why is the government in the business of protecting a “big bad corporation?”
Again, he claims, it's just a question, not an attack.  Of course anyone with more than 17 brain cells can see right through this and see it as the attack that it is.  The federal law to which he is referring is the National Childhood Vaccine Injury Act of 1986 which was aimed at protecting vaccine manufacturers so that the supply of vaccines would remain stable.  In the 1970s several lawsuits were brought against manufacturers of the DPT vaccine, and even though there was no scientific evidence to support the claims, large awards were granted, vaccine prices skyrocketed, several vaccine manufacturers halted production, and vaccine shortages ensued.  To prevent the industry from collapsing, the law was enacted in the interest of public health.  Of course Geary's reason for attacking the manufacturers is plainly obvious.
Is it ever legitimate for the government to remove the risk of litigation from a company? The answer, if you care at all about your own wellbeing, is no.
Geary doesn't seem to know (or care about) the purpose or history of the law.  It looks like you need to do your research, Mr. Geary.

Unfortunately for Geary, his antivax sentiment becomes more and more transparent as his attack piece goes on:
What I’m going to argue is that the “putting others at risk of death” argument defeats itself based on statistical significance.  Most of the hysteria and current vaccine debate is in regards to the current measles “outbreak,” so we’ll use that as an example.  The death rate among those infected is typically 0.2%, or close to equal that of your chances of dying in a car accident.
Notice how he calls it "hysteria" and puts "outbreak" in quotations, thereby trying to minimise it.  Apparently 170 cases (approximately) isn't quite good enough for him.  What he fails to mention is that the complication rate of measles is MUCH higher than 0.2%, and that the hospitalisation rate in this outbreak is 25%.  The death rate is so low because of the success of modern supportive care.  What he also fails to mention is the fact that as recently as 2013, measles still killed well over 145,000 people worldwide, and that the measles vaccine has prevented an estimated 15.6 million deaths since 2000.  And that's JUST the measles vaccine.  When you factor in diphtheria, pertussis, tetanus, mumps, rubella, polio, H. flu, and all the other preventable infectious diseases, the number of illnesses, complications, hospitalisations, and deaths prevented (not to mention the money saved treating those infections) is simply remarkable.  I suppose Geary "forgot" to mention any of that.

Oh, but Geary isn't done.  Aping the comments of paleo-cardiologist Jack Wolfson who doesn't believe in protecting those who can't protect themselves ("I'm not going to sacrifice the well-being of my child. My child is pure."), regarding herd immunity he says:
Putting the science about herd immunity aside, this argument is faulty because its premise is that I should alter my behavior for the good of the collective. 

Geary makes it plainly obvious that he doesn't care about infants who are too young to get vaccinated or immunocompromised people who have no ability to fend off these infections which, in them, would be much worse.  As a doctor, I care.  As a father, I care.  As a decent human being, I care.

 But wait, it gets worse:
This is a debate about immunity, is it not?  If it is, then how can you not mandate vaginal birth and breast feeding until the age of two (minimum), the two primary components of the development of a healthy immune system—an immune system that can reduce the spread and severity of disease along with injury and death rates?
Yes you read that right - Geary actually argues (oops . . . I mean he asks a question) that if you are trying to optimise your child's immune system by vaccinating, then you also must mandate vaginal birth (because there is some data suggesting caesarian section can affect immune function later in life) and breast feeding (which also helps the developing immune system).  Well Mr. Geary, my daughter was born via caesarian section because of a nuchal cord.  Without the C-section she would have died.  Would that have been ok with you?  And when my son was born a few years later (also via C-section), if Mrs. Bastard had tried a VBAC (vaginal birth after delivery) there was a real (though small) risk that my wife's uterus could have ruptured, thereby putting her and my son's lives at risk.  Mandated vaginal birth?  Are you really that foolish?  Oh wait . . . you were simply asking a question, not taking sides or making statements.  I must have forgotten.

What Geary doesn't realise is that nothing is absolute, especially in medicine.  No one would mandate a vaccine for someone who is allergic or has some other hard contraindication.  And before you mention religious exemptions, no major religion on Earth actually prohibits vaccinations.  Fact.

To be fair, Geary then makes two statements with which I agree:
“Vaccines aren’t natural, so I’m opposed to them.”
You can be against the use of vaccines, but this not a legitimate argument. It doesn’t require much discussion, it’s a textbook logical fallacy.
True.  And
With Autism specifically, there is a correlation between Autism rates and vaccine rates. But correlation does not equal causation.
Also true.  Maybe he's finally gotten something right!  But just when I thought he might be turning it around, he dives right back into the antivax dungheap:
The general statement that vaccines cause Autism is unacceptable. Is it a specific vaccine? Is it a combination of certain vaccines? Is it the full vaccine schedule? If it’s not a guarantee that Autism will occur (and it’s not a guarantee that vaccines are 100% safe), then what is the underlying trigger?
Again with the question marks - he's just asking questions, right?  Surely he can't be suggesting it actually is a specific vaccine or "too many too soon", despite the overwhelming evidence to the contrary, right?  RIGHT?
But we’re talking about something that has known safety issues and reactions other than Autism, so it’s something that should be looked at more closely.
Oh, I guess he is suggesting exactly that.  And that makes it plainly obvious that he completely missed the study in the journal Vaccine which looked at over 1.25 million children and found:
In Geary's defense, the study is less than a year old, and I suppose the rather obscure name of the journal (Vaccine) and the somewhat confusing and ambiguous title of the study ("Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies.") may have thrown him off.  But surely he isn't still making that argument, is he?
See, there’s a lot of things to sort out. While I can’t say for sure that the use of vaccines has never caused a case of Autism, I also can’t say that it has. I’m not sure anyone can confidently say yes or no on either side, can they?
Yes, we can.

Finally Geary sums it all up with what I can only call the Jenny McCarthy defence:
Perhaps we need to increase our mutual desire for data and decrease our rampant confidence?
Again with the question mark.  Yes Mr. Geary, we can in fact say confidently that vaccines DO NOT CAUSE AUTISM.  The question has been asked and answered, asked and answered, asked and answered.  And just like when my children ask for the 93rd time if they can have another cookie, asking the question again will not change the answer.

Monday, 16 February 2015

Nurses

Who makes your bed, gets you water when you're thirsty, wipes your ass after you poop, cleans up your vomit, gets you medicine when you're feeling sick, and cares for you unconditionally?  No, I'm not talking about your mother (who hopefully does all those things too, only she doesn't get paid for it).  Come on, have you not been paying attention?  The title is a dead giveaway!  Didn't you read it?

YES, NURSES.  Well done, you.

These vastly under-appreciated (and generally underpaid) people are always on the front lines of healthcare.  Doctors, surgeons especially, do not spend every waking moment in the hospital, so when we aren't there we rely on the nurses to be our eyes and ears, seeing things we may not, listening to patients' complaints, and calling us when something seems awry.  DadBastard (who, as you may recall, was a surgeon himself) taught me one very important lesson just before I started medical school, the same lesson his father, GrandpaBastard (also a physician), taught him:
Be nice to the nurses, because they can be your best friend or your worst enemy.
Sager words were never spoken.  However, as important as they are, not every nurse is worth his/her weight in gold (yes, some nurses are men).  It is relatively easy to differentiate a Good One from a Bad One, one you can trust versus one you wouldn't want caring for your hamster, if you had a hamster of course.  But who the hell wants a hamster anyway?  I guess they're sort of cute, but cats are far better pets.  If Mrs. Bastard weren't deathly allergic to them, my theoretical cat would totally eat your stupid hamster.

Er, sorry about that stupid non sequitur.  Those responsible have been sacked.

Since this blog is about stupid people and stupid things and stupid mistakes, and since I've already verbally abused doctors, patients, lawyers, paramedics, police officers, and myself (repeatedly), it only stands to reason that, despite my esteem for them, I can't just give a free pass to nurses.

Especially nurses like Thelma (not her real name©). 

When I first started my training, I heard from several of my senior colleagues (who had suffered through working with her for several years) that Thelma wasn't exactly the sharpest scalpel in the box.  They told me that she needed strict, thorough instructions, and that if her instructions were explicit enough, they would be followed.  No more, no less.  Thelma was that literal.  Literally.  She was utterly literally literal.  One night around midnight just as I was finishing up a last-minute assignment, my pager beeped.  It was Thelma, who wasnted to tell me the results of one of my patient's blood tests.  All the numbers came back normal, though the bilirubin (a normal product of red blood cell breakdown and component of bile) level was low.  Though it was early in my training, even I knew that high bilirubin is a cause for concern, but low bilirubin is completely meaningless.  Having been a nurse for over 20 years, Thelma should have known this, but she made sure to emphasise the low bilirubin several times.  So, not yet knowing Thelma's literalness, I decided to have a little fun.  I jokingly told her to give the patient 2 grams of bilirubin.  Ha!  Hilarious, right?

"Ok," she said and hung up.

Wha . . . wait . . . she did know I was joking, right?  There's no such thing as giving bilirubin.  She's been a nurse for 20 years, so she knows that . . . doesn't she?  As I mulled over whether or not I should call her back, my pager went off again.  It was Thelma calling me back, asking if I wanted to give the patient the bilirubin orally or through the IV.

Seriously.

A few months (and several more complaints) later, Thelma struck again, this time with Edward (not his real name©), one of my fellow trainees.  Edward was a bit, oh let's just say odd, and by 'odd' I mean completely loony-tunes whackadoodle barmy fucked-in-the-head batshit crazy.  There's a very strong chance (riiiight around a 100% probability) that he did not finish his training with us, partially (read: almost entirely) because of this episode.

One of our surgical patients, who had just had a major 6-hour abdominal surgery earlier that day, was having heartburn, and Thelma called Edward to let him know.  The patient couldn't take anything by mouth because he still had a nasogastric tube suctioning out his stomach, so Thelma needed an IV medicine.  Edward took a page out of the What The Fuck Were You Thinking textbook of surgery and told Thelma, completely sincerely, to give the patient hot tea through his nasogastric tube until he felt better.

"Ok," she said and hung up.

Just take a minute to let that sink in.  I'll wait.

Now before you think Edward was just joking and having fun at Thelma's expense (like I had been), I assure you he was not.  In the investigation that followed, he revealed that he had fully intended for Thelma give the tea, because , um, Edward reasons.  The worst part (or best part, depending on how deranged your sense of humour is) to come out of this was the actual, real, I-swear-I-couldn't-even-make-this-shit-up clarification phone call Thelma made to Edward not one minute after she hung up with him:

"Excuse me Dr. Edward, you said to give the patient 'hot tea.'  How hot?"

Monday, 9 February 2015

Sssssmoking

I've been on a bit of a rampage about measles, vaccines, and the antivax movement for the past week or so, so I think it's time to take a break from that and get back to the smoking update I meant to post last week before I got sidetracked.  So without further ado . . .

I was looking through my posts for the past few months, and I realised I haven't railed on cigarettes lately.  I apologise for this obvious oversight.  If you are a smoker, you may want to change the channel now, because you aren't going to like this one bit.  I'm sure you smokers think you know what I'm about to say already:

Oh isn't this just great!  Doc's going to get all self-righteous and tell me exactly what I already hear a million goddamned times a day, that smoking fucking kills.  He's going to say that it causes lung cancer and COPD and heart disease and strokes and oesophageal cancer and stomach cancer.  He's going to say that smoking is stupid and should be illegal because it's so fucking stupid.  YEAH, I KNOW!  I ALREADY FUCKING KNOW, DOC!
No you don't, smarty pants.  It seems smoking also causes presumptuousness.  Because that wasn't what I was going to say at all.  Ok, maybe it was just a little.  But that's not what this story is about.  Mostly.

Yes, we all know that smoking kills (sorry, I know I said I wasn't going to say it, but I changed my damned mind).  Non-smokers know it.  Smokers know it.  Children know it.  Cats and gerbils know it.  EVERYONE knows it.  And we all know how smoking kills (see the partial list of Ways Smoking Can Potentially Kill You above).  Until recently I thought I knew all the various ways that cigarettes can kill you.

And then I met Howie (not his real name©), who taught me 1) there's always more to learn, and 2) there are always more ways that smoking can kill.

When I see "Other" on my pager, it's one of the mysteries of trauma that always gives my Inner Sleuth a bit of a thrill.  I see more than my fill of car accidents, falls, pedestrians struck, assaults, stabbings, and shootings, but "other" is often quite interesting.  My Inner Sleuth likes to guess if I'll be getting someone kicked by a horse or run over by a snowmobile or in a parasailing accident.  However, when I see "other" at 1 AM, my Inner Sleuth is almost impossible to wake up.  It's all fine and dandy at noon to guess if I'll be getting a lawnmower accident or a table saw accident or a guy who was hit by a falling piano, but in the middle of the night my Inner Sleuth is a lazy little fuck, and he actively refuses to participate.

And so it was that I found myself trudging down to the trauma bay at 1 AM wishing my pager had just said "MVC".  I wasn't particularly interested in solving any mysteries just then.  I just wanted to fix a problem and get back to bed.  Howie, an average, everyday 40-ish year old dude, was brought to me that Saturday night with a bandage wrapped around his entire face.  He had no signs of injuries below the neck, so despite his usual nighttime sluggishness, my Inner Sleuth began ticking off possibilities:

Ooh, maybe his ceiling fan exploded and sent shrapnel into his ear!  No no, he was hit in the nose by a speeding goose.  Oh wait no, he walked into a post and impaled his eyeball!  Oh oh oh I got it, Pop Rocks and Coke made his face explode!

My Inner Sleuth can be an annoying twit at times, and he's usually wrong.  Since we were talking about cigarettes earlier, you've obviously deduced that this was a smoking-related injury.  Well done indeed, Mr. Holmes.

Howie had been drinking with his buddies when he decided he needed a cigarette break.  His wife doesn't let him smoke in the house, so she forced him to go outside.  He went to his back porch to light up, and as soon as his cigarette was lit, a dog jumped out of nowhere and latched onto his face, severely lacerating his eyebrow and ripping off the entire tip of his nose.

The damage to his nasal cartilage was extensive, so I asked the plastic reconstructive surgeon on call to take a look at it.  He's had one procedure so far with (most likely) several more to go.

So the moral of the story is this: if he hadn't been a smoker, he would never have gone outside while that killer dog was lying in wait, and this never would have happened.  I think we can now safely and appropriately add "dog bite" onto the ever-growing list of Ways Smoking Can Potentially Kill You.

Even dogs know that smoking is stupid.

Monday, 2 February 2015

Twitter

WARNING: TWEETS AHEAD, SOME BY CLUELESS ASSHATS

I had written a post on smoking and was fully intending on publishing it today, but a funny thing happened to me on Twitter a few days ago, and I thought I'd ruminate on it a bit. So I'll put the smoking post on the back burner (hardy har har) until next week and shamelessly try to capitalise on a bit of good fortune. 

I was rummaging through several articles on the recent measles outbreak in California, and I came across a comment by a paediatrician (who practices, likely not coincidentally, in California) named Mike Ginsberg which rang so true in my head that I took a screenshot of it so I could show Mrs. Bastard.  Now I'm not a huge Twitter user with only around 1800 followers (FOLLOW ME ON TWITTER, DAMN IT), and the highest number of retweets I've ever gotten was about 150 a few months ago, which inexplicably made me very proud that that many people not only cared about what I said, but agreed with me. 

After reading Dr.Ginsberg's comment again and mentally fist-bumping and/or bro-hugging him, however, I realised I shouldn't keep such medical gold to myself, so I decided I'd share it with the world (or at least, with my 1800 followers):
Yeah.  YEAH!  Damn right!  Harrumph!  Immediately after posting his quite breathtakingly elegant diatribe, however, I knew something was curiously awry.  People started retweeting . . . and retweeting . . . and retweeting.  As of this writing (about 36 hours later), it's been retweeted over 5000 times and counting.  And @DocBastard, #VaccinateYourKids, and #vaccineswork were trending in Sydney, Melbourne, Brisbane, London, Toronto, and Chicago.  Hm . . . I didn't even know that a person could trend.  Boy, I suck at Twitter . . . noob.  Anyway, the vast majority of the comments I've seen on it have been very supportive of Dr. Ginsberg:
But unfortunately as with any story about vaccines anywhere, the usual anti-vaccine idiots came out of the woodwork:

One clueless person (*cough* Snickadelphia *cough*) asked me if I knew what squalene was, thinking it was some dangerous-sounding toxic chemical (SQUALENE?  OH MY GOD, RUN!) used in vaccines when in reality it's an intermediary in cholesterol synthesis and we all have it in our bodies right now in much higher concentrations than in any vaccine (same goes for formaldehyde, by the way).  And then some comments have been downright hilarious.
That guy gets a well-deserved harrumph.  Much to the surprise of no one with an IQ higher than a naked mole rat's, some of the antivaxxers trotted out the same old trite, thoroughly untrue and/or unsubstantiated tropes like toxins, too much too soon, aluminum, formaldehyde, aborted fetal cells, cancer cells, Big Pharma, the government, and mercury

I can't say I agree with 100% of what Dr. Ginsberg says (calling child protective services on these antivax parents may be going a tad overboard, not to mention useless and would only serve to alienate these misguided people even further), but other than that I'd say he hit the proverbial nail directly on its proverbial head.  Over the past 36 hours I've been called a lot of things (including a fascist . . . really?  Is your knowledge of political history that poor that you think this is fascism??), but I am heartened to say the Twitterverse overwhelmingly seems to agree with me and Dr. Ginsberg, as my follower count has risen by almost 40% (holy shit, who the hell are you people?).  Also since then, I've gotten an email from an editor at an Australian newspaper, and even more surprisingly I got an offer from the Tech and Health editor at The Daily Beast to be a regular contributor for them.

I haven't decided yet if I'm going to accept The Daily Beast's offer, but I'm thinking about it.  Regardless, I'm curious about others' views on Dr. Ginsberg's rather strong (and strongly-worded) opinion.

Monday, 26 January 2015

Medicalisms

Now before your blood pressure starts rising, yes I'm prefectly aware that "medicalism" isn't a word.  But I originally titled this post "Things medical people say", but that had NO zing to it, so I dropped it faster than a politician drops all his political promises exactly 24 hours after he wins an election.  So I decided to coin "medicalism" instead, until a 0.289 second Google search told me that someone already did back in the 1800's.  Damn it . . . only missed it by 180 years or so.  Anyway, even though I'm not quite as clever and creative as I thought, every industry has their fair share of acronyms and nicknames and complex terminology that is known only to its insiders, and medicine is no exception.  I sometimes think that doctors like to use big sciency-sounding words just to make themselves look and sound smarter than everyone else.  Consider:
Doctor: Your daughter seems to have epistaxis.
Mother: Oh my god!  Is that fatal??!  How long does she have?
Doctor: Epistaxis is just a nosebleed, madam.
Mother: Well why didn't you just say "nosebleed" then, asshole?
Why else would a doctor say that a patient has an erythematous eruption rather than a red rash other than because he thinks it sounds more complicated?  Does "abscess" sound more scientific than "pus"?  (Ok, maybe it does and that's just a terrible example.)  For some reason doctors seem to feel some overwhelming need to say that an ankle is edematous instead of swollen, "palpate" rather than "touch", "percuss" not "tap", and "auscultate" instead of "listen".  Maybe we think it sets us apart from the general public somehow.  Maybe it's our way of clinging desperately to the "We're smarter than everyone else" reputation.  And maybe that's why that reputation is crumbling so rapidly.

Regardless, there are dozens of terms used in medicine that don't quite make their way into everyday conversation.  So thanks to the inspiration of Dr. Mark Reid's Twitter feed (@medixalaxioms) I've started to compile a list of terms that people in the medical field use that everyone else may not quite understand.
  • When nonmedical people say "SOB", they mean it as an insult, not short of breath.
  • When nonmedical people say "lol", they mean something is funny, not little old lady.
  • When nonmedical people say "CC", they mean carbon copy, not chief complaint.
  • When nonmedical people say "RT", they mean they are retweeting, not respiratory therapy.
  • When nonmedical people say "lap", they mean a place children sit, not minimally invasive surgery.
  • When nonmedical people say "open", they mean ajar, not widely invading the peritoneal cavity.
  • When nonmedical people say "pearl", they mean something taken from an oyster, not a useful tidbit of medical information.
  • When nonmedical people say "BID", they are trying to buy something on eBay, not instructions to take or do something twice a day.
  • When nonmedical people say "floor", they mean what you're standing on, not a non-ICU hospital ward.
  • When nonmedical people say "pimp", they mean a prostitute's boss, not grilling medical students on difficult information they probably shouldn't know yet.
  • When nonmedical people say "rounds", they mean ammunition, not seeing patients in hospital.
  • When nonmedical people say "cabbage", they mean a vegetable, not a coronary artery bypass graft.  Speaking of which . . .
  • When nonmedical people say "vegetable", they mean an edible plant, not a permanently-comatose patient.
  • When nonmedical people say "staff", they mean a group of employed people, not a potentially-deadly infection.
  • When nonmedical people say "shot", they mean 44.36 ml of liquor, not poking people with needles.
  • When nonmedical people say "spin", they mean using an exercise bicycle, not getting a CT scan.
  • When nonmedical people say "Scope", they mean minty mouthwash, not a 2-meter long tube used to look up your ass.
  • When nonmedical people say "arrest", they mean something that police officers do, not something the 90-year old woman having an MI just did.
  • When nonmedical people say "JP", they mean Mr. Morgan, not a type of surgical drain.
  • When nonmedical people say "reduce", they mean decrease, not putting a dislocated joint back in.
  • When nonmedical people say "pronounce", they mean how to say something, not to declare someone dead.
  • When nonmedical people say "PEG", they mean a short cylindrical piece of wood, not a feeding tube.
  • When nonmedical people say "tele", they mean the box you use to watch idiots make fools of themselves, not a monitor used to watch vital signs.
  • When nonmedical people say "sux", they mean that something is terrible, not an anaesthesia medicine that paralyses you within seconds.
  • When nonmedical people say "tank", they mean a vessel for storing things, not expanding intravascular volume.
  • When nonmedical people say "crash", they mean something you do in your car, not someone dying.
  • When nonmedical people say "clear", they mean transparent or obvious, not "GET THE FUCK OUT OF THE WAY, I'M ABOUT TO SHOCK THIS GUY."
  •  When nonmedical people say "stool", they mean a place to rest your ass, not what comes out of it.
I'm sure there are several I'm forgetting, and by "several" I of course mean "hundreds".  I'm fully expecting commenters to help me and my terrible memory.  If anyone has other medicalisms to share, please do.