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.

Tuesday, 20 January 2015

Impossible

I'd propose that most people agree that nearly anything is possible.  NEARLY.  It's something that I frequently say to my children - anything is possible.  Unfortunately that's a total lie, just one of many lies that parents say to their children:
  • Santa Claus
  • Easter Bunny
  • Tooth Fairy
  • People are generally good
  • Yes, you can have ice cream after dinner
  • Mommy and Daddy were just wrestling!
Awkward non-sequitur notwithstanding, some things are, indeed, impossible. There are a few things that most people would agree will never happen:
Well, something happened to me a few days ago that I previously thought impossible. Something I think is right on par with "Justin Bieber gaining some goddamned self-respect" and "Politicians being honest".  Something I thought could never happen in a million years:

I had a silent trauma day.

Believe it or not, over a 24-hour period, no one in the entire {redacted} metropolitan area got into a serious car accident.  No one fell down the stairs.  No one was stabbed or shot.  No one was assaulted.  No old people were found down.  No pedestrians were struck by cars.  No feet were mangled by lawnmowers.  No fingers were amputated by table saws.  

Nothing.  Zip.  Zilch.  Nil.  Naught.  Nada.  Niente.  

For an entire day, I sat in the hospital and waited.  And waited.  And watched a movie (Transformers: Age of Extinction . . . it was meh, despite Nicola Peltz).  And waited.  And watched another movie (Captain America: The Winter Soldier . . . it was meh, despite Scarlett Johansson). And waited. 

And then 24 hours later, I went home.  No lives saved, no idiots educated. 

So you'd think that, having nothing else to do, I'd at least get a full night's sleep, right?  Haha!  No. 

That would be impossible.  

Monday, 12 January 2015

Just Some Guy

Unlike most surgeons, trauma surgeons don't usually have the luxury of getting to know their patients before they operate on them.  Most surgeons see patients in their office and have the opportunity to ask and answer questions prior to scheduling surgery.  On the other hand, my typical preoperative introduction goes something like this:

Me: Hi, I'm DocBastard (not my real name).  You're dying.  I'm going to try to prevent that from happening.  Now.

That's only a slight exaggeration.  Seriously.  Even in a typical "normal" emergency situation (ruptured appendicitis or perforated gastric ulcer, for example), I have the opportunity to ask my patients various questions about themselves.  However, when you have a hole in your abdomen and are actively bleeding to death or leaking stool into your peritoneal cavity, I barely have time to ask your name before I need to start doing terrible things to you, like cutting you open, removing things, repairing things, stopping exsanguinating haemorrhaging. . . you know, a typical Saturday night.

Despite this sense of overwhelming urgency, I try my damnedest to avoid dehumanising my patients by referring to them as "The guy in trauma one."  Unfortunately in my position it can be next to impossible to think of everyone as an individual person rather than Gunshot Wound Victim, Car Accident, Run-Over-By-Lawnmower Guy, or Old Lady Who Fell.

I got an excellent lesson on why this is so important early in my training while in the ICU.

The guy in bed 4 (not his real name) was not just some guy.  Apparently he was a member of the Board of Trustees of the hospital, and everyone was doing everything possible to make his hospital stay as comfortable and uneventful (read: complication-free) as possible.  But he wasn't the one who was actively dying that night.  No, that would be his neighbour, the guy in bed 3 (also not his real name).  He had undergone a heart transplant earlier that day, and things had not gone exactly as planned.  After his surgery, he started bleeding profusely.  He had been brought back to the operating theatre, but the transplant surgeon had not found any specific bleeding site.  Rather, he was bleeding from every raw surface in his chest due to DIC (disseminated intravascular coagulation), because his body was rejecting his new heart (we found this out later).  Unfortunately that is medical bleeding, not surgical bleeding.  All we could do when he got back from surgery was continue transfusing him with blood products, replacing what he was losing faster than he was losing it, and hope he started clotting.

But every unit of red blood cells we gave him, every pack of platelets, every unit of plasma, he bled right out again.  We had IVs everywhere we could think of, but still we were having trouble keeping up.

He was still dying, and we couldn't stop it.

People were running around, shouting, getting equipment and supplies, trying to do everything they could.  I could have stood there watching, but instead of simply letting the blood drip in or putting it on a pressure bag, I decided that the best thing I could do was to squeeze the blood products into him.  So that's what I did, one bag after another, waiting until one bag was empty, then spiking a new one.  One bag of blood after the next.  For 6 hours.

And in the midst of this chaos, I overheard a conversation between two nurses just outside the room that would change my bedside behaviour forever:

Nurse 1: Oh, that doesn't look good.  Is that the VIP?
Nurse 2: No, that's just some guy. The VIP is next door in four.

Just some guy?  Really?  His name was David (also not his real name) and he had just gotten a brand new heart less than 24 hours ago.  Was his life really any less valuable than the VIP next door, just because his bank account was smaller?  Were we supposed to give less or care less or do less, just because he didn't have a famous name?  After gaping at them for a few seconds, I turned away and squeezed in bag #89.

Over the course of the night, I squeezed in 134 bags of blood products (the human body only holds about 8 liters of blood, and each bag contained between 250 and 500ml.  Do the math.)  David survived the night, but I found out the next day that, despite everything, he had succumbed later that afternoon a few hours after I went home.  His body had rejected the heart much like I had rejected those nurses' lousy attitude.

Ever since that day I have made it a point to learn my patients' names, even if there really isn't time for it.  To me, my patient isn't The Guy Waiting To Have His Appendix Out.  He isn't The Splenic Rupture In Trauma 2 or the Drunk Idiot In 6.  No one deserves to be Just Some Guy.

Everyone is Someone.

Monday, 5 January 2015

Confessions

I should get this out of the way at the very beginning (since hopefully everyone reads the title before the story): NO I WILL NOT BE CONFESSING TO NOT BEING A DOCTOR.  I'm fairly sure that will not come as a surprise for most of you (since, unlike the people who still don't believe me, your IQs are greater than that of a fruit bat), but I'm a bit more sure that it will disappoint my critics.  And I'm absolutely positive that I seldom give a flying fuck about what any of my critics think, but I remain amused that people like that even exist.  Regardless, over the past 12 months there have been some things that I felt I should confess but haven't had the inclination.  Well, since this is a new year and all, I think it's high time to get a few things off my chest and start 2015 with a clean slate.

So without further ado, allow me to present the Official DocBastard Confessional.  Some assembly required, batteries not included, please allow 6-8 weeks for delivery, your results may vary.

  • Though my stories are real, there is one that I nearly wholly invented.  No, I will not reveal which one, because what's the fun in that?
  • I was never really considering dumping my anonymity, though I did have a passing thought about it.  I just wanted to gauge everyone's response to the idea, and I confess it was the exact opposite of what I had expected.  Sorry for using you good people as guinea pigs.  Not really.
  • I love building furniture almost as much as I love performing surgery.  If I could make as good a living doing woodworking, I would retire from medicine faster than a 50-50 thinned coat of lacquer dries. 
  • I hate hospital politics and actively avoid any and all committee meetings. 
  • After a particularly stressful day, I sometimes come home and take out my frustrations on my wife.  She knows what I'm doing and why, and she always lets me do it because she knows it makes me feel better.  This is just one of the approximately 6,836,356 reasons I've identified (so far) why I love her. 
  • I love cold, rainy days because it keeps the idiots indoors and out of my trauma bay. 
  • I enjoy taking care of people, but every now and then I'd like a day where the Call Gods have mercy on me and let everyone stay blissfully uninjured.
  • I wish I could hit some of my patients, but only the ones who really deserve it. 
  • Finding and writing new stories for this blog that I think won't be boring and/or repetitive is becoming increasingly difficult.
  • I wish some publisher would stumble across this blog and ask me to make a book out of it. 
  • I like the smell of cauterised human tissue.
  • I'm not sure if that last one makes me a cannibal, but I am sure I don't really care. 
  • I have a not-so-secret man-crush on Neil DeGrasse Tyson.  Seriously Neil, call me. 
  • Sometimes it seems ibuprofen and coffee are the only things that get me through the day. 
  • I love getting fan mail, and I have kept all of the emails I've gotten. 
  • I love getting hate mail even more, though I haven't gotten any in a while.  No, I'm not asking anyone to write me any, thank you very much. 
  • One of my colleagues left a bottle of wine in my call room as a Christmas gift, and I was tempted to drink it while on call.  No, I did NOT drink it.  I know this is supposed to be a confessional, but come on.
  • I sometimes speak more kindly to my female patients.  Sorry gents, but that's just human nature.
  • I still tell my idiot female patients that what they did was stupid. 
  • I've never once actually felt remorse for telling my idiot patients that their actions were stupid.
  • There have been a few times during an operation when I've thought, "What the fuck do I do now?"
  • While I enjoy challenges, I'd MUCH rather do a simple appendectomy than a complicated perforated appendectomy with an abscess.  
  • I'd rather watch "Keeping Up With The Kardashians" while making out with Miley Cyrus and listening to Justin Bieber than do a dead bowel case.  Dead bowel is the worst possible smell in the world, and even if I double-glove and wash my hands repeatedly afterwards, the stench stays on my hands for days.  Forget any finger food for a week. 
  • One of these confessions isn't true.  No, I will not say which one, because what's the fun in that? 
Well folks, there you have it.  I'm sure there are other more egregious sins I've committed, but either I have forgotten or am too bashful to confess them.  Hm . . . I think that's the first time I've ever described myself as "bashful".
  • Believe it or not, I can be bashful.
Ok, now I'm done.  Really.  If any of you have anything you'd like to confess, leave it in the comments below.  But I warn you that I will not assign you any Hail Marys, Our Fathers, or any other Penance, and you will not be absolved of any of your sins.  And I confess that people may be amused by your confession, but you might just feel better nevertheless.

And . . . go.

Monday, 29 December 2014

Even more things I don't understand

Despite the fact that I've written a handful of complimentary posts about myself, I'm not one to toot my own horn very often.  That said, though I rarely claim to be smarter than anyone, I have to admit that I'm a fairly intelligent guy.  Despite this, I've written about things I don't understand in the past, and it's been quite a while since I have, so I feel it's high time I embiggen the list of things I just can't seem to wrap my mind around.
  • women (yes, I still don't understand them)
  • the appeal of mushrooms
  • how anything got done before the Internet
  • Twilight
  • smoking
Of the myriad things I just can't fathom, I think I understand smoking the least.  With all of the health problems that cigarettes cause, I simply can't understand how anyone these days could possibly begin (or continue) smoking.  Now before anyone starts yelling and screaming that nicotine is addictive, I ALREADY KNOW.  I know how easy it is to become addicted to cigarettes, and I know how difficult it is to quit once you're hooked.  But it's a rare soul who doesn't know at least one person who was affected adversely by cigarettes - lung cancer, emphysema, chronic bronchitis, oral cancer, cataracts, heart disease, stroke . . .

And yet, people still smoke.

"GET TO THE POINT, DOC!" I can hear you screaming.

I will.  I promise.

I got a call from an emergency physician some time back for Samuel (not his real name©), a gentleman in his 50s who had a history of severe peripheral arterial disease.  If you've never heard of PAD, it's very similar to coronary artery disease, except that instead of the arteries of the heart getting blocked by gunk and causing a heart attack, it's the arteries in the rest of the body (including the legs, intestine, etc) that become blocked, causing all the tissue downstream to die.  The most common causative agents are smoking, diabetes, hypertension, and high cholesterol, all of which Samuel had or did.

About a month prior to coming to my hospital, Samuel's aorta, that rather-important artery that comes off the heart and supplies blood to the entire body, had become completely blocked at the point where it splits to supply blood to the legs, so a bypass surgery was done at an outside hospital.
Today Samuel was having severe abdominal pain, so the emergency physician correctly presumed that he was having a complication from that surgery.  He promptly ordered a CT scan of his abdomen which fortunately ruled out any complication of his bypass (such as a leak or infection or blockage of an artery), but it surprisingly showed a small bowel obstruction.  His small intestine was dilated to about 8-times its normal diameter, but more even more ominous was that it looked like the blood supply to a segment of the bowel had twisted on itself, an entity called intestinal volvulus.  Any tissue whose blood supply is twisted will eventually die, so this is a dire surgical emergency.

Thirty minutes later he was in the operating theatre, and 30 minutes after that I had successfully untwisted his intestine, which was perhaps an hour or so from dying.  As you can probably imagine, that's not a good thing.  I watched it for a few minutes, waiting for the colour to normalise (it did), and then I closed him up.  Another life saved!

Maybe.  (Cue the dramatic music.)

I went out to the waiting room to find his wife and let her know that everything went well.  As I was chatting with her and letting her know how I expected his recovery to go, a familiar odour reached my nostrils - cigarette smoke.  After I was done, I asked her if she had any questions.  When she said "no", I told her that I had one:

"When are you going to quit smoking?"

Her smile immediately faded, and she looked at her feet.  "We're trying to quit," she almost whispered.

Wait . . . we?  Are you telling me this man who nearly lost his legs a month ago because of his smoking is STILL SMOKING?

With a stern look and not even a hint of mirth, I told her that she and Samuel had to quit.  NOW.  "I don't care if you go cold turkey, use nicotine gum, a nicotine patch, prescription medicine, chewing gum, e-cigarettes, meditation, yoga, hypnosis, acupuncture, or voodoo," I said, trying not to yell.  "Your smoking was making him smoke, and his smoking is killing him, slowly but surely."

I sent Samuel home a week later, repeatedly beating my point into his skull daily.  Unfortunately (though perhaps not surprisingly) he never showed up for his follow-up appointment.

I don't expect perfection, except from myself (though I rarely attain such heights).  But I do expect people to help me help them get better.  Why can't (or won't) so many people do that?

Yet another thing I don't understand. 

Tuesday, 23 December 2014

Spirit of the season

In the interest of peace, love, and goodwill toward idiots, I've decided to forgo a formal update this week and leave everyone with a few thoughts:

1) We're approaching 3 million page views here.  That's just unfathomable.
2) I'll probably do a post soon about personal confessions.  I have plenty from which to choose. 
3) I've been contemplating dropping the anonymity.  

With that said, Merry Christmas, Happy Chanukah, Joyous Festivus, and Happy Holidays.  

I would like to sincerely wish everyone who reads this a happy, healthy, and safe 2015. 

Best,
Doc

Tuesday, 16 December 2014

Compliments

WARNING: I WILL BE SHAMELESSLY RISKING SPRAINING MY SHOULDER BY PATTING MYSELF ON THE BACK IN THIS POST.  

Admittedly this blog is dedicated to idiots and stupidity, and as I've said numerous times my favourite idiot remains me.  So having told several stories where I am the goat, I think I've disparaged myself enough to have earned myself a complimentary update.

If you want more idiot stories, you'll have to wait.  Probably not very long.

Since finishing my training I have spent very little time around other doctors in clinical situations, so I therefore have no idea how my colleagues speak to patients.  I don't know what kind of terminology they use, if they have prepared speeches for certain situations, or how they treat patients in general.  I have a fairly well-established bedside manner, and it seems to serve me very well in the vast majority of situations.  Though my demeanor rarely changes much, every now and then I have to tailor it for certain types of patient (those who are very difficult, very drunk, very upset, very young, very old, etc).  Some people need a bit more care, some need a stern talking-to, others need massive doses of sedatives to shut them up.

Kidding, kidding.  Sort of.

Generally speaking, my philosophy is this: If you're nice to me, I'll be nice to you.  Because of this ideology, every so often patients tell me (compliment warning) that I make them feel better just by sitting with them for a few minutes, talking with them, and explaining everything in excruciating detail, probably more detail than they want or need.

Apparently this is not the norm for surgeons.

Nathaniel (not his real name©) was the unfortunate driver of a petrol (gasoline) tanker truck.  In the wee hours of the morning Nathaniel swerved to avoid another driver, and his truck lost control and flipped on its side.  Incidentally, I hate the term "wee hours".  "Small hours" is no better.  I don't know why it bothers me so much.  Non sequitur over.  Anyway, sparks began to fly from the now-exposed underside of the truck, and despite debilitating pain in his chest, Nathaniel wisely decided not to be anywhere near his truck when those sparks interacted with the several thousand gallons of highly-explosive fuel he had been hauling, and he ran.

When he was brought to me about 30 minutes later, he was clearly agitated, clutching his chest and having trouble breathing.  When I pushed lightly on his chest, he grunted and looked at me as if I were Satan.  His chest felt unstable to me, and an X-ray confirmed that he had 4 fractured ribs.  Fortunately his lung had not collapsed, he had no bleeding in his chest, and he had no other serious injuries.  I explained that his injuries were painful but not life-threatening and that the only treatment was pain medicine and time.  That seemed to calm him somewhat.

Over the next several days, I quickly assessed that he would be a patient who required a bit more TLC than my typical patients.  My daily rounds with him, which should have taken no more than 3 minutes to press on and listen to his chest, assess his pain, and go over his X-ray, took at least 15 minutes while I sat with him, listened to him describe his pain, and reassured him that he would heal, but it would simply take time.

A few days later his pain had improved to the point where he could walk without difficulty, and he no longer needed IV narcotics.  I discharged him, telling him he could continue his recovery at home, though it would be several more weeks until he felt completely better.

As I was sitting in my office about a week later, I got a call from Nathaniel, asking if he could transfer his care to me.  Confused, I told him I was already his doctor, so I asked him what he meant.  "Well, I really liked the way you cared for me in the hospital.  You were so patient with me and you really listened to me, so I want you to be my primary doctor."

I told him that while I don't do primary care, I was truly honoured by the request, and that simple question was one of the best compliments a surgeon could get.  I gave him the phone number for an internist whose philosophy is very similar to mine - be direct and honest, and above all else listen to the patient.

To the medical students reading this, I hope you take this vignette to heart and learn a valuable lesson that DadBastard and GrandpaBastard taught me a long time ago.  Ultimately all patients want the same thing: to be treated like a human being.  What I did isn't difficult, it isn't special, and it isn't unique.

All I did was treat Nathaniel like I treat everyone - with respect.