Monday, August 31, 2015

Take A Bow, Douchecanoe @$$hole Mouthy Visitors

It never ceases to baffle me how people who would never lip off at the DMV, or when getting dinner at a restaurant, or while standing in line at Starbucks, or anywhere else, think that when they show up at the hospital, the rules of civility and decency have suddenly magically disappeared - for them.

Dear fuckweasels: Thought For The Rest Of Your Life
Didja ever lip off at a restaurant, and show that dumb waiter who's the boss?
Didja ever notice afterwards that your food all tasted like spit??!!!

Take a lesson: some of us won't be badgered by your rude assholerry, and will not only give you worse than you send, and that right in front of your friends and family, we're big enough to make it stick, including sideways up your ass in the parking lot if you think you can go there.

And nota bene: your friend/relative in the bed is the patient. They have an actual reason for being here. Your presence is a mere courtesy, and a revocable one at that. The minute, no, the second dealing with a knobjob like you interferes in the slightest way with patient care in my room, I don't care if you're the Pope's uncle, your ass is out, for good, permanently. I will make you persona non grata, with no visiting privileges, and I'll happily swear out the restraining order in the morning to make that a permanent situation. Test me, I triple dog dare you.

If you shut down your mouth long enough to engage your eyes and ears, you might also notice that your friend is
1) Getting damned good care
2) Not very happy when you're being an obnoxious litter box nugget
3) Eager to forget he/she knows you when you bring your Inner Jackass, and let him/her out to play in front of God and everybody.

So instead of "advocating for your friend"*, realize that you're just another pain in my ass, because all you're really doing is demonstrating your impotence to do anything more helpful than dropping a hand grenade into the outhouse just to watch the shit fly.

My cure for your problem is sending you to Siberia, forever, and if you want to go double or nothing, you can find out what the bail is on Monday morning for disturbing the peace, trespassing, and/or assault and making terroristic threats. See if the judge thinks it's as funny then as you do now. Especially if you blow a point-anything on the jail breathalyzer.
BTW, I document the antics of lunatics for a living; good luck with "your side" of things after I file my totally accurate notes of the encounter in a legal document, for the permanent record, right after it all happens, while you're still hitching up your trousers and looking for that missing piece of your hindquarters, sobering up in a holding cell, or trying to get someone to go good for your bond.

Or just cowboy up, and realize that if we're taking care of a friend or family member who's having a heart attack, a stroke, or bleeding out, fucking with us while we're doing our jobs probably isn't in their best interests either.

So do yourself and your buddy a great big favor: sit your ignorant ass down, or go get yourself a nice steaming hot cup of STFU, while people smarter than you do the job they're being paid to do, instead of dealing with dumbasses like you interfering with other peoples' care.

Momma may have pinned your diapers up on the family refrigerator and told you they were art since you were two years old, but now that you're only acting like a two year old, the rest of us can see your handiwork for exactly what it is, and reality is about to slap you real hard right in the back of the head. With a sock full of quarters.

*(After 20 years of this BS, it's no longer anecdotal evidence: 99.98% of these Special Snowflake Wannabe Patient Advocate douchenozzles are the visitors, not the patients. If you like watching Wheel Of Fortune for hours, and reading old dental hygiene magazines, keep bucking for Permanent Waiting Room Flourescent Light Therapy, proud soldiers of the Dumbass Army.)

Thursday, August 27, 2015

Trauma Is Never Pretty

I've been working trauma cases professionally since the early 1990s. (Before that was simply happenstance.) And while all trauma is the same after the first 500 times, no two are ever exactly alike.

Something you have to know, in a way most of you hopefully will never learn from bitter experience, is that some wounds are non-fixable. Whether you're working with a victim of a car accident or someone attacked by a mob, or simply one dedicated assailant, you have to know going in that you will not fix certain things, and that in many cases, no one can.
Not even if the injury in question happened inside a trauma surgical suite, with the doctors and team prepped and ready to go, even if you had 20 units of O-negative blood hanging ready to transfuse.

HIPPA and concern for a certain family prevent me from getting detailed at this point.
But suffice it to say that sometimes, a gunshot or blade will create more damage than can be fixed, and that person is simply going to die, rapidly.

There's a scene at the beginning of the plane crash in The Grey, when Liam Neeson's character is surveying the injured and dead, and he finds a guy with traumatic abdominal bleeding, and he tells the man, in his final moments, that yes, he is indeed going to die, right there, and rather quickly, which he then proceeds to do on screen.

That was truth: it works just like that in the real world too. When someone pumps out all their lifeblood in ten or twenty pumps, like they will, that's it. Getting an IV won't work, you aren't going to cut them open and crossclamp their aorta, and an IV or five isn't going to save them, because there's no hemoglobin in normal saline.

That means you can start IVs, even IO lines (that's an IV in your bones for the laymen in the audience), and pump in liter after liter of fluid, even with whole blood, and it ain't gonna do anything but come out the hole(s) you can't fix. And run all over the place outside. They'll still get no oxygen in their vital organs, and they'll simply be warm and dead and white as a ghost when you're finished, and that truth is ordained before you ever lay hands on your patient.

That's going to be true in a disaster, or even a trauma unit. In the latter, you do every damned thing you can, especially on a young healthy victim, because they have the best chance. Best being relative when the absolute odds are close to absolutely zero.

In a disaster or worse scenario, you aren't going to - and probably shouldn't - do all that. At that point, you're simply wasting precious supplies to feel better about someone dying that you couldn't save. Which is both wasteful and unwise.

God help you and your conscience if you haven't wrapped your head around that reality long before the day you get there. Even knowing the truth, the moments will hang around in your head for a good long time.

If you're going to do this, yeah, you save the ones you can.
But you have to know in your bones that there will be plenty you can't save, and you have to let them go. Physically, mentally, and emotionally.

And I can't even begin to tell someone how to do that when it's someone you know, or care for deeply.